TechNation - August 2014

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EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

AUGUST 2014

TACKLING NEW TECHNOLOGY DOES THE FIELD REQUIRE NEW SKILLS?

20 34 Address Service Requested MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269

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Biomed Adventures Pushing Past Exhaustion The Roundtable Sterilizers What's on Your Bench?

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CONTENTS Features

34 42 TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

34

THE ROUNDTABLE - STERILIZERS Sterilizers play a critical role in healthcare. TechNation asked a panel of industry experts to share their insights regarding new technology, maintenance and training materials.

Next month’s Roundtable article: Flexible Endoscopy

42

TACKLING NEW TECHNOLOGY Biomed managers are concerned about a shortage of clinical engineers who can work on new technology. We look at how clinical engineering directors locate biomeds who are proficient at servicing the latest technology, which often requires IT skills. We also look at how college biomed programs are preparing the next generation of students.

Next month’s Feature article: How to Build a Biomed Association

TechNation (Vol. 5, Issue #8) August 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.

AUGUST 2014

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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

Betsy Popinga Michelle McMonigle Taylor Martin

ACCOUNTING

Sue Cinq-Mars

P.14 SPOTLIGHT p.14

Department Profile: Ministry of National Guard-Health Affairs HTM Department p.18 Professional of the Month: Joe Cook, BMET p.20 Biomed Adventures: Pushing Past Exhaustion

P.24 THE BENCH p.24 p.26 p.29 p.30 p.32

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

P.48 EXPERT ADVICE

p.48 Career Center p.50 Ultrasound Tech Expert Sponsored by Conquest Imaging p.52 Myron Hartman p.54 Patrick Lynch p.56 Karen Waninger p.58 Beyond Certification p.60 The Roman Review

P.62 BREAKROOM 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.62 p.64 p.66 p.70

Did You Know?

The Vault What’s on Your Bench?

Parting Shot

p.69 Index Like us on Facebook, www.facebook.com/TechNationMag

Follow us on Twitter, twitter.com/#!/1technation

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DEPARTMENT PROFILE Ministry of National Guard-Health Affairs HTM Department

By K. Richard Douglas

A

mericans often think of Saudi Arabia as a place that has princes, a king and great wealth. It is the Kingdom of Saudi Arabia after all. As the world’s leader in oil production capacity, the country enjoys great wealth, but it also has most of the same attributes of any other modern, developed country.

One of those attributes is a growing healthcare system. Healthcare IT (HIT) is growing at an 11 percent annual rate there.

In May, Myron Hartman and Frank Painter were visiting the country conducting CBET and CCE training.

Painter is a professor and internship program director of the Clinical Engineering Program at the University of Connecticut and Hartman is the program coordinator for the Biomedical Engineering Technology program at Penn State University.

Hartman pointed out that he found the Ministry of National Guard-Health Affairs HTM Department in Riyadh to have many good qualities. He said that the department’s director recently changed its name from clinical engineering to health technology management based upon the AAMI recommendation.

Of the department’s director, Hartman said: “He is very progressive in promoting certification to all of his technicians to obtain the CBET certification (and) he is very progressive in promoting certification to all of his engineers to obtain the CCE certification.”

Hartman said that the director had sponsored a five-day training program for the technicians and engineers to learn about certification and to help them prepare for certification.

“They have a very forward program on technology management and project management regarding medical equipment,” Hartman says. “They are currently very active with the construction activities relating to medical equipment for a new

1TECHNATION.COM

AUGUST 2014

Members of the Ministry of National Guard-Health Affairs HTM Department pose for a photo with visiting educators Myron Hartman and Frank Painter.

children’s hospital — this is a very large and modern facility.”

“Our Healthcare Technology Management Department is under the health system of the Ministry of National Guard-Health Affairs that provides optimum healthcare to national guard personnel, their dependents and other eligible and paying patients kingdomwide,” says Abdullah A. Al Aqeel MSc, CCE, PE, associate executive director of Clinical Engineering for the Ministry of National Guard-Health Affairs.

“The health system also provides excellent academic opportunities, conducts research and participates in the industry and community service programs in healthcare. Our HTM department sits on a strong reporting hierarchical structure directly responsible to the chief operating officer,” Al Aqeel says.

The department covers most of the same functions found in a U.S.-based HTM department, including technology planning, service contract management, safety and risk management and quality improvement efforts.

The department handles the medical equipment needs in five facilities, totaling 2,551 beds. They also take care of the equipment in 69 primary health clinics.

“The HTM department in our institution has been keeping up with the current trends and development in the field in order to confront the many challenges in advancing healthcare, using cutting edge-technology, to identify and characterize the professionals working in the field, and to facilitate future expansion and long-term growth of responsibilities, among others,” Al Aqeel adds.

HTM professionals work on devices in Saudi Arabia.

“To embrace and implement the progress in the specialty, our Clinical Engineering Department was renamed as Healthcare Technology Management Department last month (in May). This is also in line with the department’s continued concentration on risk management, safety and efficient technical support of healthcare technologies that has an impact on enhancing the efficiency and sustain-

technology management,” Al Aqeel says.

Those organizations include AAMI, ECRI, ACCE, the Saudi Council of Engineers, the Saudi Food and Drug Authority, the Saudi Standards, Metrology and Quality Organization and the King Saud University. The department promotes the HTM academic program at the university.

“They have a very forward program on technology management and project management regarding medical equipment.”

-Myron Hartman

ability of the provided programmed services in our institution resulting in improved and increased health outcomes,” he says.

To keep connected with their fellow HTM professionals in Saudi Arabia and abroad, the team members are in, or participate with, several industry organizations.

“Our HTM department has been involved in activities with some local and international organizations/affiliations for memberships, standards, regulations and best practices in the field of healthcare

RECENT PROJECTS In line with the purpose of Hartman’s visit, the department has realized the importance of certification and has pursued that course for its employee contingent.

“Aside from the pioneering expansion of HTM services, our HTM department has been pushing for the certifications of our engineers relevant to their education, skills and job experience, such as CCE, CBET, CRES, CLES, Professional Engineer, ect., and sustainably allocating budget for review courses for these certifications,” Al Aqeel says.

Just like its American counterparts, the department is faced with assessing service contract needs and decisions.

“Service contracts are reviewed for practical application and cost effectiveness, lack of expertise or logistical resources, maximizing the benefits within a highly regulated and cost-constrained setting,” he says. “After evaluating the need/implementation for a service contract, all requests for service on contracted equipment are coordinated through (the) relevant department of our institution.”

Beyond PMs and other routine tasks, the department has been involved in several projects recently.

“Our HTM department has been involved in several major project management and clinical application of healthcare technologies across the regions,” Al Aqeel says.

One of those projects was a departure from what a U.S.-based biomed might encounter. Al Aqeel explains that the project required “managing the identification, acquisition, and customization of (an) appropriate, cost-effective, 57 patient-bed mobile field hospital and equipping it with advance healthcare technologies and prepare it for deployment.”

Another undertaking was “the establishment of (a) Cyclotron Operation under our department to manage the high-technology cyclotron machine for the intricate manufacturing of radio nuclides and radiopharmaceutical needed for the SPECT and PET/CT service.”

Like many departments, the HTM professionals in the Ministry of National Guard-Health Affairs HTM Department have recently taken on the replacement and acquisition of a very large number of infusion pumps. That project was extensive and included all the facilities of the Ministry in all regions with brand new technology.

Al Aqeel also points to “the acquisition of laboratory medical devices and systems with huge numbers of consumable items through GPRR deals,” as a recent challenge.

Next time you think of Saudi Arabia, don’t just think of the oil wells, but also a cutting-edge HTM department working to make a difference.

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PROFESSIONAL OF THE MONTH Joe Cook, BMET

By K. Richard Douglas

B

iomeds have been introduced to the HTM field in a variety of ways, including through family members. That was the case with Joe Cook, BMET, who works in the Biomedical Services Department at McLeod Health in Florence, S.C. “I first heard of the profession from an uncle,” Cook recalls. “He worked as a biomed tech for 27 plus years and spoke highly of his experiences.

He mentioned biomeds needed troubleshooting skills and that there was a big demand in the field. I knew I liked to troubleshoot, so when looking at education options, I felt it would be a good fit.”

Cook attended Caldwell Community College in Hudson, N.C. He received an associate degree in applied science and received a certificate in networking technology-basics. He plans to take the CBET exam soon.

He started his biomed career with his current employer and has continued his education by attending several schools and taking additional training.

On the job, he specializes in anesthesia, surgical microscopes, Dornoch and ultrasound, with plans to grow more on the imaging side. He covers 25 OR suites and anesthesia, along with the cardiovascular ORs (CVOR).

GAINING TRUST “One of my most special challenges was taking over the OR. The OR is a difficult place to gain the nurses’ and

1TECHNATION.COM

AUGUST 2014

doctors’ trust and respect,” Cook says. “If they called, they wanted you there, right then and there. And if you didn’t show up, they didn’t like

“Listen to what the doctor says. If they call; just go. They don’t like waiting around,” he says.

Being there when needed is how you build confidence in the OR staff, according to Cook.

Cook says it’s important for a biomed to remain calm when other staff may be panicking. When a surgical process is impeded because the image on a 26-inch monitor has suddenly reduced in size, the quick thinking of a biomed in the

“Whenever they called me, I was there.

I was in the operating room; I didn’t give them an excuse. I dropped whatever I was doing and I was there.”

– Joe Cook you; they had no use for you. That was my biggest challenge; just to have them like me and respect me and have their trust in me.”

“Whenever they called me, I was there. I was in the operating room; I didn’t give them an excuse. I dropped whatever I was doing and I was there,” he adds. “Now, everyone loves me in the OR and respects me.”

For a biomed who may be contemplating working in the OR or who is slated for work in the OR, Cook has some advice. His primary tip is that the level of urgency that the OR staff feels should be shared by the biomed.

OR is required.

Sometimes the screen images will reset on one brand of monitor says Cook.

“It will reset to S-Video or SDI and you won’t have your full image,” he explains.

He says that a trip to the nursing station and resetting the DVI channel solves the problem.

Cook still has a knack for troubleshooting and enjoys it when he gets a chance to work on something different.

“I like the challenge of working on new equipment. I don’t get to work on equipment outside of the OR much, and when I do, I love the challenge. I have been to ultrasound

training on the IE33 and the IU22 from Philips. These ultrasound units are very time consuming and a challenge at times,” Cook says.

“Also, I have been to GE for training on anesthesia units. I love working on anesthesia units,” he says. “Working on these units is also challenging. These units can have a leak inside and can take five minutes or two hours to find. It is a challenge that I love and to keep customers alive and well.”

Some special projects gave Cook a lot of hands-on experience after going to work at McLeod.

His first project at McLeod was the upgrade of 2,000 Cafefusion IV pumps. The Carefusion team was there for a week.

“We had to find all 2,000 channels.

The guys from Carefusion had to run their process and we had to run our process. Then, we had to do a check-in test to make sure every unit passed before sending it back out for use,” Cook says. “This project took about a week and half.”

The department’s director gave the OK for overtime.

“My second project at McLeod was checking in and inventorying all our new Carefusion Alaris EtCO2 modules,” Cook recalls. “The EtCO2 attaches to our PCA pumps and our SPO2 modules. I had to run a check-in test to make sure (the) unit works properly and that it is not an out-ofbox failure. Then, I had to inventory (the) unit and schedule a PM on it. I had to do this for 90 units.”

Joe Cook, BMET, enjoys troubleshooting.

LEISURE TIME Not everything is work. Cook is an avid fisher and participates in Striper tournaments every chance he gets.

“My favorite part is being out on the water and, of course, winning tournaments,” he says.

He also enjoys spending time with family. His wife, Angela, works for a bank in Florence, S.C., where they live. Cook’s parents and sister live in North Carolina where he grew up.

“I am a very caring person and very outgoing. I am a person who sincerely wants my customers to know I am there to help in any way I can. They come first to me. My customers are the nurses, doctors and ancillary staff in the OR suites,” Cook says. “Their job is stressful, making critical decisions regarding patient care all day, every day. My goal is to keep the equipment in the OR suites working efficiently as to relieve any stress I can to help them in their job.”

FAVORITE BOOK Phil Robertson, “Happy, Happy, Happy: My Life and Legacy as the Duck Commander” FAVORITE MOVIE Step Brothers FAVORITE FOOD Pizza – Supreme HIDDEN TALENT My hidden talent would be doing landscaping. I love to work in the yard or just be outside. I try to make my yard the best looking yard in the neighborhood.

FAVORITE PART OF BEING A BIOMED Getting to work on equipment that I don’t normally get to work on. It is a challenge to work on other equipment and I like challenges.

WHAT’S ON MY BENCH? Computer, phone, screwdriver, coffee and Skittles

SPOTLIGHT

BIOMED ADVENTURES Pushing Past Exhaustion

By K. Richard Douglas

R

eality TV, and many popular videos on the Internet, show the lengths humans are willing to push themselves, far beyond their comfort zones. Going to the very edge of endurance, and then beyond, has become an amazing spectacle for viewers and a challenge for those who are so inclined.

With this in mind, imagine for a moment that you are required to run more than eight miles. This isn’t eight miles on a level, dry surface, but eight miles going up and down hills, running in mud, and jumping over obstacles or ducking under obstacles. Add to this, a requirement that you carry a heavy sand bag or an equally heavy log as you press ahead.

This may sound like a day of Navy Seal training, but actually it is just one of the ways that regular people challenge themselves and get pushed to their limits.

This is the Super Spartan race.

Sandra Calderon, BMET Supervisor for INOVA Clinical Engineering in Falls Church, Va., is one of those gluttons for punishment who has the ambition and drive to take on the Super Spartan race and conquer it. Her co-workers, Jeremy Fletcher, Edwin Tanchez and Ralph Navarette had all participated in challenging events, like marathons and military obstacle courses, but not the Super Spartan.

It was actually one of those reality TV shows that sparked Calderon’s interest in the challenge.

“You know the show ‘Wipeout?’ Well, my dream has always been to be a contestant on that show,” she recalls.

“The thrill of completing the obstacle

20

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AUGUST 2014

course race in the fastest time seems so fascinating. I love a challenge.”

That competitive spirit is what initially led Calderon to the Super Spartan race.

“My coworkers pushed me to join their team. I was hesitant at first because I would be the only female on the team.

But that made it more of an initiative; to be the only female to complete the eight-plus mile, 20 obstacle course race.

Plus, one of my coworkers had made a bet with me, and I was not going to let him win. I was that determined,” Calderon says.

PREPARING FOR THE CHALLENGE Training for an event that pushes your limits of endurance often means doing the same in your training. Calderon bit the bullet and threw herself into a training routine that included activities that were not on her favorites list.

“I despised running before the race,” she says. “But I knew that was the one, and most important, exercise in order to prepare for any race. So, from no running, to running two to three miles, four to five times a week. I also joined a gym and did the P90X program when I had spare time. But to be honest, there was nothing you could do to prepare for the Super Spartan in Wintergreen, Va.

Sandra Calderon and Jeremy Fletcher participate in the Object Carry portion of the Super Spartan. It was one of the first of more than 20 obstacles.

Even past Tough Mudder participants had a difficult time with the course.”

The Tough Mudder is a series of endurance events with courses that are generally 10 to 12 miles in length and full of imaginative obstacles with names like “electric eel” and “island hopping.”

Calderon had run in some 5k events; the Hero Rush and ROC (ridiculous obstacle course) race in the past.

There is an easier event that is often the precursor to the Super Spartan for many entrants. That race is the Spartan Sprint, which includes over 15 obstacles spanning a three-plus mile course. Although difficult, many participants in the more challenging Super Spartan hone their skills, and get a taste of this type of challenge by participating in the Sprint initially.

Calderon’s team took a different approach.

TOP LEFT: Sandra Calderon and team members run through the Gladiator Arena. “I was just trying to make it to the finish line but had to get through the ‘gladiators’ who were trying to knock me down using their pugil sticks,” she said.

TOP RIGHT: Team member Edwin Tanchez muscles through the Log Carry. Participants had to carry a 40-pound, damp log down and up a hill.

Sandra Calderon, Ralph Navarrete and Edwin Tanchez were all smiles before the race.

STARING DOWN THE SUPER SPARTAN “We decided to do the Super because it was more of a challenge than the Sprint, but less intimidating than the Beast. But after completing the strenuous and wearisome race, I am positive I am capable of finishing the Beast. And of course the Sprint would be a walk in the park,” Calderon says.

The Beast is worthy of its frightening label. The Spartan Beast is billed as “the ultimate Spartan’s Race distance” at more than 12 miles. The course includes more than 25 obstacles. The Spartan website describes the race as “an obstacle race from Hell.”

Although the Beast would seem to have the ability to inflict a sizable portion of pain and discomfort on its participants, Calderon says that there are some real challenging moments in the Super Spartan as well.

“After completing the sixth mile, with scarce water and no food, I would have to say that the log carry was the one

“After the first minute, I was considering tossing in the towel and doing burpees instead.

But, my determination told me otherwise.” obstacle that I almost called quits on,” she says. “It was a log that averaged 40 pounds when dry, but with my luck, it had rained the night before making the log extra heavy.”

“The goal was to carry it for a quarter of a mile down a hill and back up. After the first minute, I was considering tossing in the towel and doing burpees instead. But, my determination told me otherwise. I made several stops to catch my breath and rest. I would even drop my log and sit on it for some type of comfort. It took me quite a while to get to the finish line but I did it.”

After experiencing the Super Spartan, Calderon doesn’t mince words about the experience.

“It was a nightmare that wouldn’t end,” she says, recalling every challenging obstacle at the event.

“An eight-plus mile, 20 obstacle course race on a ski resort. The conditions were extreme. The slopes reached as high as 3,500 feet. On top of that, they were

muddy due to the previous night’s rainfall,” Calderon says. “It took me five hours and 11 minutes to complete the race and I was the first one on my team to cross the finish line. I took home a medal and I can say I am a Spartan Warrior.”

On the job, as a BMET supervisor, Calderon says that her job is fascinating and never gets old.

“I was promoted to a BMET Supervisor in 2012, after six years in the field. I love what I do and I am good at it,” she says.

“I have 11 technicians under me. And yes, I still get my hands dirty from time to time, although I am more involved with projects and process improvements.”

“I love and respect my team,” Calderon says. “And, I strongly (believe) the feeling is mutual. We work hard, but we also have good times at work and outside of work. I generally organize activities outside of work to get the team together for a few laughs, and on top of that, (it) increases the work morale.”

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23

AAMI UPDATE

AAMI Launches New HTM Career Video

A

AMI has publicly unveiled a new video promoting healthcare technology management (HTM) as a career option. The video first aired at the AAMI 2014 Conference & Expo in Philadelphia in June.

Karen Waninger and Barrett Franklin of AAMI’s Technology Management Council appear on the video, which was shot at Community Heart and Vascular Hospital in Indianapolis, Ind. The two discuss some of the opportunities provided by a career in the field.

“The HTM field offers great opportunities for clinical engineers, biomedical equipment technicians (BMETs), lab and radiology specialists, and others who use their expertise to ensure that medical devices are safe and effective and available for clinical use,” said Franklin. He also highlighted estimates from the U.S. Bureau of Labor Statistics that the BMET field will grow by 30 percent by 2022.

“The career opportunities available in the HTM field are virtually limitless,” added Waninger, who noted that there is a great potential for advancement for those who opt for this career choice.

The full video can be accessed at http://vimeo.com/95551129.

GROUP RECOMMENDS CREATION OF ENDOSCOPE REPROCESSING STANDARD Recognizing the need for additional guidance for healthcare facilities in the reprocessing of flexible and semi-rigid endoscopes, an AAMI working group has decided to expand a technical

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information report (TIR) into a standard.

Members of the Endoscope Reprocessing Working Group recently proposed replacing TIR54, Processing of Flexible and Semi-Rigid Scopes, which was still in development, to a proposed American National Standard, titled ST91 – Comprehensive guide to flexible and semi-rigid endoscope reprocessing in health care facilities.

Initially, the working group had intended the TIR to serve as an educational document to help sterile processing professionals work through some of the existing — and often conflicting — guidelines. As the group worked on the document, it evolved into a format and structure similar to existing standards, and was more than just an education document.

“The AAMI Standards Board approved the request to upgrade it to a standard based upon the working group’s recommendation,” said Nancy Chobin, a consultant and educator with the Saint Barnabas Health Care System in Livingston, N.J., and co-chair of the group.

“The working group felt that there was a need to publish a national standard on flexible endoscopes because of all the issues concerning reprocessing of these devices,” Chobin

said. She added that the working group has representatives from the Association of periOperative Registered Nurses, Society of Gastroenterology Nurses, and the Association for Professionals in Infection Control, all of which have examined the scientific evidence of recommendations made in the document.

The document will be go out to ballot this summer. Depending on the ballot results, it could be finished by the end of the year.

“As far as hospitals and surgery centers are concerned, this document will set a standard of care for their practice,” Chobin said. “Facilities will now have a single source to reference for their flexible endoscope reprocessing practices. Manufacturers will also understand the standards facilities need to meet and will be able to help them in terms of education and products.”

The rationale for changing the TIR to a standard stemmed from the AAMI/ FDA Medical Device Reprocessing Summit that took place on Oct. 11-12, 2011, in Silver Spring, Md. This event addressed challenges highlighted by the U.S. Food and Drug Administration (FDA) on the reprocessing of reusable medical devices. Some of the priorities identified at the summit included developing instructions to determine whether a device is clean, and the training and education of staff.

STERILIZATION TEXTBOOK BREAKS DOWN STERILIZATION PRINCIPLES Are you a professional puzzled by the esoteric definitions of the terms sterilization verification, validation, and

qualification? If so, a new resource from AAMI may be right up your alley.

Authored by Donna Swenson, a sterilization expert with more than 30 years of experience in the field, Basic Concepts in Sterilization Processes: Verification, Validation, and Qualification is a textbook that makes the science of sterilization more accessible to those who aren’t sterilization engineers.

As Swenson writes in the preface, the idea for the textbook came during an AAMI Sterilization Standards Committee meeting several years ago. She fell into conversation with a colleague, who said there was a great need for a book that explains what some professional terms mean in plain English. “This knowledge seems to be the private domain of sterilization engineers,” who

seemingly have the uncanny ability to understand the abstruse world of sterilization principles, noted Swenson.

Several months after this conversation, she contacted AAMI to start work on the textbook, which defines and provides examples of sterilization science, quality management, validation theory, and cleaning and sterilization practices.

The resource also includes a section covering definitions and abbreviations, a chapter providing an overview of microbiology, and an overview of the steam sterilization process verification in healthcare facilities.

TO LEARN MORE ABOUT THE PUBLICATION, VISIT www.aami.org/publications/ Books/spvvq.html.

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THE BENCH

THE ABC’S OF ORTHOPEDIC SURGICAL ROBOTS

S

urgical robots are hot. They appeal to healthcare facilities as a new technology that can be added to their high-tech portfolio. Orthopedic robots, which assist the surgeon with selected tasks by guiding the movements of surgical instruments during an orthopedic procedure, are no exception. However, the acquisition and use of these systems must be approached with caution. Before investing in an orthopedic robot, you’ll need to thoroughly assess your situation to determine whether the system can both add value to patient care and boost your bottom line. Each hospital is unique, and considerations vary from facility to facility.

TYPES OF SURGICAL ROBOTS Surgical robotic systems can be broadly divided into two groups: those designed to perform a number of different minimally invasive surgery (MIS) procedures, and those — including orthopedic robots — designed to focus on specific procedures or a particular surgical specialty.

Systems can also be classified based on the amount of autonomy the robot has during a procedure: • Active surgical robots perform a surgery according to a patient-specific plan programmed before the procedure. The surgeon supervises the robot intraoperatively and intervenes if necessary (e.g., pausing, stopping, recalibrating), but cannot physically control the actions of the robot during the procedure. In this scenario, each procedure is uniquely planned and programmed.

• Semiactive surgical robots allow the surgeon to hold and directly control the surgical instrument, but prevent the instrument from moving outside of the preoperatively defined physical boundaries.

• Telemanipulation surgical robots enable the surgeon to remotely control the system through hand/foot controls.

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Currently, orthopedic surgical robots are available that are used for total hip arthroplasty (THA), total knee arthroplasty (TKA), partial knee resurfacing (PKR), spine implant placement (predominantly pedicle screws), and brain implant placement. Different robots have different capabilities; no one system can perform every type of procedure.

CLAIMED CLINICAL BENEFITS OF ORTHOPEDIC ROBOTS Orthopedic robots are intended to improve patient outcomes in either of two ways: 1. By improving the accuracy of implant placement. The rationale is that by increasing the accuracy of the procedure, hospitals will see a reduction of postoperative complications, such as premature implant failure and the need for revision surgery, and patients will experience improved function, less pain, and decreased length of stay.

2. By reducing the invasiveness of the procedure. Some orthopedic robots are designed to replace open surgery with MIS, while other systems are designed to replace a major open procedure with a more minor one. For instance, Mako’s RIO (Robotic Arm Interactive Orthope-

dic System) enables surgeons to perform the minimally invasive PKR procedure on some patients instead of TKA.

PROCEDURAL WORKFLOW BEFORE SURGERY The patient undergoes a CT scan, and the robot’s workstation uses the CT images to create a 3-D planning model of the joint of interest. These 3-D images are used to determine the surgical approach, the type of instrumentation to use, and the optimal implant design and size.

DURING SURGERY One universal step for all orthopedic robots is system registration, which creates a mapping between the CT image coordinates and the robot coordinates and thus allows the system to align the robotic arm with the patient’s anatomy. A tracking camera or a mechanical tracking arm can be used to map the robot’s position with the CT images.

Once registered, the system will either autonomously perform the surgical task (if active) or guide the position of the surgeon’s tools (if semiactive). The system’s video monitor displays the position of the patient’s joint and the surgical tool, along with other parameters, so that the surgical team can track the robot’s progress.

Typically, an orthopedic robot, whether active or semiactive, is involved in only one task during the procedure.

Such tasks include bone resurfacing, milling bone cavities, and positioning of traditional instruments. The rest of the procedure, including site preparation, incisions, implant insertion, and closure, is performed as it would be in traditional surgery.

AFTER SURGERY The robot must be moved from the patient bed, sterile drapes must be removed from the robot, and the robot-specific consumables must be sterilized.

No major changes to the patient’s postoperative care are necessary compared to traditional surgery.

KEY CLINICAL AND FINANCIAL CONSIDERATIONS THE DATA ON EFFICACY Many clinical studies that assess the performance of orthopedic robotic systems are sponsored by the supplier, creating obvious conflict-of-interest concerns. Also, the usefulness of each study depends heavily on the study design. Randomized controlled trials (RCTs) are the gold standard study methodology; however, few

more patients to be studied, and the studies are easier and less costly to conduct — and are therefore more numerous. However, observational studies are susceptible to selection bias and the inability to identify or account for confounders that may compromise the

By increasing the accuracy of the procedure, hospitals will see a reduction of postoperative complications.

RCTs have been published on orthopedic robotic surgery. The bulk of the clinical data ECRI Institute has assessed comes from observational studies. Most observational studies show that robotic-assisted orthopedic surgery improves the accuracy of the procedures compared to traditional surgery. However, there is no long-term clinical data (i.e., 10 or more years) to substantiate the claim that robotic-assisted surgery provides long-term patient benefits and improves implant survival rate.

If few or no RCTs are available, an acceptable alternative design is an observational study. In these studies, as many patients as possible receiving either treatment are tracked, either prospectively or retrospectively. This design allows

results. Planned observational studies can reduce both bias and confounders compared to observational studies that were not planned.

REIMBURSEMENT Currently, no additional reimbursement or specific billing codes are available for the use of robotic-assisted technology. For example, robotic-assisted TKA procedures are billed under existing traditional reimbursement codes for TKA. Whether codes will be developed in the future is unknown. It is possible that codes could be proposed if robotic-assisted surgery is viewed as significantly improving the course of patient care or as resulting in long-term savings.

If the development of billing codes for robotics follows the historical pattern of laparoscopic surgery, robotic-specific billing codes could emerge eventually.

However, the soonest this could happen would be several years from now because of the time lag between generating sufficient supporting data and proposing, establishing, and implementing codes.

One factor that commonly drives medical device adoption — reduced 30-day readmission rates — is not likely to apply in the case of orthopedic robots, since complications (other than surgical infection) following implantation may take years to manifest.

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 March 18, 2014.

The full article includes more guidance on Orthopedic Surgical Robotics, reported problems, and market drivers and limiters.

The article also includes a supplementary table explaining the key information on the three leading orthopedic robots. 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.

THE BENCH

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TOOLS OF THE TRADE The TechNation Magazine App

T

he TechNation magazine app sponsored by Fluke Biomedical is the ultimate HTM resource.

The new app, available on iTunes, brings the monthly magazine to iPhones.

The free app includes the same diverse articles and information that help Biomeds/CE, Imaging and IT professionals keep their finger on the pulse of the healthcare technology community. The app includes the same material as the printed product with a convenient menu that resembles the table of contents featuring the following sections: Breaking News, Cover Story, Expert Advice, Spotlight, The Bench and Whitepapers. The app will be updated each month with content from the latest issue of the magazine. Each issue will be archived beginning with the June 2014 issue that is currently available via the app.

FOR MORE INFORMATION about the TechNation app visit the iTunes App Store.

THE BENCH

AUGUST 2014

1TECHNATION.COM

29

SHOP TALK

Conversations From the TechNation Community Q A

Do you belong to an HTM Association? Why or why not?

From my point of view there isn’t a good reason to not belong to a HTMA, but there are a lot of reasons to be in one. At the very least, being a HTMA member will give you opportunities to receive “local” biomedical training free or at a reduced cost, opportunities to network with other biomedical managers and technicians, a chance to learn an easier way to solve an on-going or troublesome issue with a vendor or a specific piece of equipment, and by just being a participant in HTMA meetings or symposiums you may hear of a biomed job opening that may not be posted yet.

In my 20-plus years as a biomed I’ve belonged to three HTMAs (NESCE, NCBA and SCBA) and each has its own unique way of furthering a biomed’s career by offering incentives to study for the CBET exam. I know that many biomeds refuse to see that by being a CBET additional opportunities will make them more marketable in any career move they may want to make. I truly believe I would have my current BMET III position without being a CBET, but I also believe that by being a CBET my resume was looked at a little bit more because it showed my future employer that I was willing to do more.

To sum this up, I’d say HTMAs will provide a biomed with additional educational opportunities, a chance for

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networking with other biomeds, and, if looking, job opportunities (either internally or at another hospital).

A

Technically, I still belong to TABETA/MACES, but when our chapter president suddenly left the area and several members that rode with him stopped coming to our meetings, our chapter has been in somewhat of a limbo state. The next nearest association is in Kansas City and meets on days that I have prior commitments. I can’t leave the area, let alone complete a three-hour drive each way.

Now, if I could “attend” a meeting via Skype or something similar, I might consider it, especially if it would still earn points toward for my re-certification.

A A

Yes, I belong to an HTMA.

I have been a member of our local association and am currently the president of the Baltimore Medical Engineers and Technicians Society. Since I have been a member it is the best for networking with fellow BMETs (HTM) and finding out what is working and what is not by asking if there are similar problems within other hospital organizations.

I feel that being a member of a society or association is a benefit to an individual’s growth and experience. Meeting with younger HTM professionals and

teaching them that this is how something is done or not done, while also learning from the older colleagues. The biggest advantage is having an educational format for our members during our monthly meetings to help keep them informed and educated about new and upcoming processes.

If anyone would like to attend one of our monthly meetings – starting in September – please email me personally at cjone100@jhmi.edu.

A

Does anyone know if there is an HTM Association in the State of Florida? If so, where? Also, contact information would be appreciated.

A

Florida has a state society and five chapters: FBS, BAAMI, CFBIS, GCBS, NEFAMI and SFAMI if you visit www.FBSonline.net you can get all the current contacts.

A

I am a part of the IBS (Indiana Biomedical Society). I believe it is a great way to network with vendors during our annual conference, meet new students and those that want to get in, and even meet some of the old birds and learn how easy we have it now compared to before. If you don’t believe me talk to Kelly Vandewalker or Pat Lynch or Manny Roman, they have some great stories. It is also a great opportunity for free education (other than membership fees) as we have vendors provide educational

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material during our annual conference as well as a mid-year conference and sometimes two other meetings throughout the year. I look at it this way … you can never have enough education or meet enough people.

A

I am a member of the Washington State Biomedical Association. You can find more information at www.bmet.org.

A

I am a member of the Biomedical Society of Western New York. While relatively new and still forming, it’s a casual method for biomeds from the area to meet one another, discuss headaches, see some vendor presentations and gain some knowledge along the way.

A A

I am also a member of the WSBA!

I belong to the one in Indiana. I have attended the meeting in Indy and have hosted a meeting in southern Indiana. I have been in biomed for over 42 years and the more you know the better. This is another tool for learning.

A

I am a member of the association in Michigan. The website is www. michbmet.com/.

A

I am a member of the California Medical Instrumentation Association Bay Area Chapter.

Q

What department services your electrical/gas booms in the OR rooms in your hospital? Is it the clinical engineering department or the engineering department? Do you know of any guidelines for this?

A A

Plant Services.

A

Quite often, biomed is responsible for everything from the wall out.

I am a CBET in the clinical engineering department and I service the light booms and engineering services the gas and electrical booms.

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A

I belong to the NCBA – North Carolina Biomedical Association. Find out more at www.ncbiomedassoc.com.

A

I belong to the Virginia association and the South Carolina association.

You can find more information about these groups online at www.vabiomed. org and http://scba.onefireplace.com/.

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.

THE BENCH

Visit us online at: www.NetechCorporation.com or Call: 1-800-547-6557

BIOMED 101

Extracorporeal Shock Wave Lithotripsy (ESWL)

By Tim Hooks

E

xtracorporeal shock wave lithotripsy therapy treatment uses vary from the most widely known and commonly performed kidney stone treatment to other less common uses like heel spurs, tennis elbow, and even gallstones.

The original first generation lithotripter designs had the patient submerged in a bath of water enabling hydrodynamic waves produced by a shock wave generator to have adequate unhindered propagation through water, the patient’s body, and into the kidney stone. Newer second- and third-generation lithotripter designs have the patient apply mineral oil on and around skin in the pathway of the shock wave, a mineral oil coated water bag filled with de-ionized, de-gassed, and distilled water can also be placed between the patient and the shock wave generator.

The operator must be continually conscientious regarding air bubbles in the mineral oil and/or the water bag to insure the optimum amount of therapy is delivered.

The smaller portable type systems are typically used for the non-kidney stone procedures. Their fundamental theory of operation is similar, with the exception of the usage of lower levels of KV in the shock wave generator and variations in the coupling medium(s) between the patient and the shock wave generator.

Extracorporeal shock wave lithotripter systems cross the boundary between the skill sets of both an in-house biomedical equipment technology generalist and a radiology equipment specialist. A BMET, radiology equipment specialist or a field

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of high-voltage systems, knowledge of human anatomy, knowledge of computers and electronics, in-depth knowledge of X-rays, and in some cases an in-depth knowledge of ultrasound and 3D positioning systems.

Having worked with these machines in the past, it is quite clear to me that a hospital BMET or Radiology Equipment Specialist would do well to have an adequate amount of research and training under his/her belt before trying to tackle a major repair on one of these devices.

The types of problems you can encounter with these machines is extensive especially with the older systems.

SOME EXAMPLES OF MAJOR PROBLEMS INCLUDE: • Liquid damage to electronics • Worn bearings and gear • High-voltage problems • Alignment problems with the positioning system

SOME EXAMPLES OF MINOR PROBLEMS INCLUDE: TIM HOOKS former Extracorporeal Shock Wave Lithotripter (ESWL) East Coast Field Engineer for Medstone International Inc. now a Healthtronics Company.

engineer should have a fundamental understanding of the individual sections of the lithotripter system to be able to proceed with any type of major repair and/or testing of these devices. These sections include: ellipse F2 analysis, knowledge of water filtration systems, knowledge of ECG monitors, knowledge

• Defective or worn electrodes • Old or worn water filters • Old or worn shock wave generator covers • Other peripheral mechanical components and water system leaks For various reasons, many healthcare facilities are choosing to lease or pay a fee per usage with many of the lithotripter manufacturers, distributors, and/ or dealers in business today. By not purchasing the machine it is very likely that the manufacturer will provide service for these machines. Unfortunately, as those who have been in this industry for

some time know, the company’s Field Engineer cannot always make it to the site in the next five minutes. When you have a patient on the table, therapy is in session, and there is that infamous overhead or phone page to the HTM, clinical engineering and/or biomed department you may wish you had touched up on your extracorporeal shock wave lithotripter repair skills.

So, although you may not be personally responsible for these devices at your facility, having a basic understanding of a Lithotripter’s individual sections and some of its common problems may result in you saving the day, getting a well deserved pat on the back from the treating physician and/or staff, or just getting the regular “thank you” from the operator.

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THE BENCH

ROUNDTABLE

Sterilizers

Sterilizers play a critical role in healthcare. TechNation asked a panel of industry experts to share their insights regarding new technology, maintenance and training materials.

Our expert panel is made up of Marie LaFrance, Senior Product Manager at STERIS Corp.; Tim Koes, President of Technical Life Care Medical Company; Janet Prust, Global Marketing Manager with 3M Infection Prevention Division; and Connie Mansfield, Manager of Marketing Communications and Regulatory Compliance at PRIMUS.

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Q

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN STERILIZERS AND IN THE STERILIZER MARKET IN THE PAST YEAR?

LaFrance: Due to changes in AAMI standards, steam sterilization has been challenged to perform like never before.

Sterilizer manufacturers must meet the requirement to process 25-pound sets (up from 16 pounds), which in some cases has doubled the total weight of the load processed. In addition, concerns about HAI rates and reduction in Immediate Use procedures has driven more processing to the main Sterile Processing Department, so in terms of productivity, some steam sterilizers are well equipped to handle the increased volume. AAMI has also recommended lumen testing, so that will be another challenge in validating cycles in the future.

Koes: Nothing in the past year per say, but over the past five years we have seen customers migrate towards a desire for “clean steam” using steam to steam heat exchangers or onboard electric boilers.

This is mandatory in pharma, increasing its adoption in food service, and is starting to see significant benefits in the medical industry. Other technologies include resource efficiencies through connecting to the hospital’s chilled water system to reduce water used per cycle from 500-600 gallons down to 2.6 gallons (Belimed specific). Lastly, automation with sterilizers has assisted staff productivity where they can “set it and forget it” as opposed to continuously checking the remaining time on the cycle.

Once the cycle is complete, the rack automatically unloads and then pulls in the next waiting rack.

Prust: While available in the market prior to the last year, the most significant and recent advances relate to connectivity of sterilizers to electronic instrument management systems and remote access to the sterilizer for a service provider.

JANET PRUST Global Marketing Manage, 3M Infection Prevention Division

Access to electronic systems have been a long time coming in sterile processing but now, nearly all new sterilizers have these features available.

Mansfield: The sterilizer market continues its focus on green technologies including water conservation systems, sterilizer refurbishment and recycling components as LEED requirements have been instituted on virtually all new construction projects throughout the country.

Q

HOW WILL THOSE CHANGES IMPACT THE STERILIZER MARKET IN THE FUTURE? HOW WILL THEY IMPACT MAINTENANCE?

LaFrance: The trend has been to reduce or eliminate the amount of immediate use sterilization done in the OR for fear of instruments being reprocessed and transported improperly, so sterilizers in the Sterile Processing Deaprtment will be logging more cycles than before. This makes ready availability of knowledgeable service technicians and

good preventative maintenance a must to maximize equipment uptime. Of course, there will always be a need to process some items for emergency use, so the challenge in the future will also be to provide a safe, compliant way to do that.

Some facilities are purchasing small steam sterilizers for quick-turnaround in the Sterile Processing Deaprtment, so whoever is servicing these units needs to be equipped to do that.

Koes: “Clean steam” eliminates chamber cleaning and additional utilization of the house boiler. Less impact on the house boiler equates to less maintenance through adding less makeup water and less chemistry with little to no consumption of the house steam. A more space efficient design and manufacturing is needed with the facilities/engineering team in mind. We found a manufacturer that has front service access to reduce the space requirement in the department and undesirable access points for service members (i.e less forearm burn marks as all service components moved forward.)

This would be something our service techs would greatly appreciate.

Prust: Connection of the sterilizer to electronic systems helps to improve the accuracy of the process by providing better data to make decisions. This helps to improve the quality of the output, e.g. sterilized product. Remote access for service diagnosis and first-level assistance can save sterilizer downtime and optimize service support. Knowing when to send the service technician with an idea of the issue will speed the repair service to allow the sterilizer to be up and running faster.

Mansfield: The continuing focus on green technologies will drive sterilizer manufacturers to develop more ways to reuse, refurbish and develop a more efficient sterilizer. The importance of OEM provided operator and maintenance technician training programs will help facilities minimize their cost and maximize the life of the sterilizer by

THE ROUNDTABLE

controls, e.g., a color touch screen versus a touchpad. Trained first responders are my recommendation for saving repair costs and providing routine maintenance.

conducting timely routine preventive maintenance and “first responder” corrective activities. Simplicity is the key.

With technology advances in controls and materials “hidden under the covers” operating personnel will continue to experience greater sterilizer capability, but with simpler and more user-friendly interfaces.

Q

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

Q

WHAT TECHNOLOGIES ARE WORTHY OF THE INITIAL INVESTMENT? HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE STERILIZER NEEDS OF TODAY? LaFrance: It’s not a stretch to argue that a healthcare system should prioritize its operational budget with the best sterilizer it can afford based on its particular needs. Without sterile instruments there are no surgeries. That said, when a facility truly considers the total cost of operating a sterilizer, and that includes utilities, instrument capacity, turnaround time, troubleshooting, service, compliance, etc., often times it’s not the lowest initial sticker price that ends up as the determining factor. Additionally, a certified pre-owned sterilizer could be an attractive option for limited-budget facilities.

Koes: Focusing again on “clean steam,” we have seen cost savings with instrument replacement and repair along with higher quality instrumentation being delivered to the surgeon for overall surgeon satisfaction. Other cost savings include the elimination of costly chamber cleaning and reduction of cold spots, which can cause wet packs, due to mineral buildup in the sterilizer jacket.

Chilled water has proven to save millions of gallons of water annually and payback usually occurs within the first year. Automation limits the strenuous pushing and pulling of racks to reduce worker’s comp claims.

Prust: All facilities need both steam and low-temperature sterilization system (ethylene oxide and vaporized hydrogen

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MARIE LAFRANCE Senior Product Manager at STERIS Corp.

peroxide) to process the complex devices used in hospitals and other healthcare delivery sites. It’s not an option. Which manufacturer to source from is the bigger decision for all types of sterilizers.

Facilities should develop the business case for new equipment and analyze the impact of high-performing equipment on both throughput and service costs. For low-temperature systems, analyzing the instrument utilization is important to justify the costs. Not all heat and moisture sensitive devices are used again the same day so the lower cost, but longer cycle, systems like ethylene oxide can be a better financial choice for certain instruments. Facilities should also complete a careful comparison of the total costs for equipment from the different manufacturers that includes cost to run, cost to train and service analysis. What may be less expensive for the initial purchase may actually be more expensive to run and keep maintained.

Mansfield: In the current capital constrained economic environment, a refurbished sterilizer can be the answer for many cost-conscious end user customers. Control kits can save money by extending the life of older sterilizers while offering the latest in sterilizer

LaFrance: We talk to a lot of healthcare facilities who have been told that they need “clean steam” to operate their sterilizers, but that simply isn’t always the case. Many hospitals are unnecessarily spending money to outfit their sterile processing department infrastructure to accommodate “clean steam” when it’s not necessary. Not every facility needs it, but if you’re experiencing stained instruments, pitting, corrosion, darkened or black instruments, white spots on instruments, rapid generator heating element corrosion, stains and deposits on the linens of wrapped trays, or scale and rust deposits in the sterilizer chamber it may be worth the investment. Having your water regularly tested is a good first step to determine if you should be using “clean steam.”

Koes: Buy what you need, not what you think you need. Use data and workflow to vet out appropriate “rightsizing” of the department. By purchasing the largest chamber sterilizer, what are the resource implications upstream? How long does it take to fill the chamber to run a load?

Will this meet the demands of the OR schedule and turnover of instruments?

How much will the sterilizer cost per cycle to operate and how much will service support cost long term.

Prust: The useful service life for sterilizers is less than it was in the past due to the advanced electronics used for the equipment today. In the past it was not uncommon for a sterilizer to function fairly well for 15-20 years.

Currently, most sterilizer manufacturers expect the useful service life to be 8-10 years primarily due to the part and electronic obsolescence related issues.

Q

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR WHEN DECIDING WHETHER TO GO WITH AN ORIGINAL EQUIPMENT MANUFACTURER OR A REPUTABLE THIRD-PARTY STERILIZER PROVIDER? LaFrance: Availability of certified, validated parts is a key thing to consider. OEMs must meet strict FDA standards for testing and validation, as well as meet other pressure equipment standards. The FDA wants third parties to refurbish sterilizers to meet the OEM’s original specifications, but there is no provision for inspectors to ensure that.

Koes: Ratio of service cost to asset cost!

This calculation considers warranty information, reliability, downtime, uptime, service technical skill level, response time, etc.

Prust: Because sterilizer features are continually being added, new cycles cleared

by FDA and because parts often become obsolete, facilities should look at new equipment rather than used equipment.

New, large, high ticket sterilizers are commonly only available direct from the manufacturer. Small, table top models are often sold and serviced through third-party suppliers who provide very good service. A careful up-front analysis considering all factors is what’s important and will provide the data needed by the facility to make the right decision for the need. It’s not an OEM vs. third-party decision; rather it should be a decision on what is the best solution for the facility.

Mansfield: When purchasing from a third party, a healthcare end user must ensure the selling company has a current FDA 510k to sell a specific brand and size steam sterilizer (new or used) to the healthcare market. If a third party is selling a remanufactured or refurbished sterilizer to the healthcare market, the sterilizer must meet the manufacturer’s original design specifications. If any changes are made to the original sterilizer, then the third-party provider must apply for and receive a FDA 510k. Because of the issues noted above, healthcare end users must be extremely cautious when purchasing from a used or

TIM KOES President of Technical Life Care Medical Company

aftermarket provider. Ensure the third-party sterilizer provider is properly representing the sterilizer being purchased. Purchasing from the OEM provides complete documentation at the time of purchase, factory support and greater aftermarket service. Always determine whether the third-party provider is able and willing to stand behind the sterilizer over its useful life and provide thorough aftermarket training, technical support and warranty. Always determine if a third-party supplier is fully compliant with quality requirements including ASME, UL, ISO 9001, ISO 13485, FDA 21 CFR Part 820, and cGMP.

Q

IS IT POSSIBLE TO KEEP UP WITH THE LATEST STERILIZER ADVANCES AND IMPROVEMENTS WITHOUT BUYING BRAND NEW? WHAT ARE SOME OF THE NEWER TECHNOLOGIES AVAILABLE? LaFrance: Some healthcare systems are still using – and still happy with the performance of – sterilizers they purchased years ago. While it’s not completely necessary to buy new, the latest sterilizers will run more efficiently, accommodate larger or more delicate instrument sets, adhere to the latest compliance regulations

and be more environmentally friendly.

Water-saving devices, improved loading methods, including automation, and integral steam generators for medium sterilizers are all advances designed to decrease operating costs, improve ergonomics and increase productivity in a smaller overall footprint.

Koes: Personally, I do not think this is possible because you can’t rebuild a sterilizer to have a vacuum pump. Also, what are the cost/benefit to upgrading a control panel versus replacing a more resource efficient unit?

Prust: Yes, it is possible through active participation in continuing education programs that are widely available for sterilization. The professional organizations and manufacturers both offer a wide range of educational programs where the latest technology is described. It’s important for biomeds to attend programs related to sterilization equipment. Meeting with manufacturer representatives is another avenue for information on the latest technology.

Mansfield: Purchasing a PRIMUS PRI-Furb provides a sterilizer that meets ASME standards, is compliant with FDA regulations, is refurbished to the latest sterilizer design using many new components, is fully documented and has completed a full comprehensive factory acceptance test. Older sterilizers operating in the field may be refurbished from top to bottom. To upgrade to the latest software and control systems, control kits can be an effective and relatively inexpensive way of extending the life and capability of an older Steris, Getinge, or Beta Star steam sterilizer.

Other effective ways to upgrade existing sterilizers without purchasing new is to add an aftermarket system such as drain water quench, reverse osmosis, and/or a water conservation system for a small to medium sterilizer. Purchases of other aftermarket new technologies including ergonomic loading carts, drop leg loading carts for space constrained operating environments and heavy duty loading carts for especially heavy loads provide ways to upgrade sterilization systems without purchasing a new sterilizer.

THE ROUNDTABLE

Q

HOW CAN PURCHASERS ENSURE THEY ARE MAKING A WISE INVESTMENT IN A STERILIZER? HOW CAN THEY ENSURE THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS? LaFrance: It’s extremely important to do your homework when investing in a sterilizer, and that includes working with an experienced provider; one that fully understands the unique dynamics of sterile processing and the OR; one that’s an innovator and has a track record of standing behind its products. If your provider does not offer the necessary tools for training and educating staff on proper use and troubleshooting of the equipment – both at the time of the sale and ongoing – you’re working with the wrong provider.

And let’s not overlook the need for clinical expertise. With increased rates of staff turnover the availability of continuing education courses is also more critical.

Koes: Again, force your department to make data driven decisions in picking the appropriate size for today and projected growth into the future. Why are you picking this model or vendor? Why this size chamber? Don’t simply pick a vendor “because that’s what we always used” or because I am friends with the Service Tech.”

Be a change agent, just as you want your doctors and nurses to utilize best practice when treating patients through research and technology, you also need to appropriately research the best options to ultimately support patients and staff with the safest most effective healthcare possible.

There is a wealth of knowledge and tools through numerous websites to obtain material and training videos.

Prust: The up-front assessment must be done well and include a careful, detailed analysis of the options and the benefit to the facility so purchasers can feel confident.

All of the needed information is available either from the supplier or within the facility. Take the time to do a detailed assessment. It will justify the spend and ensure the right purchase is made. Look at suppliers you know are reliable, and provide comprehensive support packages.

Looking at the training materials and support literature should be done before the

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CONNIE MANSFIELD Manager of Marketing Communications and Regulatory Compliance at PRIMUS.

purchase is made, not after. This support should be a factor in the purchase decision.

Mansfield: Newer vertical and horizontal sliding door sterilizers should always be selected versus older hinged door models that are costly to maintain and have experienced several field safety issues (doors coming off during operation and numerous operator burns). Most important is Total Cost of Ownership (TOC). Always make sure that “apples to apples” comparisons are done when purchasing a new steam sterilizer. Total Cost of Ownership not only includes the acquisition costs, but a host of other salient issues. Not all steam sterilizer companies support their older control platforms, but instead require customers to make expensive upgrades in order to maintain their sterilizer controls. Other hidden costs include sterilizer set-up/ deployment costs, operating and maintenance costs, change management costs, infrastructure support costs, environmental impact costs, insurance costs, and disposal/decommissioning costs.

Q

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT STERILIZER? LaFrance: Providers who have an in-depth understanding of sterile processing and the

intricacies needed to keep you up and running fully supporting the OR also understand the need for continual maintenance, repair and inspection of sterilizers. One of the key factors in the selection of a sterilizer provider is finding a capable, well-rounded partner to work with from a biomedical perspective. A provider that has ample service coverage, training programs (both on-site and online) is crucial to the success of the surgical department. Biomed needs to be comfortable in an established partnership with its sterilization providers, since they are the experts on the equipment they manufacture.

Koes: What is the impact on infection control? How does this impact patient safety or staff safety? This is the true kill phase of harmful viruses and bacteria (washers simply deem safe to handle) and with that comes a need for proper usage and maintenance. This single piece of equipment is arguably the most important in the whole process and needs to be treated that way.

Prust: It’s important for biomeds to understand how the sterilizers in their facilities function, how they are used and be able to provide some level of first line troubleshooting. Often sterilizers under a preventative maintenance agreement with a service provider are hands-off for the biomed. Sterilizers are critical medical devices and as such, biomeds should be knowledgeable and involved in the purchase and maintenance.

Mansfield: Water quality is very important to the efficient and effective operation of a steam sterilizer. As an analogy, poor water quality for a sterilizer is equivalent to adulterated gasoline for an automobile.

Proper maintenance and operating training are critical to the longevity, uptime, and cost of operating a steam sterilizer. Always maintain the original design state of the sterilizer – do not use non-standard parts and never allow the sterilizer’s original design to be compromised. Only purchase sterilizers from an OEM or an OEM’s representative.

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TACKLING NEW TECHNOLOGY DOES THE FIELD REQUIRE NEW SKILLS?

BY K. RICHARD DOUGLAS

T

his isn’t your grandfather’s biomed. It may hold true that it isn’t your father or mother’s biomed either. Change has come to Dodge and that change is spelled; t-e-c-h-n-o-l-o-g-y.

Much has changed in the last decade and while that change

can be found throughout our culture, and throughout the world, it is driven by processors and hard drives, HDTV, broadband Internet, Wi-Fi, smartphones, flash storage, 3D printers and voice recognition.

Much of that technology has found a home in healthcare settings where the latest technological advances can improve sterile environments, improve imaging, aid in communications and diagnosis and allow for the uploading of EMR (electronic medical records) data. EHR (electronic health records) has become a part of the healthcare lexicon.

For these very reasons, the HTM professional of today has to wear a more comprehensive tool belt. Electronics training has been supplemented with network knowledge. Patient safety considerations now include the safekeeping and safe transmission of patient EMR data.

NEW TECHNOLOGY

Biomed managers today are worried about the shortage of clinical engineers who can work on new technology. How do clinical engineering directors find biomeds who are proficient at servicing the latest technology, which often requires IT skills? And how are college biomed programs preparing the next generation of students for the challenges of servicing increasingly complex, computerized medical equipment?

Are these relevant questions and have the requirements for a biomed new hire changed as much as was predicted a couple of years ago?

THE RECRUITER “We are asked to find a biomedical equipment technician that has an associates degree in Biomedical Instrumentation or military BMET training. Our client will then describe the number of years and any specialty equipment — ventilators, anesthesia, sterilization — that they require,” says Doug Stephens, chairman of Stephens International Recruiting Inc.

AN EVOLVING CLASSROOM “Our advisory committee, made up of employers, keeps us up to date as to what changes are needed in the curriculum to meet changing skills and abilities needed by new hires,” says Roger Bowles, MS, Ed.D, CBET, department chair and professor in the Biomedical Equipment Technology Department at Texas State Technical College in Waco, Texas.

“They tell us what skills the new hires are lacking. Amazingly enough, it is the soft skills such as customer service, that they continuously stress. They tell us we are doing a good job with the technical aspect; just to beef up the soft skills.”

Scott F. Percy, D.Sc., chair and director of the Clinical Engineering program for Brown Mackie College in Tucson, Ariz. says that hands-on learning is still a valuable part of a well-rounded biomed.

As healthcare employers upgrade their technology and integrate more devices to networks, there are more opportunities for students to learn real-world skills that are in demand today.

“I suggest strongly, with all new students, that they volunteer in a clinical

DOUG STEPHENS is the Chairman of Stephens International Recruiting Inc.

that with a two-year program, it is important to work the program alongside additional parallel activities to get the most benefit.

“An excellent example is our VA Hospital here in Tucson. They encourage our veteran students to

“ We are seeing many schools that now have basic computer repair training and the basic theory of networking in their curriculum for the biomedical equipment degree.” – Doug Stephens “Many managers will express a desire to have any additional training and/or certification as an A+ or Net+ or other computer related training.

This is becoming more prevalent as most clinical devices are now networked with other devices such as electronic medical records.”

“We are seeing many schools that now have basic computer repair training and the basic theory of networking in their curriculum for the biomedical equipment degree,” Stephens says.

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engineering or IT department in one of our many hospitals,” Percy says. “Some students will accumulate almost two years of volunteering in parallel with their college class work.”

“Of course, a big part of the student’s college classroom activity centers around IT training, coupled with electronics and current biomedical equipment classes,” he adds.

Brown Mackie College offers an associate of applied science degree in Biomedical Equipment Technology at its Tucson campus. Percy points out

apply for work/study which will pay the student while they learn the latest in biomedical and IT skills. Other hospitals here also gladly welcome our students as volunteers with the same type of learning experiences,” Percy says.

“I find it heartening when I see the growth of one of our volunteering students. It can be quite amazing.

Some students actually spread out their volunteer time between two or more facilities, which gives them an outstanding bit of education,” he adds.

Bowles agrees that the exposure to real-world work is an important learning tool and a basic component of his program.

“The mandatory internship in our program allows students to get real experience with the latest technologies and put it all together,” he explains.

“The internship is also a good opportunity for students to both build and demonstrate their skills and abilities to future employers. Even if they do not go to work for their internship employer, they can still have a powerful reference for other employers.”

“We have also had a renewed focus on critical thinking skills and soft skills, such as communicating with management, over the past five years. The basic courses stay up with the A+ and Network+ certifications, plus we have a medical networking specific course in which the instructor updates regularly,” he says.

The program at Brown Mackie also has the work experience component that is expected of students. Working in a real biomed environment allows for exposure to the newest technologies.

“We have an externship requirement for all biomeds near graduation. This gives them constant access to new hospital device/IT processes and allows them the time to assimilate these processes,” Percy says. “They have access to all clinical engineering staff and IT personnel. Learning can be designed around the student’s wants and needs.”

The access to newer devices and processes may be one of the many benefits of on-site training. One challenge that Bowles points to is the aging of what was once current technology on hand in the classroom environment.

“It is increasingly difficult to prepare students for servicing the latest equipment. Especially because many schools, us included, rely on donated equipment that is usually 10-plus years old. However, our program does include a healthy dose of computer hardware and networking courses and we are constantly scouting for newer equipment,” he says.

“We have been teaching DICOM but it has been a part of our curriculum for quite some time. In the past couple of years, EHR has started to become a

“ Attending regional and national biomedical conventions is not mandatory for our students, but I suggest strongly that these gatherings of manufacturers and biomedical experts presenting is an excellent way of learning about the newest in devices and theory.” – Scott Percy topic,” he explains. “We do not teach specifics on this, but a couple of us have gone through Implementation Specialist training, so the topic is starting to integrate.”

“We also stress application in all of our courses so hopefully they fit together and build on each other and are not just individual courses tied together to make a degree,” he adds.

biomeds connected to the newest trends and technologies can be a good source for students.

“Attending regional and national biomedical conventions is not mandatory for our students, but I suggest strongly that these gatherings of manufacturers and biomedical experts presenting is an excellent way of learning about the newest in devices and theory,” Percy says.

“Those who attend are always better informed. I have been impressed at how many of our students find ways to attend conventions throughout the U.S. I insist that all my students subscribe to, or have access to, all related journals,” he says.

“Staying current is a full-time job that they have to accomplish on a very part-time schedule.”

HIRING MANAGERS ASSESSMENT

SCOTT F. PERCY, D.SC. is the chair and director of the Clinical Engineering program for Brown Mackie College

Percy adds that bringing in subject matter experts, in addition to teaching faculty, can be beneficial.

“We will, on occasion, have visiting experts. Those in the future will be more IT oriented. I find that getting an expert to speak about what they know about is not a difficult task,” Percy says.

The same methods that keep veteran

Tim Huffman, manager of biomedical technology services for Baylor Scott and White Health, says that the IT department should continue to be tapped for those things they do best.

“In general, instead of looking to transform HTM professionals into IT professionals as an industry, we should look at engaging the IT personnel which are often right down the hall,” he says.

“The skill sets needed are already in the building and it doesn’t make sense to focus a ton of energy into making an HTM person duplicate that skill set.”

Huffman does see a role and need for HTM professionals to be trained in some areas that cross over into the IT realm.

“Of course there are some basic tasks that the HTM professional should know how to do such as setting up AE titles, IP

NEW TECHNOLOGY

addresses and port numbers for DICOM settings,” he says.

“They should be able to ping a device to see if it is communicating on the network.

They should also be able to enter a security key for WEP or WPA,” Huffman adds. “These skills are often obtained through OJT, and some basic questions in an interview allows you to assess their knowledge. HTM professionals are already somewhat generalist because of the huge variety of items that we encounter.

Adding a significant amount of IT skills to this very complicated mix will only dilute the ability of a technician.”

“Some departments have select individuals that are stronger in IT functions and often these individuals can bridge the gap to the IT department,” Huffman continues. “IT works with computers all day, every day, and we should be much quicker about engaging them to assist and provide OJT to our biomeds than we are today.”

“We ask some pretty basic questions about IT capabilities, though certain positions require a much heavier knowledge like what we call a Clinical Engineer. Baylor has three CE positions for the system, and they focus on project management, quality of data in the CMMS, recall management, and some of the biomed IT functions,” he says.

“There are several servers that this team

“IT works with computers all day, every day, and we should be much quicker about engaging them to assist and provide OJT to our biomeds than we are today.”

– Tim Huffman

“There are no ivory towers here. My motto is; ‘Grow or Die.’ That may seem harsh, but it is a reality in the everchanging world of biomedical equipment technology.” – Roger Bowles manages including Philips physiological monitor servers, the Hospira IV pump (Mednet) server which manages drug library pushes, and a gateway from GE physiological monitoring to the MUSE system, to name a few.”

Huffman points out that 10 percent of the CBET exam is devoted to IT. Indeed, he is right. Buried among the questions related to patient safety, anatomy and physiology, electronics and problem

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solving are questions about IEC 800001 and network protocols. That should provide a glimpse into what is a current reality for the field and a hint of things to come in the future; a future where technology doesn’t go away.

Jorge Ramos, technology manager for the Aramark-run Healthcare Technologies Department at University Medical Center Clinical Engineering Department in Las Vegas says that there is an

advantage to having part-time employees in his department. It allows for people pursuing an education to also work.

Ramos runs his facility’s equipment distribution program.

“It is from this program that we promoted our current CE/IT BMET who continues to acquire certifications even after his AA degree,” he says.

It’s not always an advanced high-tech skill set that is sought. Sometimes, it’s the skills that come with specializing. On the rare occasions that Ramos needs to consider an add-to-staff, he has some specific considerations.

“In addition, we have an extremely low turnover rate, if any at all. Regardless, in those situations, I would evaluate

ROGER BOWLES, MS, ED.D, CBET, is the department chair and professor in the Biomedical Equipment Technology Department at Texas State Technical College.

what were the modalities that the outgoing staff specialized in,” Ramos says. “This, in turn, would be what I would place high on the list of credentials that the new candidate should possess. I would then work closely with the Aramark recruitment division to put out the posting.”

It’s not just the biomed students who need to be up-to-date with their skills, but faculty also, Bowles points out.

“There are no ivory towers here. My motto is; ‘Grow or Die.’ That may seem harsh, but it is a reality in the ever-changing world of biomedical equipment technology.”

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CAREER CENTER

Managing Successful Careers

By Jenifer Brown

W

hat does success mean to you? Be it a new position with another organization or advancement within your current one, you need to assess what you consider success to mean and what you are or are not willing to do to get there.

Jenifer Brown has 24 years of experience in talent acquisition and placement in technical fields and for the last 19 years she has specialized in healthcare’s medical equipment service industry, which is the focus of her company Health Tech Talent Management LLC.

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Surveys tell us that there are major differences in what each generation is looking for in a career. This issue has been covered at ACHE conferences, in mainstream publications and books, and by corporations that are changing their career ladders to accommodate these generational differences. Let’s take a look at some of the findings from the research.

TODAY’S WORKFORCE POPULATION AND DIFFERENCES Silent Generation: Born from 1925-1945 (age 69-89), this group includes 38 million people that make up 5 to 10 percent of the workforce. They are known as “Traditionalist” that grew up in the Great Depression. They tend to be very hard working and remain loyal to the company where they began their career. They are used to specific direction and support.

Baby Boomers: Born 1946 to 1964 (age 50-68), this group includes 78 to 80 million people that make up 45 percent of the workforce. They grew up during prosperity and applied a hard work ethic. Their focus is more toward their careers rather than toward the company where they began their career. They want two-way interaction and have a desire to be involved in decisions.

Generation X: Born 1965 to 1979 (age 35-49), this group includes 46 to 60 million people that make up 35 percent of the workforce. They grew up with parents who lived to work and who had little time for family. Consequently, a work/life balance is more valued.

Sometimes called the “Squeeze” generation because they are trying to find a more efficient way to handle work, meet financials needs, and still have quality family time. They value

education and independence rather than direction.

Generation Y: Born 1980 to 2001 (age 13-34), this group includes 76 to 90 million people that make up 10 to 15 percent of the workforce. They are known as the “Millennials” and are ethnically more diverse than any generation in our nation’s history. They are the “connect me” generation where their means of communication is through texting, social media and email.

THE VALUE OF UNDERSTANDING THESE DIFFERENCES Whether it be interviewing or working with these different generations, you can communicate and engage more effectively if you understand their values and work ethics. This will be beneficial in obtaining a new position and as one continues to advance in a career.

To be a successful manager in today’s workforce, you need to have an understanding and sensitivity of these differences as well as be open to mentor and “share your experiences.”

More people get selected or advance in their careers due to their interpersonal skills rather than their tactical skills.

MANAGING YOUR SUCCESSFUL CAREER Now that you have a better understanding of what a successful career means to you and/or others you can take the following steps in managing that career!

Self-Assessment: Realistically analyze your knowledge, attributes and skill sets in order to know how to align yourself with different types of positions.

Identify Your Ideal Position: An “ideal” position is how closely the performance, expectations and rewards of the position

fit with your interest, values and abilities. If you are new in the field or in this type of position you need to be flexible in accepting positions that offer some of these ideal aspects.

Gap Analysis and Action Planning: Analyze the “gaps” found through your self-assessment whether it is education, certification, and/or training. Then, you need to take action to fill in those “gaps” to obtain that ideal job.

Personal Marketing: Use these tips to marketing yourself.

• Cultivate and maintain a professional network • Maximize the use of social media tools • Write an effective cover letter and resume • Prepare for all stages of the interview process

COMPETENCIES NEEDED FOR TODAY’S MARKET Managers: The organizational alignment should ensure that the department’s

performance is in direct alignment with the organization’s objectives.

Managers should have the agility to be able to quickly adapt as well as have their team adapt to changes in the organization’s priorities. They must be business savvy and have the knowledge and experience to run the department as a lean but profitable business. They should use strategic thinking to provide action plan solutions for cost savings and/or financial growth. Managers need high-level communication skills for building relationships with all levels of management, including the C-Suite.

Technicians: Instead of just being tactical and/or reactionary, they should be proactive and solution focused.

They should combine strong technical ability with strong communication and customer relations skills. Technicians should handle difficult people or situations with diplomacy. It is important to remember the value of human interaction and the need for “face-to-face” time which remains important in a fast-paced technology driven environment.

REVIEW: CAREER TIPS TO BE MORE EFFECTIVE • Stay abreast of current and future changes.

• Take time to continually update your skills to be current.

• Be active in your regional and national associations for knowledge and networking.

• Perfect marketing yourself and the value you bring from the resume presentation to communicating up.

• Take control of your career – no one will take better care of your career than yourself!

REVOLUTION is Coming

“To be a successful manager in today’s workforce, you need to have an understanding and sensitivity of these differences as well as be open to mentor and share your experiences.”

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Is Price the ONLY Difference?

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ltrasound replacement parts are available form a wide variety of sources and can vary in cost by as much as 15-20 percent but is price the only differentiator? There are different types or levels of ultrasound parts vendors and they can be categorized by the processes a part goes through prior to shipping.

Matt Tomory Vice President of Sales, Marketing, and Training

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The first level is a harvested part. This is when an ultrasound system is tested as a whole, passes power up or other low level diagnostics and then is disassembled so the parts can be sold individually. This process is very superficial and many intermittent, function-specific and thermal related malfunctions of components are missed.

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The last level is a process called Quality Assurance 360째 developed by Conquest Imaging and involves fully reconditioning a part to OEM specifications, thorough technical and clinical testing, ultrasonic cleaning and part specific packaging. The first step is an ultrasonic cleaning where a part is submerged in a chemical bath and surrounded by varying frequencies of ultrasonic waves which literally scrub and polish the assembly. Next, we perform a process called the Standard Fix which proactively replaces all high-failure components on circuit boards, power supplies, displays and user interfaces to ensure longevity and allow us to place extended warranties on our parts. Through the integration of years of historical data, we have identified high failure components on these assemblies and replace them prior to multiple levels of quality assurance.

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ONE WORD TO CHANGE YOUR FUTURE The Other Side

By Myron Hartman

W

hile in the Intensive Care Unit (ICU) after being in a coma, time appeared to move slowly. Each day the dressings on my leg fasciotomies and blisters were changed. The dialysis tech attended to the dialysis machine and treatments. Nurses gave me my medications throughout the day. The TV became my best friend as I passed the time. I do not watch a lot of TV, but I enjoy some of the shows on the History Channel and that is was how I passed the time, when I wasn’t watching the Pittsburgh Penguins.

EDITOR’S NOTE: This is the fourth installment in a series of columns. The series began with a column in the December 2013 edition of TechNation. The columns can be found online at www.1technation.com.

Myron Hartman Program Coordinator at Penn State University

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One morning at about 6 a.m., the surgical team was making rounds and came to visit me. I was not too alert that day. I was tired from the meds and I had my days and nights mixed up. I was listening to one of the medical resident students tell another student about mean arterial blood pressure (MAP). He said MAP pressure was a measured parameter and systolic and diastolic pressures were calculated. I thought that MAP is calculated and S/D is measured. I was too tired and drowsy to respond, but I made a point to remember what he said.

The next morning I made sure I was up and alert at 6 a.m. When they finished checking on me, I pointed to the resident student and asked him to repeat what he said the day before about blood pressure measurements. He responded that I was not awake and he was sure that I did not hear him the day before. I assured him that I remembered what he had said and asked him to repeat it.

This grabbed everyone’s attention and they encouraged him to repeat himself. So, he began talking about systolic and diastolic pressures being calculated and mean being measured. I asked him how mean pressure is derived and if he knew the formula. He

did and said that S-D/3 plus D is used to get the MAP. I stated that if you use a formula to calculate it then it must be a calculated parameter. I think this is when he realized that he had confused the terms of calculated and measured. I asked him to calculate my mean pressure and compare it to the monitor values. He took out his phone and started the calculations. Before he could answer, I stated that it was most likely 2-3 mmhg off from the displayed value of the monitor. He confirmed that it was slightly different than the monitor and asked how I had known. This continued to garner the attention of the surgical team.

I asked someone to get me a tablet and pen so I could explain how the monitor uses integral calculus to calculate the MAP. I drew a blood pressure waveform and used the analogy of a civil engineer making a road through the mountains, pushing the peaks of the mountains into the valleys.

One peak to one valley, when we are done we will have a flat road across the mountains. The elevation of the new road is the MAP pressure. Integral calculus is what the monitor uses to calculate the MAP from the systolic, diastolic and shape of the waveform.

When I finished, the lead surgical

physician leaned over and told me it was the best explanation of MAP pressure he had ever heard and that he now had a much better understanding of it. We all had a good chuckle over the lesson and I invited them back the next day for another one.

The story of the professor in the ICU giving lectures to the physicians spread through the nursing staff and several nurses commented on it.

After being in the ICU for about a week, I was moved to a med-surg unit where I was placed on intermittent dialysis. Next to being on a ventilator, the intermittent dialysis treatment was by far my least favorite. I was connected to the dialysis

“One day a physician asked if there was anything that he could do to make me more comfortable. I thought for a moment and said, ‘How about a beer?’ ” machine and the treatment took about four hours. During this time, they tried to pull off several gallons of fluid.

During the treatment, I felt very cold and was unable to get warm. They placed a hot air blanket on me. My wife, Amy, brought in a wool blanket and a tassel hat, but I was still freezing and could not warm up. At the end of the treatment, I felt exhausted and just wanted to sleep. On occasion, my legs would cramp as well. This gave me a new appreciation of what individuals go through who are on dialysis on a regular basis.

After about seven days of treatments, my kidneys started working again but my electrolytes did not stabilize. However, I was producing enough urine to prevent the need for more dialysis treatments. As time continued, my kidneys returned to normal.

One morning while in the med-surg unit, a physician came in and talked to me about performing a bone marrow biopsy. He said it could help identify the cause of the blood clots and could possibly identify any cancer

in my body. I agreed to the procedure. It was done in my bed and was painful.

A needle with Xylocaine was used to provide a local anesthetic to the skin, tissue and bone. The needle was inserted at several locations and the shots were similar to those one gets at the dentist. The physician gave the Xylocaine some time to absorb into the tissue and returned with a drill. The bone marrow sample was taken from my pelvis requiring me to roll on my side. The drill bit went through skin and tissue and into the bone. I was surprised that I could feel the drill bit when it went into my bone marrow. The bit had a tip that was able to withdraw the marrow and parts of the bone. The physician examined the retrieved specimens. Luckily, he was pleased and the procedure was over.

A small adhesive bandage was placed on my skin where the drill had entered and it was all over in several minutes. I asked him if I could take a photo of the drill and the bit that he had used to take the sample. I

explained that I teach about medical equipment at Penn State and could use the photo to explain how the equipment is used. He agreed and we both took pictures of the equipment.

During my time in the hospital, I liked to kid around with the physicians. One day a physician asked if there was anything that he could do to make me more comfortable.

I thought for a moment and said, “How about a beer?” We joked a little and then he asked, “Do you really want one?” I said, “Yes.” He said he would take care of it.

When dinner came that evening, there was my beer. I was amazed and it tasted great (even though I didn’t finish it). I talked with the nurse and asked how this was possible. He explained that when they have patients that are also alcoholics they give them some alcohol on a controlled basis to reduce withdrawal symptoms and to keep them calm. So I enjoyed some beer with my pain meds and my hospital dinner.

Life was great!

EXPERT ADVICE

PATRICK LYNCH

Keeping Excellent Records is the Best Way to Prevent Outsourcing of HTM

By Patrick Lynch

W

hy are so many HTM (aka Biomed or Clinical Engineering) departments being outsourced? There are basically two reasons. First, there are some lazy managers who fail to keep up with the latest technology. They are content to have as much as 70 percent of their medical devices serviced under an outside contract. This makes the in-house program less cost effective and makes outside takeover extremely easy.

Second, there are many excellent programs that fail to collect data to prove their value and cost savings on paper. When a proposal comes to a CFO, COO or CEO from a national ISO, it is often a matter of cold, hard dollars. If the in-house program cannot prove their value, they are subject to losing their jobs to a corporation that is much better at quantifying costs and savings to the C-Suite.

Patrick K. Lynch Biomedical Support Specialist for GMI

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I don’t have a solution for the first problem, but there is an easy fix for the second issue – lack of documented proof of value. It all stems from your CMMS computer system and the information that is loaded into it.

The metric of the future for HTM is Cost of Service Ratio (COSR). It is a percentage that is calculated by dividing the annual cost of maintaining an asset (item of equipment) by the original purchase price of that item. It yields a percentage that is remarkably consistent across all medical devices. Most manufacturer contracts charge between 10 percent and 25 percent of the original purchase price for an annual maintenance agreement. A very mature in-house program can drive this percentage to as low as 4 percent. (Please refer to the article “Measuring the Cost of Service” in the July 2013 issue of TechNation. It can be found at www.1technation.com) There are only two numbers needed to calculate COSR. The first is the original price paid for the individual piece of equipment. All CMMS systems have a field for this information. But most biomeds do not capture or record this information. And trying to backfill an entire inventory is a monumental task.

But I have a solution. I have posted on

the GMI website a list of 1,700 different items of medical equipment, along with their average price paid. You can download this spreadsheet and use it to fill in your own inventory with purchase prices. Sure, it won’t be your exact price paid, but it will be better than a bunch of zeroes.

Filling in the purchase price of every individual item of medical equipment is the first step to preparing to calculate the COSR (Cost Of Service Ratio). It is also next to impossible to research hospital purchase orders to determine the actual price paid. So, we have to estimate. Below is a tool to help you with that. I have compiled a list of over 1,700 different medical equipment descriptions, along with the average price paid by the hospitals. It comes from an inventory of 213,000 items, so the number should be pretty good. Please download it and use it to backfill your inventory price. You will then be one step closer to calculating COSR. Here is the website for the information: http://gmi3.com/ blog/?p=3550 Next month I will discuss the next steps – calculating your internal labor rate and capturing repair data for all service providers both internal and external.

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KAREN WANINGER Residual Stress

By Karen Waninger

I

t finally got warm in Indiana, and I keep thinking that some afternoon soon I will take off work early just to get outside for a couple of hours before it gets dark.

That shouldn’t be too difficult, since it doesn’t get dark until about 9:30, right?

Well, let’s just say I haven’t been able to manage my time well enough to make that happen. I do realize the longer I go without finding a way to take some time off, the more stressed I seem to feel and the less energy I have available to respond to new or added requests. Worse yet, basic tasks like completing my quarterly reports seem to take longer than ever before, like there is some kind of residual effect that is dragging me down.

Karen Waninger Director of Clinical Engineering for Community Health Network

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With any troubleshooting process, you have to look at the symptoms to understand the root cause of the problem. Once the symptoms are identified, it’s time to draw on the knowledge and experience you have to start to isolate possible causes. This situation is no different, it’s just a matter of figuring out what is really going on and then finding the solution. I remember learning about a lot of different kinds of “residual effects” when I was going to school, so I may be able to apply what I remember from then to make some sense of what is happening now.

From the electronics classes, something way back in my brain is telling me there is this thing called residual voltage. Oh, now I remember, that was what caused a guy I worked with a long time ago to almost fall off his lab stool! He had a capacitor out of an old defibrillator sitting on his work bench, and somehow managed to brush his hand across both of the terminals at the same time. Residual voltage: the charge remaining on the plates of a capacitor after initial discharge. That’s not the same kind of “residual effect” I am experiencing currently, although laughing at the memory of that event seemed to give me a

boost of energy for a moment. Wait, what was the difference between residual voltage and residual charge? I don’t know, I think the other one had to do with batteries, and how a lower residual charge is better in batteries with nickel in them because it means the memory effect won’t be an issue.

Well, so far I am not really getting anywhere closer to understanding this issue of feeling like there is some kind of residual stress dragging me down. That’s it, residual stress is the term I was searching for! It wasn’t from the electronics classes at all, it was from one of the mechanical engineering classes.

Now that I have a valid term for this effect, the next obvious step is to do an Internet search and see what shows up, right?

1. From www.toolingu.com: Residual Stress is defined as stress that remains in the composite after the force that originally caused the stress has been removed.

2. From www.twi-global.com: tensile residual stresses may reduce the performance or cause failure of manufactured products. They may increase the rate of damage by fatigue … or cause other forms of damage such as shape change or crazing.

a. Reduced performance or failure of manufactured products – I am not sure reports count as manufactured products, but since I don’t do any real work anymore, that is about as close to an output product as I get with my current job. The fact that it takes longer to prepare them is clearly an indication of reduced performance somewhere in the process. b. Fatigue, shape change, and crazing? Yes, that definitely describes what is happening when I don’t get away from that office before dark. I don’t take lunch breaks because I am trying to cram in every minute of time I possibly can, then when I leave for the day I am too tired to get any exercise.

Both of those contribute in a negative way to the shape change.

I am sure my crew will tell you that there are clear signs of crazing, too.

3. Also from twi-global.com: residual stresses are self-balanced stresses caused by incompatible internal strains … may be generated or modified at every stage … a. Self-balanced and incompatible internal strains? Yes, that fits too. I do this to myself, always trying to do more than I can possibly fit into any normal week, and that applies to both my world at work and everything else that I try to do outside of my regular paid position. Therefore, the fact that I am being pulled from all directions makes it self-balancing and incompatible at the same time. b. May be generated or modified at every stage – Since there is always some new request, or some change in the project that was started last week, the stresses are different

every day. Another symptom validated.

4. From Ali Fatemi, via an excellent presentation developed and made available by the University of Toledo: Induce a wide variety of residual stress and their effects may be beneficial or detrimental. To improve fatigue resistance we should try to avoid tensile mean stress and have compressive mean stress. a. Effects may be beneficial? Well, in some cases I know I do my best work when there is an imminent deadline, so I guess that could fit. b. Tensile mean stress would be equivalent to stretching ourselves too thin, and I can see how that should be avoided to reduce fatigue. This one really makes sense.

Well, after all of this, I believe residual stress is a valid cause of all the symptoms I am experiencing. As in all troubleshooting and repair processes, once the root cause has been identified, the last step is to implement an appropriate solution. Fortunately, the web search offered one of those, too! I haven’t tried it yet, but here it is in case anyone else out there is experiencing similar issues … Residual Stress up to 70 percent off� - www.sale-fire.com/ Residual+Stress.

Wait a minute, that’s not a solution! I don’t need any more residual stress, even if it is available at fire-sale prices. What I need is some of that compressive mean stress, whatever that is. Oh, I get it, that’s what vacations are for, pulling yourself back together so you can tackle the next challenge with renewed energy.

So the solution now becomes 1) Suck it up, cupcake, and get back to work or 2) Take a vacation!

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BEYOND CERTIFICATION Certifications Outside Your Profession

By David Scott

I

was recently at the AAMI Conference in Philadelphia. It had been a few years since I attended an AAMI Conference. I was surprised how big it is. I’m not sure if I remember it differently or if it has grown. I had a good time there and saw many former members of the CABMET Certification Study Group. A few of them were asking me about renewing their certification and what they should do. I gave them a quick rundown of the articles that have been running in TechNation since January 2013. I told them to go back and review the issues to get the maximum points toward renewal, which is also what I suggest to anyone reading this article. All the articles are available online at 1technation.com just look for the “Beyond Certification” articles.

David Scott Biomedical Technician, Children’s Hospital Colorado; CABMET Study Group Organizer

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We have looked at different certifications available in our profession (CBET, CRES, CLES). What about certifications outside of our profession that have some crossover value to what we do? There are several Information Technology (IT) certifications available.

Some of these certifications are becoming more desired by employers since the advent of integration of medical equipment with Electronic Medical Records (EMR). In the May 2014 issue of TechNation the Biomed 101 article covered certifications available through Healthcare Information and Management Systems Society (HIMSS). They are Certified Associate of Healthcare Information Management Systems (CAHIMS) and Certified Professional of Healthcare Information Management Systems (CPHIMS).

I was recently reading certification information on the Healthcare Technology Management Association of Ohio’s website. (www.ohiocea.org) They have very informative pages that cover many different certifications. Both HTM related and IT related. The site gives good

background information regarding certification. I was surprised to learn there are so many different IT certifications.

The site says there are up to 100 different types of IT certifications. HTMA of Ohio suggests that any individual in pursuit of IT certification do their own research and due diligence to determine what is best for them. The IT certification landscape changes almost as swiftly as the technologies being supported. They have a listing of the top 12 IT Certifications of Spring 2012. These may have changed since then, but it gives you an idea about all the different IT certifications. Some are definitely more relevant than others. Take a look at their website for yourself. I’m sure you will find some useful information toward making a decision whether or not you want to pursue an IT certification and if so which direction to go.

I have friends that work for OEMs and many of them are being sent to Cisco or Microsoft certifications through their company, which is what many of the OEM networked systems use now. I think it is a good idea for HTM professionals

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In some cases it could lead to a promotion or new job title for you when you get these certifications. There is a somewhat new job title in HTM called Equipment Interface Specialist. This job specializes in the interfacing of medical equipment with other systems throughout the hospital or healthcare provider network. The kind of certifications discussed in this article can be helpful in moving your career toward that rapidly growing specialty within the HTM field.

In closing, certifications can help in advancing a career and there are many options to consider. The key is to do some research and find the one that is best for you and your career track.

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THE ROMAN REVIEW

People are NOT our Greatest Asset

By Manny Roman

“P

eople are our greatest asset” is a blanket statement that has been the mantra for so many years that we have come to accept it and even believe it. True, people are a great asset for an organization, however, it really should be said: “The right people are our greatest asset.”

Manny Roman

Manny.Roman@me.com

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The “right” people must possess the right skills to do the right job. More importantly, they must possess the right attitude. It is the attitude that makes people the right people. Skilled people with the wrong attitude will be the wrong people. Look around your organization to see who has technical skills yet does not quite fit in. You will find that it is the attitude that makes the difference.

The wrong people will hurt the organization, sometimes in minor ways, yet they will still cause damage. They may be a demotivating factor, a stressful drain on the energies of others, or a negative influence that tends to reduce the oxygen in the room. Worse, they can affect customers’ perceptions of the organization and negatively influence external relationships.

The above describes the effects of the wrong people in an organization. So what does it mean to be the right people? The right people fit well into the culture of the organization. The key is to create a well-understood and accepted organizational culture. Although the different departments of a larger organization may have separate and distinct cultures of their own, it is important to have an overall corporate culture that is well-defined and understood. The departmental culture must not clash with the organizational culture.

Peter Drucker said, “Culture eats strategy for breakfast.” In other words, all the strategy in the world will fail if the organization has a flawed culture. Some of the elements contained in the culture are vision, values, norms, systems, beliefs, patterns of collective behaviors,

AUGUST 2014

assumptions, etc. In short, culture is how members of an organization think, behave and feel about the organization, each other, and clients. It is a way of life within the organization. The corporate culture must be carefully created around the value system and the mission and vision of the organization.

So how do we ensure that our people are in tune with our organizational culture? First, make sure that the culture really is well-defined and understood.

Second, make sure that all the people in the organization have a sense of ownership of the culture through continuous training and education. Only when all people are “on board” the culture, will the organization run smoothly (assuming good practices in the other aspects of conducting successful business).

When hiring, leadership and management must be sure that prospective employees possess an attitude that will fit the defined corporate culture.

Since attitude is a choice, we must make sure that the people are of the appropriate mentality to make the desired choice. We normally hire for skills, I’m suggesting we hire for attitude and train for skills. Attitude goes a long way toward success.

It is a courageous supervisor that will admit to making a bad hiring choice, especially if the issue is attitude, not technical competence. Yet the people with the wrong “culture attitude” cause the most damage. We just say that there are personality conflicts, accept the damage, and move on. The right person will hit the ground running. The wrong person will not only fall but will also trip others on the way down.

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THE VAULT

D

o you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your chance to prove it!

Check out “The Vault” photo. Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will receive a $5 gift card to Starbucks and will be entered to win a $25 gift card. To submit your answer, visit 1technation.com/vault-august-2014/. Good luck!

LAST MONTH’S PHOTO

an HP ECG Monitor.

The photo was submitted by David Pham. To find out who won a $25 gift card for correctly identifying the medical device visit 1technation.com.

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Send us a photo of an old medical device to jwallace@mdpublishing. com and you could win lunch for your department courtesy of TechNation!

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Terrible towel, Steerlers fan, orginially from Pennsylvania Flags above monitor, right to left: • Don’t Tread On Me – Navy • U.S. Flag • Don’t Tread On Me – Culpepper Minutemen Small photo on desk under Potato Head football player in Steelers helmet are my children Aidyn and Gavin Stress ball by computer mouse from TriMedx Slinky sitting on top of subwoofer

ith, Jr. Kerry L. Nesm list ia Imaging Spec al Center dic e M a lask Providence A

“I am the walking dead until I’ve had my coffee in the morning.”

- Kerry Nesmith Jr

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Screwdrivers in cabinet handle Walking Dead mug

Photos behind desk from top to bottom: • Boondock Saints • Artwork by Aidyn • Photo of my sons Aidyn and Gavin

Diplomas Left to right: Durham College – Biomedical Engineering Technology, University of Liverpool – International Management, and Bemidji State University – Technology Management, My beautiful daughter Lexi Linton Poster telling us what to do in case of a workplace injury My MDExpo Badge from the recent Las Vegas show!

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TechNation Webinar Wednesday email on right monitor.

James Linton Ac Biomedical/Clinical Engin et. Bas. Msim. eering & Central Equip ment Woodstock Hospital

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Aramark Healthcare Technologies……………… 28 Ph: 1.800.825.1786 www.aramarkhealthcaretechnologies.com

MedEquip Biomedical……………………………… 55 Ph: 877.470.8013 • www.medequipbiomedical.com

ATS Laboratories…………………………………… 23 Ph: 203.579.2700 www.atslaboratories-Phantoms.com BC Group International, Inc. …………………… BC Ph: 888.223.6763 • www.bcgroupintl.com Bio-Medical Equipment Service Co.……………… 22 Ph: 888.828.2637 • www.bmesco.com Biomed Ed…………………………………………… 63 Ph: 412.379.3233 • www.biomed-ed.com CIRS, Inc.…………………………………………… 28 Ph: 757.855.2765 • www.cirsinc.com Conquest Imaging………………………………… 11 Ph: 866.900.9404 • www.conquestimaging.com Cool Pair Plus……………………………………… 51 Ph: 800.861.5956 • www.coolpair.com Crothall Healthcare Technology Solutions……… 13 Ph: 404.616.9022 • www.crothall.com Doctors Depot……………………………………… 17 Ph: 800.979.4993 • www.doctorsdepot.com ECRI Institute…………………………………… IBC Ph: 610.825.6000 www.ecri.org/alertstrackerautomatch Elite Biomedical Solutions………………………… 41 Ph: 1.855.291.6701 www.elitebiomedicalsolutions.com

National Ultrasound………………………………59 Ph: 800.797.4546 • www.nationalultrasound.com NETECH Corporation………………………………… 31 Ph: 800.547.6557 • www.Netechcorporation.com Ozark Biomedical……………………………………65 Ph: 800.457.7576 • www.ozarkbiomedical.com Pacific Medical LLC………………………………… 47 Ph: 800.449.5328 www.pacificmedicalsupply.com Philips HealthCare………………………………… 7 Ph: 1.800.229.6417 • www.usa.philips.com Pronk Technologies………………………………… 6 Ph: 800.609.9802 • www.pronktech.com Rieter Medical Services…………………………… 63 Ph: 864.948.5250 • www.rietermedical.com RTI Electronics………………………………………59 Ph: 800.222.7537 • www.rtielectronics.com Sage Services Group……………………………… 61 Ph: 877.281.7243 • www.SageServicesGroup.com Seaward Services Group/Rigel Medical………… 5 Ph: 1.813.886.2775 www.seward-groupusa.com/technation Soaring Hearts, Inc.………………………………68 Ph:855.438.7744 • www.soaringheatsinc.com Southeastern Biomedical…………………………65 Ph: 888.310.7322 • www.sebiomedical.com

Four Rivers Software Solutions…………………… 55 Ph: 412.256.9020 • www.frsoft.com

Stephens International Recruiting Inc.………… 63 Ph: 888.785.2638 • www.BMETS-USA.com

General Anesthetic Services, Inc.…………………40 Ph: 800.717.5955 www.generalanestheticservices.com

Technical Prospects LLC…………………………… 39 Ph: 877.604.6583 • www.TechnicalProspects.com

Government Liquidation………………………… 3 Ph: 480.367.1300 • www.govliquidation.com Hans Rudolph, Inc.………………………………… 23 Ph: 1.800.456.6695 • www.rudolphkc.com Health Tech Talent Management, Inc.………… 55 Ph: 757.563.0448 • www.HealthTechTM.com Imprex International……………………………… 33 Ph: 800.445.8242 • www.imprex.net

INDEX

Introducing the Bulletin Board!

MedWrench…………………………………………69 Ph: 866.989.7057 • www.medwrench.com/join5

Fluke Biomedical ………………………………… 4 Ph: 800.850.4608 • www.flukebiomedical.com

Global Medical Imaging…………………………… 2 Ph: 800.958.9986 • www.gmi3.com

The Medical Product Support Network.

A new resource where you can find all the information needed to help you be more successful! The easy to navigate Bulletin Board allows you to see: • Our weekly blog • Upcoming expos & events • Continuing education & classes • Careers

Tenacore Holdings, Inc.…………………………… 16 Ph: 800.297.2241 • www.tenacore.com Trisonics……………………………………………… 23 Ph: 1.877.876.6427 • www.trisonics.com Troff Medical………………………………………… 33 Ph: 800.726.2314 • Troffmedical.com Universal Medical Resources, Inc.………………40 Ph: 888.239.3510 • www.uni-med.com USOC Medical………………………………………… 12 Ph: 855.888.8762 • www.usocmedical.com

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