The responsibility of purchasing capital equipment for your organization is a great one. The size of such an expenditure and the finality of your choice can make this a daunting task. With so many options, it can be difficult to differentiate between the manufacturers and their systems. However, knowing which questions to ask can help you make your decision with confidence.
Purchasing capital equipment for your sleep lab is like getting married. You are entering into a long-term relationship with the product, the company, and your sales representative. It is important to thoroughly evaluate all three to make sure you are choosing the system that is the best fit for your lab and organization.
Between 15 and 25 manufacturers of sleep diagnostic systems sell their products in the United States, and many of those manufacturers sell multiple versions of their product. Chances are that you don’t have time to closely evaluate each one. Before meeting with a salesperson and viewing a demonstration of their product, think about what features and capabilities are most important to you and your technicians. Ask for their input and come up with a list of dealbreakers—features or capabilities that you cannot live without. Talk to the salesperson before scheduling the demonstration to ensure that their product meets your minimum specification. Purchasers can create a checklist, compiling information from multiple vendors for easier side-by-side comparison. By doing this in advance, you will narrow the field and save yourself some time.
Consider how the system will be used. Do you need to view data outside the lab or across town? Then the networkability of the system will be important. It is helpful to schedule a call between the IT/IS representatives in your facility and the product support/installation technicians from the manufacturer to discuss the structure of the network and how the system will integrate. Do you need the capability to do portable sleep studies? If so, can the system be configured to operate on a laptop, and what other features lend themselves to a portable application?
Visit Sleep Review’s online product guide for more information about sleep diagnostic systems.
For physician access to study data, some manufacturers offer a read-only version of their software for physician use. Also, a free data viewer that is embedded with the study when it is copied to a CD can be useful for physicians that need to be highly mobile. This enables a burned copy of a study to be read on any computer, even if the software had not been previously installed on that PC. The viewing software is included in the patient file when it is copied to the CD (or other media), and launches automatically when the CD is inserted in the CD-ROM drive.
Inquire about what options are available for procuring computer hardware. Will the manufacturer allow the customer to purchase their own computers, monitors, or printers? If so, what are the minimum specifications and how is computer support affected (if at all)?
How are reports generated, and what is the process for customizing report templates? Does the software allow the user to customize their reports, or is it done by request by product support? Can a customized interpretation report be developed to eliminate transcription? What is the format of the reports? Are they generated using a common software program such as Microsoft Word or Excel, or are they generated in a proprietary format? You may want to use an existing report template or one from another system. Can the company adapt existing templates into their format?
What different types of software licenses are available? Is there a read-only version available for physician review? Historically, how often are new versions of software released? How is it determined which features are added or which improvements are made? What new features and capabilities were added to the last two or three versions of software? What new features will be included in the next software release, and when is it scheduled to be released to market?
What is the maximum sampling rate? For EEG, EOG, EMG, and ECG, the AASM specifies a rate of 500 Hz as “desirable,” and a rate of 200 Hz as “minimal.”1 A higher sampling rate could improve your ability to recognize and diagnose certain EEG activity, such as spikes. Consult the technical and digital specifications detailed in The AASM Manual for the Scoring of Sleep and Associated Events—Rules, Terminology and Technical Specifications.
How is the data managed post-collection? What database options are available, and what are the capabilities of the database? Many database products have the ability to interface with hospital EMR (electronic medical record) systems. Research in advance the compatibility of the database with any existing system you may be using.
Technology Investments: Lessons from the Labs
Unlike buying a car, sleep equipment requires an ongoing, two-way relationship between purchaser and supplier. When it comes to maintaining optimum operating levels, organizations that treat sleep disorders rely heavily on manufacturers and service providers to keep equipment running properly.
“Equipment uptime is of the utmost importance to us,” says Mark Loos, vice president of Perioperative Services, Respiratory Care, and Pharmacy at the Sleep Center at The Reading Hospital and Medical Center, Reading, Pa. “For every night of lost equipment time, we lose significant revenue. It is important that sleep equipment providers are able to provide tools to the sleep laboratory to help clinicians diagnose and treat patients more effectively, as well as to increase productivity.”
“Sleep center managers shouldn’t be afraid to ask detailed questions about the quality of the service they’re receiving,” says Tom Chowaniec, senior VP of customer care at VIASYS Healthcare, Yorba Linda, Calif, makers of sleep treatment equipment. “Service is an area of vital importance that can be overlooked in the decision-making process, as the focus is generally on the product’s specifications.”
The Reading Hospital and Medical Center is now branching out into more than one area of sleep diagnostics. The facility’s system includes integrated features in its software and hardware that provide for a variety of ages and body sizes so that the sleep center is able to implement new diagnostic programs, such as for pediatric and neonatal patients.
Taking advantage of the latest advances in equipment servicing technology has also increased productivity at the St Luke’s Sleep Disorders Center in Milwaukee. Kathy Foran of St Luke’s Medical Center says, “In the past, if a sleep study became corrupted for some reason, I would mail the data on CD for examination, resulting in 2 to 3 days of shipping lag time before receiving a resolution. Now the support technicians can remotely access our system to immediately resolve issues, while I tend to sleep studies.”
As the diagnosis of sleeping disorders becomes a more crowded marketplace, it is essential that sleep center managers know what to look for in an equipment provider.
—Sharon Kline, BS, RRT, RPSGT, and Ron Sherman, BS, RRT, FAARC
Sharon Kline, BS, RRT, RPSGT, is neurodiagnostic coordinator, and Ron Sherman, BS, RRT, FAARC, is director of Respiratory Care Services at The Reading Hospital and Medical Center, Reading, Pa.
Research the stability and financial history of the manufacturer. Find out how long it has been in business. Because you will depend on this company for the next several years for support, you want to make sure that the company will be around to support you. If the company is publicly traded, you can find this kind of information at Web sites like www.morningstar.com and finance.yahoo.com. Look at the value of the stock over the last few years, and read its annual reports and press releases. If you cannot find this information, or if the company is privately held, ask the sales representative to provide it to you.
Many companies have their origins in other diagnostic fields, such as EEG, and have developed a sleep diagnostic system as a secondary product. Ask about the company’s original area of expertise and the amount of its experience in sleep diagnostics.
Find out as much detail as you can about the product support department. This department is going to be your lifeline when things go wrong and you need help.
Typically, a manufacturer is able to offer many financing options. The most common type of financing for capital equipment is leasing. A lease gives you the ability to pay over time and reserve capital for other expenditures. Often a payment “skip” is available at the start of a lease term, which gives you the ability to use the equipment to generate revenue before your monthly lease payments begin. Standard lease terms vary from 12 to 60 months, and usually end with a “buyout” at the end of the term, at which time ownership of the equipment is transferred from the leasing company to your company. Evaluate financing options as early as possible in the buying process.
One of the key areas of differentiation among companies is warranty. Find out in detail what is included in the warranty, and how much coverage is included in the purchase price. Then, what happens when the warranty ends? Is the warranty able to be extended indefinitely? You may want to consider budgeting an extra year or two of extended warranty as part of the initial purchase if your budget allows.
Be sure to find out in advance which tasks are the responsibilities of the installer and which are the responsibilities of the customer and required to be completed before their arrival (running cables, mounting cameras, etc). Get as much information as possible about the specifics of the installation timeline, training agenda, and preinstallation requirements.
Beyond the sale, the sales representative can be a valuable part of your team, and is your advocate in dealing with any issue related to the product or the company. However, it is difficult to determine the reliability of a salesperson in a 1- or 2-hour demo. The solution: ask for references. Rather than just asking for product references, ask to speak to other clients who can testify to the reliability and accessibility of the representative. Find out as much information as you can about how responsive they are to phone calls and e-mails and how integral they are in resolving problems.
Armed with the right information, you can make your sleep diagnostic system purchase with confidence, and rest assured that you selected the system that best suits your lab’s needs. Don’t lose sleep over choosing the right sleep diagnostic system. A little bit of preparation will minimize unpleasant surprises about the capabilities of the system, the quality of the company, and the reliability of the sales representative after the installation.
Tim Jordan, RPSGT, has a combined 15 years of experience in the sleep field, as a technician, PSG installer/trainer, and PSG salesperson. He can be reached at .
- Iber C, Ancoli-Israel S, Chesson A, Quan S. The AASM Manual for the Scoring of Sleep and Associated Events—Rules, Terminology and Technical Specifications. Westchester, Ill: American Academy of Sleep Medicine; 2007.