Healthcare technology management (HTM) professionals usually encourage their organizations (or clients) to use objective criteria when prioritizing equipment replacement. This desire for objectivity commonly leads to some type of technology assessment using a scoring system based on criteria such as age, reliability, overall condition, utilization, state of the technology (from cutting edge to obsolete), useful life, service costs, serviceability, and OEM end-of-life. Some also add a score-weighting mechanism to give certain criteria more influence over the outcome than others. The theory behind this scoring exercise is that the resulting numerical value fairly represents replacement need. The reports generated from these efforts are substantive, comprehensive, allow for easy prioritization, and suggest a level of sophistication and objective analysis. They are also not very useful.
There are several weaknesses with this type of technology assessment and replacement planning tool. Although the process of scoring and tabulating has the appearance of objectivity, the assignation of values to variables such as useful life, condition, and degree of obsolescence is subjective. Weighting the scores adds another layer of subjectivity. Even if useful and objective criteria are included, such as whether a device can be repaired or whether a networked device meets the organization’s network security requirements, the inclusion of all the other specious indicators leaves the outcome suspect. What these tools often do is simply package our subjectivity into something that looks objective.
Assessment criteria are also often irrelevant or ill-defined. For instance, equipment age is almost always used as part of a replacement justification even though age is a poor predictor of replacement necessity. A device’s “useful life” is rarely defined in a meaningful way. The American Hospital Association’s (AHA) useful life guide is sometimes referred to without acknowledging that the AHA guidelines are designed to schedule depreciation and not as an indicator of how long a device might be useful to the owner or how long it may function as designed. The clearest indicator of the useful life of a device is whether it is still in use. Scores indicating equipment is in poor condition are the numerical equivalent of saying, “this is a bunch of junk”, which may be our opinion, but it is not objective nor is it useful in determining replacement need.
Another weakness of equipment scoring matrices is that they represent the way we as HTM professionals think about replacement necessity and do not account for the decision criteria that clinicians or administrators use and that can include such disparate issues as the recruitment or retention of a key physician, marketing opportunities, competitive external environment, business growth or contraction, strategic initiatives, internal politics, patient experience, changes in reimbursements, and regulatory requirements.
Finally, I would suggest that most technology assessment tools are reductive and devalue our critical thinking skills. Capital funding decisions are largely value judgements made in the context of competing interests. Our contribution to equipment replacement decisions ought to be more than a number at the bottom of a spreadsheet.
Russell Furst is director of clinical technology assessment and planning with ISS Solutions—Geisinger Health System. He is a member of the Editorial Board for AAMI’s journal, BI&T.