TechNation - June 2014 by MD Publishing

1technation.com

vol.6

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

JUNE 2014

G N I V IMPRO : Y T I L I VISIB

E U L A V G N SHOWI C-SUITE R U O Y TO

30 Biomed Adventures

Spreading the Knowledge

46 The Roundtable

Infusion Therapy

76 What's on Your Bench?

Highlighting the workbenches of HTM Professionals

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CONTENTS Features

46 50 TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

T HE ROUNDTABLE - Infusion Therapy This month, TechNation asked experts about purchasing and servicing infusion therapy devices. Our panels weighs in on the latest technology and service options. Next monthâ&#x20AC;&#x2122;s Roundtable article: Ultrasound

Improving Visibility: Showing value to your C-suite HTM professionals are a vital part of the healthcare formula that can be overlooked by members of the C-suite. TechNation examines how biomeds can demonstrate the value they bring to the healthcare facility in which they work and elevate their standing among member of the C-suite. Next monthâ&#x20AC;&#x2122;s Feature article: Improvements in Distance Support Technology

TechNation (Vol. 5, Issue #6) May 2014 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

JUNE 2014

1TECHNATION.COM

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Sharon Farley Warren Kaufman Jayme McKelvey

ART DEPARTMENT

Jonathan Riley Yareia Frazier Jessica Laurain

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas Myron Hartman Patrick K. Lynch Todd Rogers Manny Roman Cindy Stephens Matt Tomory Karen Waninger

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Nam Bui Michelle McMonigle Taylor Martin

ACCOUNTING

Sue Cinq-Mars

EDITORIAL BOARD

Manny Roman: manny.roman@me.com Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com Eddie Acosta: A Clinical Systems Engineer at Kaiser Permanente, Northern California, Fastedy99@yahoo.com John Noblitt: Program Director at Caldwell Community College & Technical Institute in North Carolina jnoblitt@cccti.edu

P.14 SPOTLIGHT p.14 p.16 p.20 p.22 p.26

MD Expo Hits the Jackpot in Vegas Company Showcase: Philips Healthcare Professional of the Month: Bernie Dixon 2014 TechNation Scholarship Winners Department Profile: Rex Healthcare Biomedical Engineering Department p.30 Biomed Adventures: Spreading the Knowledge

P.34 THE BENCH p.34 p.36 p.39 p.40 p.42

AAMI Update ECRI Institute Update Tools of the Trade Shop Talk Biomed 101

P.58 EXPERT ADVICE

p.58 Career Center p.61 Ultrasound Tech Expert Sponsored by Conquest Imaging p.62 The Future p.64 Patrick Lynch p.67 The Roman Review p.68 Karen waninger p.70 Beyond Certification

P.70 BREAKROOM p.74 p.76 p.80 p.82 p.90

The Vault Did You Know What’s on Your Bench? Scrapbook Parting Shot

p.89 Index Like us on Facebook, www.facebook.com/TechNationMag MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

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MD EXPO HITS THE JACKPOT IN VEGAS By John Wallace, Editor

lvis was a big hit, but there is no doubt that MD Expo is king when it comes to Las Vegas.

The spring exposition crushed attendance records. There were more than 350 attendees and more than 100 world-class vendors with 275 exhibitor personnel. The three-day event combined work and educational sessions with social networking opportunities. There were also special visits from Elvis and a pair of Vegas showgirls. MD Publishing President John Krieg teed off the festivities at the golf tournament sponsored by DirectMed Parts on Wednesday morning. Golfers enjoyed perfect weather at Badlands Golf Club. Meanwhile, exhibitors started registering and setting up their booths at the luxurious Red Rock Casino, Resort and Spa in beautiful Red Rock Canyon. Day One was capped off with a welcome reception at Cherry Lounge sponsored by AllParts Medical. Educational seminars kicked off the second day of the MD Expo with respected educators leading classes. Dr. Purna Prasad’s two classes drew a crowd, especially his 8 a.m. class “Clinical Alarms and Alarm Fatigue.” Izabella Gieras’ class “Doing More With Less” was also a popular class. Scott Long’s two-part class “Best Practices in Eliminating Expensive Clinical Service Contracts” was packed. Frank Cabrera, Perry Kirwan and Frank Robles from Banner Health and Michael Petelin from RSTI also shared their knowledge on Thursday. Industry veterans Manny Roman and Frank Magnarelli shared

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JUNE 2014

Fluke Biomedical’s Edward Bennett, Hal Andersen and Andrew Clay pose for a photo with Elvis in the exhibit hall at MD Expo 2014 in Las Vegas.

their wisdom as well at the MD Expo. The exhibit hall opened at noon on Thursday and attendees flooded the floor where they encountered the latest in technology, cost savings and third-party alternatives. Vegas showgirls toured the hall and helped draw winners of brand new Kindle Fire tablets at the Hot Spots. The first day was capped off with a networking happy hour sponsored by Advanced Ultrasound Electronics. An early start on Friday was kicked off with a Manager’s Networking Breakfast, sponsored by Health Tech Talent Management, which included a presentation by Bill Wagner. The educational sessions continued on Friday with classes on several topics, including a Joint Commission update, networking fundamentals, and a look at certification tips and tricks. Elvis was in the house at noon to open the exhibit hall and was a huge hit inside

the exhibit hall posing for photos and drawing Hot Spot winners. The grand finale on Friday was the MD ExBowl where everyone was invited to bowl in luxury on the private VIP lanes at Red Rock Lanes. More than 200 people participated in the festivities and all had a good time. Gieras said this was her first MD Expo and she left impressed by the overall experience. “The MD Expo in Las Vegas was my first MD Expo I have attended so I was looking forward to learning more about the structure of the conference, the type of attendees and exhibitors and the overall feel for the conference,” she said. “The MD Expo 2014 is smaller and more focused on specific topics in the clinical and biomedical engineering community as compared to other conferences I have attended. This gives MD Expo a great niche, especially for those that are focused and interested in

MD Expo 2014 attendees Joni Krieg, Jeff Taltavull from AIV, Michelle Deschaine from AIV, Izabella Gieras from Huntington Hospital in Pasadena, Calif., and Ben Lam from AIV network during the welcome reception.

those specific areas and have budget constraints to attend more conferences.” Gieras added that she looks forward to the next MD Expo. “Overall, it was a highly enjoyable conference,” she said, “and I hope I will have the opportunity in the future to attend again!” Roman agreed. “It was just outstanding,” Roman said. He said the only negative is that he felt like he did not have enough time to visit with all of the people at the MD Expo because there were so many people in attendance. Also, Roman said he has been to several events in Las Vegas and he was surprised that the MD Expo did not lose people to “all the distractions” that Las Vegas has to offer. “One thing that stood out is that this is Vegas and people still attended all of the events,” Roman said. “This demonstrates to me that people really do want to attend (the MD Expo) and not just visit Vegas.” This was not the first MD Expo for Cabrera, but he said it was one of the best. “I thought it was a terrific show. I’ve been to a few of the MD Expos and this one looked like it was the most-well received from the vendors as well as the attendees,” he said. “I don’t know what the actual numbers were but there were a lot of folks there.” “I don’t know,” Cabrera said when asked how the MD Expo could be better,

“because every show I go to is better than the last. So, whatever you are doing, keep doing it.” He said providing meals and snacks throughout the day really adds to the MD Expo.

attended,” he added. Michael Kelley, MSM, CBET, Biomedical Engineering Supervisor at Children’s Hospital Colorado, attended the MD Expo in Las Vegas and praised the schedule and venue. “Overall, I thought it was well put together,” Kelley said. “I enjoyed the format of having the classes in the morning and the exhibit hall in the afternoon. I really liked that setup. I think it worked really well. The flow of people through both parts of that went really well.” “I think the venue you picked was great,” he added. “It gave you the opportunity to make everybody stay around the resort. The Red Rock, it was crazy. It had any and everything you needed.” Kelley also praised the amount of social networking that was available at planned events. He said he was also able to connect with people informally during the MD Expo when he bumped into them around the resort. “I can say that both of those venues (the welcome reception and the happy

“This gives MD Expo a great niche, especially for those that are focused and interested in those specific areas and have budget constraints to attend more conferences.” – Izabella Gieras

“(Having meals and break stations) is a tremendous help for the local biomeds and just thinking along those lines, the zero registration fee for the biomeds, that helps a lot as well because a lot of those guys go on their own,” Cabrera said. “They take their own PTO from wherever they are working and they are staying with friends, they are bunking with somebody else, they’re just taking advantage of the networking opportunities as well as the educational opportunities. I know I had to do that when I was coming up through the ranks.” “I think you put on a bang up show. It was a great opportunity for all who

hour) were well received,” Kelley said. “I definitely walked around a lot. Once again, it was a good opportunity to catch up with old colleagues and obviously meet some new people as well.” Roman said expectations are always high when it comes to an MD Expo. He said MD Publishing meets and exceeds those expectations every time. Next for MD Publishing is the MD Imaging Expo in Indianapolis this July followed by the fall MD Expo in Orlando in early October. For more information about these events, visit mdexposhow.com.

SPOTLIGHT

COMPANY SHOWCASE

Philips Healthcare Services Focuses on ‘In-House’ Teams

t’s no secret that large organizations can often be rigid with a strict set of service offerings that tend to be confined to specific issues without the flexibility that is often needed to solve problems. But Philips Healthcare Services, ‘Philips’, strives to break-through the stereotypes of large organizations and be unlike any other service provider. While Philips is a large multi-billion dollar global company, the company remains as focused today on supporting patient care and the highest level of quality service as it did the day it opened its doors in 1896 when Philips manufactured the first X-ray tubes for medical applications. Philips’ rich and storied history in providing industry leading innovations in products and services is entering into a new chapter in which the company has a goal to be the most “in-house friendly” service provider in the marketplace. Delivering on this goal, Philips offers a catalog of service opportunities called RightFit Service Agreements that allow in-house teams to design and tailor a flexible service program to fit their unique needs. “We get great feedback every day from customers who articulate the ever changing and dynamic environment,” says Todd Reinke, Philips’ Senior Director of Service

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JUNE 2014

Philips continues to invest in their service infrastructure. Over the past five years, Philips has invested heavily into their USA based 24/7 customer service center and remote service resolution capabilities to ensure fast and accurate response and service to customers’ inquiries.

Marketing for the Americas. “They ask us to help them with cost control and ‘getting more for less,’ while still maintaining quality and safe patient care. They need to maintain older equipment inventories, while investing into emerging technology innovations. They want to partner with us as the administrative burden with federal and state reporting and privacy requirements grow. They want flexibility in their service contracts as they consider balancing financial risk with service quality. And they ask us for value-added service to support long-term business relationships.”

“Philips’ goal is to meet these customer needs by being more than just a vendor to our customers,” Reinke adds. “We want to enable our customers to prepare to react to changes quickly and effectively. Quick and effective reaction to changes requires flexibility in organization and processes including vendor relationships. And as an OEM service provider with additional capabilities to service equipment from other manufacturers, Philips is strongly positioned to support in-house teams by providing flexibility as well as resources.”

WHAT SETS PHILIPS APART? Philips differentiates itself by providing strong partnerships with their customers, as well as by meeting or exceeding customers’ clinical support and service agreement guidelines. Philips is committed to providing meaningful innovations that improve the quality of care, enhance patients’ lives and enable the delivery of better outcomes at lower cost. Philips continually ranks No. 1 in Service Quality as measured through IMV surveys for equipment and service engineer performance. Philips invests directly in customers’ business by providing dedicated on-site support and remote services. Known as the “people” company, Philips builds relationships with all areas of their customers’ business. Philips’ global brand strength and reputation are built on the strength of locally focused service teams that are actively engaged in their customers’ communities.

SERVICE PLANS AND OFFERINGS FOR IN-HOUSE TEAMS By taking advantage of leading technology and access to top quality service and parts, Philips’ RightFit Service Agreements maximize and protect their customers and their equipment with improved productivity, extending each customer’s system’s lifetime while maintaining peak performance. Philips provides flexible, effective solutions assuring the “RightFit” without compromising service expectations. Philips Service Agreements range from Comprehensive to Shared Services to Time and Materials and are available for Philips and non-Philips systems. For in-house teams, Philips offers a range of service coverage and options.

Supporting in-house teams, Philips has over 2,500 qualified and trained service engineers servicing equipment from every major manufacturer.

For organizations that want back-up support, Philips RightFit Service Agreement SUPPORT delivers unlimited second-response labor and full coverage for critical parts like PET crystals, photomultiplier tubes, MR cryogens, and coils. They enjoy shared PMs and service event calls with Philips’ engineering team to gain further insight into how to repair the system. RightFit SUPPORT also provides options for strategic parts (tubes, flat detectors, image intensifiers) coverage, parts and labor pools, and premium value-added services. For organizations that want to create a customized solution based on the talent and technical skills of their in-house staff and budgetary requirements, Philips RightFit Service Agreement ASSIST is ideal. RightFit ASSIST provides access to diagnostic software, service documentation licenses, and remote diagnostics on Philips equipment, and unlimited standard parts for non-Philips equipment. A wide range of coverage options, including strategic parts and labor pools, is also available. Customers who have changing service needs and future plans to support a system with an in-house team, may choose a service option called Transition Assist at no additional charge. Living up to its name, Transition Assist allows the customer to move from Full-Service plans

to shared services upon their agreement anniversary date without any penalties. For the customer, the benefit of this unique feature is the ability to prepare and plan to take their imaging system servicing in-house. A Technical Training Flex Account option empowers customers to select which team members will be trained when and Philips works with them to develop a training schedule. For customers wanting clinical education, Philips offers online and on-site training programs for a variety of imaging systems. Repairs require parts and Philips offers easy and quick access to quality, certified parts through a variety of parts only programs leveraging its relationship with AllParts Medical, www.allpartsmedical. com, a division of Philips Healthcare. “Whether you need full-service, shared service or demand services for your in-house teams” says Eunni Lee, Service Marketing Manager for Philips in-house programs, “we have a solution for you. We are all about flexing to meet customers’ needs and partnering with them. We are there to help them make sure that their imaging servicing and business goals are not compromised.” FOR MORE INFORMATION about Philips Services, visit www.philips.com/uscustomerservices.

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PROFESSIONAL OF THE MONTH Bernie Dixon By John Wallace, Editor

It has been said that sometimes you pick a career and sometimes a career picks you.

In the case of Crothall Healthcare Zone Imaging Specialist Bernie Dixon, the U.S. Air Force picked a career for him. Dixon was struggling to balance his time as a college freshman. He said it was difficult to be a student-athlete and work fulltime as an 18-year-old enrolled at McNeese State. He was a quarterback on the football team at the time and after looking at his options he decided to join the Air Force. “It didn’t take me long to realize I wouldn’t make it four years,” Dixon said about working, studying and playing football throughout college. The freshman from Beaumont, Texas, decided to trade in his football helmet for a life as the American version of James Bond. “I was barely 18 years old and had little to no direction when I walked into the Air Force recruiter’s office. My goal was to be a linguist and be able to be a spy,” Dixon recalled. “That’s really funny, looking back on it now.” “However, the recruiter told me, ‘Son, the Air Force says you are going to be a BMET,’ ” Dixon said. “I had no idea what that meant, but I am so thankful the USAF had more sense than I did.”

1TECHNATION.COM

JUNE 2014

The USAF also helped him make another life decision. Dixon and his wife of more than 20 years, Kim, met at tech school at Sheppard Air Force Base in Wichita Falls, Texas. The couple knew each other for seven weeks before they were married. “I guess when it’s right, you just know,” Dixon said about marrying Kim. “We have three great kids, Haley, 20, a student at Texas State University. Hunter, 18, and graduating this May from high school. And Alyssa, 15, our baby, and she will let you know that she is the baby.” “Family means everything to me,” he added.

hired by GE as a Field Service Engineer in Jonesboro, Ark., when I was just 22 years old. I worked for GE in Arkansas and then in Tennessee, before moving to Houston, Texas, and becoming the CT/PET and Nuclear Team Leader.” Dixon said his work as nuclear team leader was his most challenging and proved to be very insightful. “Working at the largest medical center complex in the world taught me a lot about people, but even more about myself,” Dixon explained. “I came to Crothall Healthcare a little over a year ago and, honestly, it was the best career move I ever made. I really couldn’t be happier.”

“Working at the largest medical center complex in the world taught me a lot about people, but even more about myself.” – Bernie Dixon

Dixon said the family atmosphere at Crothall Healthcare is amazing and while he did not dislike his previous job he can’t imagine working anywhere else. “I started as a BMET in the USAF, then moved on to work as an in-house BMET for Modern Biomedical Services,” Dixon said. “I then went on to work for a third-party X-ray company in Knoxville, Tenn., for a couple of years, before being

Crothall is also happy about Dixon’s decision to join them. He was awarded a leadership award last year and is thought highly of by his supervisor Glen McQuien. “The CREST Services Leadership Award offered prior to the complete integration of CREST Services into the Crothall Healthcare Technology Solutions group was a peer-nominated and peer-chosen award for the technician exhibiting true leadership

Bernie Dixon works on a Toshiba Aquilion 64 CT.

qualities,” McQuien said. “As the award states, ‘For providing leadership in word and deed.’ Clearly, Bernie’s peers feel the same way about his abilities and leadership skills as the management team of Crothall.” Crothall, while a large organization, doesn’t feel particularly big to Dixon after his time at GE. He enjoys the friendly, family-like atmosphere. He said working at Crothall fits his personality. “I feel that I have found my calling … not just the field that I am in, but also the company that I am with,” Dixon said. “Crothall feels like family and I am so glad that I found them, or they found me, whichever it was.” Dixon, who revisited football by playing semi-pro ball while working in Tennessee, continues to serve as a quarterback just like in his college days. He is a team leader at Crothall, but he isn’t on the sidelines or in the coach’s box high above the trenches. He continues to get his hands dirty. “I kind of run the operations with 15 imaging guys in my area where I am their direct supervisor,” Dixon said about his job. “My area extends (from Texas) to California.”

“I’m a working supervisor,” he added. “I still do a little bit of everything. I like to keep my hands on the equipment. I don’t want to lose that.” His training and work experience pay dividends on a daily basis whether he is repairing a device or providing his insights via a phone call to somebody out in the field. “Like so many in this field, I went through the BMET program at Sheppard AFB in Wichita Falls, Texas. I went on to work for GE Healthcare as a Field Service Engineer for almost 17 years and most of it was spent in a remote location. I had the opportunity to learn all modalities and also multivendor equipment, at the Healthcare Institute in Milwaukee, and also at the Technical Center of Excellence in Arlington, Texas,” Dixon said. “My list of formal training is very extensive. If the system makes a diagnostic image of a patient, I have probably received formal training on it.” Currently, Crothall is leaning on Dixon’s expertise to help set up a new client in New York. “Crothall was recently awarded a very large healthcare system contract in the

greater New York City area. As Vice President of Diagnostic Imaging Services for Crothall, I immediately looked to Bernie to assist me in defining initial startup strategies, operational objectives, and ongoing support for the area while long-term staffing strategies are put into place,” McQuien said. “Bernie has risen to the occasion and is spending extended periods in the area as we complete this very important program initiative.” At the end of the day, Dixon said all his training and the hours and hours of repairs he has performed on medical imaging devices are all worth it because he has achieved the goal all biomeds strive to achieve – help deliver quality healthcare. “What’s not to love (about being a biomed) … the challenge, the camaraderie of my team, the constant change of pace, the customer satisfaction,” he said, “but most importantly, knowing that I have played an integral part in providing quality healthcare for so many people, including my own family members.”

FAVORITE BOOK Anything by Greg Iles FAVORITE MOVIE Terminator series FAVORITE FOOD Doughnuts...not picky about which kind HIDDEN TALENT I can still throw a football 65 yards WHAT’S ON MY DESK/BENCH? Well, not much. I don’t spend much time on a bench. My bench is every piece of diagnostic imaging equipment in our inventory. On my small desk, in the biomed shop, you can probably find some parts that I need to send back and a coffee mug that really needs to go through the dishwasher.

SPOTLIGHT

2014 SCHOLARSHIP WINNERS

Jacob Hetu & Samantha Muhhuku By John Wallace, Editor

echNation and Penn State’s College of Engineering have teamed up to create an essay competition to recognize dedicated students in the university’s Biomedical Engineering Technology program. The winner of the essay contest receives a $500 scholarship to be put toward their education. The competition produced two worthy essays this year and each student will receive a $500 award.

The award is named for Myron Hartman, a senior instructor in engineering at Penn State Kensington. Hartman returned to his alma mater to teach the next generations of biomeds after serving in the field for several years. Hartman screened the essays to make sure they met the requirements to be considered for the award and sent the essays to the TechNation staff for review. The essays were judged on creativity, organization and writing skills. Jacob Hetu and Samantha N. Muhhuku are co-winners of the essay competition for 2014. Their winning essays and printed below.

WHY I CHOOSE BIOMEDICAL ENGINEERING TECHNOLOGY AND MY JOURNEY TO A NEW PROFESSION BY JACOB HETU What do door knobs, VCRs, robots and celiac disease have in common? For most people, not a whole lot, but in my life they mean everything. There are events in my life that follow a common theme. These events are the reasons why I chose to follow the path of becoming a biomedical engineering technician, whether I knew it at the time or not. My mother is a teacher at a Catholic grade school. Often times when I was in grade school I would stay in her classroom after school until it was time to go home.

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Being a kid I never wanted to do my homework right away, so I would help her out. She would give me little tasks to do to keep me busy. A lot of times it would be fixing something small like a child’s toy. The one instance that I remember clearly was when we got locked out of the classroom. The door knob was jammed. I was able to open it and fix the jammed lock. My mother was impressed and soon began giving me other things to fix. This was the first time I remember fixing anything of significant importance for someone. It made me proud that my mom was proud of me. As I grew older I became more interested in repairing and building things for fun or for other people. I remember my grandfather telling me how smart or clever I was. When I was a kid I never thought about it much and was just happy to make my grandfather happy. Once when my grandparents were watching me, their VCR broke. My “Pap” was going to go out and buy a new one and he let me play with the broken one. I remember unscrewing the lid and taking out the stuck and tangled tape. We put another tape in and the VCR worked again. I remember my grandfather jostling my hair and saying, “I wish I had your brains.” Looking back on it I didn’t really do anything to fix the VCR, but all the same it made me happy to help my “Pap” out.

Jacob Hetu

My interest in machines grew and in high school I joined the robotics team. My senior year our team won “Rookie of the Year” at a local competition. This meant that we were going to Atlanta, Ga., for the national competition. I was the primary builder and designer for the robot, and the team captain. I remember how great it felt that something I had a big part in won an award. The award wasn’t what I enjoyed

When you are in high school the only things you think about are food, video games and that cute girl in the desk beside you. You never think about how something like an endoscope saved your life or how it works. This is perhaps the greatest reason I choose to start my journey to becoming a biomedical engineering technician. If something I work on plays even the tiniest role in making a terrified teenager’s life even a fraction better, then I can be happy knowing I’m making a difference. That, to me, is greater than any competition or award I could win.

Samantha N. Muhhuku

the most though; it was the satisfaction in creating something with my hands and then repairing it after each round of the competition. It was at that moment that I knew I wanted to be an engineer. Despite the great times I had with robotics in high school, my sophomore year of high school was a hard time for me. The previous year my sister was diagnosed with celiac disease, and then I was too not long after. It is strange for two people in the same family to be diagnosed with this disease. It is a genetic disease and can become active at any point in the gene holders life for no reason, if it ever does. The disease is an autoimmune disease that causes intestinal damage when gluten – found in wheat, rye, and barley – is ingested. I remember the trips to the doctor and the tests to find out what was wrong with my sister and how afraid my family was. Then, when I began to show the symptoms I had to go through those same tests. Eventually I had to have an endoscopy. I remember being afraid of the machines and the flashing lights in the room. At the same time, I was intrigued and wanted to ask the doctor what they were for but I was too nervous. Thank God I was put under anesthesia because I was more terrified than nervous when I think about it. Now, I know what the machines are and what they are for and, I am not afraid of them anymore.

WHY I CHOOSE BIOMEDICAL ENGINEERING TECHNOLOGY AND MY JOURNEY TO A NEW PROFESSION BY SAMANTHA N. MUHHUKU When you enter my class of 10 students, the first thing you notice is the one female right in the middle of the class – me. Every time someone enters the room, they wear an expression I have seen many times. The expression is one that says, “Are you sure you are in the right room?” Or “How did you end up here?” I know that all women in engineering have had to deal with that and it does not bother me to be the only female in a class. However, it is not just my gender that makes me different from the rest of my classmates, it is my background and nationality too. I was born and raised in Uganda, Africa. I came to the United States in 2012 for a college education. Little did I know that my dream to become a surgeon was going to be replaced by a new dream. So many people ask me, “How does a girl born and raised in Uganda, Africa end up in the Biomedical Engineering Technology program at Penn State New Kensington?” Every time someone asks me that, I think about the time I was so sure I wanted to go to medical school. My plan was to join the biomedical program as a pre-med student. New Kensington, being the only Penn State campus that offered the program, left me no choice but to join one of Penn State’s smaller commuter campuses. I later noticed, however, that when they asked me that question, it was less about my major and more about the campus. To me, it was more about what profession I would be getting into and less

about the size or location of the campus. Penn State New Kensington without a doubt has one of the leading Biomedical Engineering Technology programs in the country but it had never even crossed my mind that I would become an engineer. I was always sure that I was meant to be a surgeon because I always preferred biology and chemistry over physics. I loved mathematics too but I preferred watching “Grey’s Anatomy,” “House” or “The Untold Stories of the ER,” all medical shows, instead of taking apart my laptop when it stopped working. To me, watching medical oriented shows was getting me a step closer to my dream, just like joining the Biomedical Engineering program as a pre-med. I completed my general education classes and got into my major. I was able to learn a lot about the profession. I met different people in the profession and I slowly fell in love with what I was doing. It slowly started to feel like this might be the profession for me. I knew that I had to be completely sure that this was what I wanted to do instead of going on to medical school, so I decided to do an internship the summer after my freshman year. I went back to Uganda to be with my family that summer. While there, I applied and got an internship at Mulago Hospital in Kampala, Uganda. After three months of my internship, I was convinced. I had always had a few doubts about going to medical school and now I was very sure of what I wanted to do. I was going to become one of the few women Biomedical Engineering Technicians. Now I plan to earn a bachelor’s degree in Electrical Engineering Technology with a minor in Information Technology. I believe strongly that with a degree in Biomedical Engineering along with a knowledge in networking, computer systems, electrical systems and experience in the field, I will be prepared to join the manufacturing industry. This will enable me to eventually manufacture medical equipment suitable for Uganda and other developing countries in Africa and the rest of the world that cannot afford the medical equipment they need to help improve their health systems and reduce their mortality rate.

SPOTLIGHT

DEPARTMENT PROFILE Rex Healthcare Biomedical Engineering Department By K. Richard Douglas

aleigh, N.C., is a thriving research center and the state’s capital. The city is characterized by its many oak trees, several universities in the surrounding area and the North Carolina Museum of Art.

The city is also home to Rex Healthcare, a member of the University of North Carolina (UNC) Health Care. Rex Healthcare is a 660-bed not-for-profit healthcare system and one of the state’s largest employers. The healthcare system includes a dedicated cancer center, surgery center, heart and vascular centers, skilled nursing care center and acute rehab center. With more than 1,100 physicians on staff, Rex treats more than 34,000 inpatients each year. Located in Wake County, Rex Healthcare has facilities in the cities and towns of Holly Springs, Knightdale, Wakefield, Apex, Garner, Cary and Raleigh. Becker’s Hospital Review named Rex one of the country’s 100 Great Hospitals in 2013.

KEEPING IT RUNNING The technical support and intervention on 15,000 clinical devices, and a wide array of medical equipment systems to over 230 clinical and support departments, falls to the Rex Biomedical Engineering Department. The 15-person team represents over 462 years of cumulative biomedical and electronics-related experience. The department has 10 full-time biomedical technicians, two part-time biomedical technicians, a biomed coordinator, an administrative coordinator and a biomed manager. They are responsible for an acute care hospital, five wellness centers, two skilled nursing facilities, six suburban campuses, a freestanding

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outpatient diagnostic center, urgent care and surgery centers. “Much emphasis of involvement and endeavor for our biomed department involves special projects, installations, and upgrade efforts to promote expansion of services, enhancement of patient care, and effectiveness of the overall clinical experience at Rex,” says Steven Bowers, CET, biomedical engineering manager. Bowers points out that all the experience that the members of the team bring to their employer as HTM professionals is supplemented with regular training. “Through a comprehensive, ongoing technical training regimen,” he says. “(The department) continues to keep current and highly responsive to the needs and requirements of our medical staff and patients. We were pleased to accept the North Carolina Biomedical Association’s prestigious Kevin Scoggins’ North Carolina Biomed Shop of the Year Award in 2013.” Special projects have been a regular part of the department’s day-to-day work. They have included ongoing work with capsule/ middleware, as part of EPIC EMR Device Integration, medical network upgrade and EMR integration through Carescape Gateways and an alarm committee initiative. The committee is researching issues to enhance alarm management. The department recently upgraded their electronic equipment database to an online version.

“The database is updated with all technical intervention, installations, projects, and outside service field reports,” Bowers says. “We rely upon it and use it extensively to retrieve information and service history data to make best choices in equipment system procurement, maintenance schedules, procedures, and policy.” To gauge the effectiveness, compliance and reliability of the equipment systems under their care, the department periodically runs queries and custom reports. They utilize data from sources such as ECRI, The Joint Commission, the FDA and AAMI to make equipment support decisions.

FINDING VALUE FOR THE CUSTOMER Incorporating the LEAN process, as a tool to brainstorm, review and resolve challenges to improve efficiency and effectiveness, the Rex biomed shop has enhanced service to clinical staff and patients in various ways. One example has been an ongoing issue with an inadequate number of patient beds available. Bowers says the LEAN process “revealed over 10 different models of beds, prevalent in the organization, which presented issues with logistics, repair, and user familiarity for controls and operation.” “(The) ages of beds were well beyond available parts and technical support to effectively retain. Information was presented to the hospital executive team and new beds were placed on order,” he says. “A single model was selected so that logistics, training, and user controls would be common throughout patient care areas,” he adds. “A designated storage location was identified as well so that spares would be available when needed. Since this event, at no time has there been

Rex Hospital on South Street, 1894 -1909

Members of the Rex Healthcare Biomedical Engineering Department are, front row, left to right, Susan Trombley; Barbara Barnes; Ivan Greene, second row, left to right, Mike Leblanc; Tommy Ballard; Steven Bowers; Arnold Rabinovich; Bill Blake; Bert Bierstedt, back row, left to right, Robin Williams; Pat Carpenter; Jim Tripp; Jeff Kimrey; Fred Donnelly; and Rich Richardson (not pictured).

Rex Hospital on South Street, 1909 -1937

Rex Hospital on Saint Mary’s Street, 1937 -1980

Rex Hospital Campus, 1980 - Present

an actual shortage of patient-ready beds.” Another way the team used the LEAN process to approach a challenge was when they encountered an issue with telemetry transmitter loss and availability. “(A) group was created to investigate the problem and came up with several solutions to alleviate (it),” Bowers says. “A new central location for monitoring telemetry patients, controlling telemetry transmitter inventory, and providing for one select group of clinical staff to monitor patients has resulted in enhanced awareness, safety for patients, full availability of telemetry devices when needed, and 100 percent reduction in loss of hardware assets — a win, win,” he says. “Biomedical Engineering designed, built, and implemented the new central monitoring location – named here the TCC or Telemetry Command Center.” Managing service contracts and costs have been a priority for the department. “In 2005, all equipment service and maintenance dollars were shifted from individual clinical department accounts to the biomedical engineering budget for management and oversight,” Bowers says. “All service contracts were reviewed for need, cost effectiveness, and options for

tailoring them to specific requirements based on service histories, reliability, and risk. Many contracts were reduced and/or taken over by the biomedical engineering department,” he says. “Some were modified as a biomed first call option to reduce costs and, where applicable, contracts were assimilated into master agreements and reduced through negotiation and best business practices,” Bowers adds. “The result of all of this was a 25 percent reduction in service costs the first year and a continued vigilance and cost-effective program that is both effective and flexible to service requirements.” The biomedical engineering department is involved in a number of outside organizations including the North Carolina Biomedical Association (NCBA), the Association for the Advancement of Medical Instrumentation (AAMI), the International Society of Certified Electronics Technicians (ISCET), the National Fire Protection Agency (NFPA) and ECRI. This cutting-edge department’s work speaks for itself and illustrates why it is an award-winning team. FOR MORE photos visit www.1technation.com

SPOTLIGHT

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MANNY ROMAN

Announced as Keynote Speaker at Inaugural MD Imaging Expo! Staff Report

D Publishing is pleased to announce that industry veteran Manny Roman will be the keynote speaker at the inaugural MD Imaging Expo (July 16-17) at the JW Marriott Indianapolis.

MD Publishing President and founder John Krieg said he is excited to have a professional of Roman’s stature within the industry presenting the keynote address. “There was really only one choice when looking for a keynote speaker for the first-ever MD Imaging Expo,” Krieg said. “I am proud and extremely honored to have Manny Roman serve as the keynote speaker. The industry would not be where it is today without his influence. “He is arguably the most influential person in the medical imaging industry,” Krieg added. Billed as "Manny's Happy Hour," Roman will deliver a humorous and informative keynote, on Wednesday, July 16 from 3:30-4:30 p.m. Refreshments will be provided. Roman’s presentation will be immediately followed by the exhibit hall grand opening. The keynote address is titled “On the Trail of Invisible Light – A History of Diagnostic Imaging” and will examine the discovery of X-ray and how medical imaging has advanced since the 1800s. “The discovery of X-rays in 1895 spawned our industry,” Roman says. “Throughout the nearly 120 years since

Industry veteran Manny Roman will be the keynote speaker at the MD Imaging Expo.

the discovery, our industry has taken many quantum leaps as innovative pioneers developed new techniques, equipment and processes. This presentation will discuss some of the critical advances and industry pioneers that brought us to today’s advanced state.” Roman has more than 30 years of experience working in the healthcare technology management industry. He is a regular presenter at the MD Expo on a wide

range of topics from medical imaging to management and best business practices. He has experienced highs and lows as well as many baffling events that have helped shape his unique perspective and engaging teaching style. Roman advanced from the lowest levels of participation to the presidency of an organization and has “seen it all.” He has learned about relationships and experienced many business lessons firsthand. MD Publishing Editor John Wallace said Roman is the ideal speaker for the MD Imaging Expo. “I can’t wait to hear his presentation,” Wallace said. “Manny is a great communicator and he has so many funny stories that draw you in and then at the end there is a lesson to be learned.” “He has an amazing way to connect with people. He makes you feel like he is talking directly to you and that is hard to do,” Wallace added. “When he finishes talking you are usually laughing because he has such a great sense of humor. Then, there is that moment when you realize that he just shared a life lesson via a short, entertaining story.” “He is amazing,” Wallace said. TO LEARN MORE about Manny Roman and his unique style of communication, check out his blog at www.iamtechnation.com/manny. TO REGISTER for the MD Imaging Expo or for more information about the event, visit www.theimagingexpo.com.

SPOTLIGHT

BIOMED ADVENTURES Spreading the Knowledge By K. Richard Douglas

rganizations and companies across the U.S. have teamed with specialists in various professions to make great things happen. A classic example of this type of teamwork is a training collaboration between Exxon Mobile, MediSend International and an HTM professional named Sheneka Rains, BSEE, CBET, who is currently the director of clinical engineering for Rosellini Scientific. With help from Exxon, and MediSend used medical equipment is provided to hospitals in developing countries. MediSend also tests and repairs laboratories and provides certified training and education in biomedical equipment technology. That’s where Rains comes in. “While working at MediSend, I also repaired and tested hundreds of medical devices that were donated by large foundations to various developing country hospitals,” she says. “We filled 50-foot shipping containers with as much donated equipment and supplies as we could fit in the containers. Our team ensured that the equipment was outfitted and tested to work in the countries that we were sending them to.” MediSend International is a not-forprofit organization that works with healthcare systems in developing countries. The organization’s Global Education Center and distribution facility are located in the Elisabeth Dahan Humanitarian Center at MediSend’s headquarters in Dallas, Texas. While it may not seem like an adventure working close to home, the task of training biomeds from dozens of countries, and assembling custom biomedical kits, can be fraught with challenges. During her four and a half years with MediSend International, Rains learned to appreciate the challenge her students faced by leaving their native environments for six months.

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“We filled 50-foot shipping containers with as much donated equipment and supplies as we could fit in the containers.” – Sheneka Rains, BSEE, CBET

TRAINING THE WORLD’S BIOMEDS “The MediSend International Biomedical Repair Program started as a pilot program founded and funded by ExxonMobil and mirrored DODs BMET program in many ways,” Rains says. “We brought students here to the United States from underdeveloped countries for a six-month, ultra-intensive course that consisted of more than 950 hours of hands-on instruction — exceeding the number of hours of an associate’s degree.” Rains has worked with students from Kazakhstan, India, Palestine, Papua New Guinea, Haiti and many African countries. “We taught them electronics, basic safety (CPR/blood borne pathogens), medical device development, operating principals, clinical usage, maintenance and troubleshooting,” she says. The troubleshooting portion of the training covered 32 major classifications of medical equipment, ranging from suction pumps and centrifuges to defibrillators, clinical chemistry

analyzers and diagnostic ultrasound imaging systems. “We believed that an effective technician must understand the normal operating condition of the medical technology they support, so we spent a lot of time teaching theory of operation and clinical usage prior to troubleshooting and preventive maintenance,” Rains says. “This teaching methodology is one of the differentiators that makes MediSend’s program unique. The student’s remaining two weeks were spent at a state-of-the-art hospital for an internship experience,” she adds. “It was important to have the training here to better control the learning environment, expose them to their future and the future of medical technology, break them of their old-world habits and create a solid English-based teaching platform.” Rains responsibilities were the electronics, ultrasound physics, medical equipment program management and clinical chemistry system courses.

Sheneka Rains demonstrates how to use an ultrasound.

ASSEMBLING BIOMEDICAL KITS “I also designed, procured and assembled biomedical kits,” Rains says. “Each kit had over 4,000 components and had everything needed to set up a biomedical shop with test equipment, supplies and consumables to maintain 80 percent of all medical equipment found in a hospital. I trained 96 technicians in the five years I was at the school and made over 100 of the biomedical kits.” Those biomedical kits were specifically tailored to a hospital in the destination country. “For example, all biomedical test equipment had the proper power configuration and plugs to match the recipient country,” Rains says. “We also took an inventory of the recipients’ hospitals’ patient monitoring equipment and ensured that the kits had the proper peripheral adapters to test and repair their equipment.” Rains says that one challenge of working with donated equipment was finding the necessary accessories before shipping the equipment off to its final destination. “MediSend International also took in gently used medical equipment donations,

Sheneka Rains instructs a class during her time with MediSend International.

less than five years old, outfitted them with the proper power configuration, supplies, accessories and literature for the recipient hospitals,” she says. “The challenge was often sourcing the additional supplies and accessories to support the device in the field. We aimed to be part of the solution not create more problems for the recipient hospitals.”

AS CLINICAL ENGINEERING DIRECTOR In her position at Rosellini Scientific, she is involved in important work also. “In my current role, as Director of Clinical Engineering at Rosellini Scientific, I help facilitate the evolution of medical technology projects into companies through business organization, managing operations, planning of growth and exit strategies,” Rains says. “Current projects include deployed medical services, telemedicine, clinical engineering services, pre-clinical/clinical trials and commercialization support for migraine therapy, overactive bladder and atrial fibrillation implantable neurotechnology — just to name a few,” she adds. Rains says that the entrepreneurial spirit

at Rosellini attracts like-minded people to the company’s projects. “We simply give them the tools they need to be successful and sit back and watch the results. It’s very gratifying,” she says. Rains is also a member of the North Texas Biomedical Association. In her spare time, she dotes on a pair of three-year-old twin goddaughters, who she describes as very smart. She is also an avid reader and enjoys rowing. “I row leisurely at the Dallas Rowing Club but hope to start racing this year,” she says. It was back in high school that Rains first realized that she should pursue a career in math, science or computers, after a counselor revealed the results of an aptitude test. She went to college to study electronic engineering. She first became a teaching assistant with MediSend. She went on to earn her CBET certification and became a full-time instructor of electronics and ultrasound physics. That early career choice proved fruitful for not only Rains, but for many others. Her efforts have had a global impact on the lives of countless patients.

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AAMI UPDATE

AAMI Annual Conference Sports a Fresh Feel

ttendees of the AAMI Annual Conference and Expo in Philadelphia, Pa., should expect changes in both substance and style this year.

Unique educational sessions, varying formats for presentations, an expanded Career Center, and new opportunities to network and brainstorm are among the features awaiting attendees. “We have really mixed it up,” said AAMI President Mary Logan, noting that the association hired an outside consultant last year, who attended the 2013 conference with an eye on looking for ways to improve the experience and generate a stronger sense of community. “People really want more interactive learning, shorter sessions, the opportunity to learn from one another, instead of just reading a PowerPoint presentation,” Logan said. They also want an element of fun, and Logan promised to deliver that as well. Among the first details attendees will notice is “AAMI Central,” located outside the educational breakout sessions. The space will allow attendees to meet and mingle as they browse the latest AAMI publications at the bookstore. Speakers from the sessions also will be on hand to take questions. Those looking for a job are urged to

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visit the Career Center, which, over the past 10 years, has helped both employers and job seekers meet and network. This year, the center will have more recruiters on hand than ever before. Companies looking for employees include ARAMARK Healthcare Technologies, Health Tech Talent Management, ISS Solutions (Geisinger), TriMedx (Medexcel), Modern Medical Systems, Sodexo, Stephens International Recruiting, Universal Hospital Services, and the U.S. Department of Veterans Affairs.

TMC WELCOMES NEW MEMBERS A human factors expert with a Toronto-based health network, a management professional with a background in information technology (IT), and a seasoned healthcare veteran with 37 years of experience in administration, engineering, and clinical technology will join the AAMI Technology Management Council (TMC) this year. The TMC represents thousands of biomedical equipment technicians,

clinical engineers, and other professionals who manage and service medical technology around the world. The council tackles issues that matter to these professionals and looks for ways to highlight the crucial role they play in modern healthcare. Melissa Griffin is passionate about ensuring patient safety both in the home and hospital settings. As a human factors analyst at the Centre for Global eHealth Innovation within the University Health Network in Toronto, Griffin has helped run numerous usability studies to help determine the best designs for medical equipment. Currently, she is co-leading an exploratory study for a cancer agency to examine safety concerns and best practices related to prescribing, dispensing, and administration of oral chemotherapy. As chief information officer at Johnson Memorial Hospital in Franklin, Ind., Scott Krodel developed a strategy plan to meet “meaningful use” requirements. He considers working with other departments — clinicians, pharmacists, and others — as an essential component to ensuring patient safety and keeping a hospital running. During his career, Krodel has managed projects ranging from software architect design, to IT best practice deployment, and ongoing operational management.

For the Biomedical Engineering Technology Professional

Biomed Ed is now partnered with Penn State New Kensington to offer Continuing Education Units (CEUs) and Course Certificate for ALL courses offered by Biomed Ed.

On-Line Courses: 19 Medical Equipment Courses available Dennis Minsent is the director of clinical technology services at the Oregon Health & Science University in Portland. Minsent was in the U.S. Air Force (USAF) for 20 years, ending his career as chief of the USAF biomedical equipment support at the Air Force Medical Logistics Office. In that role, he managed worldwide operations for the biomedical equipment support program. The terms for the new members begin immediately after AAMI’s Annual Conference and Expo.

AAMI RELEASES DIALYSIS USER GUIDE TO HELP WITH COMPLIANCE The water used to treat hemodialysis patients can pose a great risk, as it can contain contaminants such as chemicals, bacteria, and toxins. End-stage renal disease (ESRD) outpatient dialysis facilities must meet specific federal requirements, including those dealing with safe water, to remain in compliance with Centers for Medicare & Medicaid Services (CMS) Conditions for Coverage. To help those professionals who are responsible for the oversight and operations of hemodialysis facilities, AAMI has unveiled “Dialysis Water and Dialysate Recommendations: A User Guide”. Expert Glenda Payne edited the resource, which is intended to help

these individuals understand regulatory requirements and current AAMI guidance. Payne’s background includes surveying dialysis facilities and renal transplant centers in Texas. In addition, for more than 20 years, she was a member of the CMS core faculty that trained surveyors responsible for surveys of dialysis facilities. The idea for the updated resource came as a result of an evolution in AAMI standards. In 2008, CMS published a major revision of its conditions for coverage to incorporate almost all of ANSI/AAMI RD52:2004, Dialysate for hemodialysis. However, in 2012, AAMI released TIR43, Ultrapure dialysate for hemodialysis and related therapies, which updated and replaced RD52. The change meant the conditions for coverage no longer mirrored current AAMI standards. The guide is intended to help facilities understand the changes. “I hope this guide will help all dialysis providers move to the use of higher quality water, and thus provide better quality treatments for dialysis patients,” Payne said.

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SMART PUMP ASSESSMENTS

Tips and Tools For Getting it Right

erforming a meaningful clinical assessment of smart infusion pumps, including getting high-quality end-user feedback and correctly interpreting the test data, requires careful preparation. Here’s help in defining a process that will produce smart purchasing decisions and improve buy-in from your users. When you’re shopping for infusion pumps, especially smart pumps, having end users test prospective models can be immensely helpful. Not only do these clinical assessments provide assurance that the models are clinically appropriate for their intended use within specific care areas, but they also provide an opportunity to solicit end-user input on the pumps’ ease of use, which can be integrated into purchasing decisions. The result is increased end-user buy-in and acceptance of incoming equipment. But a hastily prepared or poorly thought-out assessment can produce misleading or even useless results. To get the most reliable and helpful data, a smart pump assessment requires careful preparation – namely: • Working with appropriate personnel to review clinical practices in your facility or department, and deciding what factors should be included in the assessment and the relative importance of those factors. • Based on the results of the previous step, developing assessment forms for

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end users to fill out that highlight relevant ease-of-use or other issues they may encounter when using the pumps, as well as the key differentiating factors between the pumps. • Deciding which pumps will be included in the assessment, and ensuring that all the pumps under consideration are available at one time and are configured to allow interactions relevant to the facility. • During the assessment, ensuring that guidance is provided on how to use the pumps correctly and what features to look for, while keeping assessors from being swayed by factors like marketing materials and sales personnel.

CHOOSE THE ASSESSMENT QUESTIONS Perhaps the most important part of the planning process is making sure the questions asked as part of the assessment reflect the most important issues for your facility. Before creating the form that will be used during the assessment, you’ll need to bring

stakeholders together and get them to agree on what aspects of the pumps should be the focus of the clinicians’ attention. This is also the time to develop the weighting that will be applied to each question during the scoring of end users’ responses. You’ll want to keep the list of questions as short as possible while also asking about all the important issues as specifically as possible. The next step is to create the assessment form. Keep the form as simple and easy to use as possible. ECRI Institute recommends a hybrid form that asks for both quantitative and qualitative impressions: Asking the clinicians to assess each pump on a consistent scale allows the aggregation and analysis of data, but it’s also useful to ask open-ended questions to solicit feedback that doesn’t fit into the scoring matrix.

DEVELOP CLINICAL SCENARIOS AND A DRUG LIBRARY ECRI Institute also recommends developing clinical programming scenarios – standard tasks that each participating clinician will perform on each device to trigger soft and hard drug library limits and to highlight other model-specific aspects. The goal of these scenarios is to give clinicians a sense of how easy it is to use and understand the devices’ alarms and other design elements. It’s important to develop the clinical

scenarios and the drug library in tandem so that, for example, each scenario refers to a drug that is included in the library using the appropriate drug name, dosing units, and starting dose.

COORDINATE WITH VENDORS Coordinating with vendors to get all their devices in a facility at the same time takes a significant amount of work; however, it’s worth the effort. First, impressions may not be retained over time, making it hard for clinicians to properly compare a device they are seeing today with one they tested a week or a month ago. Second, having all the devices in the same place at the same time allows clinicians to move back and forth between them; this will be helpful if they discover something on one pump that prompts re-examination of another. Third, having just one or two days set aside for the pump assessment can minimize the disruption to your facility.

SET UP THE ASSESSMENT TO SUCCEED On the actual day(s) of the assessment, it’s important to prepare so that clinicians can make informed comparisons between the devices. Clinicians should be familiar with the theory behind drug libraries and soft and hard limits; if this is your first smart pump purchase, it may make sense to provide some form of training along these lines before the assessment. Clinicians should be introduced to each pump – this can be done by the vendor representative or by someone on the facility’s selection committee. Here are some additional pointers to help things run smoothly: • Leave plenty of room between pumps so that clinicians can interact with them without getting in each other’s way. • Allocate enough time so that clinicians from every shift can participate in the assessment. Keep in mind that this will tie up the assessment space for the duration of the assessment.

Perhaps the most important part of the planning process is making sure the questions asked as part of the assessment reflect the most important issues for your facility. • Have someone from clinical engineering on hand to answer questions about how each model works and to troubleshoot device problems. • Prevent supplier representatives from pointing out the strengths of their own models and potentially swaying clinicians. You can give them strict instructions or even keep them out of the assessment room altogether. • Have contact information for each supplier available to handle model-specific questions and for troubleshooting.

PREPARE A REPORT OF THE ASSESSMENT When preparing a report, you should start out by converting the assessment results into scores for each pump. If you are using the scale in our example assessment, calculating an overall score for each pump is straightforward. First, convert each clinician’s good (+), bad (-), and neutral (0) ratings into numbers (+1, -1, and 0, respectively). Apply weightings as determined during the planning. Then average everyone’s responses for each

question for a given pump and determine an overall weighted average. The open-ended questions can provide further insight. It’s important to discuss the results of the data analysis with nursing managers for buy-in and validation before making a final recommendation to the purchasing committee. THIS ARTICLE is an excerpt from a Health Devices article posted on ECRI Institute’s Health Devices System, Health Devices Gold, and SELECTplus membership websites on February 5, 2014. The full article includes more guidance on the pump selection process and several supplements. The supplements include: a pump assessment and scoring form template, examples of clinical scenarios and a drug library, and a letter template for inviting vendors to participate in a hospital’s pump evaluation. To purchase this article and its supplementary materials or to learn more about membership programs, visit www.ecri.org, contact clientservices@ecri.org, or call (610) 825-6000, ext. 5891.

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new plastic molds in 7 different colors of the X2 clip that snaps into the existing area. Garnet also developed a color-coded table to correspond with departments in the hospital. Cook Childrenâ&#x20AC;&#x2122;s has purchased the clips and is using them as follows: red is for emergency room, blue is for PICU, pink is

for NICU, orange is for OR, purple is for BMT, green is for surgery and yellow means it is open. FOR MORE INFORMATION about this tool, contact Steve Smith at stevesmith@GarnetBiomedical.com.

JUNE 2014

1TECHNATION.COM

SHOP TALK

Conversations from the TechNation Community COMMUNICATING WITH THE C SUITE

How do you report value and savings to the C suite? I am looking for a way to communicate how the CE/ HTM department contributes to the bottom line.

COSR (Cost of Service Ratio) should be your benchmark. COO (Cost of Ownership) should be another for high-end devices. I use both. There are lots of good articles on COSR. COO is something we have been preaching for years now. COO covers all service costs including any contract costs. We look at 5-10 years of projected costs. You have to look past just the capital costs.

So is there a site that managers can compare COO so that we can better evaluate for purchasing?

In my case, I was recently hired as the supervisor of our department. My department had been under the direct supervision of the facilities maintenance director who has no background in HTM. My department had been running this way for years, and I will give my techs credit, they are highly thought of in the facility. They are great at performing repairs down to the circuit board component level and maintaining the PM schedule. Coming in from a different employer, my chief worry was personnel issues. That has not been the case at all, but policies, procedures, and (two weeks after I started) the latest CMS mandate have

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been my focus. In the year before I started, the department had moved the service and maintenance of our sterilization equipment, with the exception of the Sterrad, in-house. Since I am well experienced with the equipment we have, this was a perfect fit for me, and translated to about $60,000 a year in contract savings. In a 210-bed facility, that is a number that gets attention. When I was interviewing for my position, I was asked what else I would move in-house that would be comparable and as easily done. My answer, prefaced with the fact that I had no idea of the facilityâ&#x20AC;&#x2122;s inventory, was anesthesia machines. I was able to show that the break-even on costs (factory training, analyzers, etc versus contract costs) would be less than two years for one tech, and slightly over two years for two techs. When I started, I was approached fairly quickly by the director of our respiratory therapy department asking if I would be interested in moving all of his ventilators and PFT machines in-house. I was able to show that the purchase of the analyzers and other miscellaneous equipment would still break even in around nine months, since I have factory training on one vent that we have and one of my techs is factory-trained on another. The capital purchase of the new test equipment was approved as soon as I turned it in. The huge plus for my department now is the fact that everything we need to maintain our anesthesia machines, except for the gas analyzer,

was purchased for the vents. So, my estimated cost has now dropped considerably. Our anesthesia machines have been on a lease that runs out in July. I was contacted in February by the director of our anesthesia department requesting my assistance on setting up anesthesia machine demonstrations and performing COO (cost of ownership) analyses on each one that we would demo. In our discussions, I requested that each manufacturer be directed that their bids include training for two technicians, period. She was actually excited to hear this; she had no idea that we were planning on moving her machines in-house. To her, this translates to a five-minute wait for a tech when a machine goes down instead of the current three-hour (or even tomorrow sometime) that she currently has. We have now completed three of the four demos that we are going to do, and both she and our procurement director have each received Biomedical and COO analyses on them. This is the first time that this type of analysis has been done on a capital purchase here. I guess that the short answer would be that if you want the C-Suite to notice you, find what you can do to make their jobs easier. In my departmentâ&#x20AC;&#x2122;s case, this translates to making it possible for them to report well over $100,000 in contract savings to the board within two to three years. The fact that we are also showing that we want to take on more and more responsibility for more and more of our equipment gets their attention, too.

PASSWORD HELP

Would anyone know the service mode password for the Edwards Lifesciences Vigilance II CCO monitors? I need to review the error logs.

A A A

All zeroes, or fives, or eights, typically. 8898

Don’t know if this will work but demo on ours is 0000.

SERVICE MANUAL REQUIREMENT

Have any of you heard of a requirement for a hospital to have a service manual for each like devices? If so is this a CMS or TJC requirement?

There is no requirement for hospitals to have the service manuals. Several guidelines, and some state laws may mention performing service in accordance with manufacturer specifications, and many times, the only way to prove compliance with that requirement is through possession of the service information. X-ray servicers are required to perform checks in accordance with 21 CFR 1020.30-33, and the X-ray service manuals are expected to be present in the X-ray room. This is not always the case, though it has become a fairly common practice. 21 CFR 870.170 requires that manufacturers of any device requiring installation provide

installers and maintainers with adequate installation and maintenance information to ensure the device is working as expected after installation. So, again, there are no requirements either with TJC or any accrediting body I know of that requires hospitals to have service information. It would be a little unfair if they did, especially considering many hospitals hire outside companies, or even manufacturers, for maintenance. There are, however, requirements for servicers and installers, though these requirements may not apply to all medical devices. The military requires it of their biomed shops – you must have the service information available, and in some cases, you must have the service information present while servicing. I believe this should be everybody’s standard, and we should all work toward achieving it.

If your state has adopted NFPA 70 or 99 both documents reference the requirement for service manuals. That being said, in 40 years of biomed I have not seen an inspector who actually cited this if they were aware of it.

THESE POSTS are from TechNation’s ListServ. Go to www.1technation.com to find out how you can join and be part of the discussion.

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BIOMED 101

A Look at RTLS Technology By Christine Vogel

n a large institution, there can be upwards of 20,000 medical devices that are managed by a biomedical engineering department. Real Time Locating Systems (RTLS) save hospital employees time by enabling them to locate devices quickly. Biomedical Engineering Technicians (BMETs) can use the web-based user interface to search for a device that is due for preventive maintenance (PM) or is affected by a recall. Clinicians can use the web interface to quickly locate a spare medical device such as an infusion pump. In addition, the RTLS prevents devices from becoming lost or hidden. VALUE OF RTLS When equipment is lost, the hospital needs to secure funds to purchase replacement equipment for the misplaced devices. Thus, the RTLS allows hospital personnel to spend more time completing their job duties and less time physically searching for medical equipment. In addition to asset management tracking, RTLS technologies are broadening to include other areas of healthcare monitoring such as temperature and patient monitoring; however, this article focuses on RTLS use for tracking medical equipment.

RTLS COMMUNICATION METHODS CHRISTINE VOGEL Christine Vogel is a clinical engineering intern at Brigham & Women’s Hospital and a graduate M.S. student at the University of Connecticut. She placed second in the American College of Clinical Engineering essay contest with a paper on troubleshooting a RTLS system.

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Some of the most common communication methods used for RTLS are Radio Frequency Identification/ Infrared (RFID/IR), Zigbee, Wi-Fi and ultrasound. Healthcare Provider Organizations (HPOs) should carefully weigh the benefits and risks for the type of RTLS communication that a vendor’s product uses. The RTLS signal transmission should not interfere with other communications on the HPO’s network such as Wi-Fi, which may be used for cellphones or telemetry devices. However, Wi-Fi can leverage the hospital’s previously installed access points so that additional receiver hardware does not need to be purchased

for the RTLS. With RFID/IR RTLS, tags transmit two types of signals, RTLS and IR, to the receivers. Thus, RTLS specific receivers and cabling must be installed throughout the facility. On the other hand, RFID/IR improves the system’s accuracy by employing multiple ways of detecting the signal. RF provides coarse-grain positioning (e.g., floor) while the IR signals provide additional resolution (e.g., room). The IR technology transmits optical signals that cannot go through walls and therefore provides room-level tracking. For all of these methods, there are three major components of the RTLS: the hardware, the software and the web-based user interface. The hardware includes tags, which can be passive or active, access points, the RTLS server, and potentially exciters or chokepoints. The software may include different components such as a database interface, a RFID interface and a web service (Real Time Locating Systems 2009, 6-7). The RTLS company’s employees may use the RFID interface software to tune the receivers to accurately locate tags. The webpage application allows the user to search for a tagged medical device in any area of the hospital equipped with RTLS receivers. Most companies’ webpage also shows a floor map with the medical device’s location pinpointed on a certain floor of the facility. The webpage

application needs to be updated whenever a tag is unassigned from a device or assigned to a new device. Trilateration collects data from multiple receivers near a tag and uses a series of algorithms to calculate the location of the tags. The received signal strength at each receiver from the tag signals is used to determine the distance of that tag from each of the three surrounding receivers. Next the position of the tag is computed by drawing an imaginary circle around each reader that surrounds the tag (Real Time Locating Systems 2009, 5). The circle radius corresponds to the tag’s computed distance from each receiver. The intersection of three circles defines the tag’s position.

RTLS RFID/IR SYSTEM MAINTENANCE The RFID/IR RTLS infrastructure includes the battery-powered tags, which are affixed to many of Biomedical Engineering’s medical devices, receivers and cabling from the receivers to the switches in network closets. The receivers, also known as tag readers, pick up signals sent from the tags. Each receiver has its own unique, static IP address with an attached label such as “Biomed shop,” or the name of the place where the receiver resides. The receiver sends information to the server through this labeled path. To get to the server, the data is sent from the receiver through

an Ethernet cable to a switch in a network closet. A router then passes this data from the switch to the server. After the RTLS is installed, the institution should implement a maintenance plan to ensure that the system’s accuracy is kept above a certain level, such as 95 percent of tags identified in their actual location. The maintenance plan should include replacing active tag batteries, verifying receiver connectivity to the server and installing receivers in any new construction areas. Active tags have internal battery power and ping receivers intermittently. Typically, BMETs replace these batteries when they perform repairs or preventive maintenance on the tagged devices. Some receivers may be installed, but not connected to the server. There are multiple reasons why a receiver does not communicate with a server. First, the cable that runs from the receiver to the patch panel in the network closet may be damaged. The cable that runs from the patch panel to the switch may not be connected to the correct ports. Also the IP configuration of the switch may not be programmed for a certain receiver. If a receiver’s location changes, the RTLS company’s team needs to document the new location of the receiver, the receiver’s serial number and IP address in their database for record keeping and programming purposes. In

Aeroscout. 2014. “The Aeroscout Difference.” Accessed April 8. http://www.aeroscout.com/aeroscout-difference. Clarinox Technologies Pty. Ltd. “Real Time Locating Systems.” Nov. 2009. http://www.clarinox.com/docs/whitepapers/ RealTime_main.pdf. Health IT Outcomes. December 1, 2009. “Brochure: Ekahau RTLS.” http://www.healthitoutcomes.com/doc/ekahau-rtls-0001?referringlink=SiteSearch. Kreimer, Susan. 2013. “RTLS Provides Hospital With The

addition, it is a smart idea for the Biomed department to also maintain an internal record of this information regarding the status of all the institution’s receivers. It is important to educate people working within the hospital not to remove RTLS receivers without consulting the Biomed department first. Another reason to move a receiver from its original location is if an area will be under construction or renovated.

SUMMARY In summary, the specifications of different vendors’ technology offerings should be compared. One important specification to evaluate is the type of communication technology employed by the RTLS. The most prominent RTLS communication methods include a combination of RFID and IR, Zigbee sensors and Wi-Fi. It is important for the Biomed department to work with a wide variety of groups, such as clinicians, the RTLS vendor representatives, electrical contractors and Information Systems personnel, in order to install and maintain the RTLS.

ACKNOWLEDGEMENTS: I am thankful

to Prakhar Kapoor, Clinical Engineer, Brigham and Women’s Hospital, for his expertise in RTLS and his mentorship. I would like to acknowledge Michael Fraai as well for his support and for sharing his knowledge on RTLS systems.

Gift Of Time.” Health IT Outcomes, October 1. http://www. healthitoutcomes.com/doc/rtls-provides-hospital-with-the-giftof-time-0001?referringlink=SiteSearch. Snowday, HT. 2010. “Understanding RTLS in Healthcare.” Health IT Outcomes, June 9. http://www.healthitoutcomes. com/doc/understanding-rtls-in-healthcare-0001. Wikipedia. 2014. “Real-time locating system.” Last modified March 4. http://en.wikipedia.org/wiki/Real-time_locating_system.

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ROUNDTABLE Infusion Therapy

his month, TechNation asked experts about purchasing and servicing infusion therapy devices. The panel of responders includes Engineering Manager Oswaldo Chavez from Tenacore Holdings Inc., AIV Inc. Director of Sales Jeff Taltavull and Robert Caples, owner of Med-E-Quip Locators Inc.

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN INFUSION THERAPY AND IN THE INFUSION THERAPY MARKET IN THE PAST YEAR? Taltavull: More integration with wireless delivery and monitoring systems will become more prevalent as the technology becomes more accessible and affordable. Chavez: The latest advances include continued improved patient safety and data communication. Patient safety improvements include technologies like bar code scans to confirm the “Five Right” test (right patient, right drug, right dose, right time and right administration) and wireless communication of infusion delivery performance. The electronic communication over a hospital’s network reports the functionality and operation of in-service pumps. It also supports remote correction of the pumps’ performance. Caples: The biggest significant change is the coming out with the new smart pumps.

HOW WILL THOSE CHANGES IMPACT THE INFUSION THERAPY MARKET IN THE FUTURE? HOW WILL THEY IMPACT MAINTENANCE? Taltavull: As a third-party vendor, our technicians will need to be trained to properly repair and maintain these new technologies correctly. Chavez: Technology has increased the speed to impact of many variables within a hospital’s daily regimen such as staff

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resources required, time required for implementation, and patient safety – in addition to ROI. The key impacts will be an improvement to the quality of patient care, improvement to the speed of information and patient data, improvement to the dosing methodologies via drug libraries, improvement to nursing satisfaction and productivity, and platforms that allow integration with future technologies.

protocols. Facilities with limited budgets should look into rental companies that offer the new technologies, this would reduce the facility’s initial investment and spread the cost over the monthly usage. Another approach would be to upgrade existing infusion equipment with the OEM on a more frequent schedule while the exchange value is high and not waiting until end of life to invest in new technology that could be a two- or three-generation upgrade.

Caples: The material managers will be afraid of not being able to connect and upload with what they are currently using with the units they purchased from the manufacturer and there is always the chance the unit(s) may have been stolen from a different hospital.

Caples: The Medley 8015 Point of Care unit is worthy of the initial investment but with hospitals that cannot afford these units they must be able to show and document TJC and FDA that they are more than capable of taking care of the old technology and that OEM parts will be available for years to come.

WHAT TECHNOLOGIES ARE WORTHY OF THE INITIAL INVESTMENT? HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE INFUSION THERAPY NEEDS OF TODAY? Taltavull: Facilities with limited budgets can take advantage of the third-party refurbished pump market where used equipment is brought back to like-new condition, enabling facilities to meet all of their infusion therapy needs for a fraction of the cost of a new pump. Chavez: Add-on technologies that are worthy of investments would first need to be vetted by the hospital as a real need and would impact performance. Technologies worth looking into would include wireless technology, performance communication, data sharing, drug libraries and dosing

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING INFUSION THERAPY?

Taltavull: Have a good partner. Whether it’s the OEM or a third-party vendor, use someone you trust to handle the work that you need to send out of your biomed shop. Being on a first-name basis with your service provider enables both of you to understand and anticipate the needs of your facility together. Chavez: It is a location-by-location or network-by-network decision. A facility must understand its current infusion needs and future capabilities required with changing services, regulations and growth.

A facility does not want to overbuy on technology that will not improve performance of its services, but also needs to be concerned that it does not limit future growth by under buying technology. The key to service will be aligning with a servicer that understands more than just the infusion pump functionality, but also understands all the other technologies that support the pump and its communications plus supply the appropriate software. Caples: Know your equipment, and shop OEM parts that you may need. Don’t buy the first quoted parts from the manufacturer. There are only a handful of companies capable of mass-producing the OEM parts that the hospital can buy, but at almost half the cost. Biomeds and material managers must not be fooled into doing it the same way it’s been done for years. It’s their responsibility to know how the pump works and they must have little card indexes that they can refer to for competitive pricing, in other words, don’t be satisfied with the first price

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REPUTABLE THIRD-PARTY INFUSION THERAPY PROVIDER? Taltavull: Quality and longevity. Chances are a company that has been around for 30-plus years is doing things right when it comes to your biomedical needs. You should also see what others are saying about third-party vendors through your local biomed and HTM organizations. Chavez: The most important things are competence, quality and protocols. Competence includes OEM training, experience and turnaround time. Quality includes workmanship, compliant risk mitigation, ISO certification and warranty. Protocols include third-party equipment handling procedures that match a facility’s rights and responsibilities document, HIIPA compliant, and meet local or state regulations.

Caples: Look to see how long they’ve been in business. Check to see if their biomeds have been certified and factory trained by the infusion pump manufacturer. See if they are approved by the Better Business Bureau or TJC certified or ISO approved. Lastly, it’s the third-party provider’s reaction time when something goes wrong with a piece of equipment they have bought from this third-party company. To me, you have to give 100 percent effort from the time of the sell until the end of the warranty and hopefully beyond. No one is as important as the customer.

IS IT POSSIBLE TO KEEP UP WITH THE LATEST INFUSION THERAPY ADVANCES AND IMPROVEMENTS WITHOUT BUYING BRAND NEW? WHAT ARE SOME OF THE NEWER TECHNOLOGIES AVAILABLE? Taltavull: There is a large market of refurbished pumps out there. Newer models can be harder to come by, as they are normally under warranty, lessening the chances the pumps become available for third-party vendors to refurbish and resell.

Chavez: Similar to facilities with limited budgets, they should look into rental or leasing from companies that offer the new technologies. This would reduce the facility’s initial investment and spread the cost over the monthly usage. Another approach would be to upgrade existing infusion equipment with the OEM on a more frequent schedule while the exchange value is high and not waiting until end of life to invest in new technology that could be a two- or three-generation upgrade. Caples: Yes, by reading and the Internet. They have some great videos on “YouTube” explaining the newer technology and how it works.

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HAR BY K. RIC

of medic ackgrou the HTM inventory ly in the b e story of th th o o at ll te sm r to u occ ion’s was are of wh The idea want it to the profess fully unaw t ss h li r g e b li e th h b o ig n d an y ca and h hospitals where the profession ibutions to tr n o ing. c reasons is n t e n p is hap . importa the wrong ts r n ts e fo n e m n n o m o ti rt en envir e right depa While att ility for th healthcare ionals and ib ss is fe v se ro t, t” p u -i o e , th ght hts of tho e “fix For years never sou The insig seen as th . n lp e g e ft h r in o o rr ly re e u n an o ls, we ral rec morgu reasons c in hospita xt to the d on seve e re n s. t te ie n n it d e e il c n m c a h ite wit om fa depart y the C-su we spoke ishable fr guys, the dM rception b e indistingu T p s as the me H e n l e a o th n th rs e s; io d e p e ss m g fe e g o th ro d p repair s a M e nh ghtof the HT to know th perceptio elped enli clinicians If this mis ; the need has not h rt ie it p ic x s, rt e n a y p ia g e olo hav clinic aintain ical techn field with those who ite and m h u it -s w C t e n e th of artm priorities d in other tle. en the dep mittees an ve of their ti ti m rt u o a c c e p x s in e a f n o pati s. “chief” up of chie noloional to rship role ite, made chief tech M profess ght-leade , u T rs o e H c The C-su th e ffi th o r ng e useful fo the C-suit ief operati cers and It is also officer, ch ation offi of those in s rm rune l fo ti e a il ri it in h o f sp ri w ie o p , ch vations of the h ect the ti e o sp d m re si gy officers ir ss e e th sin every derstand ve the bu ve minds n. and to un others, ha ir collecti rganizatio e o th f re o a is c t o h n h lt o a w fr e t h re u a o fo b g e nin in th ly think a d y may rare torying an n e v day. The in , g maintainin repairing,

IMPROVING VISIBILITY

IMPROVING

SCORING POINTS It’s all about opening up lines of communication through professionalism and offering options for decision making.

“Experience has taught me that gaining visibility to any chief business decision maker or committee, such as the C-suite, can only be accomplished through professional

Huntington Hospital in Pasadena, Calif. is a member of the EOC committee, Capital Medical Equipment Committee, Clinical Research Committee, Clinical Leadership Committee and chairs the hospital’s Clinical Alarms Committee. Her clinical technology department has eight employees, including six technicians and an admin. The department reports to the CIO.

“ Experience has taught me that gaining visibility to any chief business decision maker or committee, such as the C-suite, can only be accomplished through professional and effective representation and communication.” – Curtis Ange, BSTM, Manager, WellStar Health System

and effective representation and communication,” says Curtis Ange, BSTM, Manager, WellStar Health System in Marietta, Ga. “As a leader, it’s my job to bridge information both to and from my department as well as providing options, facts or opinions to the C-suite business leaders in regards to fiscal plans, available technologies, project timelines, inherent risk factors, capital expenditures, warranties, service agreements, or anything else that may impact the organization financially.” The participation of the clinical engineering leadership on committees can be a boon to a hospital’s HTM professionals. Combined with projects that help the hospital with budgetary constraints and patient safety. Izabella Gieras, MS, MBA, CCE, director of clinical technology at

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“The staff works very closely with IT and all clinical end users, maintaining close to 9,000 pieces of medical equipment,” Gieras says. She says that several significant undertakings have helped increase the department’s visibility. “Participation, and often leadership, of multidisciplinary teams on medical equipment evaluations” has been one way that her department has maintained visibility, according to Gieras. “Oversight of medical device integration to EMR for anesthesia gas machines and physiological patient monitors,” has been another. Gieras also says that finding cost-effective and efficient solutions through the management of service contracts can capture the attention of the C-suite, which is always interested in the bottom line. Also, educating clinicians on the proper operation

and safe use of medical equipment shows upper management that the biomed department adds value in several ways. The clinical technology department at Huntington is also involved in assisting in hospital-wide regulatory reviews and risk assessments and the development of strategic, multiyear medical technology replacement planning. These value-added services catch the attention of those watching the budget.

HTM EXPERTISE

Establishing a sense that the HTM professional is in the driver’s seat and the resident expert on all things related to medical equipment is shared by Perry Kirwan, MSBME, senior director, Clinical Technology Assessment and Planning for Banner Health. “Visibility is increased by performing functions that are difficult for most IDNs. We develop and lead processes to standardize clinical technology throughout the enterprise,” Kirwin says. “We were allowed to pursue this role/responsibility by demonstrating three key things – subject matter expertise, process development and the ability to use data to drive decisions, and ability to move large groups to consensus.” “Standardization reduces variation in healthcare delivery and leverages the full purchasing power of the IDN,” Kirwin adds. “Both drive value in terms of clinical quality/outcomes and the financial bottom-line.” Kirwin points out that the role of the healthcare technology professional also includes developing and leading processes to evaluate and assess new clinical technologies for their facilities. “This represents the convergence of evidence-based medicine to clinical

technology acquisition and adoption strategy,” he says. “This function actively interacts with physician thought leaders who design care practice and delivery of healthcare by the clinical service line/discipline.” Patrick (Pat) Lynch, CBET, CCE, CPHIMS, HIT Pro/PW, of Global Medical Imaging in Charlotte, N.C., has put a lot of thought into this topic. Lynch presented “Talking to the C-suite: How to get their support” at the MD Expo held in Las Vegas earlier this year. Lynch says that a good starting point is for the HTM professional to know who the members of the C-suite are and their responsibilities. He points out that the goals of the C-suite are multi-faceted and include everything from attracting physicians and overseeing daily operations to dealing with competing hospitals and keeping up with state and federal regulations. It helps also, according to Lynch, to be aware of what the C-suite’s priorities are. He says that their top issue is “financial,” followed by patient safety and quality of care, care for the uninsured, physician-hospital relations and personnel shortages. To know what hot buttons are important to the C-suite, you have to understand their world view. “First, we technical people do not think in the same terms as does hospital administration,” Lynch says. “Our vision is much more tactical and immediate. We are problem solvers. We have difficulty putting our proposals in terms of long-term, strategic goals.” “I specifically obtained an MBA so I could understand the thought processes of upper administration. It is this process of adapting to the wants, needs and priorities of the C-suite that is essential to biomed becoming strategic partners,” Lynch says. Lynch says that when the biomed

“I specifically obtained an MBA so I could understand the thought processes of upper administration. It is this process of adapting to the wants, needs and priorities of the C-suite that is essential to biomed becoming strategic partners.” – Patrick (Pat) Lynch, CBET, CCE, CPHIMS, HIT Pro/PW, of Global Medical Imaging

shop makes requests of the C-suite, the request should be framed in a way that addresses the needs of the administration and not just the needs of biomed. “Let’s face it, as BMETs, we all take human anatomy and physiology to better be able to talk with nurses and doctors,” he says. “We do not expect them to learn our language. It is up to us to translate our conversations into language and terms that they understand and relate to. We have not taken this step with administration.” “We speak to them in techno-geek talk and expect them to be able to translate it into hospital long-term goals. It does not work,” Lynch says. “We have to spend the time and effort to be able to reframe our goals in terms of the goals of the overall organization.” In a presentation at last year’s AAMI conference, titled “C-Suite Driven Clinical Engineering Operations,” John-Paul Guimond, director, THCE Operations for Trinity Health Clinical Engineering covered the importance of thinking outside the box. Emphasizing the point that Lynch makes about knowing the C-suite’s concerns, Guimond asks if

the biomed shop understands the C-suites view of them. Does the C-suite think of CE as the “fix-it shop,” able to fix only general biomed equipment, but not the high-end stuff, or a department that doesn’t understand finances? Conversely, he asks of CE, do you benchmark, what makes your program better than an ISO and what are you doing to help your facility with capital planning? Guimond says that if you lead change, you will change the view of the C-suite. He suggests that CE set goals to “add relevance and importance to the services and value your department brings.” He also suggests that you “get smarter on service support expenses and look for opportunities to manage costs. Develop a good working relationship with the finance department or controller department, similar to the relationship built with key clinical department managers. Offer to help the CFO or controller with capital equipment purchases.” Getting the respect of the chief financial officer might come down to thinking outside the box. “COSR (Cost of Service Ratio) should be your benchmark. COO

IMPROVING VISIBILITY

(Cost of Ownership) should be another for high-end devices. I use both,” says Douglas Dreps, MBA, director of eastern regional operations for Mercy Clinical Engineering Services”. “(There are) lots of good articles on COSR. COO is something we have been preaching for years now. COO covers all service costs including any contract costs,” he adds. “We look at five to 10 years of projected costs. You have to

THE BOSS’S PERSPECTIVE

Thomas Malasto, chief patient experience officer for Community Health Network, provides some insights from the C-suite. “The items that catch my attention in my role as CXO, and this applies to any idea not only those coming from clinical engineering, include the following: Improve patient or team member safety, improve clinical

officer’s perspective. “Increasing visibility in the eyes of the C-suite comes down to understanding the challenges they face and creating value that matches their needs,” says Tim Riehm, MBA, CBET, CRES, vice president, Technology Management for Banner Health. Riehm suggests that the best approach is the same as in marketing or financial services — know your customer.

“If you want the C-Suite to notice you, find what you can do to make their jobs easier” – Dean Stephens, EET, CBET, supervisor, Biomedical Engineering Department, Penn Highlands Healthcare

look past just the capital costs.” Dean Stephens, EET, CBET, supervisor, Biomedical Engineering Department at Penn Highlands Healthcare says that cost considerations and a willingness to be an even bigger resource to the institution are two winning ideas for visibility. “If you want the C-Suite to notice you, find what you can do to make their jobs easier,” Stephens says. “In my department’s case, this translates to making it possible for them to report well over $100,000 in contract savings to the board within two-three years. The fact that we are also showing that we want to take on more and more responsibility for more and more of our equipment gets their attention, too.”

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outcomes, remove ‘waste,’ decrease cost or improve patient/family/guest perception of care.” “An idea with a material impact in any of these areas, or an idea that touches more than one of these areas in a meaningful way, are the ideas that get my attention,” Malasto says. “I also believe having a regular dialogue with key C-suite leaders is a must for clinical engineering. Look for a leader where you can establish a mentoring relationship and take advantage of their insight and sponsorship to get your voice heard.” There is a perspective that shouldn’t be missed when trying to understand the whims of the C-suite. Senior management is as plugged in as anyone and understands the chief

“Presenting traditional clinical engineering metrics that do not match the current landscape of healthcare provides little value to our stakeholders. The first step to creating visibility should always be to find out what is important to the audience and creating processes that help support those functions,” he says. “Increasing and keeping visibility is also equally important once you establish the connection,” Riehm adds. “Always be transparent in meetings regardless of whether the information is perceived as good or bad. C-suite members will respect the fact that you always present the facts and elicit support when facing tough obstacles.”

“ If the C-suite doesn’t understand the drivers of our business then we have little chance to place any value on the services we perform” – Tim Riehm, MBA, CBET, CRES, vice president, Technology Management, Banner Health

A VALUE PROPOSITION

Whether on the Internet or in a corporate setting, the concept of bringing value to any engagement is paramount. Websites that bring value to their visitors are particularly popular. Departments that bring value to a corporation or its customers are prized. The concept holds true in the relationship between the biomed or clinical engineering department and the C-suite as well. “Providing value to the facilities is one of the easiest things to accomplish, but one of the most difficult for traditional clinical engineering departments to present,” Riehm says. “Controlling expenses, decreasing capital expenses, increased clinical productivity, reducing variability in care, and providing expertise to many systemwide committees regarding technology are all examples of how to provide value.” “At Banner Health, we meet with several of the system-wide C-suite teams on a monthly or quarterly basis,” Riehm says. “During these meetings, we provide many of the updates above that impact the organi-

zation and tie them back to the overall system-wide goals of Banner Health.” Riehm expands on the concept of value with the suggestion that a transparent financial model can help the C-suite appreciate the cost versus service paradigm. “Creating a transparent financial model is also extremely helpful in regards to bringing value to our facilities. Clinical engineering expenses should never be a mystery to the hospital. Clearly outlining the expenses and the drivers to either increased or decreased costs is imperative to bringing value,” he says. “If the C-suite doesn’t understand the drivers of our business then we have little chance to place any value on the services we perform,” Riehm adds. “The C-suite should clearly understand the expenses in Clinical Engineering and understand the plans you have in place to address any gaps. A simple question I often ask our C-suite is ‘Do you clearly understand the cost of our Clinical Engineering services and the value you are receiving in return?’ ” The reporting that funnels its way up to senior management, and

eventually to the C-suite, should give those chief officers a clear picture of the state of medical devices and financial considerations. “Standardization efforts get reported on each time a project is completed and then year-end results are also summarized and presented to senior leadership in the form of a publication,” Kirwin says. “Technology Assessment reports are presented and published for senior leadership as well. In addition to those published materials, senior leadership also sees the financial value of this process each time we perform capital planning.” Knowing how the C-suite sees the world will go a long way to make certain that the biomed shop, and its mission, are in clear focus. From the great starting point of AAMI’s promotional materials (available at IamHTM.com), to knowing what the C-suite values, the HTM professional has an opportunity to elevate their shop and profession before administration. Putting ideas into action is the first step to reminding the C-suite of the critical role that HTM professionals play in their organization.

IMPROVING VISIBILITY

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CAREER CENTER Quick-hit Career Tips By Todd Rogers

s an avid reader of multiple current event websites, it has occurred to me that there is a growing trend to produce quick-hit content; material that can be digested in minutes. The most notable of these are the “Top Ten Ways to …” lists that the writer suggests will enable you to improve whatever it is that you’re not happy with about yourself. Most of the ones that I read tend to be sensible and useful.

Todd Rogers Talent Acquisiton Specialist for TriMedx, Axess Ultrasound, eProtex and TriMedx Foundation

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Recently I read about the “Top Ten Ways to use Excel to Your Benefit.” I found myself writing down a few of the ideas and although most of what I read is long forgotten, there are a couple of tips that I am currently using. Here are some of my quick-hit career tips. If you want to actually get something out of this, I suggest that you first create a 15-minute appointment on your calendar and use that time to accomplish one of the ideas that follow. 1 Make a list of the people you would use as references; include accurate contact information. If you can’t reach someone, take that person off of the list until you can reach him or her. 2 Write a brief explanation of your most regrettable professional failure and what you learned from it. This one stings and I expect few will do this step. However, I believe that recognizing failures is essential to progress. I believe Thomas Edison failed at making the light bulb hundreds of times before he got it right. 3 Write the three questions that you hope no one ever asks you during a job interview. Write out the answers. If you can handle this, nothing that could be thrown at you during an interview will be too difficult to handle. 4 Write a brief summary of your two most significant professional accomplishments. I believe two is the minimum. Anyone who asks for accomplishments during an interview will probably ask for more than one. 5 Set up an automated email from a major job board that gives you a daily “drip” of local positions that might one day be of interest to you. Examine those jobs as they trickle in. 6 Update your resume with what you have been doing in your most recent job. This involves finding your

resume first, which might take a few minutes unto itself. But, while you’re not under-the-gun, it’s best to write this update when your head is clear. 7 Write down your top three professional strengths. Have at least one example of how that strength has been of value to you and your employer. 8 Write down your three biggest weaknesses. How did you discover them? What are you doing to work past them? Write all of that down. This will also sting. 9 Locate past letters of appreciation, kudos-messages, awards or any other accolades that would be helpful and organize them in some manner. 10 Write down your top three career motivators and why those things are important to you. 11 Update your Linked-In profile. This assumes that you even have a Linked-In profile. If you don’t have one, it might be time to create one. So, that is actually 11 ideas. Remember, you only need to do one of these. Open your calendar, block off a 15-minute appointment and set a reminder. When that little chime reminds you of the appointment, stop what you are doing and do the one thing you selected off the list. You could even schedule to do one per week until you have done all 11.

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