Healthcare Technology Management Research Articles

A ‘Risky’ Conversation With Your Boss Is Vital

Risk. Our everyday lives are controlled by our view of risk and how much of it we are comfortable with. It shapes the decisions we make, the opportunities we pursue, and, consequently, the way that we live our lives. At work, those of us in healthcare technology management (HTM) are the leaders of medical device maintenance in our hospitals. In this arena, the hospital takes its lead from us—how we make decisions, what risks we take, and how we manage that risk.But what role should we take? Should we be meek and seek to preserve the status quo? Or should we be wild-eyed cowboys (or girls) and take every risk we possibly can to drive down costs?I believe that in most cases, our employers would like us to be somewhere in the middle, but to really find out, you need to talk to your boss. This type of conversation is vital. When at work, you are spending the hospital's money. How you spend it should be discussed with the hospital leadership. This needs to be a frank discussion. Many leaders speak in a type of code. You must be willing and prepared to read between the lines and rephrase what they tell you to check your understanding of their wishes.Who is your boss? For the purposes of this topic, it is the person who can fire you. Regardless of your personal preference, you need to be on the same page as your boss when it comes to risk. Biomeds who work for an independent service organization (ISO) have a more complex relationship because they serve two masters; either can remove them from their jobs.When asked, most everyone will initially say that they want to maximize cost savings while minimizing the risk of unexpected things happening. That kind of answer is a platitude, a weasel's way of saying nothing. Of course everybody wants to balance cost versus risk. But what exactly is that balance at your organization?First, it's important to define the terms properly and calibrate your understanding of risk with the hospital administration. There is much misunderstanding about the amount of risk one incurs when seeking to self-maintain medical equipment. This misinformation is promulgated by the sellers of the very lucrative service contracts—what I call the “Zeds” of the world. (For an introduction to “Zed, Inc.”, see my blog at www.gmi3.com/blog and search “Zed.”)If you are seeking to reduce all contracts and start paying your equipment maintenance costs as they come up, this can be seen by the administration as exposing the hospital to large and unacceptable risks—risks of equipment downtime, risks of huge costs, risks of unreliable equipment, risks of erroneous results, and risks of poor patient treatments.Risk is very different to HTM professionals, who have been intimately involved in the repair of medical equipment for a long time. We have learned from experience that very little happens to medical devices that is unexpected. Sure, things break. Things wear out. Parts need replacing. But very few failures are catastrophic.Let's talk about reliability, uptime, and accuracy of measurements. Anecdotal evidence suggest that all of these metrics can increase when the maintenance of medical equipment is undertaken by a hospital-based biomed. Most manufacturers do not perform the full preventive maintenance procedures indicated in their own service manuals. An in-house or hospital-based engineer is much more likely to provide increased levels of maintenance if a machine is shown to require it. Those of us based in hospitals can provide much more customized maintenance strategies than can a manufacturer's representative. They are bound by the corporate mandates and standards, and they also take care of many devices in many different hospitals. It is difficult for them to provide custom solutions based on individual needs. We in the hospital can easily add more maintenance if it is required or reduce maintenance if that is warranted.But the sellers of service contracts would have you believe otherwise. The “Zeds” of the world would tell you that you must have protection from the crippling and catastrophic failures that routinely occur to electronic patient care devices all over the world. Wrong. Medical devices have increased their reliability and now have fewer failures than ever before. The Zeds don't want to sell you a service contract to protect you. They sell them to make profits for themselves and eliminate your options of using anyone else for equipment service.So, consider your boss's understanding about the risks involved in taking medical equipment service in-house. I'll bet you that he or she sees it as far riskier than the facts bear out. But, by all means, have a very candid conversation with your boss about what risk means, what the REAL risks are, and where along the risk/ reward spectrum you should operate.

Safe and Secure? Healthcare in The Cyberworld

Safe and Secure? Healthcare in The Cyberworld

The Human Touch: Learning That the Job Is About More Than Machines

<i>The Human Touch:</i> Learning That the Job Is About More Than Machines

Healthcare Technology Management: AAMI Survey Sheds Light on Salaries, Benefits

<i>Healthcare Technology Management:</i> AAMI Survey Sheds Light on Salaries, Benefits

Frontlines: Are You Secure?

As most of my friends would tell you, I'm not the world's most tech-savvy guy. The clock on my VCR (remember those?) always seemed to be blinking, and for the longest time my home computer teetered on the verge of a complete breakdown. I won't tell you how long I had dial-up service.One evening, my home computer crashed, likely done in by virus or worm that I had neglected to protect against. A friend was able to resurrect my computer, clean it up, and install new firewalls and virus protection. I've since gotten a new laptop and am far more diligent about keeping it secure and bug-free.The crash was a valuable lesson learned but, in truth, it came at little cost to me. Sure, I was out of a home computer for a few days, but it was little more than a hassle.Can anyone say the same about the potential threats posed to healthcare in an increasingly “networked” world, that any disruption of service would be a mere hassle? I think not.There's a whole new world of healthcare because of the incredible advances in technology. Medical devices are doing things today—in some cases virtually talking to one another—that might have seemed pure fantasy only 10 years ago. But with that great potential come new risks to patient safety.The federal Information Security and Privacy Advisory Board recently put it this way: “With increasing connectivity comes greater functionality and manageability, but also increased risks of both unintentional interference and malicious tampering via these communication channels.”Of more concern, says the board, is that there is a “diffusion of responsibility” when it comes to the cybersecurity of medical devices, making it harder to tackle the issue.Our cover story examines the functional risks to medical devices and the vulnerability of patient information. The article provides some tips on what healthcare technology management professionals can do to help their facilities move forward in protecting their devices—and their patients.Do you have tips or other ideas to share? Please write. Your colleagues want to know.

The Broad Impact of EHR Implementation

The focus on healthcare information technology (IT) has led to remarkable growth in healthcare IT staffing. The federal government is moving ahead with its plan to advance the use of electronic health records (EHRs) in the U.S. healthcare system. The Centers for Medicare & Medicaid Services (CMS) recently collected public comments related to its proposed rule for Stage 2 of the “meaningful use” program. Under the three-stage program, hospitals and other healthcare facilities that demonstrate a meaningful use of EHRs are eligible for Medicare and Medicaid incentive payments. Stage 2 builds on Stage 1, laying out the requirements for healthcare providers. The push for EHRs got a huge boost with the American Recovery and Reinvestment Act of 2009, which committed billions of dollars to support the adoption and use of EHRs, building on an earlier goal that every American should have an electronic medical record by 2014. Fundamentally, EHRs are digital documentation that includes data from a visit to the doctor’s office or office, including the patient’s histories, exam notes, tests ordered and their results, drugs prescribed, and any other results or updated information. Some systems also check for drug interactions, can access X-rays, and even deliver a reminder for the patient to get a flu shot. In certain quarters, hopes are high about the benefits of EHRs. Some talk of millions of dollars and thousands of hospitalizations saved—seemingly based on extrapolated data. Generally, there is the anticipation, especially by the government, that the use of EHRs will improve the quality, safety, and efficiency of healthcare delivery, as well as reduce medical errors, healthcare costs, and paperwork. On the other side of the coin, there are several who warn that it’s premature to start talking about the benefits of EHRs, saying the transition will not be easy or fast. Take, for example, the benefits expected from data sharing. Peter Gabriel, director of informatics with the Department of Radiation Oncology at the University of Pennsylvania’s School of Medicine, said that it could be 10 or 15 years before data sharing in health IT is widespread, because it’s “a lot harder to achieve than most people appreciate. Simply implementing computer systems won’t dramatically improve quality overnight.” Obviously, health IT growth must also be tempered with risk assessment every step of the way. The development of 80001-1, the standard that deals with the application of risk management for IT networks that incorporate medical devices, indicates that risk analysis is getting woven into many health IT growth game plans. This kind of due diligence will IT WORLD The Broad Impact of EHR Implementation

Association Roundtable

Insights and advice from leaders of local and state biomedical associationsFred JaramilloPresident, Colorado Association of Biomedical Equipment TechniciansFirst of all, you need to have good and diversified classes/training for healthcare technology management professionals. You need to mix up training with professional development and technical training. Second, we encourage the members to bring their families to the symposium dinner. Members get to share their profession with their loved ones, and we give some great prizes to the kids. It is always fun to see a kid win a prize.Alison LauerPresident, North Carolina Biomedical AssociationWe offer classes/courses that will be beneficial to the technicians as well as the facilities where they work. We survey our attendees each year to ask them what they want, and then we do our best to offer the classes requested by the majority. We also try to keep the costs to attend as low as possible, as education budgets are one of the first to be reduced in a hospital. We have kept our attendee rates the same for the last three years. Lastly, we also incorporate one fun event.Gus SakisExecutive Chair, California Medical Instrumentation AssociationI believe the best way is provide top-notch sessions, networking opportunities, good food, fun things to do such as bowling, access to over 80 of our loyal and supportive corporate members/manufacturers and service providers, and provide all of it for FREE.

Overview: HTM Professionals And Electronic Health Records

Revolutionary changes in healthcare delivery systems are impacting every facet of healthcare itself, including clinical engineering. While basic equipment services will always be needed, more time and human resources must be dedicated to emerging markets within health IT as a part of a large delivery team. Now is the time to initiate the changes necessary to promote the evolution of health IT.

Safety Advocate Sees Progress, But ‘Frustrating’ Problems Persist

Safety Advocate Sees Progress, But ‘Frustrating’ Problems Persist

A Team Approach: A Look at Ways Biomeds Can Improve Patient Safety

A Team Approach: A Look at Ways Biomeds Can Improve Patient Safety

Reverse Mentorships: Younger Workers Can Help Veterans Stay on Right Track

We know that mentoring is a process where a person with more experience shares it with someone, usually younger, who has less. Now enter reverse mentoring, almost the same as traditional mentoring, but typically a junior employee shows a senior employee the way— highly unusual, you might initially think. Alan Webber, co-founder of the business magazine Fast Company, once offered this gritty observation about the process: “It’s a situation where the old fogies in an organization realize that by the time you’re in your forties and fifties, you’re not in touch with the future the same way the young twenty-something’s (are). They come with fresh eyes, open minds, and instant links to the technology of our future.” In fact, this upside-down mentoring concept was introduced more than a decade ago by former General Electric CEO Jack Welch. Not everyone is jumping on the bandwagon, but reverse mentoring is “trending.” Interested in pursuing a reverse mentorship? Have a formal plan before you dive in, recommends Diane Piktialis, a consultant and research working group leader at The Conference Board, a business membership and research association. She focuses on issues related to the aging and multigenerational workforce and cross-generational knowledge transfer. In a 2009 article for the website Encore Careers, she cautions both parties to be aware of age stereotypes and address them head on. ‘Learn Every Day’ Formal reverse mentoring may not be practiced in your office, but it is quietly occurring daily and informally in companies worldwide, as it wears different hats such as “interning.” “Most of our interns have very strong computer skills both from engineering, architectural level and programming software levels,” says Paul Canaris, director of clinical engineering for Central Texas Veterans Health Care System in Temple, TX. Canaris’ last college-related computer course was in the early 80s. “Now, I learn every day from the interns,” he says. In his highly administrative job, Canaris finds he needs more in-depth knowledge of computers. He’s grateful for interns “fresh out of college who live and breathe PCs, networks and social media. They’ve really opened my eyes.” AAMI President Mary Logan thinks reverse mentoring is really lifelong learning, no matter one’s profession. A disproportionately large segment of the healthcare technology management sector is between 45 and 70, “middle-aged,” she suggests. “We may think we hold all the cards of wisdom, but we don’t.” Once while she mentored, reverse mentoring just happened. “I told her I’d be her mentor if she’d be mine,” remembers Logan, describing the time while, in another job, she mentored a professional in her late 20s. Logan’s younger charge ultimately helped the executive enhance her own communications technology skills. While looking for a job, Logan’s own daughter, then 25, asked her mom questions about starting About the Author

The Case Against: A New Name for the Field

Thirty years ago, while employed at the VA Medical Center in Long Beach, I was called in and told that I would be transferring to a new department called “biomed” the next day. From my first weeks, months, and then years, I developed an understanding and desire for this unique engineering segment and its integral role in delivering medical technology to our patients and clinicians.I am now at the stage of my career where I mentor, teach, and manage a staff which exhibits the same enthusiasm and dedication to the field of biomedical engineering. I have also been privileged to witness the development of our information technology colleagues from the early dot matrix days of automating clinical lab results and patient scheduling to our current paperless realm of the electronic medical record and medical device integration.As our respective groups and affiliated disciplines move forward, we find ourselves at a crossroad where we apparently need to establish a new identity, a new mission, and, most importantly, a new vision. At our 2011 AAMI Conference &amp; Expo, a special session was devoted to discussing the April 2011 Future Forum on a unified name and vision. We were informed that the focus group decided on healthcare technology management (HTM) as the name of the field responsible for “managing the selection, maintenance, and safe and effective use of medical equipment and systems.” A few of us were a little unsettled to be informed that our field was soon to get a new name and vision, and in the opinions of a few audience members, possibly merged. We were assured that we would have the opportunity to comment. I felt a little relieved that I was going to have a small voice in determining our direction.As I left the session and entered the exhibit hall, I spied an isolated booth with a few magazines fanned across the surface. As I focused in on the inaugural edition of Healthcare Technology Management magazine the first thought that came to me was, “How in the heck did they get the ink to dry so fast? We just discussed this concept!”A subsequent Google search later confirmed that my IT counterparts were also in the same identity fix. I found links to healthcare technology alliance, healthcare technology systems, healthcare information technology management. How was I to keep track? I wondered that perhaps both of our groups were scrambling to identify our purpose and value to our healthcare organizations. And most of all I mused, who was going to manage who?Here's my suggestion: Quit the name game. Clinical and biomedical engineering will always be a standard- and evidenced-based driven discipline focusing on managing and maintaining medical devices used for the diagnosis and treatment of our patients. Information systems will always be engaged in the design and delivery of medical informatics in the management of our patients' care and treatment. Don't let the whiteboards fool you; they do a stellar job in running complex networks and workflow processes. We work together more closely now than ever, and we do not need to compete for these namesakes nor dilute or confuse our chosen fields with generic descriptions.Every clinical, electrical, computer science, architectural, and facility engineer is a healthcare technology management professional who applies unique knowledge, skills, and disciplines to the medical environment. Be proud and praise your chosen name. Let's develop a more facilitative and active approach to this dialogue about where we are heading in the evolution of healthcare support and delivery.

Putting Patient Safety First: The Sterile Processing Department and Healthcare Technology Management

<i>Putting Patient Safety First:</i> The Sterile Processing Department and Healthcare Technology Management

Healthcare Technology Management

Healthcare Technology Management

Spring Cleaning

As a former clinical research scientist, I was shocked to find myself recently in an unfamiliar position: that of a hospital patient. Having never had an operation in my life, waiting for minor surgery caused considerable anxiety. Suddenly, I was less interested in the quality of the patient's surgical biopsy, and more interested in the tools to be used. Were they sterile? Were the hospital personnel having a good day? Would I make it through the anesthetic? And if I did, would I come down with hospital-acquired, flesh-eating bacteria afterward?As it turns out, my fears were not unwarranted. According to the U.S. Centers for Disease Control, approximately one out of every 20 hospitalized patients will contract a healthcare-associated infection, through the environment or via contaminated hospital equipment. Recent news reports have shone a spotlight on the hazards of incorrectly reprocessed medical devices such as arthroscopic shavers, cannulae, and endoscopes.The reprocessing of reusable devices is a multistep process, which if incorrectly carried out can result in contamination and infection. Recent breakthroughs in minimally invasive surgery have been made possible by the development of highly specialized, complex, and flexible surgical instruments, including robotic devices. Their moving parts and channels are a far cry from the relatively simple instruments in use decades earlier, and make these tools much harder to clean.In this issue of Horizons, experts in healthcare technology management, manufacturing, and regulation came together for a roundtable discussion on the broad issues and special challenges faced by sterilization and reprocessing professionals. Our Big Picture section also includes 10 tips that facilities can follow to improve reprocessing immediately.Confused about how clean is clean? Hospital sterile processing and FDA experts dissect cleaning verification, the composition and quantification of soils left behind in medical instruments, and the thorny problem of reprocessing implantable screws and plates in orthopedic tray sets. That's just a taste of what this comprehensive issue has to offer.Patient safety and the probability of contaminated instruments were indeed on my mind as I waited for surgery. However, when I woke up with a few tiny incisions (the operation used thin robotic arms), and no complications, I also remember being grateful, in the words of one of our authors, for “how fortunate we are to have such advanced tools, processes and facilities to ensure patient safety and survival.”I have no doubt that reprocessing issues and the challenges of following complex reprocessing instructions will be solved in the future, and indeed, concerted efforts are being made to do so. The only question is whether these issues can be resolved before my (or your) next surgery.

A Roundtable Discussion: Embracing the Mobile Revolution

<i>A Roundtable Discussion:</i> Embracing the Mobile Revolution

Developing a Core Curriculum: Surgical Technologists Share Their Experience

Developing a Core Curriculum: Surgical Technologists Share Their Experience

Standards I'd Like to See

Standards I'd Like to See

Frontlines: Making the Connection

It is, in the words of the U.S. Food and Drug Administration, “a persistent and potentially deadly occurrence”—the prospect of different medical device delivery systems being mistakenly connected to one another.Such tubing misconnections, often associated with fittings known as Luer connectors, can have fatal consequences for patients, as when a feeding tube is mistakenly connected to a trach tube or an oxygen tube is erroneously connected to an IV port.Our cover story by Martha Vockley takes a look at the problem and, more importantly, what's being done to address it. To that end, AAMI is at the forefront of a major international effort to develop design standards for small-bore connectors. The goal is to design connectors in such a way so that the tubing for Device Type A can't mistakenly be coupled with Device Type B.If companies implement the standards, the design implications for manufacturers are far-reaching. And healthcare technology management professionals can expect to play a role in education and awareness initiatives at hospitals that implement the standards.On the subject of education, this issue of BI&amp;T offers a look at the experience of another profession in developing a core curriculum. Kevin Frey, with the Association of Surgical Technologists, writes about how those professionals tackled the curriculum challenge, a case study of sorts that might prove illuminating as AAMI moves ahead with its core curriculum project for schools training biomedical equipment technicians (BMETs).Want to weigh in on these articles or others? Please send your comments to sloughlin@aami.org, and they could be published in the next issue.

Preparing Biomeds For the Future

Preparing Biomeds For the Future