"When those units reached end-of-life we received the same letters everyone else has gotten. However, we have been able to purchase service from the OEM or a third party organization with specialized skills and certified quality parts, and there are small companies that meet both requirements," said Powers. "While my organization may have the resources and capacity to make sure things are always done right, there could be other organizations under different circumstances."
When the base technology does not change, the device can be supported in an ethical, safe manner, according to Powers. "When the root technology changes, for example: CMOS digital detectors, unique targeted radioisotopes, or higher tesla field magnets, the return of better patient outcomes drives adoption, and mandated obsolescence is irrelevant," he added.
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Although cybersecurity concerns with older equipment abound, there are sometimes ways to ensure that the operation of the equipment does not unduly expose the hospital to a cyber risk. Godby noted that Cabell Huntington’s IT department has been willing to step in, particularly with regard to expensive equipment and ensure that the equipment is largely isolated from a cyber threat.
Steve Grimes, principal consultant from Strategic Healthcare Technology Associates, recommends an organization consider compensating controls when faced with equipment that is no longer supported by the manufacturer. He said compensating controls are alternative protections that can be put in place when faced with a new vulnerability (e.g., security patches for operating systems no longer available from equipment manufacturer). With appropriate compensating controls, equipment may conceivably continue to be used for some time after the manufacturer declares it has reached "end of support". Compensating controls means restricting the environment in which a device operates so that it isolates the older equipment operations from another computer environment.
Even when the medical device is cyber secure and the hospital has cooperation from the manufacturer for access to permanent service keys and parts, the hospital may learn, given the age and quality of the equipment, that CMS is reducing or eliminating reimbursement. Even if the equipment is recertified, this does not always resolve the situation.
A rural hospital may be forced to close, in part, because its budget will not permit the purchase of replacement equipment and "end of support" cooperation may be limited with respect to key equipment. While the impact of a rural hospital's closure is most directly felt on patients in the region, it can also have unintended consequences for the greater local economy, since businesses can’t always attract new hires without quality healthcare close to home.