What does AMS do?

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Asset Management Systems is an independent service organization, which maintains, repairs and manages medical technology in hospitals. We help to ensure that the medical technology used in your hospital is appropriate and provide senior management with information that helps you to make informed decisions regarding the planning, procurement, acquisition, installation, operation and disposal of the medical equipment in your hospital. We do not sell medical equipment. We make sure that the medical technology in your hospital is operating safely for use by the hospital staff on your patients. We pay close attention to the cost. We serve hospitals by saving them money and helping them provide quality care to their patients. Our job is to make sure the hospital's medical team has the appropriate equipment available when they need it to serve their patients. It is our responsibility to ensure this equipment is always working accurately, safely and in the most economic manner. We perform our job professionally, profitably and ethically. We continually strive to improve all aspects of our business.

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How do you do it? What resources do you have in Thailand?

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We have our own staff of over 65 university trained biomedical and electronics engineers and technicians who have a minimum of 5 years work experience repairing medical equipment. Our senior executives and managers have proven experience managing professional service and healthcare organizations and are respected leaders in the field of medical asset management. Most of our parts are purchased right here in Thailand from the OEM, distributors and/or suppliers of general electrical and mechanical components. Over 98% of the parts we use to maintain and repair the medical equipment in your hospital are purchased here in Thailand. If we cannot purchase a part here in Thailand because it is out of stock or there is no distributor, we can buy it from many other vendors in Europe, North America or Asia and import it directly.

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What do you actually do in the hospital?

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We set up an office and biomedical engineering workshop in your hospital and become an integral part of your hospital staff. We provide you with 5 core services that make up our integrated Medical Asset Management Program. These services are: 
 

• Planning and Procurement advice for when you need to replace your ageing medical equipment or buy new equipment to meet expanding needs;

• User Training for your clinical staff on the safe and effective use of the medical equipment that they operate everyday; 

• Advice on Environmental Conditions relating to electricity, temperature, humidity, air flow and water quality that might have a detrimental effect on the performance of your medical equipment; 

• Planned Maintenance (what some hospitals call “PMs” or “Calibrations”) for all of your medical equipment; and, 

• Repairs of your medical equipment when it fails. 

Our office is the first point of contact for any medical equipment related issues and problems in the hospital. All your hospital staff has to do is call our 24 Hour Call Center number and they will get assistance for any problem they might be experiencing with your medical equipment.

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How can AMS save hospitals money?

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Most hospitals around the world rely on Original Equipment Manufacturers (OEMs) and medical equipment suppliers/distributors to perform planned maintenance and repairs. Typically, hospitals in Thailand do not have in-house biomedical engineers or technicians with the skills or experience to effectively evaluate the need for or extent of planned maintenance and repairs undertaken by your vendors. As a result, hospitals tend to spend more for the maintenance and repair of their medical equipment than necessary. For example, in the year 2000, we were called on to assist a hospital find an alternative source for a hard disk drive (HDD) for a Cath Lab unit. The hospital was quoted THB 780,000 for a new HDD from the manufacturer. AMS was able to find the exact HDD from another manufacturer here in Thailand for THB 250,000, saving the hospital over THB 530,000!

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What if it takes you longer than your guaranteed repair time to fix a device? Is the hospital compensated?

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Yes, the hospital is compensated. We guarantee performance and refund you money should it take us longer to fix a device than we have guaranteed.

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What is ECRI? JCI?

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ECRI (formerly the Emergency Care Research Institute) is an independent nonprofit health services research agency. Their mission is to promote the highest standards of safety, quality, and cost-effectiveness in healthcare to benefit patient care through research, publishing, education, and consultation. They are widely recognized as one of the world's most trusted organizations for unbiased, reliable information. ECRI's focus is healthcare technology, healthcare risk and quality management, and healthcare environmental management. It provides information services and technical assistance to more than 5,000 hospitals, healthcare organizations, ministries of health, government and planning agencies, voluntary sector organizations, associations, and accrediting agencies worldwide. Its more than 30 databases, publications, information services, and technical assistance services set the standard for the healthcare community. ECRI's services alert readers to technology-related hazards; disseminate the results of medical product evaluations and technology assessments; provide expert advice on technology acquisitions, staffing, and management; report on hazardous materials management policy and practices; and supply authoritative information on risk control in healthcare facilities and clinical practice guidelines and standards.

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JCI stands for the Joint Commission International. The JCI is the international hospital accreditation division of the US based Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the official healthcare accrediting body for organizations in the USA. The Joint Commission evaluates and accredits nearly 17,000 health care organizations and programs in the United States. An independent, not-for-profit organization, JCAHO is the nation's predominant standards-setting and accrediting body in health care. JCAHO's standards address the organization's level of performance in key functional areas, such as patient rights, patient treatment, and infection control. The standards focus not simply on what the organization has, but what it does. Standards set forth performance expectations for activities that affect the safety and quality of patient care. JCAHO develops its standards in consultation with health care experts, providers, measurement experts, purchasers and consumers.

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What is ISO 9001?

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The term ISO 9001 refers to a series of internationally-recognized standards for the documentation of quality systems. The standards, promulgated by the International Organization for Standardization, have been adopted in more than 70 countries, including the United States, Canada, European Union, Australia, and Japan. More than 7,500 business units in the United States have registered under one of the ISO 9001 standards. The heaviest emphasis has been in Europe, where the concept of international standards for quality systems originated, and where approximately two-thirds of the major companies have completed or are seeking ISO 9001 registration. The overriding goal of ISO 9001 is customer confidence. When a business registers to the appropriate ISO 9001 standard, customers can be confident that there is an established, well-documented system in place to assure the quality of goods and services. As a result, many registered companies, particularly in Europe, make ISO 9001 compliance part of the purchase agreement, and will decline to deal buy supplies and services from non-registered businesses, even at lower cost.

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Who are your customers? 

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We currently have 11 hospital customers who we have under our full Medical Asset Management (MAM) Program. In addition, we have provided medical equipment calibration services, supplied replacement x-ray tubes and done special projects, such as installing and moving x-ray and MRI equipment, for over 70 private and public sector hospitals in Thailand.

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Can you help us achieve Hospital Accreditation Thailand Certification?

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When a hospital goes through any audit, AMS will be responsible in getting the medical equipment management plan compliant with the standards and requirements of the accreditation body, and we will be answering the auditor's questions on behalf of the hospital. We work very closely to insure that the hospital will pass any medical equipment related accreditation that is it aiming for.

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Can AMS staff maintain and repair all the types of equipment in the hospital?

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While AMS staff cannot maintain and repair all of the types of equipment that are usually owned by a hospital, we can do the planned maintenance and repairs on over 90% of all of the typical equipment in a hospital. However, we do take the financial and operational responsibility for all of the equipment and make sure that it is maintained and operating accurately and repaired quickly if it fails unexpectedly.

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How important is planned maintenance and properly calibrated medical equipment?

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 It is very important to undertake planned maintenance and calibrate your equipment for several reasons. First, it has been proven that doing the appropriate planned maintenance on medical equipment reduces the frequency of unplanned repairs and increases the “mean time between failure (MTBF)”, or the time between repairs. Fewer and less frequent repairs mean that your hospital will spend less money on maintenance. Second, it is very important to calibrate the medical equipment when it is not performing within the manufacturer's specifications. Incorrectly calibrated equipment will not function accurately and may result in the provision of a wrong diagnosis, thereby risking patient health. It is integral to conduct the appropriate and necessary amount of planned maintenance. Too little planned maintenance may put your patients at risk and pose a financial liability. On the other hand, excessive planned maintenance, though not harmful, is costly and disrupts operations through unnecessary downtime.

 

What medical equipment needs to be included in my hospitals Medical Equipment Management Plan?

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AMS uses methods developed by the Association for the Advancement of Medical Instrumentation (AAMI), the American Hospital Association (AHA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other internationally recognized organizations to determine which of your medical devices needs to be included in your Medical Equipment Management Plan (MEMP). Your MEMP is the guidebook of rules and procedures that your Biomedical Engineering (BME) Department follows to insure that it is doing its job properly. We determine what medical equipment should be included in your MEMP by using these proven methods and the inventory of equipment in your hospital before we begin our contract.

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How often does my medical equipment need to have Planned Maintenance performed?

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AMS follows the recommendations given by the Association for the Advancement of Medical Instrumentation (AAMI) together with the Joint Commission on Accreditation of Healthcare Organizations ( JCAHO). These factors include: 
 

• Equipment Function (E) 

• Clinical Application (A) 

• PM Requirement (P) 

• Likelihood of Failure (F) 

The frequency with which your medical equipment needs to be maintained depends on a number of factors that vary depending on the type of equipment. We analyze each device in your inventory against these factors to determine the appropriate and necessary amount of planned maintenance required.

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What are the components of Planned Maintenance?

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Planned Maintenance (PM) is a composite of some or all of the following activities: Scheduled Maintenance (SM), including cleaning and/or decontamination; Performance Verification (PV), including calibration; and Safety Testing (ST). The goal of planned maintenance is to prevent equipment failure. The PM team works to ensure that medical equipment is working accurately and safely, all of the time, and to reduce the prevalence of corrective maintenance calls. The Association for the Advancement of Medical Instrumentation (AAMI) defines Planned Maintenance as follows: Planned Maintenance is comprised of several components including: Performance Verification typically called “Calibration” here in Thailand. When we perform performance verification we use special test equipment to determine whether your medical equipment is operating within manufacturer tolerances. Only when equipment is out of tolerance or fails its performance verification tests does it need to be calibrated. Safety Testing is performed to insure that particular operating parameters are not exceeded. A good example of Safety Testing is the annual testing of all radiology equipment by the Department of Medical Sciences. They do Safety Testing to insure that the radiation output of these devices is within safe limits. Scheduled Maintenance includes the changing of consumable part and components that need to be replaced on a regular basis to insure the safe and accurate operation of the equipment. Parts that are typically changed during scheduled maintenance are filters, batteries and seals.

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Is a replacement part from a non-OEM okay?

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Yes it is. Most medical original equipment manufacturers (OEMs) do not make the individual parts that they use to manufacture their equipment. They buy discrete parts and components from global manufacturers. For example, CT scanners manufactures do not make most of their x-ray tubes. A separate company manufactures these tubes. We can buy x-ray tubes directly from these manufacturers and other sources to use in your equipment. Another example is hard disk drives for CT scanners. None of the OEM's manufacture their own HDDs. They buy them from global manufacturers of these drives. We can buy the same drives from these manufacturers and other HDD manufacturers at substantial discounts, thus saving you money. Many other parts are standard electronic components such as resisters, capacitors and integrated circuits (IC); electrical motors, bearings and filters that can be purchased from many different global manufacturers and distributors at a much lower cost than buying them from the OEM. For example, when you need a battery for your car you do not need to buy it from the car manufacturer, you can buy these batteries from many different sources. Your hospital may already be using non-OEM components in your laser printers. There are many companies that recycle toner cartridges. They are refilling them with new toner at a much lower cost that buying a new cartridge. This is very similar to what AMS does when we replace an original OEM x-ray tube with a reloaded x-ray tube.

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If something breaks and it cannot be repaired by anyone, what happens? Do you buy us a new one?

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Most of the time when a piece of medical equipment breaks and cannot be fixed it is very old and pasts its useful lifetime. The average useful lifetime of most medical equipment is about 10 years, after which a hospital should consider replacing it. There are many reasons for this. First, medical equipment technology is changing and improving rapidly, and equipment and techniques become obsolete; or newer, safer, less expensive and more effective technologies are introduced. Second, after about 10 years, medical equipment OEMs stop supplying parts for the equipment. If an old medical device breaks and a generic part needs to be replaced, then AMS can in most cases fix it. However, if a very specialized part needs to be replaced that must be purchased from the manufacturer, and this part is no longer being made, then the hospital will need to replace the equipment. We have had this happen to us only a few times. In one case we were asked to repair an infant incubator that was over 20 years old. We respectfully declined to do the repair and suggested that the hospital replace the incubator in the interests of the health and safety of its patients. When the hospital management found out how old the device was they agreed that it was appropriate to replace the device. In another case we had to make a decision on what to do with a 38 year old Rad-Flu unit. The x-ray system still worked well, but we could not find the parts to repair the fluoroscopy camera and image intensifier tube. We discussed the situation with the hospital and suggested that we disconnect the fluoroscopy system so that it could not be used and continue to use the system only for general x-rays. We also discontinued the Planned Maintenance on the fluoroscopy unit and clearly marked the unit so that no one would try to use it to do a fluoroscopy procedure.

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Currently we have equipment under service contract and use the suppliers for the work you are proposing. What happens after we hire you? Do we have to pay both AMS and the supplier?

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Absolutely not. After you hire AMS, we take full financial responsibility for the costs of all of your current service contracts. We will pay the vendors directly for the length of our contract with your hospital.

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If our MRI has failed, how can you assure us that it will be repaired in a reasonable amount of time? How long will it take for you to get it repaired?

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We do our best to try to minimize equipment downtime. We have a proven track record of low down-time performance. Our average equipment downtime is only 3.2 days per work order. The average down-time per work order in hospitals in Thailand without a formal Medical Asset Management program is between 26–41 days. When we can't meet our contractual commitments to downtime, and in our experience this does not occur very often, then we refund the hospital cash to make up for the profits lost while the equipment was not working.

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If a piece of revenue generating equipment is not working for many days, what kind of protection do you provide against lost profits and damage to my reputation?

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Before we even begin working in your hospital, we begin planning for such an event. We call equipment like MRIs and CT scanners that generate revenue for your hospital "Revenue Generating Equipment". If our own staff is able to maintain and repair the MRI, e.g. a GE Vectra or MAX, we make sure that we have reliable sources for the most commonly replaced parts for the device before we begin to provide service to your hospital. We make sure that we can get these parts either from the local OEM or distributor or our own international suppliers of parts and components. We have a target of a maximum of 3 days of down-time for revenue generating equipment. If the equipment is not useable for more than the guaranteed number of days, then we refund the hospital cash to make up for the profits lost while the equipment was not working.

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What happens when we buy a new piece of equipment? Do you cover it? At what cost?

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Yes. Here is how it works: When you buy a new device, it typically comes with a 1 or 2 year warranty. We will make sure that while it is under warranty the supplier fulfills their contractual obligation to provide regularly scheduled planned maintenance and repair it at no cost if it breaks. Once it comes off of warranty, there is a formula in our contract for increasing our fee to cover our costs for maintaining and repairing the equipment for the rest of its useful life. The amount of money that we increase the contract depends on the value of the equipment. For very simple and inexpensive equipment such as new sphygmomanometers, there is no charge for adding it to your inventory. For very expensive equipment the additional charge is based on the value of the equipment.

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How can we be sure that when you fix something that it will perform to the manufacturer's specifications?

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AMS is an ISO 9001:2000 certified firm. Our medical asset management program is audited every year by BVQI to make sure that 1) we have the proper procedures in place to maintain and repair your medical equipment according to accepted international standards and 2) we are following these procedures when we undertake Planned Maintenance and repairs on your equipment. Our Planned Maintenance and Repair procedures have been developed by taking into account the manufacturer's service procedures; internationally accepted medical equipment maintenance and repair best practice; and, our own experience. Most importantly, after every repair, we do Planned Maintenance (PM) on the device, which includes a Performance Verification procedure to check whether the equipment needs to be calibrated. If it fails this performance verification then we will calibrate it to make sure it is working accurately before returning it to the clinical department.

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What if we only have one unit of a particular device and it needs repair? Do you have spare equipment that we can borrow until our own device is returned?

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Yes. Before we begin working in your hospital, we make a list of all of the devices of which the hospital only has one unit and there are no other devices that can be used as a substitute. We then work with your clinical staff to prepare contingency procedures for when one of these devices fails. We also work with your clinical staff, distributors and the OEMs to put together a procedure for borrowing equipment when it is necessary.

 

Do you have stocks of parts?

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Yes. We have a warehouse in our offices in the KPN building where we stock general medical equipment parts and consumables. In addition, we also maintain stocks of fast moving parts and consumables, e.g. batteries, at your hospital.

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How can we trust that you don't get any commission from suppliers through your suggestions on purchasing new equipment?

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Please feel free to ask any vendor whether they give AMS a commission on the equipment that they sell to your hospital. You will find that the management of AMS is very adamant about never taking a commission for recommending a particular manufacturer's equipment. Also, we never pay commissions or under-the-table payments in order to win business. AMS management knows that our reputation is our greatest asset. Being honest and doing what is right for our customers is good business. 

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Do you continue training our staff until they are sufficiently skilled to operate the medical equipment?

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Yes. Before we do training, we give all of the staff in the session a pre-test to evaluate their knowledge of the subject. After the training session, we give them a post-test to evaluate how well they understood the training and what they learned. Throughout the year we evaluate the technical competency of your clinical staff and use this information to prepare our training program. If we find out that your staff needs additional training on the same topic, we will schedule this additional training as often as necessary to bring their competence up to the minimum required level.

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How do you allocate technicians, considering the variety of equipment under management? 

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We review the inventory of equipment in your hospital and put together a team of engineers and technicians with the appropriate mix of skills to maintain and repair the equipment in your facility. We will assign a technician who has both background knowledge and factory trained certification of biomedical equipment to service your equipment. If they need assistance in repairing any device, they can call on our team of over 65 engineers and technicians for advice.

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Why does the contract have to be for five years? What would happen if we want to cancel the service before that?

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There are several reasons why our standard contracts are for a period of 3-5 years. First, in order for you to realize the benefits of AMS' integrated asset management services, we must take the time to establish appropriate planned maintenance and end user training programs at your hospital. It takes over a year for the effects of the planned maintenance and user training programs to be felt. Second, we need to purchase specific stocks of spare parts for your hospital, arrange for loaner equipment when needed, train our staff, purchase additional test and measurement equipment and hire additional staff. In order to make a return on our investment in these resources we need to be sure that we have the time to plan our services effectively. Should you be unsatisfied with our service we will need to discuss the reason for your dissatisfaction and develop a plan to meet your needs fully.

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How many people do you put at our hospital? do you support us on evenings, weekends and holidays?

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Whether we place a technician or engineer at your hospital or not depends on the size of the hospital, the amount of equipment you have and how busy you are. A very small hospital without a lot of equipment does not need to have a full time engineer on site all of the time. With small hospitals, we typically allocate staff on a rotation, with technician or engineer site visits occurring every few days. However, we have staff on-call 24 hours a day 7 days a week to service your needs.

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