









































17 J Global Clinical Engineering Vol.2 Issue 2: 17-21 ; 2020

Received April 2, 2019, accepted February 11, 2020, date of publication February 24, 2020

Application of Multiparameter Method as an Assistance 
to the Evaluation of the Need for Replacement of 
Medical Equipment 
By M. A. Marciano1 and E. K. Souza2

1Moinhos de Vento Hospital/Clinical and Hospital Engineering, Porto Alegre, Brasil
2Moinhos de Vento Hospital/Clinical Engineering, Porto Alegre, Brasil

ABSTRACT
Medical equipment is an increasingly important element in modern medicine and medical and hospital care. For medical 
equipment to contribute effectively and productively to health organizations, it is necessary to carry out the management 
of their life cycle. A decisive factor in this life cycle is to know when a piece of equipment must be replaced. It is observed 
that defined and clear methods must be in place to assist the clinical engineering and hospital management in deciding 
and prioritizing which medical equipment needs to be replaced and when. This work has a practical application in the 
management of the medical equipment inventory. As a result, the classification of medical equipment and the prioritiza-
tion of substitution is obtained concerning variety, quantity, and cost of the equipment to be replaced. The application of 
this method may contribute to the increased quality of the installed equipment and effective budget planning for hospital 
investments.

Keywords – Prioritization replacement, multiparameter method, Biomedical equipment. 
Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

INTRODUCTION
Medical equipment is increasingly important in mod-

ern medicine to aid in research, diagnosis, monitoring, 
therapy, and life support of human beings in need of 
medical and hospital care. Hospitals, in turn, have become 
sophisticated centers of technology.1 The inappropriate 
use of technology may put users and the effectiveness of 
health organizations at risk. For medical equipment to 
contribute effectively and for health organizations to use 
them more productively, there is a need to manage their 
life cycle. The equipment’s life cycle is divided into phases, 
in the following sequence: Innovation, Initial Diffusion, 
Incorporation, Large-Scale Use, and Renouncement/
Substitution.2

A key factor in this life cycle is knowing when any medi-
cal equipment should be replaced (to avoid inefficiency, 
unavailability, risks to patients, etc.). Other reasons for 
replacement need may be high operation cost, obsoles-
cence, or inadequacy in meeting demand.3 The equipment 
can be classified into two groups, those with decreasing 
efficiency and a predictable useful life (with low equity 
options without replacement, low with replacement by 
same type equipment, and low with replacement by more 
efficient equipment), and those with constant efficiency 
and unpredictable useful life.3 As there is a historical 
scarcity of financial resources in healthcare an increas-
ing, rational allocation of this resource is vital. Therefore 

http://www.globalce.org
http://globalce.org
http://globalce.org


Marciano, Souza: Application of Multiparameter Method as an Assistance to the Evaluation of the Need for 
Replacement of Medical Equipment

J Global Clinical Engineering Vol.2 Issue 2: 17-21 ; 2020  18

studies, methodologies development, and tools to define 
the cost of a technology’s useful life are increasingly val-
ued to avoid those subjective criteria being used in the 
decision-making process.4

For some factors, such as which technologies tend to 
be cumulative rather than substitutive, it is complex to 
define obsolescence criteria for medical technology.5 In 
view of such complexity, it is observed there is an absence 
of clear and defined methods in the literature, as well as 
the application of methods and criteria to assist clinical 
engineering and hospital management in deciding which 
medical equipment needs to be replaced.

This study presents an alternative method, practical 
application and has the main objective to present a clas-
sification of medical equipment regarding replacement 
priorization as a consequence of obsolescence, evaluation 
of the technological medical equipment in use in the hos-
pital, and to assist with direction in the variety, quantity, 
and costs of medical equipment needing replacement ac-
cording to obsolescence criteria. The method used in this 
practical application was the Multiparameter developed 
in 1992 and applied for the first time at St. Luke Medical 
Center to a range of five different types of equipment, 
such as intra-aortic balloon, ECG, defibrillator, neonatal 
incubator, and ergometric treadmill, totaling 146 pieces 
of equipment.6 The option for this method was to under-
stand that it covers a variety of parameters and attributes, 
from technical, economic-financial and medical-assistance 
points of view. In the evaluation of the medical equipment 
life cycle, the importance of the observation by the prism 
of manufacturer and medical-care user is relevant.7 This 
proposed method has a clear and objective formulation 
and allows applying to a variety and quantity of medical 
equipment, which is one of the assumptions of this work. 
Because it is composed of quantitative and qualitative 
attributes, and thus a wide coverage of the evaluation 
criteria, the application becomes attractive in relating 
practice and experience with actual data.8 The applica-
tion of this method can contribute to an increase in the 
quality of the management of medical equipment installed 
and with the investment planning of the hospital budget. 
This demonstrates that the knowledge acquired and de-
veloped by frequent research from clinical engineering 
professionals and the disseminated practical application 

can contribute to the decisions of health organizations´ 
management and thus add value in a more meaningful 
way because well-prepared professionals are essential to 
guide the decisions of health organizations.5

MATERIALS AND METHOD
The applied method considers four groups of parameters 

to compose the plots of the equation denominated RPV 
(Replacement Priority Value), being: technical (contribut-
ing with 40% in the equation), criticality (contributing 
20%), financial-economic (contributing 20%), and clinical 
parameters (contributing 20%). One of the prerequisites 
for this application is to have the information about the 
medical equipment inventory to be analyzed, as well as 
the maintenance history of each one.

The first group mentioned, shown in Table 1, is com-
posed of four attributes related to equipment: the age, 
maintenance cost (in this study, the maintenance cost 
[MC] was adapted to 24% according to the Brazilian real-
ity, since in the original study the MC reference is 15%, 
considering the last 3 years regarding the purchase value), 
stopping time, and end of manufacturer support. In the 
four attributes, if the analyzed medical equipment has a 
good classification it receives a zero score, otherwise, it 
receives 1. Limits are described in Table 1.

TABLE 1. Technical Parameters

Criteria Scoring Rule

Technical Criteria MAN = Age + MC + ST + MS

Age (Age)
Age ≥ 7 years = 1

Age < 7 years = 0

Maintenance Cost
(MC)

MC ≥ 24% New equipment = 1

CM < 24% New equipment = 0

Stopping Time (ST)
ST ≥ Average group break time=1

ST < Average group break time = 0

End of Manufacturer
Support (MS)

MS = 1, when spare parts are available  
on the market

MS = 0, when spare parts are not



19 J Global Clinical Engineering Vol.2 Issue 2: 17-21 ; 2020

Marciano, Souza: Application of Multiparameter Method as an Assistance to the Evaluation of the Need for 
Replacement of Medical Equipment

The age of the equipment was considered using data 
provided by the accounting sector of the institution. The 
MC and stopping time of the equipment were acquired 
through the asset management software. For the end of 
manufacturer support criteria, the formal communication 
issued by manufacturers was used as a reference.

The second group mentioned, as shown in Table 2, is 
composed of a single attribute, which is the function of 
the equipment. In this attribute, the medical equipment 
is framed in one of four classifications, according to the 
function, as shown in Table 2. In relation to criticality, the 
equipment was classified according to its application/
function.

The third group, shown in Table 3, is composed of two 
attributes, one is the increase of billing and the other is the 
reduction of cost. In the two attributes, if the replacement 
of the medical equipment analyzed results in increased 
billing or cost reduction, it receives a score of 1.

To classify or score the equipment in the financial-
economic parameter, it was necessary to know by which 
technology the equipment under analysis could be replaced. 
And, also be aware whether the replacement could bring 
cost reduction or increased billing. If positive, the score of 
each of the two mentioned attributes would be 1 (Table 4).

In this parameter group, it was necessary to know if 
the equipment replacement in the evaluation could be 
more efficient, to increase the standardization, or to have 
increased user preference. This classification was conducted 
with the support of care managers and doctors from the 
areas in which the analyzed equipment were allocated.

TABLE 2. EM Criticality

Criteria Scoring Rule

Medical equipment 
criticality (FUN) FUN

Life support FUN = 4

Therapy FUN = 3

Diagnosis/ 
monitoring FUN = 2

Analysis / support / 
assistant FUN = 1

TABLE 3. Financial-Economic Parameters

Criteria Scoring Rule

Financial-Economic
Parameters Cost Benefit (CB) = IB + CR

Increased Billing (IB)

IB = 1, if the replacement equipment
provides a higher billing

IB = 0, if the replacement equipment
does not provide a higher billing

Cost Reduction (CR)

CR=1, if the replacement equipment
provides a reduction in the cost of

operation and/or maintenance

CR = 0, if the replacement equipment
does not provide a reduction in the 

cost
of operation and/or maintenance

TABLE 4. Clinical-Safety Parameters

Criteria Scoring Rule

Clinical Parameters 
and Safety

Clinical efficacy and preference (CEP)
CEP = IT + UP + IS

Improvement in
treatment (IT)

IT = 1, if EM offers improvement in 
the treatment

MT = 0, if EM doesn´t offer
improvement in the treatment

User preference (UP)

UP = 2, if the user preference for
exchanging equipment is large

UP = 1, if the user preference is 
medium

UP = 0, if there is no preference for
exchange

Increased
standardization (IS)

IS = 1, if the replacement equipment
provides increased standardization

among medical equipment

IS = 0, if the replacement equipment
doesn´t increase standardization 

among medical equipment



Marciano, Souza: Application of Multiparameter Method as an Assistance to the Evaluation of the Need for 
Replacement of Medical Equipment

J Global Clinical Engineering Vol.2 Issue 2: 17-21 ; 2020  20

After completing all the parameters listed, the follow-
ing formula was applied to obtain a final score, called 
Replacement Priority Value (RPV). This formula consid-
ers a weight or percentage for each group of parameters 
evaluated.

RPV = 0,4. + 0,2. + 0,2. + 0,2. (1)
To support the classification of Replacement Prioriti-

zation there is a decision scale in this method, as shown 
in Table 5.

A spreadsheet was used as a tool to apply this method 
in a private, non-profit hospital with approximately 400 
beds and an installed base of approximately 4,500 medi-
cal equipment.

RESULTS
Through the application of the Multiparametric Method, 

it was possible to know and visualize an overview of the 
replacement, which equipment should be kept in operation 
without any restriction, and how many should be kept in 
operation but with a reevaluation in the next 12 months 
(81 pieces of equipment) and 24 months (164 pieces of 
equipment), as shown in Figure 1. 

It was also possible to identify which types and quan-
tities of equipment should be prioritized, visualize the 
diversity prioritized by cost center, and provide manage-
ment with an estimate of the financial resources needed 
to invest in replacements.

Another possible analysis was the verification of the 
partial classification referring to the groups of clinical, 
financial, economic, and technical parameters that de-
termined if it was graduated with a partial result. This 
prism of analysis assists in the understanding of under 
which parameters certain equipment is worse qualified.

DISCUSSION
Health organizations, through clinical engineering ser-

vices, need to have effective control of the medical equip-
ment they own. The use of medical equipment life-cycle 
management software allows us to record all maintenance 
history. Knowledge of this data and information are a 
prerequisite for using technology evaluation methods.

The Multiparametric Method, with the range of criteria 
demonstrated, may be a practical alternative when evalu-
ating the Replacement Prioritization of a wide range of 
medical equipment types. The continuity of application 
of this method, adaptations of attributes, and way of ap-
plying (mainly subjective ones) are subject to refinement 
and adjustment. There is also a need to implement the 
results after modeling, simulation, and resolution of the 
equations and types of computational tools being used. 
Both the methods and results of this practical applica-
tion were fully accepted by senior management, by the 
managers, coordinators, and the multi-professional team 
responsible for the evaluation of hospital investments.

The list of medical equipment with a priority of replace-
ment, as a result of the evaluation of obsolescence of the 

TABLE 5. Classification of Replacement Priorization

Criteria Scoring Rule

Keep in operation RPV < 1

Reevaluate the 
condition of the
equipment in the 
next 12 months

1 ≤ RPV ≤ 1,2

Replace in the next 
24 months 1,3 ≤ RPV ≤ 1,6

Replace in the next 
12 months RPV ≥ 1,7

FIGURE 1. Overview of the replacement.



21 J Global Clinical Engineering Vol.2 Issue 2: 17-21 ; 2020

Marciano, Souza: Application of Multiparameter Method as an Assistance to the Evaluation of the Need for 
Replacement of Medical Equipment

inventory of the technology was the basis of the biomedical 
equipment investment sheet. Other medical equipment 
made the list but came from other hospital needs.

CONCLUSION
Clinical engineering services can increase the perfor-

mance of this evaluation and propose plausible alterna-
tives (appropriate, comprehensive, practical, etc.) to 
hospitals regarding the use of methods and criteria that 
allow indicating the appropriate timing and prioritization 
of equipment replacement. The use of these methods can 
contribute to the quality, availability, security, and perfor-
mance of the technologies as well as aid in accounting for 
the costs related to the life cycle of the hospital medical 
equipment inventory which would help in the planning 
of the health institution investment.

Other types of methods also need to be developed, 
studied, analyzed, and applied in a larger variety of medical 
equipment (to evaluate which method is best applied to a 
certain class of equipment) and more widely in the health 
organizations, to contribute substantially to managing the 
life cycle of the medical equipment installed.

CONFLICT OF INTEREST
The authors declare that they have no conflict of interest. 

REFERENCES

1. Bronzino JD The Biomedical Engineering Handbook. 
2nd ed. USA: CRC Press, Inc; 2000.

2. Krauss-Silva L. Avaliação tecnológica em Saúde: 
questões metodológicas e operacionais. Caderno de 
Saúde Pública; 2006.

3. Brehm DO. Ponto 2: Metodologia e princípios da Análise 
de Investimentos; Análise de Projetos industriais e 
substituição de equipamentos; Prática instrumental, 
tabelas, planilhas e calculadoras Financeiras; 2012. 

4. Stiefel R and Riskalla E. The elements of a complete 
product evaluation, Biomed Instrum Technol 1995 
Nov-Dec;29(6):482–8. 

5. Novaes HMD. Produções e avaliações de tecnologias 
dos sistemas de Saúde: desafios do século XXI. São 
Paulo 2006;40:133–40.

6. Fennigkoh L. Medical equipment replacement model. 
J Clin Eng 1992 Jan/Feb; 17(1): 43–47.

7. Santos F, Garcia R. Contribuição de metodologia para 
definição de substituição e incorporação de novas 
tecnologias na área da Saúde. II XII Jornadas Inter-
nationales de Inginieria Clínica y Tecnologia Médica 
(Entre Rios-Argentina). Anais. Argentina 2006;27–31.

8. Katz Z. Estudo de Metodologias Econômicas e Mul-
tiparamétricas Aplicadas à Decisão de Substituição 
de Equipamentos Médicos. Dissertação Mestrado em 
Engenharia Elétrica. FEE UNICAMP; 1998.


