Healthcare Technology Management Research Articles

Letters to the Editor

Regarding the research paper “Assessing a Hospital's Medical IT Network Risk Management Practice with 80001-1” (January/February 2014 BI&T): The thing that amazes me is that most people I talk with claim that only big institutions like Partners and Kaiser can implement 80001, that there is no way a small hospital can do it. It takes a 40-bed hospital in Ireland to show it's going to work exactly opposite to this.I spent a few hours at the HIMSS conference in February, getting my ears bent by IS security types and a couple of CIOs. I'm beginning to think that only small hospitals can implement 80001. The larger institutions are either too arrogant to feel they need it (they already know everything) or too bureaucratic to pull it off—or possibly, both.I did talk with a couple of CIOs who “got” it. But, they confessed, only after their network had been badly compromised.Rick HamptonWireless Communications Manager, Partners HealthCare, Boston“How to become a High-Performing HTM Department” (November/December 2013 BI&T) is the best and most useful article written so far about the changing role of healthcare technology management (HTM) professionals and HTM overall. The article was packed with plenty of advice and proposals for action, but it also managed to offer a big picture on the changes we're seeing. Congratulations to the author on a great job!I am an imaging specialist at University of Chicago Medicine. I don't have a management role in the Radiology Engineering Department, but I have been looking for ways to improve department efficiency—introducing metrics, changing the culture, elevating our visibility, and doing many of the other good things mentioned in the article. The advice about “not butting heads” with IT was especially wise.I will read the article again and try to extract points of improvement and implement them in my environment. I believe in the saying, “You don't need a title to be a leader.”Aleksandar Popivoda, CRESRadiology Engineer, University of Chicago Medicine

Healthcare Technology Management Is Not an Island

AAMI's strategic planning process is underway. A multidisciplinary committee recently spent two days discussing what forces are at work in healthcare that create opportunities or pose threats for AAMI as it looks to the future. The committee discussions were lively and covered a gamut of changes in healthcare, such as the growing pressure to reduce costs, the pressing need for regulatory policies and standards to address the expansion of healthcare delivery beyond the hospital, the upcoming retirement of large numbers of Baby Boomer technology experts, the continued rise of interoperability, and the promise of innovation coming from many new entrants to the technology market.What I found more provocative, though, were two seemingly disparate insights: (1) healthcare technology management (HTM) is increasingly interdisciplinary, and relatively few professionals have expertise in all of the disciplines needed to carry out the responsibilities; and (2) short-term cost pressures and a lack of executive understanding often stand in the way of HTM evolving beyond the traditional “repair a device” focus to a broader focus on the life cycle of technology. Together, these two insights shine a bright light on the fact that HTM is not a service department in the basement of a hospital, even though that's the view of many hospital and industry executives. They see HTM as a cost center, ripe for expense reduction.Depending on the lens one uses, HTM is an opportunity to outsource; a group of people who can't stand up for themselves so it's easy to slash their expenses; an add-on service component to technology purchases; a headache for information technology (IT); a capital equipment competition; something new for nurses to learn; a treasure trove of clinical data for research; or an opportunity to make care safer. It's easy to see what HTM should be, and the smart departments have moved in that direction or are on their way.When HTM is viewed strictly as some isolated service department, we miss the bigger picture, which takes me back to my earlier point: HTM is increasingly interdisciplinary, and relatively few professionals have expertise in all of the disciplines needed to carry out the responsibilities. The top executives in medicine, nursing, pharmacy, IT, finance, operations, clinical safety, infection control, and risk management—and the top executives in industry—need us to help them understand HTM more holistically, viewing it as a crucial component of and link to every element of safe, efficient, and effective patient care. The best place to start in promoting a new mindset is for HTM departments to consider how they view themselves. If they see themselves as an afterthought, that's what they will be. If we they see themselves as key partners in the full life cycle of technology, then they will be. We all have a role to play to eliminate the one lens that is not helpful to anyone: seeing HTM as an island.

A Systems Approach to Patient Safety at the VA

A Systems Approach to Patient Safety at the VA

Healthcare Technology Is on the Move

Healthcare Technology Is on the Move

Applying Cyber Risk Management To Medical Device Design

Recent U.S. Food and Drug Administration (FDA) guidance recognizes that today’s medical devices face a host of cyberthreats. Medical device manufacturers, in turn, face the need to assess and mitigate cyber risks. By combining the cyber risk framework of the National Institute of Standards and Technology (NIST) with the existing International Organization for Standardization (ISO) 14971 Safety Risk Management (SRM) process, manufacturers can leverage proven best practices to make their devices safer and more effective. The cyberthreat to medical devices is based on two factors. First, increasingly faster and more efficient processors now enable full operating systems to run on small implant devices. Previously, only dedicated firmware could have been used. Second, modern hardware can readily connect to networks using wired and wireless protocols. Both factors offer markedly increased capability for patients, physicians, caregivers, and healthcare technology management (HTM) professionals, at the cost of opening unforeseen and unintended doorways into a device. Opening unintended doorways can compromise medical devices in three major areas of cybersecurity: confidentiality, integrity, and availability. Confidentiality refers to preserving authorized restrictions on information access and disclosure, including means for protecting patient privacy and corporate proprietary information. Integrity means guarding against improper information modification or destruction and includes ensuring information nonrepudiation and authenticity. Availability is ensuring timely and reliable access to and use of information. As embedded medical devices grow in complexity and ability, an end-to-end cybersecurity framework is needed to ensure that they achieve the confidentiality, integrity, and availability required for successful operation. Cybersecurity concerns have factored into medical device design for some time, but additional attention has been focused on the topic by recent FDA communications, including a recent guidance document and a safety communication. These documents, however, lack clear instructions on what needs to be considered and tested—a comprehensive standard could be years away. To ensure safety and effectiveness and reduce exposure to liability, device manufacturers need to be proactive in defining and applying cybersecurity controls for their medical devices. The problem facing medical device development teams is complex; it involves securing a device against an ever-growing number of cybersecurity threats while balancing usability, performance, and safety. A viable approach Applying Cyber Risk Management To Medical Device Design

Is This the Future of Medical Technology?

Is This the Future of Medical Technology?

The Case for In-House Laboratory Equipment Maintenance

Healthcare technology management (HTM) professionals have taken a hands-off approach to laboratory equipment maintenance. Typically, there isn't much of such equipment in the inventory, and the cost to train personnel to service can be a hurdle to making the move to in-house maintenance. Additionally, in some cases the equipment has been provided free of charge in return for a long-term contract for expendable supplies used to operate the equipment. Finally, regulatory oversight from College of American Pathologists (CAP) or other agencies can discourage in-house maintenance.However, I strongly encourage all HTM professionals to help bring laboratory maintenance back in-house. While there may be some short-term pain, the potential for long-term benefits is greater. There are three main reasons to make the move. First, we in the HTM field are losing an important technical skillset by not maintaining laboratory equipment. Second, because of this diminishing skillset, the contract cost will inevitably rise due to supply and demand and manufacturers being able to control the supply. Third, we are building walls between biomedical equipment technicians (BMETs) and laboratory technicians, and that's not healthy.In-house maintenance technicians or BMETs, have traditionally, only worked on the most basic laboratory equipment. To address this lack of experience, consider sending your in-house technicians out with the manufacturer's field service engineers (FSEs) to observe how to maintain the equipment. There may be a short-term cost in slightly decreased productivity for the BMET team, but the long-term benefit is that your in-house technicians will expand their skillsets. Additionally, they may discover that some of the equipment can be maintained in-house, reducing the contract cost for your hospital.If manufacturers continue to observe that HTM departments are reluctant to bring the laboratory maintenance in-house, the cost for contract maintenance will rise. Analysis by HTM professionals to determine the cost effectiveness of maintenance contracts will become a paperwork drill.HTM professionals need to think of options other than maintenance contracts with outside vendors. What are the total costs of the maintenance contracts for laboratory equipment? Once that is calculated, determine if it is cheaper to hire a technician to take care of the laboratory maintenance. In a medium to large hospital, I would be surprised if the savings is not there. If possible, standardize all the equipment under one manufacturer. Consider bringing in a FSE who is trained in how to service the laboratory equipment. While the FSE may not have the usual background of an associate's degree or military training, his or her experience and training by the manufacturer could lead to savings.In conclusion, I encourage you to find ways to bring laboratory maintenance in-house. Be creative, find cost-saving methods that will increase response time, and increase the knowledge base of the in-house HTM. At least consider the inclusion of laboratory maintenance as part of the overarching HTM community.

Springer Handbook of Medical Technology (2012 edition)

The Springer Handbook of Medical Technology provides basic-to-advanced information on medical technology used in hospitals. It is organized into seven main sections: Basics of Medical Technology, Functional Diagnostic Devices, Medical Imaging, Therapeutic Devices, Monitoring, Medical Information Processing, and Equipment and Tools. In the section on basics, the authors provide a brief history on how medicine and technology come together to improve healthcare. The authors describe early breakthroughs in medical technology, the transformation from analog to digital technology, and health policy. The book covers almost all medical equipment with respect to the physiological and technological theory behind each device, along with its design, development, and practical applications. This book should be on the bookshelf of every professional in the field of healthcare technology management.Audience: The handbook is an excellent resource for working professionals in healthcare technology, such as clinical engineers. It also would be useful to undergraduate and graduate students of biomedical engineering or medical physics. Additionally, the book would be helpful in preparing for certification exams, such as those for biomedical equipment technician or a laboratory equipment specialist.Features: If “a picture is worth a thousand words,” it's worth pointing out that this book has 1,008 photographs and 139 tables. These images and tables help readers understand the concepts and information, and they provide visualization of real medical equipment, offering more than simple block diagrams. The material includes some chapters usually not seen in traditional biomedical instrumentation books: Basic Electronics in Medicine, Surgical Scissors, Quality Management in Medical Technology, Intelligent Textiles and Usability of Medical Devices. The book has three indexes: contents, detailed contents, and subject Index, all of which are very convenient when looking for a specific topic. The book also includes a short biography and contact details for each author. This feature is very helpful; if I have any questions, I can directly contact the author of that chapter. Another appealing feature is that the complete book can be purchased in an e-book format. The most beneficial feature for students may be its price: If your university is a part of the Springer Link program, you will have free access to the entire e-book. I am grateful to Springer for its generosity by providing free access to the full version of the book.Assessment: The authors have made a tremendous effort to ensure that the reader not only understands the technology behind these devices, but also the physiology and history. Each chapter starts with a brief overview of the topic and then provides details on theory (with formulas, diagrams, and tables), technology, and application. Each chapter ends with a number of references. Since it is not a text book, it does not have any numerical problems for students to solve. The addition of some numerical problems in each chapter would have made this book perfect for students.My only major concern would be the lack of specific information on the healthcare technology management (HTM) field. At least one chapter on HTM and its importance would have been a valuable addition. However, it is still an excellent book for understanding how medical devices work and the theory and technology behind them. I strongly recommend it as a reference book.

Campaign Promotes Value of Healthcare Technology Management Field

Campaign Promotes Value of Healthcare Technology Management Field

The Importance of Imaging Technology

The Importance of Imaging Technology

Perspective : A Nurse's Take on the Role of Healthcare Technology Management

As the presence and purpose of technology in the hospital becomes larger and more critical to healthcare delivery, so does the interaction between healthcare technology management (HTM) and nursing. The silos containing information technology (IT) and nursing are dissolving into a more collaborative community where HTM professionals can view themselves more accurately as “co-caregivers” alongside nurses and other clinicians. As this self-perception changes, HTM decisions more naturally will reflect an awareness of how technology can enhance patient care. There is a direct correlation between an efficient flow of patient care and the improvement of patient outcomes, patient/ family satisfaction, and working conditions. Technology is a key to enabling a seamless workflow, but it must become a team effort. The nursing function depends on the skills and knowledge of HTM professionals to deploy technologies that offer improvement in workflow, diagnostics, treatment, and recovery, but the feedback from nursing to HTM is fundamental to the success of any technology. HTM leadership must be aware of the impact that new deployments have on clinical work flow, and this awareness is transferred through a much closer working relationship with nurses and other clinicians. A partnership mentality between HTM professionals, such as clinical engineers and biomedical equipment technicians (BMETS), and nurses is the way of the future. HTM professionals are more likely at present to see themselves in a technical role, making sure that medical devices and technology are functioning properly. They aren’t as likely to see themselves as “co-caregivers,” on the frontline with nurses, physicians, and other caregivers, directly interacting with patients and thinking, “How can I tap my specific skills to improve the outcome for this patient?” Typically, HTM professionals focus on the technology and allow clinicians to focus on patient care. To achieve a truly optimized care environment, this mentality must shift so that HTM professionals sees themselves alongside other caregivers, recognizing that the tools they deploy are just as critical to success as the care delivered by nurses. As this paradigm shift takes place, hospitals may see changes in the ways that HTM and nursing interact. Two examples of a changed interaction follow. 1. Hospitals may establish a process by which new technology is introduced, either by HTM professionals or nurses, in a collaborative PERSPECTIVE A Nurse’s Take on the Role of Healthcare Technology Management

The Essentials of Medical Device Inventory Tracking

As the cost and complexity of medical equipment increase, healthcare technology management (HTM) professionals find themselves more and more in need of tools to track inventory maintenance and location, particularly for commonly used portable devices. However, the computerized maintenance management systems widely used in hospitals are not designed to help locate moveable devices, and many healthcare facilities do not make use of tracking technology that has been available for many years. This article reviews some of the central issues in medical inventory management and the more common challenges HTM professionals face. Several examples of successful tracking system implementation also are discussed.

Association Roundtable

Insights and advice from leaders of local and state biomedical associations“We at the California Medical Instrumentation Association have provided some basic educational opportunities to address cybersecurity concerns in healthcare to our members through individual chapter meetings. Speakers and presenters from healthcare systems associated with both healthcare technology management and information technology (IT) have shared their experiences. Original equipment manufacturers also have been involved in some meetings with their experiences on cybersecurity concerns in healthcare.”Gus Sakis, State Board Chair, California Medical Instrumentation Association“The HTMA-SC is doing nothing in this area. Our members are struggling with mundane issues, such as training budgets. We have little support or time except for trying to get our PMs done and saving money. IT has this responsibility.”Patrick Lynch, President, Healthcare Technology Management Association of South Carolina“The Healthcare Technology Management Association of the Mid-West (HTMA-MW, formerly the Kansas City Biomed Society) has been holding classes to expand the base knowledge of the members to include more IT topics. These classes include A+ certification, Network+ certification, and planned network security topics. The association is looking to have its members more active in cooperating with hospital IT departments to prevent breaches in security through the network, as well as giving them the ability to recognize when someone is attempting to access the network inappropriately.”Robin N. Faut, Educational Coordinator, Healthcare Technology Management Association of the Mid-WestThe New England Society of Clinical Engineering (NESCE) has addressed cybersecurity in several ways, most notably through education, networking, and discussions. The society has provided subsidized network training courses for several years that have aspects delving into network security.Barrett Franklin, President, New England Society of Clinical Engineering

Clean Benches

Clean Benches

An Indicator to Estimate the Access to Imaging Services in the Costa Rican Public Health System

The aim of this work was to develop an indicator that estimates the population's access to imaging services (IS) of health care facilities in the Costa Rican Public Health System, taking into account five aspects: (a) health care facilities infrastructure, (b) capacity of the IS according to the installed technological resources, (c) epidemiological aspects, (d) demographic aspects, and (e) location of the health facility in relation to the Capital. To achieve this, 14 variables and 7 indicators were defined. These indicators were integrated into a mathematical function which resulted in a global indicator that throws quantitative data that represents the level of access of a population to the IS in their geographic region of influence. The application of the indicator was performed in eight health facility sub-networks with defined geographical regions within the territory of Costa Rica. The level of access to the imaging service of the inhabitants of the eight sub-networks results that three of them obtained a bad access, located in east and north-central of the country; other three sub-networks obtained regular access, located in the west; and the last two who obtained a good access are located in the center of the country. The results showed that the imaging services are not equitable in each sub-network. Knowing this, it is possible to work on healthcare technology management proposals in order to strengthen the regional imaging services, contributing to decentralizing the services of the general hospitals located in the Capital.

Developing Mobile Biomedical Apps

The use of mobile devices is becoming more significant than ever within the medical engineering community. Mobile devices such as smartphones and iPads help biomedical equipment technicians (BMETs) and clinical engineers (CEs) on the job, and reduce organizational waste—an added healthcare cost savings. How many useful biomedical apps are already on the market, and what the realistic uses for mobile devices and apps within healthcare technology management (HTM) departments? In this article, we will review some mobile applications pertaining to essential BMET/CE education, some of which make for promising medical devices, and also some basic terminology to give the reader insight into the development of mobile applications. Although there are many platforms that can be used to develop apps, notably Apple, this article focuses on developing biomedical apps for the flexible Android operating system. It includes aspects from several applications we are working on, to give an idea of what the development process can entail, including: • A mobile preventive maintenance procedure and checklist application • A mobile file-sharing program for reference documents, hazard recalls, and technical manuals that can be stored in a central repository • A clinical engineering encyclopedia that includes biomedical terms, pertinent scientific mathematical equations, calculators, abbreviations, acronyms, and jargon; (as well as listing institutions, projects, and other external databases) • A mobile computerized maintenance-management system

Association Roundtable

Insights and advice from leaders of local and state biomedical associationsWe have started a junior chapter of our Danish Society for biomedical engineering and they have seats on our board. This gives a revitalization of our society and our board. It gives early contact to future colleagues and better contact to the universities. And it gives the junior members a great network for their career.”Kim Dremstrup, PhD, President, Danish Society for Biomedical Engineering“After observing other association websites, we noted there was not much updating of information. Everything just seemed stagnant—something that is not good in a dynamic field such as healthcare technology management. Pursuant to the resolution of this challenge, our Information Blog was established. Each weekday a new helpful message is posted on the blog. It could be something about an upcoming webinar, a new best practice, a meeting announcement, or something technology oriented that affects our field. When these blog items are posted, our system automatically e-mails the post to our member and associate subscribers, which at this time total 246.”Dick Felton, Past President, Healthcare Technology Management Association of Ohio“We have always been involved with our local technical college. We recommend hiring talented individuals from other technical fields and training them in biomedical principles using our technical college. This way you help local individuals, the community, and create cost savings for the hospital.”Horace Hunter, Executive Director, Georgia Biomedical Instrumentation Society“We have begun two programs which are quite popular.“The first program is a certification study group. We've held weekly study groups at two Kansas City metro area hospitals which teleconference with the highly successful CABMET group. We augment that with additional training. For instance this year I taught a 2 hour X-ray fundamentals course. As a result of this program we've certified over 30 new CBET and CRES technicians. We've also held A+ training.“The other program we've instituted which seems quite popular is a raffle for a trip to the AAMI annual conference. A ticket is awarded to individuals who contribute something meaningful to the organization or profession. Examples would be teaching a class, writing an article which is published in a professional publication, or recruiting a new corporate sponsor.”Dan DeMaria, CBET, CRES, President, Healthcare Technology Management Association of the Midwest (HTMA-MW)

The Case for Biomed Involvement in Purchasing

Money talks. There is no better way for a biomedical engineering or healthcare technology management (HTM) to get the attention of the supply chain or materials management department—which is run by financially focused individuals—than to prove you can save them money. Many hospitals use Quint Studer’s management principles, which are driven by basic pillars that can be adopted and customized. They usually include: people, quality, service, and financial. Studer teaches that if you attract and retain the best people, and hardwire a culture of quality and service, then positive financial results will follow. However, I have found that describing the intangible effects of selecting better products and therefore increasing physician satisfaction, seems to result in a mild reaction from chief financial officers (CFOs), as compared to telling them that you saved $150,000 by reallocating underutilized systems. Since CFOs are almost always the lead on procurement processes, they are the ones to focus on, even if your primary motivator is one of the other pillars.

Healthcare Technology Management Challenges Related to Reform

Healthcare Technology Management Challenges Related to Reform

The Roundup

The Roundup