Right to Repair From a Patient Centered View | Perry Kirwan, Banner Health

Apr 16, 2021

Perry Kirwan Full Interview Audio
Fri, 4/16 9:09AM • 24:09

Chyrill Sandrini, Perry Kirwan

Chyrill Sandrini 00:15
Hello, everyone, and welcome to HTM Insider. I’m Chyrill with MultiMedical Systems. And we’re excited today to have Perry Kirwan, the VP of Clinical Engineering, at Banner and Entech. So welcome Perry. I know, I know you’re very well known in the industry, but it’d be great if you could just give us a little introduction for people who might not know the infamous Perry.

Perry Kirwan 00:41
Hello, everybody. My name is Perry Kirwan, and I’m the Vice President of technology management and tech for banner health. Better Health is headquartered in Phoenix, Arizona, we operate in six states predominantly in the southwest, we have over 30 hospitals, I support an asset base of over 220,000 pieces of medical equipment, with an asset value greater than $1.8 billion. And I’m happy to be here today.

Chyrill Sandrini 01:13
We’re happy to have you. So you know, the topic is right to repair. And in California, legislation is coming up pretty quickly. So we’re excited to see your views and what’s happening in your neck of the woods. I know you have hospitals in different states. But we also know that you’ve been through a lot of COVID lately, and a lot of issues around right to repair. So we’re, we’re eager to pick your brain. So let’s just start off by asking you what is the right to repair?

Perry Kirwan 01:42
What I would say first and foremost to me is that the right of repair is a debate ultimately about property rights. And what it means to be an owner versus just a user. I think what’s happened and this is just my view of modern debate is that it’s unfortunately become an oversimplification of a highly complex issue, right. And we try to take something with a lot of complexity, reduce it down to 32nd sound bites in a manner that unfortunately sets up camps, right. So you have one side and trench down and another on the other side. And now we’re fighting with each other. Sometimes I wonder if we’ve remembered what we’re really fighting for. What I would tell you, as a leader of a fairly large hospital base system, and also a leader of that service team, really what we’re trying to do at the end of the day is really what’s best for the patient. In hospital vernacular, that’s the quadruple aim. It’s about quality cost, the experience that the patient gets, and also the experience that the clinician gets. And I think with that there are barriers that actually get in the way, for us being able to do that. Certainly, if there’s any kind of restriction on service, information, parts, and the like, right that that hampers our ability to deliver. With that said, this is to presume that if you’re on the original equipment manufacturer side of the argument, right, that everything that they say is kind of bad. And I don’t necessarily espouse that belief, either. I think the OEM has, has all of the rights to want to understand what something like that looks like. And actually what it takes, right? Because again, these are very simple things to say they’re a different thing in practice to execute. So ultimately, I think what’s required here is we really have to go back to a collaboration between the OEM and non-OEM entities, right. And that includes independent service organizations as well as hospital operators in the process, but do so with the quadruple aim in mind.

Chyrill Sandrini 04:06
So I know you’ve been in clinical engineering for quite a few years. One of the best stories I’ve ever heard of how you became a clinical engineer is your story, Perry. So if you don’t know Perry’s story, I suggest you ask him someday, it’s a great story. But when did you see the division really come about between, you know, a manufacturer and an owner? And what did you actually think, wow, this is an issue. Can you put a year to it or pinpoint, maybe a timeframe?

Perry Kirwan 04:41
You have to go back really to automobiles. And where this first raised its head really in a legislative form was back in about 2012 in the state of Massachusetts, right. And the issues were very similar to what we’re grappling today with medical devices, right? It was All about being able to have the right to choose options right and to almost allow the environment to have options even to choose from. When it came to automotive-oriented repair, the cell phone industry kind of got involved with this. We had cases with cellular providers along with Apple Computer involved in it right. And that led to things like the Digital Millennium Copyright Act, right. And various things that we did around that I think a lot of people became involved with, right of repair around the John Deere case, right and probably are aware of cars and cell phones and all that along the way. But the john deere one was rather popular because it was ugly, right? It would have a lot of vitriol to it, it went back and forth in the light, right. But it ultimately results resulted in an exemption. Frankly, it just didn’t seem to be that much time afterward, that then we had the FDA workshop, right claims were being made that, you know, anybody other than OEM-based service was actually creating patient safety risk, and there. And I would say that probably most of us, right, if you hadn’t heard anything, and been following the conversation to that point, this one certainly got your attention, because this got very, very close to home objective evidence, right, was analyzed. And it concluded that, you know, whether it’s the OEM, or whether it’s the third party or a hospital operator, servicing and medical equipment, right is of high quality. And it really doesn’t matter what among those entities and who, among those entities, that the services actually are occurring by. Right. And so that continued availability, right, of all of these service options, right? Is the critical component actually, of functioning our healthcare systems. I think that’s a really important conclusion. The other thing that I thought fascinating about the outcome of that workshop is that there was a, a, won’t call it an edict, but certainly what the FDA did was kind of created this notion of collaborating communities, unfortunately, two of the big trade alliances that represented the OEMs. Along with some of the OEMs, actually just withdrew from the collaborating communities at all. And I think that was terribly damaging in there that they did that because the reality needs is that we need them to be part of that solution.

Chyrill Sandrini 07:41
A lot of OEMs come knocking on your door to sell your equipment, right? The latest, the greatest, the upgrades?

Perry Kirwan 07:49
Sure, and they’re

Chyrill Sandrini 07:50
wanting to give you a service contract, and they’re wanting you to sign a long-term agreement for service. What are your thoughts like you jump in? Do you take it back? What do you think about it? What’s your push back to the OEM?

Perry Kirwan 08:07
Reality is right, as a hospital, you know, we’re a care provider, and we’re gonna buy equipment, right? It’s the tools that you need, in order to deliver patient care. I think the way that I look at that, though, is that we always start off I mean, any sales human can pedal what they wish, I guess, I’m not off-put by that I expect them to, you know, do whatever it is really that they do. But I think they have to understand really, in working with us, you know what, what perspective we come with. And that is, we’re looking out really for the best interest of the patient. And we do that within a framework of operating in hospitals, which in their own right, are extremely highly regulated in the regulated differently from those that manufacture widgets. What I mean by the patient-centered aspect is is that So first and foremost, we go into a discussion knowing before we even started, really what we think the best answer is to that and not from the perspective of Perry Kirwan, it’s the perspective of the patient. Right? And if I have the personnel, if I have what I believe are the skills and training, we’re going to say, Hey, we think we are the best option for the patient in that scenario. So OEM, what can you do from that premise to help support us to be successful? Because if we’re successful, the patient’s going to be successful,

Chyrill Sandrini 09:44
what happened during COVID when they have travel restrictions, and you’re able to get like on the higher-end equipment, right? We’re able to get the OEM to show up to service.

Perry Kirwan 09:57
Yeah, so and then yeah, so what’s interesting about that in Banner anyway is I won’t say we had zero occurrences of that because we had people that and firms that attempted that I’ll just use the word attempted. Fortunately, what we got I want to speak on the positive side of it is that most people didn’t interact with us like that. Right. But that said, there were some practical realities to that there would be times where we would need them. And we could not get that for various reasons or another. And we had to figure out creative ways to get past that. Okay. So it’s a different kind of restriction because one restriction would be is we all know the right answer, but we’re refusing to provide it right. That’s the most toxic version of it, right. And although that one happened to me, only once of all the occurrences that we had, once is too many. And I know that colleagues around the country experienced that more than once, right? So I’m not trying to say, Oh, the situation didn’t happen, or it’s not like that, right? Because it is, we were fortunate just not to have to go through it. Too often.

Chyrill Sandrini 11:12
Do you think that’s because you’re a bigger health system?

Perry Kirwan 11:17
It could be because we’re a bigger health system, I would like to believe that it’s because of the way that we posture ourselves with our suppliers. And this relationship that we’re trying to establish with them happens long before we get to needing to know I guess what the service strategy is going to be. Right? We handle it in the acquisition phase. And so these discussions happen really, prior to acquisition. And it’s all about really setting company expectations of each other,

Chyrill Sandrini 11:53
if you were a small hospital would use the same strategy, if you didn’t have the buying power?

Perry Kirwan 11:59
What we would attempt to, you know, I think that the question is, is, you know, what’s going to happen, and I actually can say that with at least some knowledge of rural health care because there’s a fair number of our hospitals that serve rural communities. It’s just the reality. Fortunately, they’re tethered to a larger organization. And probably I mean, there’s, you know, I won’t say no doubt, but let’s play the percentages, right? They enjoy an advantage of being tethered to a health care system. So with that in mind, right, and knowing how rural healthcare works, let’s say if you were an independent, and I have the opportunity to be able to even serve as some independents out there. This is a challenging situation. And some of the things really I think, that are being debated around right to repair. Actually, I would argue, affect rural health care, probably the most, right, they can be some of these, these policies in there, if enacted, right, can really hit them hard and can be very, very restrictive. So

Chyrill Sandrini 13:11
Because a lot of them don’t have actual, maybe clinical engineers on staff 24. Seven, and facilities. And that negotiation of the contract maybe falls to somebody doesn’t have the expertise that you did this is a great takeaway is, you know, being educated on your supplier, and negotiating those terms upfront on your expectations. I think that’s great. Very,

Perry Kirwan 13:34
yeah. Well, the thing that I would conclude about rural healthcare, as I think the US healthcare system, in general, is failing rural health care.

Chyrill Sandrini 13:43
So if I was to ask you the one big myth that’s in the right to repair, and the Act and the legislation that’s coming up, if you could just say, hey, this really isn’t true and be standing on the floor of the House to give your opinion. What would that myth be?

Perry Kirwan 14:05
Well, I’m not so sure that there’s one big myth. I think there are several myths in there. What are they? And we talked about the kind of in the beginning a little bit, right. Then I think one of them is that we have patient safety issues in there, right? And that somehow, you know, anything other than the OEM is the wild wild west, right? And so, got a bunch of unregulated people out there doing God knows what to these devices, and because of that, there’s going to be patient harm. The counter to that is that that didn’t actually happen. The FDA evaluated evidence to that effect and found no evidence of it. I think a lot of things we too are that old people that are proponents of this, you know, you’re just a solution looking for a problem? Well, I would give you COVID-19. What’s interesting to us about that the COVID-19 just blew the lid on all of that, right? Because now all of a sudden, we had the perfect storm of circumstances where some of this policy right and protocol out there got exposed, and it got exposed in a big way. Right. So that’s obviously a myth. trade secrets and proprietary information, intellectual property. And this is actually one actually, I see both sides of this one. What I would say, right, if being on the defensive, right to repair is that OEMs actually work on each other stuff. So if it was really about trade secrets, and proprietary information that Lee says have worked leaks into the service side of the discussion, that pretty much undermines that a little bit, doesn’t that right? Because if they can do that, it makes you wonder, Well, okay, then why Can anybody else really do that? At this point? And then, of course, there are always things that you’re going to go in there and modify something or make it more vulnerable out there. Let’s say cybersecurity oriented in the like, and then, you know, the other thing might be is somehow we’re going to have a bad patient experience with it or a bad even a bad clinician care practice practitioner experience into that. And it could be things due to improper maintenance in the likes.

Chyrill Sandrini 16:36
Right. Do you think it just comes down to money, Perry?

Perry Kirwan 16:40
No, I don’t, I think but it but it’s part of it. Right? Because if it wasn’t part of it, it wouldn’t be taking the paths that it does. What I think our community has to understand, though, is that we want to believe that the whole thing is about money, right? Because that’s a good position for us to have, right? When you know, you can galvanize people behind that you’re like, Oh, you monopoly people in this, that and the other. So as money at play, of course, money’s at play, right. Anytime it ends up in the legislative branch money is at play. Right. So I don’t want to be you know, Pollyanna about it, either. But I think we have to, we have to understand there. There are core issues.

Chyrill Sandrini 17:23
So do you see this is a bipartisan issue on a floor with legislators?

Perry Kirwan 17:27
No, it’s partisan. It but partisan takes different forms, depending on what we’re talking about in the debate, but there are views both valid on both sides of the party. And it’s this – Well, I think this is a microcosm, but the larger issue, right, which is, how do you go back and really have true debate? And how to how to solve a problem?

Chyrill Sandrini 17:54
I think you’re right, Perry, I think it needs to be more collaborative. So how do we get the OEMs to sit down with the HTM leaders? And the, you know, the ISOs of the world? to collaborate? How do we get them all at one table?

Perry Kirwan 18:10
Yeah, I think that’s the $64 million question, right. And what I would like to try to go back to is what one of the outcomes was in the 2018 FDA workshop, right? They had this notion of like that collaborating community that I talked about earlier. And I think we need to go back to that. But even to get to that point, we have to have and develop I think, get actually get pretty formal about and actually develop a charter, for what the collaborating community is going to be and what its objectives really are, we’ll find if we make this about patient-centered care, and that’s actually where it needs to begin. And then the negotiation is as well, I have these needs. And this is why I have these needs because the patient has these needs. And I’m an advocate for the patient. And the manufacturer looks at and goes well, I have these needs, right? There is intellectual, intellectual property. They’re there are things in here that I need to be able to protect, right, from a market perspective. And I need to be able to do that from international perspectives and security-oriented perspectives and a whole host of other things that frankly, for me as a care provider, I’m not thinking of those things, right,

Chyrill Sandrini 19:38
right now with the Biomed community because that’s where audiences right. What do you suggest that they could do to help? How can they get more involved? Should they get involved? What’s your opinion on that? Perry?

Perry Kirwan 19:53
Absolutely. We need to be involved in some ways to do that. The Public Interest Research Group is is a good place to start with that. They have a lot of letters and petitions that you can go out even on an individual basis, right and be a part of right that will support positions that are more favorable, I think in the interest of patient care. And you’ll use those words deliberately, you’re not going to hear me go, well, it’ll make our jobs easier, or we can get you don’t care about that. It’s patient care, along with that hospital leadership supply chain. So maybe you as the individual Biomed say, Well, what power do I have, right? I’m just one person sounds like a familiar argument. I’m just one guy, what is my boat mate? Well, so get with your hospital leadership get with the supply chain. If you have government affairs, people in your organization, get with them, they can’t support you, if they don’t know that it’s there. So explain to them, here’s the data, what are the benefits really at this, right? Because they can speak up for you. And if you’re not feeling too excited about going that route, or a little skittish about that? You have state associations, right, our state Biomed associations, if you don’t have one in your state, look to the next one in the region, look at the American College of clinical engineering, right, they will have very different ways that you can promote advocacy right around this particular topic. So the bottom line is just to participate and get involved.

Chyrill Sandrini 21:34
I’m asking you one final question is we’re using this on every episode is what’s your wow word, your word of wisdom?

Perry Kirwan 21:44
what I would like everybody to think of with right to repair, or even if you’re not in the right to repair, but this debate is important to you, is patient-centered care. It doesn’t come up in any of the languages, it’s not in any of the bills, it’s hardly ever used when one side argues relative the other and vice versa, we are missing the entire point. Because if we focused on that, it requires the kind of collaboration ultimately that they see. Because the reality is, there isn’t enough of us in these individual little silos to make this work. We need the collective body to make it happen. Now, we’ve just got to figure out how to do it, we need to honor the things that each side brings to the table and work to solve for it. Patient-Centered Care would be my Well, I guess it’s three words, but just don’t pretend to have a hyphen in them.

Chyrill Sandrini 22:45
That’s okay, that works for today. And I think that goes right back to that analogy of mom and dad need to get along to bring up that kid the most positive, you know, well being cared for a child. And that’s we need with our patients. Right. That’s where we’re all here. It’s been great talking to you today, and we appreciate you coming on as a guest. It’s always a pleasure to see your smiling face. So have a great weekend. And we wish you the best Perry.

Perry Kirwan 23:20
Okay. And you have a great weekend, as well was a pleasure being a part of this appreciate the invitation in there. Hopefully, there’s something of value. I think that’s all we hope for any of these things is that it makes you think a little bit and like I said, hopefully, my perspective, it’s not the routine. It’ll make us think a little bit. I’m a big proponent. Again, everybody’s got a little bit right in the argument and that’s usually not how most people approach this. So I hope I’m thrown out olive branches to All of our OEM partners. Hey, come back to the table. Sit down. Let’s figure it out.

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