Rebirth of a Profession: Hybrid Positions on the Rise in Clinical, Manufacturing Settings

Abstract

In the not-so-distant future, the professionals who keep medical devices humming might not have the job title or responsibilities of today's “clinical engineer” (CE) or “biomedical equipment technician (BMET).”That's because working with medical devices increasingly requires a skill set that goes beyond those of many medical technology professionals in the field today. Hospitals and manufacturers are responding by creating new, hybrid jobs that require a broader range of skills. Moreover, more institutions are realigning their organizational, operational, and reporting structures to reflect the changing nature of job roles and responsibilities.In this environment, the days of carving a career out of “fixing boxes,” in the words of several medical technology professionals, is giving way to an era of new opportunities for careers focused on integrating, managing, and servicing highly sophisticated and interconnected systems.Several overarching factors are spurring healthcare organizations to rethink the titles, job descriptions, and roles of professionals in the medical device field:Related to the issue of convergence is the rate of change of technology, according to Rick Schrenker, systems engineering manager at Massachusetts General Hospital in Boston. “IT-based medical technology is the ‘usual suspect’ cited for emerging careers, but I sense there are other drivers as well. Consider the impact of software on medical devices. When I entered the field over 30 years ago, a device remained unchanged for its 10 or so-year life span. Now it can be patched or upgraded annually (or more or less).” This stepped-up pace of change requires continual upgrading of professional skills.The Affordable Health Care for America Act of 2010, the omnibus healthcare reform bill enacted in March, extends this theme. While the industry is still sorting out the full ramifications of the legislation, healthcare organizations understand that they will be held accountable for improving the quality and efficiency of healthcare. Effective use of medical equipment clearly is central to improving these results.“The need for new roles is coming to the forefront as medical devices are being integrated with the electronic medical record, and physicians and clinicians are expecting a single, localized support team for a growing breadth of technologies,” says Robert Rinck, director of clinical engineering at Spectrum Health in Grand Rapids, MI.The developments in the healthcare industry mean that the lines of responsibility for medical equipment are blurring. Jobs are changing on every rung of the career ladder, from BMETs and CEs to management and executive positions.“Traditionally, clinical engineering and IT have been separate entities,” says Dan DeMaria, clinical engineering manager at Olathe Medical Center in the Kansas City, KS, metropolitan area. “Typically, clinical engineers and BMETs fix boxes—individual pieces of equipment. That's not how it works today. All systems talk to each other.” And now, the people who work on this equipment need to have the skills to talk and work together as well.DeMaria offers this example to illustrate the challenges: “A blood pressure machine has to talk into a network that is integrated with an EHR. If the data is not getting to the EHR, is it a problem with the machine, the network, or the application?”DeMaria believes that medical technology professionals today need to know enough about medical equipment, IT, and telecommunications to be able to handle issues like these. “My clinicians should never have to figure out who to call,” he says. “I don't want anyone on my staff to say, ‘Call someone else.’ We have to have front-line people who can cross these barriers.”Hospitals see an increasing need for this kind of first responder, or “triage technician,” who can troubleshoot medical device issues, according to Marilyn Hailperin, associate partner at Santa Rose Consulting, a healthcare management and IT consulting company. This job requires an understanding of medical technology and basic networking, she says.“What we are seeing is a lot more crossover,” adds Ray Laxton, vice president of program management for clinical technology services at ARAMARK, a service provider, and chair-elect of AAMI's Board of Directors. “More biomeds in the field and coming out of school are focusing on IT and networking skills, which is useful. Their functions are much more important than their titles. We're all going to be required to wear multiple hats.”Similarly, the role of clinical engineers is evolving into a job that is better described as clinical systems engineers. “We've gone from the days when we dealt with discrete medical devices that required periodic scheduled maintenance (to calibrate or replace worn parts, for example) to today's integrated systems that have very few of the same maintenance requirements,” says Stephen Grimes, vice president of enterprise resource planning at Linc Health, LLC, a national provider of facility management and clinical engineering solutions to the healthcare industry based in Holliston, MA. “But today's new technology does require the ability to understand and configure complex and integrated ‘systems of systems.’“To effectively support these new technologies requires new strategic thinking in the acquisition and selection process,” he adds. “It also requires new skill sets to adequately deploy and manage the support of these systems once they are in place. It's a new mindset that not all existing CEs and BMETs are ready to adopt. How many blacksmiths working on wagons could make the transition to mechanics when the auto arrived? Some certainly did … but it required changes in both mindset and skills.”The career trends in manufacturing parallel those in clinical settings. “Many medical device manufacturers will eventually become primarily software developers,” Grimes says. “Their only hardware will be small sensors or actuators that will receive patient diagnostic information or deliver therapy. The processing and analysis that used to be done by the ‘boxes’ we knew as medical devices will be done by banks of computers behind the wall and likely in ‘the cloud.’”Manufacturers will need engineers and technicians who are familiar with the issues associated with ensuring that the converged medical and information technologies are secure—that is, that data and system confidentiality, integrity, and availability are maintained, Grimes says.“We have been noting a trend toward more engineering and architect assignments that require collaboration between medical device and electronic medical record (EMR) vendors,” Rinck says. “Customers like Spectrum Health are no longer expecting their EMR vendor to provide full turn-key integration to all medical devices, but, rather, expect the vendors to work together collaboratively to ensure a workflow that is optimized and safe for patient-care processes.”The career trends for medical technology professionals mirror a trend for clinicians as well. “Hospitalists,” for example, are a fast-growing medical specialty, with 30,000 medical professionals with that title today, up from 800 in the 1990s, according to The New York Times. This cross-functional physician-administrator coordinates patient care holistically by working with administrators, physicians, pharmacists, social workers, and families. Their charge is to improve patient care, reduce inefficiencies, contain costs, and manage staff work flow.These are the kinds of benefits that healthcare employers will be looking for from the new breed of medical technology professionals. Hospitals want people who are “systems thinkers” for management and executive positions, projects, or focal areas that bridge multiple disciplines and operations, including:Typically, these positions or projects entail working with multidisciplinary teams of professionals, which requires good communications and collaboration skills.“The professionals filling these roles are likely to come from a combination of existing clinical engineering and BMET professionals who are prepared and can evolve into the new jobs—and through the education of a new breed of professionals trained specifically for the new roles,” Grimes says.The traditional knowledge and skills of medical technology professionals are a solid foundation for the new and emerging careers. Knowledge of electronics, anatomy, and physiology will continue to be essential for medical technology professionals, DeMaria says. Building on this foundation through formal and informal training, on-the-job experience, or as a spare-time study or hobby could be a smart career move.Medical technology professionals already in the workforce are well positioned—perhaps more so than IT professionals—to skill up for the hybrid jobs. CEs and BMETs are already more closely integrated and aligned with clinical practices and patient satisfaction, in Laxton's view. In the future, he expects that people with dual degrees in biomedical engineering and IT, or a biomedical engineering major with a health care IT concentration, will be in demand.Moreover, medical technology professionals' experience working with many types of medical devices is an advantage in an industry that values flexibility. “IT is very specialized, with people focused on desktops, networks, applications,” he says. “Biomeds tend to be generalists, much broader in scope.”Schrenker's career experience, which began as an engineer for a gas and electric company before he switched to clinical engineering, is a case in point. “I've worked diligently at becoming and staying a generalist,” he says. “That I was able to move from working for a utility to a hospital speaks to that, and even within the hospitals where I've worked, I've avoided specialization. I credit my avoiding specialization as enabling me to do the things I'm doing now, and my guess is before I retire I'll be doing something else again. I'm not discounting the need for specialists, but with the rate of change of technology as it is, I consider specialization a risky bet.”The converging functions of medical technology and IT are having an impact not just on professional titles and responsibilities, but also on operations and organizational structures. The trend is toward stronger collaboration between clinical engineering and IT departments.Some hospitals and healthcare systems, for example, are merging clinical engineering call centers and IT help desks, a trend that was reported in the March/April 2007 issue of BI&T.Others are changing their reporting structures. “Anecdotal evidence suggests that about 5% of CE and IT programs used to share a common organizational link,” Grimes says. “Today it's more like 20%. Most of the time, CE reports to the chief information officer (CIO) or chief technology officer (CTO).“Another significant trend I've seen in recent years,” Grimes adds, “is that CIOs, rather than transfer a hospital's existing CE program to IT, often hire clinical engineers into IT—creating, in effect, elements of a second CE program in the same institution. Based on what I've seen, it seems to be done so CIOs can avoid some of what they consider to be the mundane aspects of clinical engineering—equipment inspections and repairs. I believe it's a troubling trend because it misses the synergy and common focus of an integrated clinical engineering program.”Some healthcare systems are being more strategic in changing their ways of doing business. Olathe Medical Center, for example, where DeMaria works, within the past three years created four management-level positions covering clinical engineering and IT functions. All of them work together and report to the C-Suite.Supporting strategic integration of biomedical, clinical, and IT practices is a growing segment of Santa Rose Consulting's business, according to Hailperin. “Convergence is creating operational complexity,” she says. “We are seeing early adopters looking at managing patient care devices from a systematic, strategic perspective. They want a tactical road map for device integration.”The firm can support healthcare systems in integrating specific devices from a particular vendor and in developing enterprise-wide solutions for device integration that encompass operational and organizational changes, including changes in job responsibilities. The third-party perspective is especially useful to organizations that are considering changes to their governance structures.“There are no drawbacks to thinking strategically,” Hailperin says. “You can actually organize toward success. If you don't at least glimpse the big picture of where you want to be, you can get lost on the road there.”