










































23 J Global Clinical Engineering Special Issue 1: 23-32; 2018 

Received April 4, 2015, accepted May 8, 2015, date of publication June 1, 2015, revised March 21, 2018.

Planning Medical Technology Management  
in a Hospital

By Y David1 and EG Jahnke2

1Biomedical Engineering Consultants, LLC, Houston, TX
2Baylor College of Medicine, Houston, TX

ABSTRACT

Appropriate deployment of technological innovation contributes to improvement in the quality of health care 
delivered, the containment of cost, and access to health care services. Hospitals have been allocating a significant 
portion of their resources to procuring and managing capital assets; they are continuously faced with demands for 
newer medical technology and are challenged to interoperate and manage legacy and newer generation of inventory 
simultaneously. To objectively manage this investment over it life cycle, hospitals are adopting medical technology 
management programs that need pertinent information and planning methodology for integrating new equipment 
into existing operations as well as for optimizing costs of ownership of all equipment. Clinical engineers can identify 
technological solutions based on the matching of new medical equipment with the hospital’s objectives. They can 
review their institution’s overall technological position, determine strengths and weaknesses, develop equipment-
selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of 
goals. This program, together with cost accounting analysis, will objectively guide the capital assets decision-making 
process. Cost accounting analysis is a multivariate function that includes determining the amount, based upon a 
strategic plan and financial resources, of funding to be allocated periodically for medical equipment acquisition and 
replacement. Often this function works closely with clinical engineering to establish equipment’s useful lifespan, 
prioritization of acquisition, upgrade, and replacement of inventory within budget confines and without conduct-
ing time-consuming, individual financial capital project evaluations. The clinical engineer’s skills and expertise are 
needed to facilitate the adoption of an objective methodology for implementing the program, thus improving the 
match between the hospital’s needs and budget projections, equipment performance and cost of ownership. System-
atic planning and execution will result in a program that assures appropriate inventory level at the lowest life-cycle 
costs at optimal performance.

Keywords – clinical engineering, equipment assessment, technology management, equipment planning, technology 
evaluation, program methodology, cost accounting, life cycle, capital asset, budget.

InTRoduCTIon
The appropriate deployment of technology contributes 

to improvement in the quality of health care delivered, the 
containment of cost and to increased access to services 
offered by the health care system.

Over the past one hundred years, the dependence of the 
health care system on medical technology for the delivery 
of its services has continuously grown. In this system, 
the technology facilitates the delivery of the “human 

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David and Jahnke: Planning Medical Technology Management in a Hospital

J Global Clinical Engineering Special Issue 1: 23-32; 2018  24

touch.” All medical specialties depend to varying extent 
on technology for achieving their goals. Some specialties 
more than others, use medical technology, be it in the 
fields of preventive medicine, diagnosis, therapeutic care, 
rehabilitation, administration or health-related education 
and training. Medical technology enables practitioners to 
collaboratively and timely intervene together with other 
caregivers with patients in a cost-effective and efficient 
manner. Technology also enables integration and con-
tinuum care in a way that improves the level of overall 
health indicators. Hospital and clinical administrators 
are faced with the expectation for return-on-investment 
that meets accounting guidelines and financial pressures.

Society’s expectations for quality care and for the 
containment of the cost of care, as expressed in rela-
tionship to the Gross National Product brought the need 
for even better integration and control into the public 
debate arena. The U.S. government, in 1983, attempted 
to contain runaway health care costs through Federal 
regulation. These regulations established a new method 
of reimbursement, called the prospective payment system, 
which encouraged hospitals to manage their resources 
more effectively. Reimbursement methodology continues 
to influence innovation, development, and adoption of 
medical technologies.

As a result, routine methods for delivering care are 
being replaced with alternatives, such as the growth of 
outpatient clinics, ambulatory surgery and telemedicine. 
Conventional as well as alternative, sites of health care 
services are expected to meet a specific set of goals and 
objectives. These goals and objectives include adminis-
trative, clinical, financial, and regulatory parameters that 
influence how the integration of medical technological 
tools are planned for, funded, and executed. It also guides 
how these tools are selected, installed, trained for, inte-
grated, safely operated, serviced, upgraded, and retired 
or replaced. These are essentially the phases of all tech-
nology, including medical technology. The application of 
knowledge about the optimal management of various 
life cycle phases of capital assets will maximize system 
utilization during each one of the phases. Capital assets 
management, one life cycle phase, the process of select-
ing and acquiring medical technology, has not been well 
coordinated in most hospitals until recently.1 In addition, 

financial evaluations, which rely upon net present value 
(NPV) and internal rate of return would consume an 
enormous amount of a manager’s or director’s time and 
may in fact be questionable when put in their proper 
context.2 NPV is an important evaluation tool that needs 
to be integrated with a clinical engineering assessment 
when evaluating new rather than existing demand-based 
service lines of business or large program comparisons of 
alternatives based on cost efficiencies. Examples include, 
the proposed addition of a diagnostic imaging center or the 
comparison of major system software packages. Examples 
of equipment not needing NPV analysis, existing assets 
include: defibrillators, infusion pumps, and anesthesia 
machines. In this case, a typical health care organization 
may have an inventory encompassing thousands of indi-
vidual pieces of equipment. However, in their attempt to 
improve allocation of resources to medical equipment, 
the majority of health care executives have been making 
significant capital expenditure decisions with growing 
involvement of clinical engineering expertise and cost-
of-ownership information.3

The concept of management of capital assets is a 
far-reaching one that goes beyond merely acquiring or 
maintaining medical equipment and generally includes 
market-based demand forecasting as a method of estimating 
future demand for a health care organization’s services.4 
Changing payment methodology and existing inventory 
operations and maintenance costs are important factors 
in planning the deployment of new equipment; these are 
management issues that merge together in the clinical 
environment.5 This paper describes the emerging process 
for managing medical technology in the hospital and the 
role that clinical engineers are fulfilling.

THe TeCHnology MAnAgeMenT  
PRogRAM – ACHIevIng goAlS

The health care delivery system is going through a 
transition that is led by three major driving forces: cost, 
technology, and social expectations. The impact of these 
forces may change from time to time, as does their relative 
significance. In addition, the human factor that interacts 
with these forces is not constant either, thus submitting 
an important subject for public debate. Nevertheless, the 



David and Jahnke: Planning Medical Technology Management in a Hospital

25 J Global Clinical Engineering Special Issue 1: 23-32; 2018

system is being subjected to mounting pressures from the 
needs to first identify its goals, secondly select and define 
priorities, and finally allocate the limited resources.

Hospitals’ rising investment demonstrates their belief 
in the importance of and the benefit from the deployment 
of technology. Health care organizations have been using 
a variety of evaluation methodologies to provide alterna-
tives in the delivery of care. They are driven by medical 
innovation, prospective reimbursement, and societal 
expectations. In this environment, evaluation method-
ologies only work if an organization is truly prepared to 
cancel a project after the initial investment. The flaw in 
the theory is not its complexity, as some have said, but 
in the fact that it ignores the psychological and political 
realities of capital investments.6 It becomes imperative 
for providers to make good resource allocations decisions 
at the outset of their capital budgeting process and often 
those decisions are biased towards equipment that has a 
positive impact on reimbursement. Health care providers 
spent $8.25 billion on capital equipment in 1988, com-
pared with $8.21 billion in 1987.7 A survey of hospitals’ 
spending plans for capital budgets, one that includes 
equipment and construction, indicates that spending rose 
during 1992 by 15%, reaching $23.6 billion.8

However, the increasing scarcity of available resources 
within the hospital community on the one hand and the 
demand for quality health care on the other, promoted 
a public debate and awareness of such a paradoxical 
economic perspective. New tools for cost and outcomes 
management include disease management and patient 
safety initiatives.9 It is in such an environment that 
hospitals have begun to manage their fixed assets (i.e. 
capital investments) and equipment-related operation 
expenditures better than ever before. As the deployment 
of medical equipment continuously evolves, its impact on 
the hospital operations and on the consumption rate of its 
financial resources increases. The ability to forecast and 
manage this continual evolution and its subsequent impli-
cations has become a major component in all health care 
decisions. In a survey of three large hospitals in Houston, 
Texas, with a combined licensed capacity of about 1400 
beds, the average number of medical devices being used 
per licensed bed has increased between 1982 and 2002 
from four devices per bed to over 17 devices per bed.10 

This illustrates that hospitals are experiencing a continual 
increase in the number of medical devices used on a per 
bed basis. It is therefore imperative that in an industry 
where the only constant is change, there is a program that:

a. provides for a guiding strategy for allocation of limited 
resources

b. maximizes the value provided by resources invested in 
medical technology

c. identifies and evaluates technological opportunities or 
threats

d. optimizes priorities in systems integration, facility 
preparation and staff planning

e. meets or exceeds standards of care

f. reduces operating costs

g. reduces risk exposurecreates

h. better care environment.

Whereas both knowledge and practice patterns of man-
agement in general are well organized in today’s literature, 
the management of the health care delivery system and 
that of medical technology in the clinical environment is 
more fragmented and has not yet reached that level of 
integration. However, we are beginning to understand 
the relationship between the methods and information 
that guide the decisions regarding the management of the 
medical technology that is being deployed in the highly 
complex environment of the health care delivery system, 
including the variances among users, applications and 
cultures from one hospital to another.

The health care delivery system presents a very complex 
environment where strategy, facilities, equipment, drugs, 
information and the full range of human interventions are 
interacting. It is in this clinical environment that patients 
in various conditions, staff, temporary skilled labor and 
the wide variety of technology converge. The technology 
that has been developed for and is deployed in the health 
care delivery system ranges from the “smart” facilities 
within which care is being provided to the products that 
are used around the provision of healthcare services, and 
to its regulation and management. “Technology means 
merely the use of tools, that is, the involvement of any 
agent which assists in the performance of a task.”11 Such 
tools have been introduced at an increasing rate during 
the past 100 years and include the use of techniques, 



David and Jahnke: Planning Medical Technology Management in a Hospital

J Global Clinical Engineering Special Issue 1: 23-32; 2018  26

instruments, materials, systems, and facilities. Of all the 
factors and resources that will shape the future of the 
health of mankind, the one that most often stretches the 
imagination is medical technology.10 But yet, it is also 
blamed for contributing to the escalation of health care 
costs without receiving recognition for improving access 
to and quality and efficiency of the system.

It is, therefore, expected that the only winners are 
those who use superior strategy and execution. Generally, 
a superior strategy is the result of the use of market-based 
demand forecasting. Market-based demand forecasting is 
a method of estimating future demand for a health care 
organization’s services by using a broad range of data that 
describe the nature of demand within the organization’s 
service area. This provides a fundamental link between 
strategic planning and financial planning and thereby 
provides a rational basis for assessing how many patients 
may be expected to use services and what level of capital 
resources is needed to provide those services.12 This 
would define the types and volume of equipment needed 
to meet demand. Equipment is categorized by its function 
and owner department requirements in an assets list 
developed by the user and equipment planner as part of 
Biomedical Engineering validation of meeting appropri-
ate clinical standards and institution integration prior 
to purchase recommendation. The plan must be layered 
with present organizational capital asset requirements for 
replacing and upgrading existing inventory to maximize 
effective use of the existing capital equipment matrix and 
for appropriate systemization of medical processes. At 
this point, it is the managers who have to link technical 
capabilities to clinical requirements. Too often planning 
is the result of a crisis, a situation that does not permit 
thorough analysis and usually it is a time when it is too 
late to begin a plan. Managers are expected to understand 
why their institution’s values and mission are set as they 
are, to pursue their institution’s strategy and business plan 
through that knowledge and to act in a way that effectively 
allocates resources for which they are responsible. One 
may not necessarily be a part of the organizational level 
that develops the institution’s strategic plan; however, 
one must be familiar with it, one must understand and 
believe in it, to be able to develop an action plan at that 
level that supports the institution’s mission.

To implement an effective plan, one will be expected to 
know how the present state of technological deployment 
should be assessed, and to have a good rapport with the 
research and development industry to be able to provide a 
forecast and review of emerging technological innovations, 
the impact that they may have on the particular institu-
tion, plus have the ability to articulate justifications and 
provisions for adoption of new technology or of the needs 
to enhance or replace existing ones. Because tomorrow’s 
clinical devices are in the research laboratories today, a 
medical equipment manager should be considering visits 
to such sites as well as to the exhibits areas of the major 
medical scientific meetings. To facilitate the process, the 
current state of the health care organization’s inventory 
should be assessed and quantified by the clinical engineer 
based upon numerous criteria. This process is aided by 
the existence of both Biomedical Engineering equipment 
and Finance capital equipment databases. The technol-
ogy management process would include an assessment 
using a multi-year template of when and if equipment 
will need upgrading, replacement, and when new acqui-
sitions are to be added. Clinical engineering should then 
calculate a life-cycle for each asset. Using cost accounting 
analysis that includes a review of the impact equipment 
has on reimbursement methodologies such as cost based 
or case based, and in conjunction with a market-based 
forecasting model, each prospective piece of equipment 
should be priced and an overall annual cost of maintain-
ing the organizational inventory assessed as well as new 
additions supporting the strategic plan. Given the limits 
of an organization’s resources, an overall prioritization 
can then be developed so that the most important medi-
cal technology related to the strategic plan are procured, 
thereby enabling the organization to satisfactorily meet 
its service obligations, maximize financial returns, and 
attain goals.

The past decade has shown a trend of increased legisla-
tion that supports more Federal regulations in health care. 
These and other pressures will require that deployment 
of, and justification for, additional or replacement medical 
technology is well planned. If you subscribe to the saying 
that you cannot manage what you do not measure, and 
you cannot measure what you do not define, then the need 
for the development and the maintenance of a systematic 



David and Jahnke: Planning Medical Technology Management in a Hospital

27 J Global Clinical Engineering Special Issue 1: 23-32; 2018

and comprehensive planning process for the adoption of 
medical technology in hospitals is obvious. A mixture of 
literature review and experience demonstrates that the 
rationale for technology adoption is derived from the 
following reasons:

Clinical Necessity
• meet or exceed medical standards of care
• impact care quality or level
• effect on life quality
• improve accuracy, specificity, reliability, timing and/

or safety of interventions
• change in service volume or focus
• response to community needs
• reduce errors or improve predictability of outcomes

Management Support
• better or more effective decision-making protocol 

for interventions
• improve operational and maintenance efficiency 

and effectiveness
• facilitate development of or current offering of service
• reduce liability exposure
• increase compliance with standards or regulations
• decrease dependence on staffing and/or the skill 

level of personnel, improve staff retention
• effect on supporting departments
• improve return on investment or cash flow
• enhances integration and knowledge sharing
• improve patient throughput

Market Preference
• improve access to quality care
• increase customers’ convenience and/or satisfaction
• enhance organization or service image
• improve financial or value impact
• reduce cost of adoption and ownership
• effect on market share
• improves community conditions
•  facilitate continuum of care

Strategic
Planning

Assets
Management

Equipment
Procurement

and Integration Technology
Assessment

Equipment
Planning

Figure 1. The technology management process at the Texas 
Children's Hospital.

Many hospitals are reformulating their technology 
management process, which starts with the strategic 
planning process, thus demonstrating clearer support 
for the prescribed management of medical technology. It 
is a process in which the understanding of the key issues 
and the critical success factors are followed by a more 
defined task of resource allocation, and assignment of the 
responsibility for sustained improvement in technology’s 
performance through attainment or progression toward 
measurable technology utilization rate goals. This is a 
planned process that may be unique for each organization 
and is essentially a prescription for the way to look ahead. 
Although it may be different for every organization, all are 
faced with the following five similar questions: What are 
we? What do we want to be? Where are we going? What 
will be our role? And, how will we do it?

PlAnnIng And MonIToRIng THe 
dePloyMenT of MedICAl TeCHnology

As we developed our medical technology management 
program model (Figure 1), adoption of the strategically 
prescribed norms took place, as well as the monitoring 
in accordance with a well-thought-out plan, equipped 
with know-how from a multidisciplinary team of users, 
and the implementation of an agreed-upon policy. The 



David and Jahnke: Planning Medical Technology Management in a Hospital

J Global Clinical Engineering Special Issue 1: 23-32; 2018  28

multidisciplinary team has a similar approach toward 
the creation of definition of needs, scope and objectives 
for a specific type of technology, such as the equipment.

The question is no longer whether a medical technology 
management plan is worth the effort, but rather can we 
afford not to implement it, and do we have the adequate 
tools to execute it? If we do then the hospital will be able 
to make informed decisions regarding deployment of new 
technology as well as monitor its utilization.3

The need for clinical engineering involvement in such a 
team became evident when the following problems were 
repeatedly encountered:

• recently purchased equipment not sufficiently used
• ongoing user problems with equipment
• excessive downtime and ownership cost
• lack of compliance with accreditation agencies and 

regulations
• high percentage of equipment failing and awaiting 

repair
• maintenance costs emerging as a large single expense
• medical equipment upgrading, replacement, and 

planning are not intertwined
• use errors and near-miss events

A further analysis of these symptoms using a system 
performance analysis technique would likely reveal.13:

• a lack of a central clearing house to collect, index and 
monitor medical technology performance for resolv-
ing current issues and for future planning purposes

• the absence of strategy for identifying emerging 
technologies for potential integration

• the lack of a systematic plan for conducting technol-
ogy assessment, thereby not being able to maximize 
the benefits from prioritization of the deployment 
of available technology

• an inability to benefit from the organization’s experi-
ence with a particular type of technology or supplier

• the random replacement of medical technologies, 
rather than a systematic protocol based on a set of 
well-developed criteria

• the lack of integration of technology forecasting into 
the strategic planning of the hospital

• limited opportunities for interdisciplinary exchange 
between engineering-related and clinically-related 
professionals

To address these issues a technology assessment plan 
was initiated with the following six objectives: (1)  Accu-
mulate pertinent information regarding decisions about 
medical equipment. (2) Develop a multi-year plan for 
technology replacement and associated costs. (3) Com-
municate replacement selection criteria that is supported 
by users. (4) Create an ongoing assessment methodology 
with outcomes measurements. (5) Improve the capital 
budget process by integrating the status of current tech-
nology with long-term needs relative to surgical-medical 
services goals. (6) Integrate the competency of clinical 
engineering into patient safety goals.

Because the program provides for both the management 
of the existing inventory of medical equipment aiming at 
the lowest reasonable life-cycle cost, and for the recom-
mendations relating to procurement, it is mandatory to 
integrate trended operational and utilization information 
with the projected budget strategy into the technology 
management plan.

At the Texas Children’s Hospital, the Biomedical En-
gineering Department has been accumulating pertinent 
information and has developed indicators for measuring 
medical equipment performance.14 A Medical Technology 
Evaluation Committee (MTEC), which is chaired by the 
Director of Biomedical Engineering, began developing 
analytical selection criteria and life-cycle costs information. 
The membership of the committee includes representa-
tives of the medical and nursing staff, high-tech users, 
administration, equipment planning, risk management, 
safety, and materials management departments. Another 
clinical engineer from the same department with nursing 
training experience serves as the committee’s designated 
coordinator for all evaluation tasks. Once the commit-
tee accepts a request for review (RR), it identifies other 
users who may have an interest in it and authorizes the 
coordinator to assemble a task force of users specified 
by the committee. This task force then serves as an ad 
hoc committee responsible for the evaluation of the 



David and Jahnke: Planning Medical Technology Management in a Hospital

29 J Global Clinical Engineering Special Issue 1: 23-32; 2018

equipment described on the RR form. During any specific 
period, there may be multiple task forces, each focusing 
on a specific equipment protocol.

The task force coordinator cooperates with the Ma-
terials Management Department in conducting a market 
survey, in obtaining equipment for evaluation purposes, 
and in scheduling of vendor-provided demonstration and 
in-service training. After establishment of a task force, 
the coordinator analyses the evaluation objectives and 
together with input from the task force devises appropri-
ate tests, and the associated evaluation feedback form. 
There are two stages to this phase: an engineering test to 
validate safety and performance issues, and a clinical trial 
to evaluate user interface issues and efficacy. Only equip-
ment that has successfully passed engineering tests may 
proceed to a clinical trial. A clinical coordinator collects 
and reports the summary of experiences gained during 
the clinical trials to the task force. The committee coor-
dinator then combines the results from the engineering 
tests and the clinical trials into a summary report and 
prepares recommendations for MTEC approval. In this 
role, the coordinator serves as a multidisciplinary profes-
sional, bridging the gap between the clinical, technical, 
and administrative needs of the hospital.

The technology assessment process actually begins 
as soon as a department or individual fills out a budget 
request and then the RR form already mentioned. The 
form is submitted to the hospital’s Product Utilization 
and Review Committee, which determines if a previously 
established standard for this equipment already exists.

On the RR form, the originator delineates the rationale 
for acquiring the medical device. For example, how the 
item will improve patient care, generate cost savings, 
support the quality of service or improve ease of use, and 
who will be the primary user.

The form is sent to the MTEC if the item requested is not 
currently used by the hospital, or if it does not conform to 
previously adopted hospital standards. The committee has 
the authority to recommend either acceptance or rejec-
tion of any request based on a consensus of its members.

If the request is approved by the MTEC, then the re-
quested technology or equipment will be evaluated using 
technical and performance standards. The role of the 

medical technology evaluation program in the purchase 
of medical equipment is threefold: (1) assuring that 
biomedical equipment facilitates the delivery of quality 
patient care, (2) assuring that the equipment purchased 
meets the needs of all users, and (3) establishing hospital 
standards for biomedical equipment. Medical technology 
evaluation occurs in two phases. Phase 1 is in the submis-
sion of recommendations for the purchase of new equip-
ment. Phase 2 is the technical and clinical evaluation. This 
allows the hospital to validate equipment specifications, 
to obtain superior equipment at a competitive price and, 
in turn, consistently improve the quality of patient care. 
The evaluation process addresses pertinent issues regard-
ing the medical equipment safety, user friendliness, and 
equipment performance history. Based on satisfactory 
evaluation results and feedback from the technical and 
clinical staff, a recommendation is made to purchase a 
specific equipment item. Following these product evalua-
tion steps facilitates the standardization of the equipment 
selection process and, therefore, the standardization of 
biomedical equipment. This will allow the hospital to 
obtain superior equipment at a competitive price and, 
in turn, provide consistent, high-quality patient care.15 
Upon completion of the review, a recommendation is 
returned to the hospital’s Product Standards Committee, 
which reviews the results of the technology evaluation, 
determines whether the particular product is suitable as 
a hospital standard, and decides if it should be purchased. 
If approved, the request to purchase will be reviewed by 
the Capital Planning Committee (CPC) to determine if 
the required expenditure meets with available financial 
resources of the institution, and if or when it may be 
feasible to make the purchase. To ensure coordination of 
the technology evaluation program, the Chairman of the 
MTEC also serves as a permanent member of the hospital’s 
CPC. In this way, technology evaluation is integrated with 
and impact budget decisions.

THe Role of A ClInICAl engIneeR
Advances in technology accelerated multidisciplinary 

approaches to healthcare management.16 Clinical engi-
neering, a profession based on both engineering and the 
life sciences, developed in response. The recently created 
American College of Clinical Engineering provides a better 



David and Jahnke: Planning Medical Technology Management in a Hospital

J Global Clinical Engineering Special Issue 1: 23-32; 2018  30

understanding of the profession, and defines a clinical 
engineer as “a professional who supports and advances 
patient care by applying engineering and managerial skills 
to healthcare technology.”17

The role of a clinical engineer is shared between plan-
ning for new equipment and optimizing the utilization 
of the existing inventory.18 The clinical engineer must 
be completely familiar with the procurement phase of 
medical equipment and with the synthesizing of clinical 
needs into a bid request document. This further includes 
bid specifications, vendor negotiations, installation prepa-
ration, acceptance criteria, user training and servicing of 
the installed base. The clinical engineer is also familiar 
with methods for assuring that medical equipment per-
formance and risks are monitored, reported and managed. 
The process includes the assigning of criteria, i.e. values 
reflecting the evaluator or user preference, and measur-
ing the degree to which those criteria are met in the daily 
routine of the clinical environment.19 Criteria could be 
the format and quality of information displayed at the 

Client
Goals and
Strategy

People,
Structure and
Management

Assets
Management

Design and
Interface

Outcomes
Performance

Budget
Allocation

Technology
Life Cycle

Technological
Environment

Figure 2. Medical technology management environment at 
Texas Children’s Hospital.

bedside physiological monitor, the set-up of minimum 
infused volume of an infusion pump, or the amount of 
work of breathing associated with one particular brand 
of mechanical ventilator compared with another.

Medical technology policy supported by an organized 
program of planning, implementing, monitoring and evalu-
ation results in effective use of resources and reduction 
in operational risks. Medical Technology Management 
Environment at Texas Children’s Hospital, outlines such 
a program (Figure 2). Positive outcomes affect allocation 
of capital and are dependent on the success of the as-
sets management program, the impact of changes in the 
technology life cycle, the inherent design and quality of 
the technology as well as the environment within which 
the assets are deployed and serviced.

The methodology for the development and sustain-
ment of medical technology management program must 
include properties that demonstrate the impact from each 
of these parameters on outcomes. Outcomes performance 
indicators include: cost effectiveness, compliance level, 
and client satisfaction and service leadership.20 Perfor-
mance indicators can include safety-related events such 
as the elimination or reduction in medical errors. Cost 
effectiveness can include return-on-investment analy-
sis, reduction in cost per procedure, or improvement in 
uptime. Other indicators can represent the result of life 
cycle technology planning and the integration of technolo-
gies at the point-of-care measured by utilization rate and 
the level of satisfaction the caregivers team has with the 
environment of care.

The program needs to encompass all involved parties. 
This may at times extend the evaluation and provide for 
participation of professionals with different interests, which 
will require mediation between parties. The acceptance 
of the process is based on respect for their participation 
and at times will require a sequence of steps taken to 
pre-empt escalation of antagonistic attitudes among the 
parties participating in the evaluation. Often, one party 
seems to prefer an equipment feature that presents un-
acceptable conditions to another. The clinical engineer 
should provide the technical and cultural leadership needed 
to maintain the progress of the evaluation process in a 
participatory mode. The individuals participating should 



David and Jahnke: Planning Medical Technology Management in a Hospital

31 J Global Clinical Engineering Special Issue 1: 23-32; 2018

be representatives of the user groups, support groups, 
medical staff, nursing, engineering risk management, 
finance and administration.

Factors by which the equipment will be evaluated are 
selected, agreed upon, and a relative importance weight is 
assigned to them. Devices that pass the engineering bench 
test are forwarded to the clinical evaluation stage, which 
must be preceded by user training that is provided to all 
shifts by the clinical engineering staff and/or the vendor. 
During the clinical evaluation, the clinical engineer serves 
as a focal point for collecting users’ problems as an indi-
cation for a possible mismatch between the equipment’s 
real-life performance and user or system requirements. 
Following the evaluation, the clinical engineer collects 
the users’ report documenting their experiences and 
presents it to the committee for a recommendation, while 
the cost accounting representative reviews the financial 
alternatives. Generally, to review financial alternatives, 
information is accumulated and developed into a capital 
equipment matrix that includes replacement cost, pro-
jected retirement, replacement, upgrade, and associated 
life-cycle dates. Based upon input from clinical engineer-
ing, equipment is prioritized regarding their role in the 
organization. This data is then compiled and provides a 
useful determination of expected capital costs for future 
capital budgets and can aid in the development of future 
strategic planning by providing specific costs by service 
component. Clinical planning thereby provides options 
for management in future years despite limited financial 
resources.

A period of time after equipment has been installed, 
for example between six and twelve months, a follow-up 
study of actual operational costs, service problems and 
utilization indicators relative to projections is performed. 
This activity supports and becomes part of the equipment 
planning and continuous quality improvement program. 
Many good lessons are learned this way. It is also impor-
tant to review the implementation state and determine 
if it can be further optimized the next time. The clinical 
engineer, from that point on, continues with managing 
the other phases of the equipment life-cycle with proper 
attention to the planning for equipment upgrades, en-
hancements and replacement. The skills of the clinical 
engineer are needed now, more than ever, to manage 

this new responsibility: a responsibility for managing 
the medical technology program within guidelines that 
range from a strategic technology planning phase to the 
planning for systems replacement.

ConflICT of InTeReST
The authors declare that there is no conflict of interest 

regarding the publication of this paper.

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AuTHoRS' BIogRAPHy
Yadin David is principal at Biomedical Engineering 

Consultants, LLC and previously has been the Director of 
the Biomedical Engineering Department at Texas Children’s 
and St. Luke’s Episcopal Hospitals since 1982. He received 
his Master and Doctorate degrees from West Virginia Uni-
versity, is affiliated with the University of Texas School of 
Public Health, and previously also with the Department 
of Pediatrics, Baylor College of Medicine. He is Registered 
Professional Engineer and Certified Clinical Engineer. 
He is a member of the FDA Advisory and NFPA technical 
committees, and chairman of IUPESM HTTG group and 
member of the IFMBE Clinical Engineering Division.

Ernest Gus Jahnke is manager of Hematology/Oncol-
ogy section at Baylor College of Medicine and holds MBA 
degree in business informatics and Bachelor’s degrees 
from the College of Charleston, is a Certified Public Ac-
countant licensed in the state of Texas, and is a Certified 
Forensic Accountant. Previously was the Manager of 
Finance at Texas Children’s Hospital where he was the 


