Point-of-Care Biomedical Engineering Equipment Management System


 BackgroundMedical devices and equipment play an important role in the modern medical service. It is necessary to integrate the relevant information in order to effectively manage all the equipment into a biomedical engineering equipment management system (BEEMS). Aims: To report our experience and satisfactory from the users of a BEEMS.MethodWe combine a central core module with intra-net and a mobile device application with internet to become a real-time BEEMS. With the combination of these two modules, the point-of-care software system become real-time and mobile for all users in the hospital. We conduct a survey about satisfactory from the users after more than one-year implementation of this system. ResultsAfter the application more than one year, only 7% users show unsatisfactory about the BEEMS. We also find this real-time and point-of-care BEEMS has high satisfactory and is especial helpful for the management staff in hospital. ConclusionA real-time BEEMS has high satisfactory and is helpful for the staff in hospital.Relevance to clinical practiceA real-time biomedical engineering equipment management system is helpful to effectively manage all the equipment in hospital.


Background
Medical devices and equipment play an important role in the medical service. Those are important in the disease prevention, diagnosis, monitoring and treatment, as well as patient rehabilitation. However, due to their variety and huge volume, it is necessary to integrate the relevant information in order to effectively manage all the medical instruments and equipment. [1,2] Therefore, the "` Biomedical Engineering Equipment Management System (BEEMS)" and "Medical Instrument Mobile Device Application (APP)" are established and become a point-of care mobile system in our hospital since 2018 to 2019. The system builds a complete medical equipment database, including the maintenance schedule and records, annual repaired cost, contracts, abnormality monitoring, automatic output management reporting, etc., and connecting with various systems to share information in the hospital (Figure 1). By using this powerful software and applications, the hospital staff can conduct online repair application, equipment operation instruction and consultation, maintenance recording, simple trouble shooting solving, which could be performed on a mobile device by the internet. The system database is also connected to other data system of the hospital, such as Tableau system, which can generate various management reports including the engineer performance, repair effectiveness monitoring, etc. [3,4] The aims of this report are to introduce the policy brief of this novel mobile device integrated point-of-care BEEMS and report the satisfaction from clinical staff for this system.

Material And Methods
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 rst step in establishment of this system is to update the equipment inventory database. We classi ed 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 classi ed our PM into 1 st degree and 2 nd degree. First degree PM is inspected and is recorded by the user monthly, 2 nd degree PM is carried out by biomedical engineers under a scheduled program. Our 2 nd PM program scheduling is based the suggestion from WHO medical maintenance program. [4] 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 di cult 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 identi cation 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 arti cial intelligence system to read the color bandage and connect with the equipment identi cation property number ( Figure 2). Finally, all of our medical equipment can be recognized through the APP with real-time mobile device.

Tableau system
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 ll 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.

Statistical analysis
Category variables are expressed as the number and percentage and the difference is tested with Chisquare test with sher exact correction.

Results
From Jan to March 2021, total 289 users join our survey and answer the questionnaire anonymously. The characteristics of responders is summarized in Table 1. Most of the responders (88.6%, 256/289) are from nursing department, most the education level for the responder is bachelor as 72% (207/289), the years of hospital servicing ranges from less than 3 years (29.1%) to more than 16 years (19.7%). And 13.5% in our responders is the management staff (MS).
The satisfactory about our BEEMS from the 289 responders is shown in Table 2. Only 7% show unsatisfactory about the BEEMS. Most of the responders show that the system is convenient (52%) or very convenient (16%). And they reveal convenient (52%) or very convenient (13%) in data query, convenient (50%) or very convenient (13%) in solving trouble shooting. There are 57% and 26% responders show helpful and very helpful for them in management of the medical equipment.
We further analysis the satisfactory according to MS or not (Table 3). Responder with manager level show a higher satisfactory than not a MS about interface design, data query, problem solving, no paper storage, grasping equipment condition and general satisfactory about the system (All p-value <0.05 by Chi-square test with sher exact correction).

Discussion
A useful bio-information management system can keep the medical equipment reliable, safe and available to be used when necessary, besides it can minimize the cost of equipment and increase e ciency. [6,7] We nd that the responders of the users show high satisfactory for our BEEMS, especially for the management staff. Only 7% users show unsatisfactory about the BEEMS.
There Are Some Features About Our Beems: 1. In modern hospital, the number of medical equipment are numerous that organizing the information need a computer system.[4] I our system, we use a risk-based prioritization suggested by WHO, with the automated scheduling preventive maintenance and calibration programs, the engineers can arrange their PM schedule according to the system and the MS can inspect and monitor the results.
2. Some hospital use stickers on the equipment to demonstrate basic information, such as operation guide, operation power need or fast trouble shooting guide. Medical device-associated healthcareacquired infections pose a threat to patient safety.
[8] With the internet APP system in our system, the user can not only complete real-time surveillance of the condition of any device and the but also get information and condition query, including the power need, operation system information risk checkup without any tags or labels attached to the equipment. This may decrease infection rate in the hospital. 3. During the COVID19 pandemic, the ventilator may become insu cient [9]; our system provides spare ventilators data and increase the e ciency of ventilators. Because the fail or spare equipment is marked in system, therefore the system can also provide the location of spare equipment when necessary. For ventilators, each patient is recorded in our BEEMS, which makes it more convenient for equipment allocation in our hospital. This system also provides the real-time data to national health care system, such data also help the government in decision making during the pandemic. 4. The BEEMS also can share information with other systems and decrease the printed paper consumption. By connecting with property management system, equipment repairing system and the mobile device, there is no need to printed les between departments; therefore, we can dramatically decrease the printed papers need. According to our estimation, we can decrease 50,000 printed papers annually after the use of this system.
A good BEEMS is helpful for the users in equipment monitoring, technology assessment and resource allocation and shows high satisfactory. By connecting to the tableau system, the performance of all staff could also be inspected real-time. We can trace the completion rate of equipment acceptance, prevention maintenance, repair and eliminate.
At the same time, the system can also provide reference for the management decision through the complete instrument resume and data integration. Furthermore, the system also simpli es the operation process, alleviates the medical personnel workload and enhances the management e ciency. The database can be used to control the instrument information and manage the relevant risk on a real-time basis, further ensuring the patient safety and service quality. We nd the managers level show higher satisfactory in MS, which may re ect the system provide real-time information for MS and is helpful in resource allocation and decision making. However, our system still has some limitations, there are still some users do not satisfactory for this system. This may be due to the internet signal become unstable in some corner in the hospital, and the system provide a lot of information and may need time to familiar with it. We believe, such a point-of-care and real-time information system is very helpful in the hospital management and medical resource allocation. In the future, it is expected that we can input and connect more data in BEEMS to continuously improve this innovative system and enhance the management e ciency.   Figure 1 Roadmap of our biomedical engineering equipment management system (BEEMS). The system architecture is consisting of a central core module with intra-net and a mobile device application with internet. With the combination of these two modules, the point-of-care software system become real-time and mobile for any user. Mobile Device Application (APP)