How openMEDIS is improving the management and maintenance of high-tech medical devices
Modern medical equipment requires a modern approach to maintenance. With German support, the Ministry of Health of Uzbekistan is setting up an inventory and maintenance system to manage the growing volume of sophisticated medical devices in the country’s hospitals.
High-technology medical devices are playing an ever greater role in the prevention, diagnosis and treatment of diseases, enabling people to live longer and healthier lives. But the full benefits of sophisticated medical technology are only realised when equipment is kept in proper working order. Repairing high-tech medical equipment such as magnetic resonance imaging systems, ultrasounds and X-ray machines is both difficult and costly. Health systems which invest in expensive electronic equipment must therefore adopt a systematic approach to preventive maintenance to ensure that the devices function safely and reliably, and to mitigate the need for corrective repairs.
Since 2015, the Ministry of Health of Uzbekistan, with support from German development cooperation, has been doing just this. Using the open source software openMEDIS, it has embarked upon an effort to establish a nationwide digital inventory and maintenance system for high-tech equipment in the country’s health system. Once the product specifications of medical devices are entered into openMEDIS, the system then tracks servicing requirements and notifies hospital managers in a timely manner when regular performance or safety inspections are required.
Massive investments in high-tech equipment in Uzbekistan
The public health system in Uzbekistan is faced with rising rates of non-communicable diseases, including heart disease, strokes, diabetes, cirrhosis and cancer, as well as with an increase in traumatology cases. Addressing these challenges has demanded, among other things, modernising outdated diagnostic and therapeutic technologies. Over the past 15 years, the Government of Uzbekistan has invested heavily in upgrading the health infrastructure, with a particular focus on the nationwide network of emergency care facilities.
According to Dr Khikmat Anvarov, deputy director of the Republican Research Centre of Emergency Medicine at the Ministry of Health, the government has spent more than USD 50 million since 2000 to equip the National Emergency Centre in Tashkent, 13 regional emergency branches, and 172 district-level emergency departments with high-tech equipment. This includes everything from medical imaging devices to ventilators, intensive care units and systems for conducting minimally invasive/endoscopic surgeries. In the national flagship facility in Tashkent alone there are more than a thousand such pieces of equipment.
Inventory and maintenance systems also need an upgrade
Yet while cutting-edge medical technology is now increasingly available, systems for managing it are lagging behind. High-tech equipment requires a completely different approach to maintenance than the Soviet-era mechanical devices which had traditionally been used in the Uzbek health system, yet a modern ‘culture of maintenance’ is still developing, particularly at lower-level facilities. Hospital managers and health workers do not yet prioritise equipment maintenance or regard it as their responsibility, there are not enough bio-medical engineers to manage the use of modern equipment, and maintenance budgets are generally insufficient. Beyond this, there is not a systematic approach in place to inventorying equipment and its operational status. Existing paper-based systems are too cumbersome to be of use in tracking maintenance demands, particularly outside the capital; as a result, maintenance deadlines often pass without notice, increasing the likelihood of device failure and nullifying the terms of equipment warranties.
This fragmented system makes it nearly impossible for the Ministry of Health to have an overview of its physical assets, which is essential for effective planning. ‘For the Ministry of Health the issue is not only whether equipment is working or not, it’s what it costs to run it and how often it’s being used,’ says Dr Gunnar Strote, of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH in Uzbekistan. ‘The Ministry needs to have a clear view of what exists and how it’s being used in order to make decisions about future investments.’
Since 2012 GIZ has been working with the Ministry of Health, on behalf of the Federal Ministry for Economic Cooperation and Development (BMZ), to strengthen the capacity of medical and technical professionals to work with modern high-technology equipment. It not only trains health personnel how to use new technologies in clinical settings, but also works with technicians and engineers on the management and maintenance of such equipment.
In this latter area GIZ works in a complementary manner with the KfW Entwicklungsbank, which is modernising infrastructure and equipment at regional pediatric and multi-profile hospitals across Uzbekistan on behalf of BMZ. Each in their own portfolios, the two arms of German development cooperation are supporting the Ministry of Health to introduce a modern, transparent inventory and maintenance system via openMEDIS.
openMEDIS: joining inventory and maintenance functions in an accessible system
openMEDIS is an open source inventory software originally developed by the Swiss Center for International Health for use in low- and middle-income countries. It offers a user-friendly web-based platform for collecting and analysing information about medical devices, including model specifications, age, cost and current status. Data is entered at the facility level, and can be accessed for monitoring, management and planning purposes by authorised users at the facility, district, regional or national level.
Since 2015 GIZ has been supporting the Ministry of Health to adapt openMEDIS for use in Uzbekistan. This has included clarifying the nomenclature for identifying and categorising devices across the health system and modifying software interfaces so that openMEDIS data can be easily exported and used by the Ministry’s financial department.
The most significant change, however, has been the addition of maintenance modules into the software. These allow openMEDIS to be used to track the servicing requirements and maintenance status of each piece of equipment, including the dates on which preventive maintenance needs to be undertaken. The objective is to ensure that required performance and safety checks are carried out according to the terms of device warranties through service contracts with manufacturer-trained engineers or authorised agents.
Bringing health system assets under one digital roof
openMEDIS is currently being rolled out on a pilot basis across Uzbekistan’s 186 emergency care facilities; approximately 70 percent of facilities are now covered. In addition to supporting the software modifications, GIZ has worked with the Swiss Center for International Health to train officials from the national Ministry of Health, regional and district health authorities, facility managers, and the engineers who are responsible for completing the electronic inventory at facility level.
It has also helped to establish a maintenance workshop and training center in Tashkent whose staff will eventually take over responsibility for openMEDIS on behalf of the Ministry of Health. The workshop’s technicians carry out certain standard repairs, diagnose problems which may require specialised corrective maintenance, and serve as the intermediaries between local engineers and overseas equipment manufacturers, and/or their local or regional agents.
Once the pilot phase is completed and openMEDIS is institutionalised in the emergency system, the intention is to extend it further to the regional pediatric and multi-profile hospitals where large investments in modern technology are presently being made with German support via KfW. To this end, KfW is already beginning to train hospital engineers to work with openMEDIS so that they are in a position to join the national inventory and maintenance system in the future.
‘The main advantage of openMEDIS is that it’s easy for facilities to have an inventory and regular updates of all maintenance requirements and status of equipment,’ says Dr Joachim Schüürmann, Senior Health Adviser with KfW. ‘It doesn’t cost very much, it’s easy to handle, and it’s accessible on all sides.’
Getting the full picture, for the first time
‘There is no question that openMEDIS is a very good tool for preventive maintenance,’ says Khikhmat Anvarov of the Ministry of Health. ‘When you deal with such a large number of assets it’s not that easy to keep track of all the dates. openMEDIS is almost like a diary: it reminds you what to do when.’
Beyond this, Anvarov explains, it gives the Ministry a full picture of what is not working in the system at any given moment. ‘This is very important for us to know,’ he continues, ‘because large procurement processes can take a long time and we need to have information on which to plan purchase requests, whether these be for spare parts or new equipment.’
openMEDIS is also facilitating closer and more effective linkages between the Ministry of Health and facilities within the republican health system, including those located great distances from Tashkent. Ministry officials can now monitor the status of equipment in something close to real time, while those responsible for equipment at facility level are able to inform their superiors immediately when problems with vital equipment arise.
‘openMEDIS is convenient as an inventory tool, but it is also very useful for communicating with the main administration,’ says Islomov Rasulion, the deputy director for high technology at the Andijan Branch of Emergency Medicine, who has been working with GIZ on the introduction of openMEDIS for more than a year. ‘Through openMEDIS we can immediately inform the head office when we need to locate spare parts for an essential piece of equipment which is not working.’
An early foray into digitalisation
Digital information systems are not yet widespread in the Uzbek health system. According to Khikhmat Anvarov, of the Ministry of Health, openMEDIS represents one of the first large-scale efforts to introduce modern information technology into health facilities. ‘The openMEDIS system helps us to move away from reliance on paper records and telephone calls for managing information within the health system,’ he says. ‘It’s a first step in the direction of a fully electronic system.’ If the approach is successful, it may help to pave the way for the digitisation of other key functions.
* Healthy DEvelopments gratefully acknowledges the contributions of Jacob Steiger, who conducted the interview with Islomov Rasulion at the Andijan Branch of Emergency Medicine.