William Osler shows benefits of first-ever MES deal

BRAMPTON, ONT. – It has been almost a year-and-a-half since William Osler Health System launched the first-ever, Managed Equipment Services (MES) deal for a Canadian hospital. As the pioneer in this area, the agreement was something of an experiment, but it has produced solid benefits for Osler, one of the country’s largest community hospitals.

“We’ve replaced about 30 pieces of diagnostic imaging equipment in the past year,” commented Joanne Flewwelling, Executive Vice President, Clinical Services and Chief Nursing Executive at Osler. “The agreement has allowed us to stay on the leading edge of clinical advances.”

Osler went live with the MES agreement, in partnership with Siemens Canada, in June 2015. Since then, others have followed. The new Humber River Hospital in Toronto, which opened in October 2015, implemented an MES with GE Healthcare, and Mackenzie Health announced an MES deal with Philips for its upcoming Mackenzie Health Vaughan site, as well as its existing facility.

Flewwelling observes that Osler was on the verge of refreshing dozens of pieces of imaging equipment when it awarded the MES contract to Siemens Canada. The hospital’s Brampton Civic site had opened as a brand new facility in 2007, with equipment that was due for a refresh after eight to 10 years.

The DI and cardiology systems at Osler’s other site, Etobicoke General, just outside Toronto, was also ready for an update.

“It was going to create a cash-flow issue all at once,” says Flewwelling. “A lot of equipment was going to reach the end of life at the same time.”

In addition, in early 2017, Osler would be opening a brand-new outpatient hospital – the new Peel Memorial Centre for Integrated Health and Wellness – which would require all new equipment.

So after issuing an RFP and going through the evaluations, Osler signed a 15-year contract with Siemens to replace and maintain 190 pieces of imaging equipment throughout the hospital.

It meant the organization could replace its aging equipment without taking a major hit on capital resources – instead, the costs would be spread over the next 15 years.

At the same time, it would receive ongoing equipment replacements and servicing over the life of the agreement for all three of its hospitals – the Brampton Civic, Etobicoke General and Peel Memorial sites.

And with Siemens, it felt it had a partner with deep experience in medical imaging and managed equipment agreements, which it has conducted in Europe and around the world.

“We wanted someone with global experience in MES,” says Flewwelling. “We did have a relationship with Siemens in the past, but when it came to choosing a partner, we had a robust RFP process. We had a fairness advisor, too, as we didn’t want others to feel excluded.”

Perhaps the greatest success story to date has been the replacement of an aging MR machine at the Etobicoke site with a state-of-the-art 1.5T scanner.

“It was a seamless transition,” says Joe-Anne McCue, Director of Diagnostic Imaging and Laboratory, noting the new Siemens machine was installed and quickly made operational in November 2015. While the old scanner was removed, and before the new one was up-and-running, Siemens supplied a portable scanner at the site.

As a result, nearly all patients could have their exams done on schedule at the Etobicoke site. “Only one patient couldn’t be accommodated, and that patient was transferred to another Osler site,” says Flewwelling.

“It was a real testament to the project management skills of the partners.”

Of course, other modalities that have been replaced have ensured the hospital is state-of-the-art in additional areas, too, including Computed Tomography.

A key part of the MES agreement is that not all of the equipment is to be supplied by Siemens.

“It was important for the stakeholders to have this assurance,” says Flewwelling. “They wanted to know they would be getting leading-edge equipment.”

For example, Osler is switching from CR to DR in its portable X-ray devices, and has opted for Carestream as the vendor. Similarly, it is replacing its general purpose ultrasound systems across the three hospitals, and has chosen Philips as the preferred supplier.

However, in many areas, Osler will be opting for Siemens equipment. “We know that Siemens is a leader in the market for MRI and CT,” says McCue.

Osler is currently focusing on a major refresh of systems at its Brampton Civic site, where $50 million to $60 million worth of equipment is nearing its end of life. This will be followed by a major investment in DI and cardiology equipment at the new Peel Memorial, in 2017, and by ongoing upgrades at Etobicoke General.

The team at Osler has focused on diagnostic imaging and cardiology equipment in its MES with Siemens – unlike other hospitals, which have created blanket agreements for all types of equipment, including surgical rooms, environmental systems and various types of software.

“We purposely limited it to DI and cardiology,” says Dr. Joseph Fairbrother, Osler’s Chief of Diagnostic Imaging and the architect of the MES strategy. He said that if too many areas are included in an MES, the project can become difficult to manage, with too many competing priorities.

“In some regions, MES hasn’t worked well,” says Dr. Fairbrother. He and members of the team examined the experiences of hospitals that have implemented MES agreements in the U.S. and U.K.

By maintaining a focus on DI and cardiology, Dr. Fairbrother believes the Osler MES has produced a manageable and effective strategy. It is delivering state-of-the-art equipment, with the features and capabilities that are needed.

It is also bringing the appropriate equipment into the hospital, at the right time, resulting in additional cost-savings.

“We’re not procurement experts, we’re imaging experts,” he notes. “Now, we’ve got people shopping the market for us, and they are experts.”

That’s proven to be a huge time-saver for Dr. Fairbrother and his colleagues.

“We were spending too much time advocating for equipment,” observes Dr. David Kelton, Site Chief of Diagnostic Imaging at Osler’s Brampton Civic Hospital and specialist in Interventional Radiology. That included researching equipment, attending meetings and making pitches for various types of technologies.

And with so many modalities involved in modern-day patient care – MRIs, CTs, ultrasound, general and portable X-ray, angiography and others – Dr. Kelton says that kind of advocacy “just isn’t possible anymore.”

The MES has been a huge advantage on this front, says Dr. Kelton. “It frees up your time, and allows you to focus on clinical care.”

In particular, this year Osler launched a new stroke program, called Code Stroke, and it opened a new vascular program – the Endovascular Therapeutics Program – before that.

By reducing the time spent on equipment procurement, physicians at Osler have had more time to develop and fine-tune these programs for patients.