TechNation - October 2014 by MD Publishing

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VOL.10

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

OCTOBER 2014

ASSET TRACKING RTLS TECHNOLOGY LOCATES AND MORE

Biomed Adventures Disaster Responder

The Roundtable Anesthesia

What's on Your Bench? Highlighting the workbenches of HTM Professionals

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38 44 TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

THE ROUNDTABLE - ANESTHESIA This month, TechNation asked experts about purchasing and servicing anesthesia equipment. Our panel weighs in the latest technology and the impact of those advances on the healthcare market. Next month’s Roundtable article: Computed Tomography

ASSET TRACKING Real-Time Locating Systems use high-tech gadgets and invisible communication modes to help healthcare facilities track everything from equipment to patients and the hand-washing practices of staff. Healthcare Technology Management professionals and other healthcare insiders share the insights regarding the potential of these systems. Next month’s Feature article: Finding Service Information for Older Equipment

TechNation (Vol. 5, Issue #10) October 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.

OCTOBER 2014

1TECHNATION.COM

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Sharon Farley Warren Kaufman Jayme McKelvey

ART DEPARTMENT

Jonathan Riley Yareia Frazier Jessica Laurain

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

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

P.34 THE BENCH

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Betsy Popinga Taylor Martin

P.58 EXPERT ADVICE

ACCOUNTING

Sue Cinq-Mars

P.14 SPOTLIGHT

p.14 Professional of the Month: Robert Tritt p.16 Company Showcase: Technical Prospects p.20 Department Profile: Community Health Network Clinical Engineering Department p.22 Company Showcase: Fluke Biomedical p.26 Biomed Adventures: Disaster Responder p.30 Webinar Wednesday: Makes Learning Easy

p.34 p.36 p.38 p.40 p.42

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

p.58 Career Center p.60 Ultrasound Tech Expert Sponsored by Conquest Imaging p.62 The Future p.64 Karen Waninger p.66 Beyond Certification p.68 Patrick Lynch p.70 The Roman Review

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.74 BREAKROOM p.74 p.76 p.78 p.82 p.90

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

p.89 Index Like us on Facebook, www.facebook.com/TechNationMag

MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

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PROFESSIONAL OF THE MONTH Robert Tritt By K. Richard Douglas

ntering the biomed profession means you never know where it will lead you. That was the case with one HTM professional at the Medical University of South Carolina (MUSC Health) in Charleston, S.C. While not even planning to be a biomed, his skills eventually led him to the east coast of Africa.

Robert Tritt is a BMET III with the biomedical engineering department at MUSC Health. Tritt did not plan on a career in biomed from the beginning. Like many, it became apparent after he started in another position. “(I) really just fell into it,” he recalls. “Right after college, I worked for a company installing and repairing nurse call systems and one account was MUSC. At that time, I wasn’t sure what I wanted to do as a career. After about two years there, Biomed from MUSC called and asked if I would work for them; they liked me and my work. So in July of 2003, I started at MUSC.” Tritt earned an associate of science degree in Electronics Engineering Technology from ITT Technical Institute. He has racked up his biomed experience with his current employer from the beginning. Back when he was starting out, he didn’t know much about biomed or the equipment he would be working on. “Learning the job was done by some manufacturer training, some on-the-job training, and some thrown in water (and) learn as you go training,” Tritt says. “The first two years was learning what I can in the way of the equipment, PMs, areas and locations of the hospital and the campus. I’m still learning new equipment, and technology coming into the hospital and healthcare.”

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OCTOBER 2014

Tritt has worked on equipment in almost every area of the hospital. “The areas that I cover have changed throughout the years, and (the) one I have kept since the beginning is neonatal ICU,” he says. In addition to PMs and repairs, two duties Tritt has had since the start, is being the lead tech on equipment integration to the EMR and the point person for a campuswide bedside monitor installation for MUSC Health. He is also the point person for the campus-wide asset tracking system. Tritt is well thought of by his co-workers. “Robert exceeds the expectations of his biomedical responsibilities at the hospital,” says Tritt’s colleague, Jake Silver, BMET. “He is a role model for all biomeds in my opinion. He is definitely the go-to guy.”

TAKING ON CHALLENGES “A lot of the nurses in my areas call me ‘Boots.’ And, a lot of people in the hospital only know me by my boots. I have worn cowboy boots to work since I started,” Tritt says. Once Tritt’s boots were in bad shape and he had to order a new pair. He had to wear different shoes while he was awaiting the delivery of his new boots. “As I was waiting for them to arrive, I wore sneakers and was later told by the

Robert Tritt is the “go-to guy” at MUSC Health.

nurses not to wear them again,” Tritt says. “They could not hear me when I walked my units and didn’t know I was there. The nurses in the nurseries got used to the sound of my boots, when I walked around checking on things. If there was a problem and they didn’t have time to page me, they would stop me or find me in the unit because they heard me walking around.” In March of 2013, Tritt seized an opportunity to visit Tanzania, Africa for a week. The purpose of the trip was the installaition of bedside monitors that

Robert Tritt says he is a general biomed who specializes in caring for the neonatal units.

MUSC had donated to an organization called Madaktari. Preparations for the trip took about a year. Also going on the trip were Dr. Scott Reeves and his daughter. Reeves was the impetus for donating the unused monitors. Madaktari takes a “teach it forward” approach to bringing doctors to east Africa to teach local doctors, who then spread the knowledge. Tritt had to get everything organized with the monitors, and crate them with destinations at hospitals in three different cities in Africa. The arduous task was complicated by getting the equipment through customs, but it arrived at the hospitals in October of 2012. When Tritt arrived in March of the following year, he installed four monitors at Bugando Medical Center in Mwanza and six at Muhimbili National Hospital in Dar es Salaam. “They only had four monitors in the ICU and we added six before I left,” Tritt says. “I also trained the biomeds on how to install and service them.” It wasn’t all work. Accompanied by Dr. Reeves and his daughter, Tritt took a safari through the Serengeti. He had the chance to see a lot of animals in the wild including

zebras, giraffes, wildebeests and lions. The only thing more exciting than going on an African safari was the chance to meet the president of Tanzania. The president wanted to thank the Americans for the work they were doing there.

RECOGNITION Tritt says he is a general biomed, but there are a couple of areas that he considers his specialties; “caring for the neonatal units and ‘IT’ within biomed,” he says. It’s a challenge trying to handle everything at one time. Tritt stays busy with various projects. He said it can be difficult to keep up with PMs and repairs while also focused on the many different projects. His good work hasn’t gone without recognition. Tritt won the Employee of the Month Award for June of 2013. Another award included some publicity. He won the Health Care Hero Award for Health Care Engineer, given by the Charleston Regional Business Journal in November of 2013. That award recognized the work he did in maintaining the neonatal and pediatric biomedical equipment at his hospital.

FAVORITE BOOK: Bible

FAVORITE TYPE OF MOVIE: Action, science fiction

FAVORITE FOOD: Lasagna

HIDDEN TALENT: Martial arts

FAVORITE PART OF BEING A BIOMED: “Helping the patient, by helping the nurses, doctors and staff to do their job effectively. And to help the babies that come into this world with a rough start; they need that little extra care.”

WHAT’S ON MY BENCH? Coca-Cola, here lately Coke Zero. My external drive with music on it. My Gerber tool.

SPOTLIGHT

TECHNICAL

PROSPECTS

Experts in Siemens Medical Imaging

COMPANY SHOWCASE Technical Prospects

ormer Siemens CT engineer Bob Probst founded Technical Prospects 18 years ago. From the beginning, Technical Prospects has been the experts in Siemens CT, providing parts and support to imaging communities worldwide. The Siemens X-ray product line was added in 2005, and they recently expanded their offerings to include OEM training in their state-of-the-art 70,000-square-foot facility located in Appleton, Wisconsin. The company currently services and supports Siemens CT, X-ray, angiography, cardiac catheterization, mammography and mobile/portable imaging units as well as offering new and used tubes with installation. John Vandersteen, Director of Sales and Marketing, pointed out that the company’s focus on Siemens lets their customers know Technical Prospects’ dedicated employees have the best available knowledge about the Siemens systems they work on. “We are a dedicated supplier of Siemens medical imaging parts, training and support. We specialize in only one manufacturer — Siemens — which means we will have more parts available in stock at better pricing than the OEM and increased knowledge of the systems and parts,” Vandersteen said. “We are the direct source for Siemens imaging parts.” Technical Prospects’ growth in recent years has presented many opportunities, and the company’s leadership has helped make the expansion seamless. “Our biggest challenge has been our growth, but with our great leadership and dedication to the operations side, we effectively manage this growth and continue to improve and increase our offerings to include repaired and refurbished parts for our customers,” Vandersteen said. In 2014, the company invested in a $1.5 million training center expansion. Their

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OCTOBER 2014

OEM-trained engineers boast almost 100 years of combined experience with multiple vendors to lead its technical support and training initiatives. The company’s expansion provides functional training/test bays, two classrooms accommodating up to 24 students, a new product repair shop and the expansion of the entire technical engineering department. “Our biggest enhancement of the services we offer is in the area of training and the

classes we offer to the clinical engineering community,” Vandersteen said. “We have also expanded our parts and tube stock for Siemens Artis rooms. We are the Siemens parts solution.” “We are excited about the training opportunities we offer. The capability of staging 32 bays of Siemens systems for training and quality assurance allows us to test our Siemens parts and ensure they are in good condition prior to shipment and installation,” he added. The staged training and testing equipment available at Technical Prospects’ headquarters includes the following Siemens models: • • • • • •

Emotion 6 Emotion 16 Sensation 4 Sensation 16 Akron Sensation 16 Straton Sensation 64

Technical Prospects employees are seen in front of the company’s 70,000-square-foot facility located in Appleton, Wisconsin.

Siemens SOMATOM Sensation 16 handson training lab is one of 32 bays of Siemens systems for training.

• • • • • • • • • • • • • • • • • •

Siemens Definition Multix TOP Multix PRO Axiom Aristos Multix MT Luminos TF Sireskop SX Iconos R200 Uroskop Access Artis FC Artis dFA Mammomat 3000 Siremobil 2000 Siremobil Compact Siremobil ISO-C Arcadis Varic Mobilett XP Hybrid Mobilett Plus HP

Jeff Rindfleisch, Vice President of Operations, reported that the training center is off to a great start. “We have trained 61 students since the center opened,” Rindfleisch said. “Our senior engineering staff is conducting the training and the feedback has been overwhelmingly positive.” Field Service Engineers are among those benefitting from these training opportunities with classes on Siemens X-ray systems that include instruction on three different generators during the two-week class. Technical Prospects also offers two-week CT training sessions on the Siemens Sensation 10 through 64. There is a two-week class on the Siemens Emotion 6 and 16. Another training opportunity they

Technical Prospects has a Siemens Multix MT hands-on training lab where it holds educational opportunities.

are providing is a one-week Mobilett class on portable X-ray. Technical Prospects is offering its first fluoroscopy class in October on the Uroskop Access surgery unit. In November, there is a fluoroscopy class on the Siemens Luminos. Each of the two-week fluoroscopy classes includes training on the table, fluorospot compact and generator and how the three are integrated to make up the system. “We are developing one-week CT basics and X-ray basics courses for 2015,” Rindfleisch said. “They will be a prerequisite for other classes being offered.” Leveraging the quality assurance processes into a training and support opportunity not only improves access to necessary training for its customers but also lowers the cost of doing business. Growth and an extensive offering of training opportunities are added benefits that Technical Prospects offers its customers. These additional services add to the Technical Prospects mission “to provide the global medical imaging community pre-owned OEM quality standard imaging parts at less than OEM pricing with an honest and consistent reputation due to quality shipping, friendly service and knowledgeable staff.” Parts and support remain the key aspect of the Technical Prospects mission as the company’s employees strive to meet each customer’s needs in a professional and courteous manner. Siemens equipment “has always been the nature of Technical Prospects’ business,”

said Vandersteen. The company’s tagline “Experts in Siemens Medical Imaging” reinforces that goal. Technical Prospects also provides legacy support on parts for some Philips CT products, but Siemens has been the bedrock of the company. “Siemens is what we know, it is what we’re best at, and it is the market that we can continue to perform the strongest in,” Vandersteen said. “A lot of other companies dabble in GE, Toshiba, maybe Siemens; you can’t be everything to everybody.” Currently their pre-owned, new and refurbished parts are as much as 30 to 90 percent off the Siemens list price. Customers who partner with Technical Prospects are not only getting a bona fide working replacement part, they are also getting a great deal. “There are several pre-owned equipment companies in the market today repairing parts, but they have no way to test that part and verify it’s working properly within the system,” he said. “We’re bringing to the market an in-house, system-tested product with our proven quality assurance program.” Vandersteen said each employee takes pride in the fact that we invest a great amount of time and expertise into supporting our existing equipment and inventory, guaranteeing the customer a superior product and overall experience. A commitment to product repair and support isn’t only environmentally and economically sustainable, but it has increased our ability to offer the most competitive prices to our customers, Vandersteen said. “A lot of this is because of the model we have,” he said. “We own our own parts, we’re direct and we control our pricing. It’s what gives us the ability to exceed our customers’ expectations.” By coming directly to Technical Prospects, Vandersteen said, customers can lock in a great price, superior technical support, on-time delivery and quality packaging. FOR MORE INFORMATION about Technical Prospects, visit www.technicalprospects.com

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DEPARTMENT PROFILE Community Health Network Clinical Engineering Department By K. Richard Douglas

ommunity Health Network is a not-for-profit health system based in Indianapolis, with over 200 sites of care and affiliates throughout Central Indiana. The health system includes hospitals, nursing homes, behavioral health centers, outpatient locations and schoolbased clinics. It also partners with Marian University’s College of Osteopathic Medicine and is one of the top 15 large employers in Central Indiana. Managing an inventory of 21,238 active devices is the task of the health system’s 25-member clinical engineering department. In 2013, the department handled 9,430 repair requests and 5,904 scheduled inspections. “Our HTM team supports the five Community Health Network hospitals in Indianapolis and one located about an hour north, in Kokomo,” says Pat Holliday, radiology service leader for Community Health Network. “In addition to the hospitals, we support many off-site facilities such as surgery centers and imaging centers. We have a total of 25 people in the department, providing service for the imaging and biomedical equipment.” “We have a technical site leader who serves as the main point of contact for the clinical care team in each facility,” Holliday explains. Those site leaders include Dwight Crowmer at the Community Hospital East, Andrew Moore at Community Howard Regional Health, Steve Erdosy at Community Hospital North and Matt Smith at Community Hospital South.

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OCTOBER 2014

Holliday leads the department’s imaging service team. Karen Waninger is the department’s director. “Eighteen of the 25 members of our team have earned the credential of Certified Biomedical Equipment Technician (CBET) in addition to their assorted levels of formal education. Additionally, many hours are spent each year for advanced technical training and professional development classes,” Holliday says. The team has a diverse skill-set with imaging specialists who support cardiac cath equipment, MRI, CT, ultrasound, CD/ DR and rad/fluoro. “On the biomedical side, we support specialty devices such as lasers, anesthesia, ventilators, neonatal intensive care, balloon pumps, physiological monitoring, neurology, pulmonary function and all general care areas and devices,” Holliday says. The need for service contracts is handled through a strategic process, according to Holliday. “Each device is evaluated to determine the most appropriate service strategy, based on the technology, the availability of

Jared Graff, Dale Chamberlain, Steve Roll, Kelly VanDeWalker and Steve Erdosy serve Community Hospital North as part of the Community Health Network Clinical Engineering Department.

training and alternative suppliers for replacement parts,” he says. “Our organization utilizes a mix of full service, shared risk, parts-only and time and materials agreements, with the desire to have all service activities tracked through our equipment management database.” He says that the clinical engineering team has a good working relationship with the IT department, with a healthy respect for the skills each brings to the table.

GOING BEYOND “As a team, we have accepted the responsibility for supporting additional facilities as our healthcare network has grown, and have even agreed to provide service, for a fee, to some other organizations in our geographical area who have needed support for their healthcare technology,” Holliday says.

TOP LEFT: David Sanders, Darrell Stevens, Dwight Crowmer, Russell Snow, Kelly Robinson and Julius Obazee are all important members of the Community Health Network Clinical Engineering Department. TOP RIGHT: Jacob Richter and Matt Smith smile while working in their office.

“We have several individuals who have been HTM award recipients, both locally and nationally, including numerous IBS Professional of the Year winners, AAMI BMET of the Year, AAMI HTM Leader of the Year. The first TechNation Professional of the Year award came to Community, as well.”

ANALYTICAL MINDS

Jennifer Nickels, Brent Milam, Pat Holliday and Doug Miller are a part of the department’s service imaging team.

“Each facility, each business affiliation arrangement, and each new bulk of additional inventory allows us to further demonstrate our value, by helping reduce the total cost of service for the medical equipment,” he adds. “Since the beginning of 2013, we have expanded our area of responsibility to deliver services to more than 10 additional locations.” Holliday says that many in the department choose to participate in the volunteer program that their organization has implemented to give back to the communities in the surrounding area. Called “serve360°,” this program includes a wide variety of activities. “Last year, we were instrumental in the development of a playground area at a local church school, where none had existed previously,” Holliday says. “We put on the jeans, T-shirts and gloves, picked up the hammers, shovels and rakes,

and had a great day of physical exertion and team building, while creating some great play areas and structures for underprivileged children.” The team is very involved in the HTM profession even while away from work. “We are a highly involved group, with great support from our vice president at the hospital,” Holliday says. “Everyone in our department, including our VP, is a member of the Indiana Biomedical Society (IBS). Each year, about 80 percent of us are able to attend the annual conference in Indianapolis in January.” “We have many people who have been officers for IBS, including some who hold positions currently. We are proud to say that we have had representation at every MD Expo since 2008, except the last one in Washington D.C., and our entire Imaging Service team participated in the inaugural MD Imaging Expo in July of 2014,” he adds.

Not just repair experts, the team has also been called upon to evaluate acquisition decisions. “Recently, our biomedical service team has been instrumental in the consideration of evaluating different patient monitors for future purchases across Community Health Network. Our current standard monitor vendor has been adequate, but the life cycle cost of the systems has continued to increase with each expansion, while some of the desired features have been slow to be developed,” Holliday says. “We spent a great deal of time talking to the clinicians, working with the product analysis team which is facilitated by our partners in purchasing, and coordinating on-site demonstrations and trial implementation/utilization areas,” he says. “The results have been positive from a variety of perspectives.” The imaging service team has been working over the past year to find the right upgrade path to move its old portable X-ray machines into the digital radiography world. “We are nearing the final stage of the first of the selected upgrades and are hopeful that this will lead to many more of these in the near future,” Holliday says. “If successful, this project alone will save our network more than $500,000 in planned capital expenditures next year.”

SPOTLIGHT

COMPANY SHOWCASE Fluke Biomedical

luke Biomedical is a true leader when it comes to biomedical test and diagnostic imaging products. The company, under the direction of General Manager Eric Conley, leads the world in the design and manufacture of biomedical test and diagnostic imaging products including: electrical safety testers, patient simulators, performance analyzers, automated testing and documentation systems, X-ray test, radiation safety, and oncology quality-assurance solutions for regulatory compliance. “We achieved our leadership position by being the company customers can rely on for more than 30 years,” Conley said. “We combined the best of the best companies in the medical quality and safety market to ensure our technology offerings meet every customer expectation.” New products, a recent acquisition and a stellar reputation are the result of a decades-long focus on customer service. Customer service that includes exceptional training and educational opportunities for the healthcare technology management professionals who rely on Fluke Biomedical products.

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The Fluke Biomedical ESA609 Electrical Safety Analyzer is a rugged, portable and easy-to-use analyzer designed for general electrical safety testing. Engineered for on-the-go technicians, it requires no training to use and has a rubberized case that allows it to sustain the rigor of transportation, and helps prevent damage when accidentally dropped.

“We believe that when you invest in the best products, you deserve the best support. For us, that not only means customer service and technical assistance, but also product training,” Conley said. “We are currently the only company that offers comprehensive academic courses to the healthcare technology management community for regulatory compliance, productivity improvement, and using test instruments effectively.” Fluke Biomedical has an uncanny ability to foresee the future needs of customers and include those within its goals. The recent acquisition of Unfors RaySafe is a perfect

illustration of that commitment. “Earlier this year, we identified an opportunity to expand in a market we feel has great growth potential – diagnostic X-ray testing,” Conley said. “We broadened our portfolio through the acquisition of Unfors RaySafe to include the technical innovation our diagnostic imaging customers need.” The addition of Unfors RaySafe created excitement within the company and with customers. “With this acquisition, we added state-of-the-art diagnostic X-ray, real time dose monitoring systems for medical

The RaySafe X2 sensors and electronics are specifically designed to minimize the need for user interaction. A groundbreaking concept in sensor design and circuitry provides unsurpassed accuracy, reproducibility and sensitivity. Intelligent algorithms clearly indicate when a parameter is outside its specified range.

personnel, and patient dose tracking software quality assurance solutions to our product portfolio. This outcome has been very beneficial to our customers as we can now accommodate more of their testing needs while maintaining the reliability and quality standards our customers trust,” Conley added. Fluke Biomedical’s impeccable reputation combined with its dedication to customer service and enhanced offerings clarifies its leadership position within the industry. “When we ask our customers why they choose our products, we consistently hear, ‘Because it’s Fluke.’ That answer alone embodies the sole purpose of what we strive for as a company, and what makes us unique,” Conley said. “Our customers stake their professional reputations on our test equipment. Reliability is the linchpin of our corporate identity, and our greatest asset. And by delivering world-class solutions coupled with unparalleled quality and reliability, we give our customers peace of mind.” Fluke Biomedical’s acquisition of Unfors RaySafe was one highlight of a very busy year for the company. The introduction of new devices also generated excitement within the company. “This year has been very eventful for us. We recently introduced two infusion device analyzers and one electrical safety analyzer to the biomedical test market,” Conley said. “We are very excited about the ultra-portable IDA-1S Infusion Device Analyzer, which features an LCD touch screen and easy-car-

ry handle for on-the-go testing. The IDA-5 is a total infusion pump test solution and can test up to four pumps at once using test automation software. Additionally, the ESA609 Electrical Safety Analyzer offers a more portable electrical safety test solution, and combines legacy reliability and accuracy with durability for field testing.” “Late last year, Unfors RaySafe launched the innovative and easy-to-use X2 X-Ray

The ability to meet customers’ needs sets Fluke Biomedical apart from the rest of the industry. “We make every effort to accommodate the testing demands of our customers. Often times this includes engineering custom products to adhere to unique testing specifications,” Conley explained. “Most recently, we facilitated the re-engineering of the VT305 Gas Flow Analyzer to increase the baud rate (speed in which the device under test communicates with the VT305) for a major ventilator manufacturing customer. Without this increased baud rate, our customer would have not been able to complete required testing.” Fluke Biomedical’s success is the result of the hard work and dedication of the best employees in the industry. “Our employees are the foundation of our business and the most key ingredient to our success,” Conley said. “Fluke Biomedical associates have a shared passion for the work that they do to make a positive impact on the healthcare community.” Fluke Biomedical strives to serve its customers, but more importantly the

“ We believe that when you invest in the best products, you deserve the best support. For us, that not only means customer service and technical assistance, but also product training” -Eric Conley, General Manager Test system,” Conley added. “The X2 eliminates the need to carry bulky test equipment and a PC by combining on-board data logging and multi-X-ray device testing in a handheld tool.” Conley said more great products are coming in the future. “Fluke Biomedical is committed to providing healthcare providers, institutions and medical device manufacturers with a complete portfolio of test equipment,” he said. “I anticipate our product portfolio will continue to grow to answer market demands with innovative and state-of-theart solutions.”

company aims to make a positive impact on healthcare throughout the world. “Our mission: to improve the quality of global health – one measurement at a time,” Conley explained. “Our mission statement is a commitment to our customers, to the health community, and patients everywhere. We deliver on that commitment by providing the best and most reliable quality assurance solutions to make medical equipment safer to use.” FOR MORE INFORMATION about Fluke Biomedical, visit www.flukebiomedical.com

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BIOMED ADVENTURES Disaster Responder By K. Richard Douglas

EMA operates a special healthcare facility, called the National Mobile Disaster Hospital, consisting of a series of prefabricated structures transported on 18-wheelers. The unit was called into action for the first time on April 28, 2014, when an EF-4 tornado struck Louisville, Miss. The tornado had wind speeds of 170 to 190 mph and was responsible for nine deaths and dozens of injuries. More than 42,000 residents were without power. The local hospital, the Winston County Medical Center, a nursing home and an outpatient clinic were heavily damaged. Gas service had to be cut off to the hospital and clinic. The mobile hospital requires the assistance of clinicians, as would be expected. It also needs the skills of a trained biomed to maintain equipment and that task fell to Cary Setzer, a BMET with Southeastern Biomedical Associates in Hudson, N.C., who works as a field service technician. Setzer was also recruited to help set up the hospital in Mississippi. “I first got involved with National Mobile Disaster Team a few years back when our company began to do PM service on their medical equipment,” says Setzer. “I was one of the techs that performed the PM service because I have been trained on their anesthesia machines. I’m sure that I was probably chosen to go to Mississippi because of the time I have spent with their equipment and because I was trained on their anesthesia machines.” Cary Setzer’s career in healthcare technology management is the result of a conversation with a friend and a co-worker while he was attending classes at a community college. Setzer’s career in the HTM profession goes back to his hands-on experience with power tools in a family business. “I grew up working in our family’s machine shop — City Machine Company — after attending Caldwell Community College for several years,” Setzer says. “Not sure what to take, a friend and co-worker

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found the biomed program. He started the program and then I started a year later.” Setzer graduated from the Caldwell program with the skills to test, troubleshoot and repair medical equipment. “It was a great fit for me, because having a machinist/fabricator background, I had a lot of the skills that it takes to repair equipment,” Setzer says. “My strongest skills are electrical and mechanical.” His current employer has also sent him to ultrasound and anesthesia training sessions. The combination of his biomed training and his metal fabrication background was put to the test.

GOING INTO ACTION A group of 25 men, known as the Baptist Men of North Carolina, volunteered to do practice runs assembling the mobile hospital in North Carolina while it has awaited its first use. They accompanied the mobile hospital to Mississippi to put that practice to the test. While Setzer was prepared to take on the medical equipment portion of the task and provide some training to local clinicians, he wasn’t aware that he would be called upon to contribute during the assembly phase as well. With the first deployment of the mobile hospital, there was some anticipation of the unknown for Setzer in the wake of the disaster in Mississippi. “I was not sure what to expect,” he says. “I thought I would be sleeping in a tent with very limited food or water. After arrival, I found that we did have hotel rooms and there was plenty of food and water. This does not mean that the work was any easier.”

Cary Setzer trains the staff on the medical equipment taken to Mississippi. The equipment included infusion pumps, patient monitors, aspirators, ventilators and defibrillators.

The mobile hospital took 36 hours to transport to Mississippi and three weeks to completely set up. Setzer was in Mississippi for 14 days. “This was the first time that this mobile disaster hospital had ever been deployed in its 10 years of existence. We were first deployed on a Thursday and we drove half way and arrived in Louisville, Miss., on Friday,” Setzer remembers. “The site where the mobile hospital was to be assembled was a warehouse that was destroyed by the tornado,” Setzer explains. “The warehouse had not been cleaned up, so for the next 30 hours straight, a team of scrap iron workers removed the rumbled warehouse. We arrived on Saturday to an almost clean

slab where that hospital would go. After the slab was cleaned, we started moving the pieces of the hospital in position.” Setzer says that the mobile hospital is made up of nine sections transported on the 18-wheelers. Those sections resemble pods. He says that the side walls are removed, and then

unloaded trucks of utility task vehicles, generators and pods. “We also helped the state of Mississippi set up their RVs for their headquarters,” Setzer says. “The assembly of the hospital was delayed by politics several times. For instance, there were 14 different site plans of the location of the hospital. Even after we

given for a couple of days until someone informed me. There was the mayor, and governor of Mississippi stopping by to do interviews at the work site to inform the public that this hospital would be available very soon,” Setzer says. He says that while all of this was going on, you could see homeowners in the area cleaning up their properties after the tornado had destroyed their homes. “There were military type tents set up with A/C (where) we could get relief from being out in the sun,” Setzer says. “Inside the tents, they had tables, chairs, snacks and coolers with drinks.”

AFTER SET-UP; TRAINING

The team works to set up the mobile X-ray unit.

Cary Seyzer and other workers were able to cool off in air-conditioned break tents that had cold drinks and snacks.

the sections are connected to form a room with a separate room at each end. “To unload the pods, we had to first unload and complete some slight assembly of a huge forklift. By Wednesday, we were unloading the pods and the side walls were being removed,” Setzer explains. Setzer worked alongside an employee of a company called SPEVCO that built the mobile operating room. The SPEVCO employee had a fifth-wheel trailer that was full of the tools needed to assemble the hospital. The first week, the two collaborated to complete multiple tasks such as fabricating plates that hold the walls together. They also assembled the forklifts and

had assembled the hospital, they wanted it moved again. This time it took a lot of planning, because now the pods are together and were supposed to be stationary. The final plan to move the hospital was to put a forklift at each end and push the whole assembly back 20 feet, and it worked.” Once the whole hospital was in place, all of the seams had to be covered to prevent any leakage from the outside. In addition, the hospital had to be hooked up to generator power, suction and medical air. “After the assembly was complete, we started to load the hospital with medical equipment,” Setzer says. “In all, there are basically three main departments; ICU, which was the mobile O.R. trailer from SPEVCO. Then, there is the patient care area, which is the mobile hospital. The third piece is the X-ray pod, which is a full length trailer where the walls let down to complete a room that is double the width of a normal trailer.” Several charitable organizations pitched in to help. The American Red Cross provided lunches for several days. “There was a temporary clinic set up in front of our site where the hospital staff was seeing about 30 patients a day. I didn’t even realize that patient care was being

Once the mobile hospital was assembled, Setzer’s attention turned toward training the staff on the medical equipment. “I held multiple classes over several days on the medical equipment to complete in-service training so that the staff would be able to use the devices we brought,” he says. “I trained the staff on infusion pumps, patient monitors, ventilators, defibrillators, ultrasound, aspirators and X-ray.” “One of the highlights for me is how appreciative the staff was to be getting this equipment,” Setzer recalls. “I believe that it saved their jobs because they would not have had a place to work since their hospital was destroyed by the tornado.”

FIRST DEPLOYMENT OVER What were Setzer’s final thoughts after being involved with this important project? “The most important part is that the staff could continue providing healthcare to their community,” he says. “I’m proud to have been able to work beside the people of Louisville, Miss., to help provide some temporary relief until, hopefully, they get a new hospital of their own.” “We worked long hard days, but (it) was very gratifying because I could see how appreciative the local community was,” he adds. “I also got to witness the strength that people have to join together for the greater good, regardless of which state or side of the country you live in.” “I also saw the side of some politics, and how the government is involved with the process; some good and some not so good,” he adds. “In all, it was a success, and the staff of the hospital were able to keep their jobs and continue to work.”

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A LIFE TO REMEMBER The Passing of Joel Nobel, MD – Clinical Engineering Icon

By James P. Keller, MS, Vice President, Health Technology Management and Safety, ECRI Institute

had the pleasure to work with Joel Nobel, M.D., founder and president emeritus of ECRI Institute, for almost 30 years. Our most recent conversation, about two months ago, was related to an invitation he received to be a keynote speaker at an upcoming Saudi Food and Drug Authority (SFDA) conference. Joel had politely declined the invitation and asked me to find another ECRI colleague to fill in for him. During our conversation his voice sounded weak and I could understand how he may not have been up for a trip to Saudi Arabia. Little did I know that it would be the last time we would speak. ECRI Institute has been receiving tributes from all over the world since we learned of Dr. Nobel’s death. An email from one of our SFDA colleagues I think says it best about how influential he was to so many. I quote, “This news falling like a rocket over my head!” Those of us who worked closely with him felt like we got hit by that rocket. I’ve had a hard time picturing an ECRI Institute without Dr. Nobel. He was a force of nature and had his strong hands on so much of our operations. Among Dr. Nobel’s many gifts was an ability to impart his knowledge and wisdom, entrepreneurial spirit, and sense of purpose to so many individuals. That definitely applies to ECRI Institute. Visitors to ECRI Institute are often amazed at how many staff have worked here for decades. We stayed or returned because we believe in the amazing mission he started nearly 50 years ago. The Clinical Engineering profession owes Dr. Nobel a huge debt of gratitude. He literally got us off the ground and has been our guide for nearly

“ Thanks for all you have done, Joel. You were one of a kind and will always be Clinical Engineering’s icon!”

50 years through the services he ran and provided at ECRI Institute. A big part of what the clinical engineering profession learned came from lessons taught by Joel. It’s that we should do it for the patients, do it well, and do it with honesty and integrity. And, although we are sad that Dr. Nobel has passed away, we are so

confident in what he has taught us over the years that we feel well prepared to carry on. If you would like to learn more about Joel Nobel and his legacy, visit: https:// www.ecri.org/Press/Pages/MemoriamJoel-Nobel.aspx. ECRI Institute will be organizing a formal memorial event during the fall of 2014.

SPOTLIGHT

WEBINAR WEDNESDAY Makes Learning Easy By John Wallace, Editor

ree educational sessions from the comfort of your home or office sounds too good to be true, but hundreds of HTM professionals are earning continuing education credits on their computers thanks to Webinar Wednesday! Hospital budget constraints often limit training and continuing education opportunities for HTM professionals, which makes the free Webinar Wednesday program perfect. The webinars cover a range of pertinent topics including test equipment, benchmarking and management strategies to name a few. Many of the sessions are ASRT certified for continuing education credits. Respected industry experts make the webinars a popular learning tool among HTM professionals and students. Among those who have presented webinars are Manny Roman, Karen Waninger, Frank Magnarelli and Bob Brochart. These giants of the industry have shared their insights and advice on how to succeed. Roundtable webinars have also been in high demand. Hundreds logged in to attend the roundtable sessions, including the popular “What’s New in Test Equipment” and “What’s New in X-ray Test Equipment” presentations. The webinars engage participants with questions-and-answer sessions. Workbooks are also available for download prior to many of the webinars for an in-depth look at the topic being examined. These workbooks also serve as study guides and remain a valuable resource after the webinar. In short, the Webinar Wednesday program is a must-have tool for HTM professionals. It helps generate a positive impact on patient safety while also providing up-to-date training on in-demand topics. Attendees at previous webinars have been quick to praise the Webinar Wednesday program. Dave Scott, who has helped run the CABMET study program for a decade, said he always benefits from a Wednesday Webinar session and looks forward to attending them. “You are able to ask questions and meet experts on the subject matter and create a network of contacts for future reference, if needed. Every webinar that I have participated in I have learned something,” Scott said. “It is also nice to get the Power Point (presentation) the presenter uses so you can reference them in the future.” “It is also good for continuing education credit toward certification renewal,” Scott said about webinar attendance. “People always want to know how they can get CE points – this is an easy one! There are a lot of webinars available for free. A few webinars a year and you can easily accumulate points and never have to leave your office/home. These points add up quickly over the three-year renewal period.”

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“TechNation’s webinar series has provided a unique way to obtain continuing education training, stay on top of cutting edge technology and training,” one participant wrote in a post-webinar survey. The Webinar Wednesday schedule will include up to three webinars a month going forward. Check out the schedule at IAmTechNation.com/webinars/ and register for a free session. Also, be sure to read the informative blogs available on the website. Al Moretti, Frank Magnarelli, Abbe Meehan and Manny Roman provide valuable insights on a weekly basis. Recordings of previous webinars are also available online at IAmTechNation.com/webinars/. The webinars are available at no charge. FOR MORE INFORMATION about Webinar Wednesday, visit www.IAmTechNation.com.

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AAMI UPDATE AAMI Asks FDA to Clarify Standards Expectations

AMI has sought clarity on what considerations U.S Food and Drug Administration (FDA) review staff would like the association and similar organizations to take into account during the standards development and revision processes. The association made the request in written comments to draft guidance the agency issued in May on the appropriate use of voluntary consensus standards in premarket submissions. The draft guidance builds upon a document released in 2007, adding information on how applicants have used standards inappropriately in their premarket submissions. In its comments, which generally welcomed the FDA’s revision, AAMI said that it would be helpful “to know more about ‘how’ standards are used incorrectly or inappropriately, so that AAMI can produce tools (e.g., checklists or guides) that make it easier for industry to know what they are doing incorrectly.” Additionally, AAMI said having a list of what reviewers are looking for in standards would be beneficial, particularly since representatives from the FDA are not always present at standards committee meetings. “AAMI believes it would strengthen standards and improve the medical device industry’s understanding of what’s important in terms of substantive content of standards,” the association said. AAMI also asked that the agency reorganize the document’s structure to make it more usable as a quick reference guide. It proposed an outline that includes a section on use of standards that is subdivided into “methods of use” and “general process.” In addition, AAMI suggested that the document include examples or case studies “to better articulate excellent practices” and highlight potential

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OCTOBER 2014

incorrect uses of standards when submitting a premarket application. AAMI also recommended that the agency reformat the Standards Data Report Form, also known as FDA Form 3654. The example form provided in a link from the draft guidance is “poorly developed” and should be updated so device manufacturers can add pages and lines.

REPORT OFFERS TIPS FOR SMOOTHER DEVICE APPROVALS Are you a medical device manufacturer trying to interpret standards and understand regulatory expectations to get your product to market as quickly as possible? AAMI is offering a free resource for you. The S3 Challenge Forum – for solutions, synthesis, and standards – took place March 11-12, 2014, in Herndon, Va., and brought together a range of stakeholders to hear experts from the U.S. Food and Drug Administration (FDA) and industry offer their tips and advice. The sessions used a different format from the S3 Challenge’s predecessor, the International Standards Conference, encouraging participants to discuss the topics among each other to gain a greater understanding of how standards and regulations have an impact on getting products to market. “The forum was excellent. This type of interaction will result in a better understanding by both industry and the FDA of the challenges each faces, which, in turn, will help drive positive change in the regulatory approval process,” said

Michael Ball, director of biological services at Covidien Surgical Solutions Group, in the report. The 23-page report summarizes the insights that came to light during the event by examining three top industry challenges: biocompatibility, sterility, and risk management. Each section defines the issue and lists relevant standards, then provides a summation of experts’ presentations. The final section of the report provides an overview of the last session, which focused on managing risk associated with catheters and endoscopes. In addition, the report includes a section of questions for companies to consider when evaluating ways to improve their risk management processes. Developed by industry consultant Stan Mastrangelo, the questions cover an array of topics, including system- and component-level hazards and standards used to evaluate risks. “We intended that this guide would serve as a summary of insights from the event and prove valuable for the medical device industry,” said Carol Herman, AAMI’s senior vice president of standards policy and programs. TO READ THE FREE REPORT, visit www.aami.org/S3/S3_Challenge_2014.pdf.

AAMI TO DEVELOP CERTIFICATIONS FOR HTM AND QUALITY SYSTEMS PROFESSIONALS AAMI has started work on developing two new professional certifications, one for quality systems experts in the medical device industry and the other for healthcare technology management (HTM) professionals. Both will be rolled out early next year. AAMI already has certification programs for biomedical equipment technicians, radiology equipment specialists, and laboratory equipment specialists.

This summer, a group of subject matter experts from leading institutions across the country were invited to AAMI’s headquarters in Arlington, Va., to develop the blueprint for the new certifications, which will prove crucial in demonstrating knowledge of and dedication to the field. “Often – too often, I might add – certification may be seen as another hurdle in professional development, and I’m amazed that people take for granted the value that certification recognizes,” said Jan paul Miller, who recently joined AAMI as director of certification programs. “Certification benefits not only the certificant, but also the employer and, most importantly, the public.” Divided into two groups based on their expertise, the attendees developed separate lists that identified the tasks quality systems professionals or HTM

managers should perform as part of their job duties. The groups then created a draft certification exam for each set of professionals. Miller noted that the certifications are being fast-tracked using a format that compresses the development from 18 to six months. “I’m very excited to see the manager certification program moving forward,” said Carol Wyatt, manager of the Biomedical Engineering Department at Baylor Scott & White Health Care in McKinney, Texas. “This is another way to show healthcare leadership that HTM managers bring an increased level of competency to the field.”

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STILL ALARMING Taking On Alarm Hazards

ast year, The Joint Commission announced that alarm safety would be added to its list of National Patient Safety Goals for 2014. And for years, clinical alarm hazards have appeared at the top of ECRI Institute’s annual Top 10 list of health technology hazards. The excessive number of alarms that can activate—in particular, those that sound even when the patient is not in distress—is a key part of the problem. But it’s not the only part. That’s a critical point that ECRI Institute stresses in its new resource, The Alarm Safety Handbook: Strategies, Tools, and Guidance. WHY GIVE ALARM HAZARDS SO MUCH ATTENTION? For starters, they’re ubiquitous. The potential for alarm-related incidents leading to patient harm exists every minute of every day in virtually all healthcare facilities. Second, alarm hazards put patients at risk. According to a 2009 analysis of the U.S. Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, 566 alarm-related patient deaths were reported from 2005 through 2008. In its 2013 Sentinel Event Alert, the Joint Commission notes that industry experts believe this figure likely underrepresents the actual number of incidents. Finally, alarm hazards are difficult to eliminate. Reducing clinical alarm hazards requires improving the manner in which alarms are managed—and that is a complex and lengthy process. In most hospitals, the number of alarms that will be active at any given time is staggering. And the optimal strategies for managing those alarms will vary from one care area to the next, and sometimes from one patient to the next. With a concerted effort, however, healthcare facilities can make headway against this high-priority hazard. That’s the

1TECHNATION.COM

message that ECRI Institute conveys in its new resource, The Alarm Safety Handbook: Strategies, Tools, and Guidance. Addressing clinical alarm hazards is not simply a matter of making sure that alarms are turned on or that the alarm volume is set appropriately. It requires a comprehensive alarm management program involving stakeholders from throughout the organization. The facility must dedicate long-term effort to developing and implementing the program, to assessing and refining its functionality, and to adapting the program to changing clinical practices and medical technologies. Goals for an alarm management program will include both (1) minimizing the number of clinically insignificant or avoidable alarms so that the conditions that truly require attention can better be recognized and (2) optimizing alarm initiation, notification, and response protocols so that the patient receives the appropriate care at the time it’s needed. ECRI Institute’s experience helping healthcare facilities achieve these goals has revealed that hospitals need to understand seven key points to find success:

OCTOBER 2014

Look beyond the technology. Recognize that alarm hazards are not just a technology problem—issues of organiza-

tional culture and processes must also be examined. Leadership must demonstrate a readiness to tackle the problem, and everyone involved must understand the full scope of the hazard.

Involve multiple departments. Address the problem through a coordinated, multidisciplinary effort. Lasting improvements cannot be achieved by departments acting in isolation; thus, a key early step will be to form a multidisciplinary alarm management team.

Understand your world of alarms. Invest the time to understand how alarms are used at your facility. A successful program will require identifying where your vulnerabilities lie and developing appropriate strategies to limit hazards. Activities that can help with this effort include: • Observing how the many different alarms are handled in each care area. Much can be learned by walking around, observing what happens on the nursing floor, and engaging frontline staff about their concerns. • Reviewing your reports of adverse events and near misses.

•

Collecting and analyzing alarm data—for example, obtaining a measure of the number and types of alarms that activate per bed per day within a care area. The more data you can collect (and make sense of), the better you can target strategies to improve alarm management. However, even comparatively brief snapshots of data can yield useful information.

ECRI INSTITUTES’S RECOMMENDED PATH FOR REDUCING ALARM HAZARDS

Don’t force “one-size-fits-all” solutions. Consider the needs of each care area individually. Although reducing clinical alarm hazards will require an organization-wide effort, the risks will vary from one care area to the next, and the solutions will need to be tailored to each area individually. That is, there is no one-size-fits-all answer. Numerous factors can play a role in whether alarms in a particular care area or for a particular device or patient will warrant attention, such as: © 2014 ECRI INSTITUTE

• • • • • •

Acuity of the patient Technologies being used in the treatment of the patient Technologies being used to communicate alarms Nurse-to-patient ratio Care model employed Architectural layout of the care area

Get input from staff. Involve frontline staff in identifying and implementing improvement strategies to help match the strategies to the needs of, and the workflow in, each clinical environment.

Evaluate, revise, refine. Assess the effect of the strategies that are implemented, and revise or refine the program as needed.

Promote your successes. Doing so can help staff see the value of any new approach and can keep the organization focused on this important patient safety program.

Many healthcare facilities find it helpful to contract with an independent organization to assess the culture and to bring together stakeholders from various departments to develop a coordinated, institution-wide strategy for improving the management of clinical alarms. Consulting organizations with experience in this area can direct you toward strategies that have been proven effective at other facilities. ECRI Institute is one of several organizations that offers this kind of customized, on-site assistance. With a long history of evaluating alarm-equipped medical technologies, investigating incidents, and providing unbiased judgment, ECRI Institute is unique among the organizations that offer this kind of customized, on-site assistance. The Institute has worked with world-re-

nowned healthcare facilities and health systems to identify their clinical alarm hazards, analyze current practices, and craft proven, practical alarm management strategies. Additionally, The Alarm Safety Handbook: Strategies, Tools, and Guidance and its accompanying workbook provide guidance and tools to help hospitals create and refine their own alarm management programs. THIS ARTICLE is excerpted from ECRI Institute’s The Alarm Safety Handbook: Strategies, Tools, and Guidance. To purchase this resource and its accompanying workbook, or to learn more about ECRI Institute’s on-site alarm management safety review capabilities, visit www.ecri.org/ alarmhandbook, contact clientservices@ ecri.org, or call (610) 825-6000, ext. 5889.

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1TECHNATION.COM

BIOMED 101

Avoiding the Sophomore Slump: Re-Tooling Your Skills & Attitude for Continued Success in HTM By Jennifer Anne DeFrancesco

s the Healthcare Technology Management field continues to grow at an unprecedented rate, upward mobility and career moves are pervasive throughout the industry. With this, individuals are facing the challenges of changing positions more frequently and earlier than they have historically. With the average biomedical engineer spending less time in each position, HTM professionals are being challenged to accomplish more within their shorter time at each position. Undoubtedly, the first year in any position is a strong indicator of one’s potential success in that position. Within the first year, colleagues, staff and executive leadership formulate perspective on your performance that can define your tenure within the organization – whether good or bad. In any new role, challenges will occur within the first year that can make your 12-month stint exhausting. Moving past the first year, it can be difficult to avoid the “sophomore slump” by plateauing with regards to performance – this is particularly true for individuals who set a very high standard within their first year. HTM professionals can leverage four simple tips to avoid burnout while re-tooling their skill set in order to effectively manage performance in their second year and beyond within a position.

REDEFINE YOUR BOUNDARIES The first year in any tenure can feel like a full throttle race to the finish line. Because of the fast-paced nature of the healthcare industry, it can be

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OCTOBER 2014

nearly impossible to define your boundaries. After your first year in a position, it is an opportune time to re-evaluate your quality of work versus quality of life and realign your priorities and boundaries. Around the 13-month mark in my first management role, I found myself to the point of exhaustion – both physically and mentally. While this was a tough time for me, I utilized it as an opportunity to objectively evaluate what I needed to strike a better balance at work. The next day I had a discussion with my boss that laid the foundation to establish a better balance between work hours and the level of assignments that I was responsible for. While this may not be the most comfortable discussion to have, it is necessary to reassess your work environment and balance on a periodic basis. This also will provide you with an opportunity to assess tasks that you can delegate to other staff members in order to offer them

JENNIFER ANNE DEFRANCESCO Chief of Biomedical Engineering at the Richard L. Roudebush VA Medical Center

“reach” roles to help develop their professional acumen. Vice versa, if you have been previously unwilling to take on special assignments or work additional hours, it could be an opportune time to approach your boss and let them know you are ready to step into a different role at work.

SORT THROUGH THE CRITICISM The healthcare and technology industries are full of a wide variety of personalities with an equally diverse range of opinions. No matter what organization you are in, what role you play or your personality profile you will receive feedback that can be positive or negative. No doubt, your first year will

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be filled with supporters as well as detractors. To be successful, you need to be adept and objective when receiving both praise and criticism. Assess the situation, ask for feedback, keep what’s useful and toss the rest. Allowing yourself to get hung up on unwarranted criticism or praise will consume your attention away from productivity. I once had an intern who spent some time rotating through my office. One afternoon, I went to assign them something and found them crying on their desk. When I asked what was wrong, they explained that they had been three minutes late to a meeting and were upset that they had been asked to leave since they couldn’t arrive on time. In discussing with them, I told them to take it as a lesson and be on time moving forward and to move on. If this was something that induced a slumped over, desk-crying tantrum they should probably search for a different profession. At the end of the day, our job is dealing with issues and tough situations with high pressure – there will always be more criticism than praise.

LET GO OF YOUR GRUDGE AGAINST “THAT GUY” We all work (or have worked) with that person who induces an eye-rolling, cringe-worthy reaction as soon as they open their mouths. Whether they roam halls shaking hands, discussing their golf game while nonchalantly stumbling into meetings 20 minutes late or they claim to have been hired as “professional managers” and admit to lacking the technical skills their position requires –

these people know exactly what to do to push your buttons. The amount of time, energy and effort that you spend loathing this person for one reason or another is distracting you from your work and the time adds up. I’m not saying that you should drop everything and become best friends with this person, but allowing yourself to let go of your grudge against them will make you feel better. You can avoid negative feelings at work and that will make you more productive in the long-run.

CONTINUED EDUCATION It goes without saying that in a rapidly evolving field one must stay current with their education. Take the time to establish a continuing education plan for yourself. Prioritize at least two weeks of training, whether professional or technical, each year to ensure you are updating your skills in targeted areas. Additionally, challenge yourself to seek out at least one certification or certificate a year. Interested in IT? Take the Network + certification you’ve been putting off. Want to get into leadership eventually? Find a sponsor and pursue your FACHE. Set an annual goal and push yourself to stick with it. While we all face dynamic challenges within the workplace, there are milestones within any position that lend themselves to change and reflection. The year mark is a critical milestone where one’s trajectory within an organization can be catapulted or flounder. Make sure you are prepared to take the next step.

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SHOP TALK

Conversations From the TechNation Community Q:

Does anyone out there have a commitment to work agreement that they have an employee sign before sending them to an expensive manufacturer’s training course?

A: A:

Yes, we currently have to sign a two-year agreement.

If you’re in a “right to work” state or if the employee is an at-will employee, you won’t have a leg to stand on.

Our health system used this kind of form for over two years and I’ve even signed it myself (with heavy protest). After pushing back a number of times, it eventually got taken to our HR department and they laughed at it. They told our facilities management people that it’s not worth the paper it’s written on. I understand the attempts to “jail or hold a gun to technicians’ heads” so management doesn’t have to spend much time on employee relations. “Why treat a technician like a valuable resource, when they can’t quit without paying back some hefty fees.” However, if management suspects any employee of using the system to get trained, then leave … don’t send them to training in the first place. I have attended various training schools for many years and through three different careers. Every employer has invested varying amounts of money and I have invested quite a lot of time in order to make me the technician I

1TECHNATION.COM

OCTOBER 2014

am today. I have worked at each company a minimum of 6 years before getting a better offer (which included counter-offers). I wonder where our careers would be today if every one of us signed these agreements 20 or 30 years ago? How about the managers, supervisors, department heads, administrators, vice presidents and CEOs … do they sign such agreements? Did they get to where they are on their own dime, or did they get help from the government or parents or maybe bosses that recognized the investment is part of doing business. Business 101 – Train good people and treat them well, give them the tools to do the job. An employee breaking a commitment to work agreement looks bad, but I doubt they are really enforceable. It would probably be considered indentured servitude. In at least one case in Illinois even a non-compete agreement was found to be unenforceable. Your agreement should have a prorated training repayment clause. That is more likely to be enforceable.

they pay for outside training, they rightfully expect to be able to benefit from that training for at least a couple of years. If HTM employees begin taking their newly acquired training and run off to get a job where they make another dollar an hour, then the hospital will soon stop paying for this training. It makes perfect sense. So, I emphasized the importance of giving the hospital at least a couple of years of service after any training, else the rest of the shop members would suffer in the long term. We made a collective, unwritten agreement – anyone who went to school would try their best to stay with the hospital for at least two years afterwards. If they were in serious stages of seeking another job, they would turn down the school opportunity. This worked well for our $280,000 annual training budget, and we never lost a single person in 7 1/2 years. People do not take advantage of the situation when they are treated fairly and made aware of the consequences of their actions. Trust on both sides is required.

Good question. You may want to send two to the training and ask for a discount.

I have used these in the past, but never tried to enforce them. I found a better way. We had a shop meeting. I explained the hospital’s view of the situation. When

How does your department specify which devices will be maintained and repaired by HTM professionals and which will be maintained and repaired by IT?

Our facility delineates by device function. Medical devices and medical servers fall under HTM. The

common network backbone and non-medical servers are IT. When medical systems interface with the standard network we separate responsibility at the point of interface. Strictly medical networks such as our 1.4 Ghz telemetry network are entirely the responsibility of biomed.

We try to base it on what is needed for that device. Some devices require network connectivity that can be done by biomeds, others are more behind the scenes that only IT can do on their infrastructure. Anything that needs to be punched down in the closets is IT, anything VLAN or wireless for the device is usually configured by IT, the rest of the equipment is us. To sum it up in a nutshell, from the wall plate back is IT and anything that needs configured/ set up on a VLAN or server related is also them. Hardware and machine functionality is us.

What time intervals do you use for PM completion? I have a policy that states PM completion must be within (plus or minus) 30 days for annual, semi-annual, quarterly, etc. Do you deﬁne this in a policy or use the default time intervals that The Joint Commission has.

We do life support equipment within the month assigned. All other equipment is done by the tenth of the following month. It is defined in our Medical Equipment Management Plan.

That is a slippery slope. We are not JCAHO and instead use DNV and we just went through a survey. This specific question was asked and the surveyor told me of his displeasure with the way various facilities try to give themselves a grace period on PMs. We use during the month due as our standard and I have never had this method questioned. It gets too difficult to explain your rationale if you start giving yourself wiggle room. We instead have some codes we can apply in situations where a device is in use, out for repair, not locatable, etc. We don’t count these as complete, but we don’t ding ourselves for not getting say a ventilator done that was in use on a patient for the entire month and let it dilute our completion percentage.

We define it in our MEMP. TJC allows for this unless another AHJ or Condition of Participation has a set standard. So, for most medical equipment we allow 60 days prior to the first day of the month it is due and 30 days after the first. Quarterly PM intervals are 30 days prior and 30 days after the first of the month the system or device is due.

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

ROUNDTABLE

ANESTHESIA

dvances in anesthesia and the impact of those changes on the market are just two topics industry experts discuss in this TechNation roundtable article. The experts on the panel are CE-Tech Service Manager David Deforge, President of Paragon Service Thomas G. Green, Dräger Director of Marketing David Karchner and Mercury Medical’s Director of Clinical Services Jim Ruggiero.

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OCTOBER 2014

What are the latest advances or signiﬁcant changes in anesthesia equipment? What technologies are worthy of the initial investment? Deforge: The integration of physiological monitors including built-in anesthetic gas modules are now the standard in higher-end anesthesia machines. Heated absorber systems, which reduce moisture in the breathing system, is a benefit for the patient, the clinician and the service technician. The ability to capture data electronically and store this information for medical records, EMR, has been a goal for many years and the OEMs use this as a selling tool. The use of the automated pre-use checkout procedures are becoming a standard. Increased ventilator modes and options are a tool for the clinician to provide improved care for their patients, ranging from neonates to geriatrics. Green: The main improvements in anesthesia equipment over the past 5-8 years have been ventilation modes that were previously only used in the ICUs. These include Pressure Support Ventilation (PSV), Synchronized Intermittent Mandatory Ventilation (SIMV) and Synchronized Mandatory Minute Ventilation (SIMV) and various derivatives of each mode. These modes are a very nice feature for orthopedic cases where the patient initiates the breath and the ventilator completes the breath. Karchner: Dräger continues to focus its Research and Development on improving the efficiency of anesthesia delivery. This not only includes proven tools like the Apollo’s Low Flow Wizard, which can significantly reduce the cost of anesthetic agents, but also future technologies that allow customers to achieve faster OR turnaround times and offer enhanced ventilation capabilities. Ruggiero: I think some of the latest advances in anesthesia equipment are the more sophisticated ventilators and ventilation modes like Volume Control

DAVID DEFORGE CE-Tech Service Manager

Ventilation (VCV) and Pressure Control Ventilation (PCV) with volume guarantee, along with Pressure Support (PS) ventilation. The integrated ventilators provide a wide range of setting and waveform displays, enabling the end-user more effective care across the wide range of patient sizes and acuity types. One significant change that is worthy of the initial investment is a machine’s capability to interface into the hospital HL7 architecture to provide Electronic Medical Records (EMR).

How will those changes impact the anesthesia equipment market in the future? Deforge: The improved ventilator options, automated checkout procedures, built in monitors and heated absorber systems will increase the cost of the machines, with the goal of improving patient safety and allow the institution to keep up with the pace of the everchanging healthcare environment. This will also make the older generation machines seem inadequate for today’s needs. Until the older generation machines are replaced, it will become more of a challenge to maintain them

due to a shortage of repair parts. Facilities and/or anesthesia departments must be pro-active and budget to buy newer machines. Green: If an anesthesia provider deems these ventilation modes necessary for patient care, then it could result in the sale of replacement equipment. Karchner: It will be more important than ever for the healthcare provider to work together with their vendor to quantify the value these differentiating technologies offer over the useful life of the anesthesia workstation. Many of these new technologies create the opportunity to significantly reduce existing fixed costs and the patient’s length of stay. Ruggiero: These changes will impact the anesthesia equipment market by improving patient outcomes. The more sophisticated the equipment becomes, the better chances of detecting problems while anesthetizing patients and making the necessary corrections in real time. More than 30 years ago, most anesthesia machines didn’t even come with an oxygen monitor on them. Advances in technology have contributed to a decrease in morbidity and an increase in quality of perioperative management. In addition, with the interface of the anesthesia equipment into the hospital IT servers, information can be integrated into the patient’s medical records.

How can a facility with a limited budget meet the anesthesia equipment needs of today? Deforge: The facility has a few options. The first option is that they can purchase pre-owned equipment from a reputable pre-owned equipment company. These companies have the anesthesia machines with the specifications that they are looking for at a lower cost than buying new. The second option is to budget a certain percentage of the machines per year to phase in this new technology. Lastly, the facility can upgrade their

THE ROUNDTABLE

existing system’s software/hardware if available. Green: Purchasing refurbished modern anesthesia equipment from a reputable refurbisher is a great alternative. Karchner: First, today’s anesthesia machines are more software driven than ever before, which means that a facility with a limited budget can add features/ functions that may not be budgeted for today at a later time. In addition, utilizing each vendor’s entire anesthesia portfolio is a great way to save money. For instance, Dräger has implemented a user interface (UI) strategy where our entire anesthesia portfolio (Apollo, Fabius GS premium, Fabius Tiro, Fabius MRI) utilizes a common UI. The purchasing team can choose the machine that best meets the technology needs of each OR, while reducing the associated training costs of the clinical team. Ruggiero: Facilities with a limited budget should consider either a certified used refurbished anesthesia machine with a full year warranty or look into a rent-to-own program.

What else do you think TechNation readers need to know about purchasing and servicing anesthesia equipment? Deforge: Before purchasing, it is very important to do your homework on these devices. Besides price shopping on this large initial investment, you need to calculate the annual maintenance costs. These costs include PM kits, service tools, applications, technical training and reliability of the machines. In the last few years, other companies have joined the anesthesia market. Now, besides the “big two,” you have other options to research. Green: Check the refurbisher/service provider’s resume. Are they factory service trained on the device to be purchased/serviced? Do they perform field service to hospitals and surgery centers? Where do they obtain parts?

1TECHNATION.COM

OCTOBER 2014

the machine down to the skeleton and rebuilding it with new parts, or just throwing a paint job on it? Another thing to consider is the cost of ownership or annual preventive maintenance cost. Some of the newer machines from Mindray are less than half of the cost of their competitors, and their annual maintenance cost is less than hundred dollars.

What are the most important things to look for in a reputable third-party anesthesia equipment provider?

THOMAS G. GREEN President of Paragon Service

Do they have adequate liability insurance? Will they provide local references? Karchner: When looking at the cost of service for an anesthesia machine, it’s important to look beyond preventive maintenance parts. Sometimes, anesthesia vendors will only provide the cost of PM parts when replying to a Request for Proposals (RFP). Unfortunately, PM parts might be just the tip of the iceberg when looking at service costs. We encourage customers during the sales cycle to dig beyond PM parts to understand the true cost of service. Many times, the best action is to get a comprehensive service quote from each vendor to gain cost transparency. Ruggiero: Do your homework when it comes to purchasing or hiring a company to perform your anesthesia equipment service. Make sure that when you’re buying an anesthesia machine, new or used, that you compare the options and what you’re getting for your money. Are they performing a full refurbishment, taking

Deforge: While looking for a thirdparty anesthesia equipment provider look into the company’s willingness to stand by their sales with warranty and service after the sale. Use references, what the company gives you, and the references you find on your own. Performing research will give you peace of mind on this purchase decision and will help you determine the integrity of the provider. If this anesthesia provider is also providing your anesthesia machine maintenance, get proof of their training records. Karchner: The acquisition of an anesthesia workstation is an important one, as it’s something that many healthcare providers only do every 10-12 years. And because of that, it’s important for healthcare providers to look at the long-term strategies of each vendor. Is the existing technology being offered upgradeable? What’s the strategy from a service perspective? How long have they been in the anesthesia market? Are they invested enough in the anesthesia market to be able to provide support for the useful life of your anesthesia purchase (10-12 years)? Also, it’s never a bad idea for a healthcare provider to request 10-15 references from each vendor for the equipment being purchased. Ruggiero: Some of the most important things to look for in a reputable

third-party anesthesia equipment provider is how long the company has been in business. Are they an ISO certified company? Are they insured and for how much liability insurance per occurrence? Are their technicians factory certified by the OEM?

training strategy, the distribution strategy for service parts and any special tools that are required to service the product. Ruggiero: The best way to ensure that you will receive the necessary literature and training tools is to put it in writing. My suggestion is to add it to the purchase order for the equipment.

Is it possible to keep up with the latest anesthesia equipment advances and improvements without buying brand new?

Deforge: Yes. By using a reputable third-party, preowned medical equipment company you can purchase refurbished anesthesia machines with the advances and improvements you are looking for, without the new system price tag. If available, upgrading your existing anesthesia machines’ software with the latest ventilator options could provide the equipment advances and improvements that you are looking for. Green: Yes. Most anesthesia equipment refurbishers have modern anesthesia equipment models in stock for a great alternative to purchasing new at a savings of 25 to 35 percent. Karchner: This is absolutely possible, but it is highly dependent of the platform purchased. While today’s machines are more upgradeable than ever, not all anesthesia platforms are created equal, and this can make a difference over the useful life of a machine. For instance, if the practice of low- and minimal-flow anesthesia is a future goal for your healthcare facility in order to save on agent costs, make sure that the platform was designed for lower flows. Is the platform designed to reduce or eliminate condensation? Is the gas sampled by the gas bench recirculated back to the breathing system? Ruggiero: Yes, it is possible to keep up with the latest technology and advancements without buying brand new. Refurbished equipment is the best alternative to buying new, especially when certain model anesthesia machines

Deforge: It is important to know and have a good working relationship with the service technician. As the service provider it will be beneficial to all parties involved to educate the clinical staff, such as the anesthesiologist, CRNA and anesthesia techs. This education should include user functions and steps that can resolve potential service issues. This will result in direct cost savings by reducing unnecessary service calls and also improve user satisfaction and overall patient safety. Green: Always check the reputation and background of each company. How long have they been in the medical business? Does the company specialize in anesthesia equipment or sell everything? What are the owner’s qualifications? Karchner: That as anesthesia vendors, we’re here to help you throughout the life of the equipment, and that includes the time of purchase. And while an anesthesia purchase is something that your healthcare facility may do only once every 10-12 years, it’s something that we do every day. Ruggiero: The difference between “End of Service” and “End of Life” on anesthesia equipment. End of Service refers to the last date of when the manufacturer will perform service on your anesthesia equipment, where End of Life is when the manufacturer will no longer support the equipment or carry spare parts.

What else would you like to add or do you think is important for biomeds to know about anesthesia equipment?

JIM RUGGIERO Mercury Medical’s Director of Clinical Services

are still being manufactured by the OEM and the latest features and options can be added with a simple software upgrade.

How can purchasers ensure that they will receive the necessary literature and training tools? Deforge: By working with your purchasing/materials management and your department managers, you can request that the OEM provides the literature, training and specialty tools that are needed to support the equipment that you are purchasing. This is best accomplished as a condition of sale. Having these necessities from the beginning will improve patient safety, increase equipment up time and lower overall maintenance costs. Green: Most literature, operator’s manuals and service manuals are available online. If not, call the company for these resources. Karchner: The best time to have these discussions is during the acquisition of the equipment. Consult your vendor’s sales executive to better understand the

THE ROUNDTABLE

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OCTOBER 2014

1TECHNATION.COM

By K. Richard Douglas

he air is full of signals and data; Wi-Fi, radio waves and various other invisible communication modes that surround us every day. If you work in a hospital, chances are that this bombardment of invisible communication is multiplied a hundred-fold.

When that one particular piece of medical equipment is needed, and it is needed now, the luxury of guesswork goes out the window. It becomes the job of technology to make location identification and retrieval an efficient process. Finding personnel, monitoring patients or keeping a check of temperatures can all be accomplished utilizing the same technology. With Real Time Locating Systems (RTLS), the task of accomplishing any

1TECHNATION.COM

APRIL 2014 OCTOBER 2014

of these goals is accelerated through the use of technology. With the pinpoint accuracy that many systems have, the location of assets, patients and staff can be determined. Clinical workflows can be maintained and improved. In some cases, clinician hand washing can be tracked and patient response times can be monitored. To get a better idea of the practical considerations involved in the acquisi-

tion, installation, maintenance, usage and expansion of these systems, we solicited the insights of OEMs and HTM professionals who have firsthand knowledge. We learned that these systems have multiple capabilities with even more on the horizon. â&#x20AC;&#x153;Most hospitals initially begin deploying RTLS for asset management, where the benefits are well documented and the ROI can be quickly realized,â&#x20AC;? says Adam Peck, director of marketing

ASS“ET TRA

CKING

The use of RTLS technology to automate workflows in healthcare can trim time lost to redundancy and process inefficiency so Rthat spend more time with TLS Tcaregivers ECHNOLOcan GY Lpatients OCATEShave patients and more to ANDaccess M ORE quality care.” -Jon Poshywak

for CenTrak, maker of the Clinical-Grade RTLS system. “For example, if a nurse needs to find an available infusion pump, with an RTLS application an available pump can be located quickly. Similarly, RTLS technology can assist clinical service personnel to identify and conduct preventive maintenance on pumps, ventilators and other high value equipment,” he says. “Building upon this foundation, RTLS asset

management also serves as the launch pad for a wider range of clinical applications.” “The use of RTLS technology to automate workflows in healthcare can trim time lost to redundancy and process inefficiency so that caregivers can spend more time with patients and more patients have access to quality care,” says Jon Poshywak, vice president and general manager for TeleTracking RTLS.

“By tagging all personnel, including physicians, nurses and patients, RTLS combined with the proper patient flow software, presents the physical functions of the entire enterprise on-screen in real time, creating a virtual ‘motion picture’ of events as they happen,” he says. “Not only does this drive daily performance improvement, but it offers a wealth of data that can be analyzed for even greater improvement.”

ASSET GOING TRACKING MOBILE

MAKING THE DECISION “We were initially interested in tracking of the telemetry transmitters that were being lost on a routine basis, however many other uses soon appeared and the telemetry issue was solved a different way,” says Kurt Burner, MBA, CBET, manager of the Biomedical Engineering department for the Akron General Health System. “While searching for a system, we were also contacted by pharmacy, which was looking for a way to centrally monitor temperatures within their medication refrigerators as the hand written temp tracking sheets sometimes were not completed,” he adds. The impetus was a little different for the decision makers at ProHealth Care. “We had a need to replace our fleet. We worked with a company to develop our RTLS system to help reduce the fleet of IV pumps needs by having the RTLS system to locate the fewer pumps and to increase utilization,” says Rob Bundick, manager of Biomedical Engineering for ProHealth Care in Waukesha County, Wis. “This allowed us to fund the RTLS system with the funds from the savings from our IV pump fleet reduction.” Get all the relevant stakeholders involved on an evaluation committee, suggests Peck. The committee can include representatives from IT, Nursing, C-suite, OR, ED, Security, Risk Management, Patient Safety, and Biomed. Agree on the specifications, including a definition of “room-level” and “bed-level” for the current intended use and for future uses. Determine the maximum system latency for all uses, he says. Focus on integration and scalability. The Minneapolis Veterans Affairs Health Care System (MVAHCS) got in on the RTLS trend early in the game.

1TECHNATION.COM

APRIL 2014 OCTOBER 2014

MICHAEL J. PHELPS Director of Biomedical Instrumentation Services for MVAHCS

“The MVAHCS was fortunate to be an early adopter of RTLS starting in 2005, when the Minneapolis Biomedical Instrumentation Service worked closely with facility leaders and the VA Central Office to secure approval and funding to pilot the technology for the first time in the Department of Veterans Affairs,” says Michael J. Phelps, director of Biomedical Instrumentation Service for MVAHCS. “MVAHCS biomedical engineering staff led a multi-disciplinary team to provide technology assessments and market research to gain greater understanding of the technology, write specifications that met the requirements of MVAHCS and evaluated vendor proposals for the project,” he says. “After much competition — 24 vendor proposals evaluated — a vendor was selected for the project and installation was completed in 2007,” Phelps says. There are several considerations during the acquisition process that can help align priorities correctly when

RTLS is being evaluated. “Start with the end in mind and look to the solution versus the technology,” Poshywak says. “Assign an owner to the system for ongoing education and management. Ensure that your service provider is certified to manage and service your RTLS infrastructure.” Poshywak suggests that a facility seeking an RTLS system find a provider who wants a long-term partnership. That provider should objectively assess the needs of your facility and customize the optimal solution. Checking with peers to see what they are buying and their reasons is another good step. “Calculate the ROI because your executive team will ask,” he says. “Purchase from an experienced RTLS provider to avoid surprises and factor in wiring, patient room closures, network redesign, battery replacement, etcetera.” He says that there should be maintenance and upgrade considerations also. “Factor in the fact that an investment in RTLS requires ongoing attention, review and care,” Poshywak says. “Batteries and devices will fail; networks will get overloaded; and people will turnover. While an RTLS system can be shared among many constituents within an organization, it’s important that there be definitive owners for activities such as maintenance.”

IMPLEMENTATION CHALLENGES Once the decision is made to go with a particular RTLS system and the acquisition is made, then the correct first steps must be taken in preparation of installation. “The first difficult challenge was the site prep required to install the system,” Phelps says. “Electrical utilities, network hardware, and other infrastructure must be assessed and modified to support the

RTLS solution purchased. The support and cooperation of the Facility Engineering Service, Information Technology, Logistics, and Finance are imperative to the success of the project.” Bundick says that educating staff on usage of the system was an early challenge. He says implementing the change in workflows that allowed for fewer devices to be deployed was another obstacle that had to be overcome. “First was the installation of current maps and the upkeep of the maps since construction is always taking place. Then fingerprinting of floors – this is where you take multiple tags and go around and say I am here right now, then move five feet and say I am here. This is time consuming; however it adds accuracy to the tags location,” Burner says. “Working with IT as they have to have the access points at a certain level, then controllers and down the line – also they must be aware that any changes to the wireless system can cause a ripple effect on the RFID system,” he adds. “Our installation was seamless, as the backbone was done in new construction,” says Terry Broussard, RN, BSN, MPA, vice president of Support Services at Our Lady of Lourdes Regional Medical Center in Lafayette, La. “We did change vendors, which required some hardware change, but that went very well with little impact to our teams.” The system that the Our Lady of Lourdes Regional Medical Center chose was a Skytron Asset Manager system using CenTrak architecture. “That decision was made prior to my arrival, but I have enjoyed the ease with which I am able to create alerts right on our web interface for special interest projects and metrics,” Broussard says. “Basically, apart from the standard reports, we build new ones as the teams determine a need.” “Our ability to create on-the-fly really encourages free thought and creativity, and I think it shows the immediate value to the clinical teams,” he adds. “We track everything — from beds, to pumps, to translation phones for special patients — it is all in the system.”

Affordable Care Act (ACA) as an incentive for hospitals to increase patient satisfaction and standards of care with a ‘pay-for-performance’ initiative,” Peck says. “The program measures patient satisfaction through patient experience surveys (HCAHPS). Based on these survey scores, the Centers for Medicare and Medicaid Services (CMS) is able to administer either incentive payments or penalties to a hospital, based on high or low HCAHPS scores, respectively,” he adds. “In its first year, the VBP program is expected to withhold almost $1 billion in hospital penalties.”

TERRY BROUSSARD RN, BSN, MPA, Vice President of Support Services at Our Lady of Lourdes Regional Medical Center.

“Current healthcare is a compliance industry; one empty blank and surveyors often delve deeper into records for trends,” Broussard says. “Asset tracking, and automated logging, removes the doubt and permits us to show alarms response as needed. Paper logs maintained by nursing staff are virtually a thing of the past.”

MORE COST SAVINGS Patient satisfaction can also benefit from RTLS. “October 1, 2013, marked the one year anniversary of the Value Based Purchasing (VBP) program. The VBP program was established by the

“Asset tracking, and automated logging, removes the doubt and permits us to show alarms response as needed. Paper logs maintained by nursing staff are virtually a thing of the past.” -Terry Boussard Peck says that research has shown a positive correlation between low HCAHPS performance and above average patient readmission rates. He points to the “Hospital Readmission Reduction Program” in the Affordable Care Act, which offers to provide significant financial incentives to reduce readmission rates. “The penalties for excessive rates were up to 1 percent of a hospital’s Medicare DRG payments in FY2013, with subsequent increases to 2 percent in FY2014 and 3 percent in FY2015,” he says.

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“When the integrity of data collected lies in the use of manual log sheets for rounding verification, it can be challenging to quantify these log sheets and validate their accuracy,” Peck says. “This, in addition to the difficulties associated with implementing, monitoring and sustaining hourly nurse rounding procedures can threaten patient safety and satisfaction, negatively impacting HCAHPS scores.”

A CenTrak monitor mounted to the ceiling at Our Lady of Lourdes Regional Medical Center provides the hospital with room-level accuracy regarding the locations of assets and personnel. to Photo courtesy of Sync Productions

LOOKING AHEAD Like most technology, RTLS has continued to evolve and promises to offer more applications and refinements in the future. “During the past year, we’ve seen a significant maturation of the RTLS market. A previously fragmented market has consolidated to just a few market leaders,” Peck says. “We’re also seeing greater demand for clinical-grade infrastructure — room, bed-level accuracy with rapid location updates and extreme battery life — to support location-ready healthcare applications like CMMS, Nurse Call and EMRs.” The ability to leverage existing infrastructure to gain the benefit of an asset visibility application is reducing the initial capital outlay, according to Peck. “Having the ability to leverage the existing Wi-Fi infrastructure is a benefit, but that will only provide general asset visibility. The combination of Wi-Fi locating with Gen2IR and Low Frequency RF provides the framework required for advanced asset management use cases such as PAR-level management, improved asset utilization and reduction of shrinkage – making the technology investment pay for itself in a matter of months,” Peck says. “When combined with automated patient flow software, RTLS is the enabling technology that is making the ‘real time hospital’ a reality,” Poshywak says. “It gives managers the ability to

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Terry Broussard uses a tablet connected to the the hospital’s web interface to locate the nearest crash cart via the facility’s RTLS. Photo courtesy of Sync Productions

immediately assess virtually all of the daily functions that keep the hospital moving, either from their PC, laptop, smartphone or tablet.” “In the future, RTLS will support the orchestration of care throughout the clinical enterprise,” says Peck. “It will streamline processes, make more efficient use of scarce resources, both human and capital, will improve clinical quality while reducing preventable errors, will integrate with other hospital information systems

share clinical data across a wider range of clinical staff, and will become components of ancillary hospital functions like facility security.” The inevitable progress of technology can add levels of efficiency to all healthcare providers, including HTM professionals. With the increased focus on every facility’s financial bottom line, and the paramount importance of patient safety, the significance of RTLS and other technologies is very real.

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CAREER CENTER By Todd Rogers

n May of 1994, I was honorably discharged from the U.S. Marine Corps, after a little more than four years of service. The Marine Corps make a really big deal about perceived exclusivity; until you graduate from boot camp or officer candidate school, calling yourself a Marine is an shortcut to a fat lip, or much worse. There is exactly one nice thing about boot camp: the day that you finish boot camp.

TODD ROGERS Talent Acquisiton Specialist for TriMedx, Axess Ultrasound, eProtex and TriMedx Foundation

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In May of 1994, I was honorably discharged from the U.S. Marine Corps, after a little more than four years of service. The Marine Corps make a really big deal about perceived exclusivity; until you graduate from boot camp or officer candidate school, calling yourself a Marine is an shortcut to a fat lip, or much worse. There is exactly one nice thing about boot camp: the day that you finish boot camp. Everything else involves a mixture of sweat, grime, exhaustion, and frustration. It is at once a place where civilians are reprogrammed and also where “nonhackers” are weeded out. Boot camp is a months-long entry-barrier to a club. The day that you finish boot camp, you are officially a life-long member. Marines who are reading this right now are probably nodding their heads. Entry barriers are everywhere and I will explain. A day doesn’t go by that I don’t receive at least one voicemail or email from someone that I don’t know who is asking me for information about a job that is listed on our career page. Actually, I get several calls each day. Quite frankly, I’m thrilled that our reputation is strong enough that we receive several unsolicited calls each day from people inquiring about employment opportunities. It’s tempting and easy to establish an electronic barrier that would prevent any of those contacts from ever reaching me. However, as someone who makes his

living off of one-on-one contact with human capital, it is ill-advised to be anything other than available. It’s necessary, though, for diligence with allocating time. I’ve recently taken it upon myself to introduce obstacles to those who request assistance in unexpected ways. It’s likely to be relevant to career-interested readers, as I’m confident that I am not the only person who employs such techniques. Indeed, many professions deploy permanent entry-barriers designed to limit admission to only those who have the ability and the will to persevere. Public accounting has the CPA requirement. To achieve that credential, one needs a bachelor degree, one additional year of prescribed schooling, two years of professionally relevant experience, and one must pass the CPA examination. Many people change careers before getting through all of that. The ones that do make it to the end tend to be those who are very committed to the good standing of the profession as a whole. Those people go on to become CPAs. One entry-barrier that I utilize is the “resume re-write.” Most of the time, when I recommend that someone re-write his or her resume, it’s because the resume is greatly in need of being re-written and sending it to a hiring manager “as-is” will be unproductive. In some instances, I am undecided about moving a candidate forward and I will recommend that the

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Call 512.477.1500 Specializes in MRI and CT candidate consider a re-write. I will be non-specific about what should be re-written, which can be frustrating to many. But, I wait a day or two and see what they come back with. Those who show that they are serious and actually do a partial or full re-write will move forward. Those who complain or try to tell me that the resume is good enough generally do not move forward. It doesn’t always happen this way. But, when I offer recommendations, regardless of the reason why, by not following those recommendations, you’re greatly reducing your chances of getting an interview. Another inquiry goes like this: “I saw your job on the Internet. I’m interested. Could you tell me a little about your company?” The very asking of that question at that particular moment signals to me that this person is only marginally interested in working for us; he or she is more likely interested in a job but not necessarily interested in a job with us. I generally take the reins right there and ask the person what he or she does currently, I ask to be provided with a resume, and I (politely) let the person know that the conversation would be more suitable after he spent at least five minutes learning about us. I offer up my email address and let him/her know that the discussion can continue thereafter. The ones that come back move forward, as previously noted, the others do not. The positive side to this is the inquirer who hits all the spots, right off the bat. This person efficiently conveys who he is, why he is calling, and then asks a relevant question. It sounds and reads like this: “Todd, my name is (name) and I live in (city/state). I’ve been a (add title) for several years. I’ve decided to consider a job change. I’m aware of your company, who you are, what you do and I’m calling because I may have potential for a position you have posted, and I’d like to know if it specializes in (fill in two or three specialty areas).” I

get about one call a week that resembles that pattern and let me state clearly: such people typically end up in an engaging discussion first with me and then with the hiring manager. I have even more good news! At your fingers, you have access to the Internet. Doing a two- or three-minute Google/ LinkedIn/website investigation will make all the difference in the world. Set a time-limit (about three minutes) and right before you draft your email or make your cold-call, look them up so you know enough about the employer that you can at least sound like you’ve done your homework. As you advance through the interview and selection process, you will encounter entry-barriers at each step. These barriers might be tasks you’re asked to complete. They might be interview questions that have multiple purposes. The fact that you are at an interview most likely means you are navigating through a series of barriers that are specifically placed in front of you so that the organization as a whole continually improves. In some cases, the interview serves only as a show to gain your favor to come and work there. Those instances don’t happen very often. More often, you’re being evaluated for overall fitness from current “tribe members” as they determine if you’ll be a good hunter, gatherer, basket weaver, etc. My message is this: regardless of your standing with your current employer, when initially approaching a new employer, it’s best to invest a little time up front and know something about the organization. You will be tested throughout the interview and selection process. These tests are entry-barriers. Whether you’re in the military, a college fraternity, or hoping to join a new company, never lose sight of the fact that you must diligently maneuver through these barriers if you hope to achieve member-status.

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Migrating Ultrasound Service In-House By Matt Tomory

igrating ultrasound service in-house is a current trend in the HTM industry and makes sense for a variety of reasons. We developed a program called Inservice-Inhouse almost 10 years ago and have partnered with many large healthcare providers to transition ultrasound support in-house and our analysis shows a 35 to 50 percent annual savings without factoring in the other benefits of increased uptime, better record keeping and customer satisfaction.

MATT TOMORY Vice President of Sales, Marketing, and Training

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As with any major project, a successful outcome is contingent on proper planning as well as execution. The first step is to partner with an organization like Conquest Imaging to receive expert guidance throughout the process. Next you will need to receive approval from the C-suite which should not be difficult these days given tight budgets and imaging reimbursement reductions. Now comes the most critical component and that is getting the approval of the clinical departments. They may have established relationships with their current service providers, developed a comfort zone with current service delivery or may have concerns regarding HTM expertise when it comes to their equipment. You must involve them in the decision and show them how they will benefit from the transition by discussing faster response times, greater uptime and cost savings. An inventory must be taken of all systems and transducers including current contracts and warranties, expiration dates and termination restrictions. A pre-inspection schedule will be created using these dates so any existing issues can be remedied while

current coverage is intact. This inventory will also be analyzed to determine FTE hours needed, training programs and the pace of the transition. Once training begins, the program gradually begins to migrate systems off of an external agreement to in-house ownership. Our expert training, technical support, supplemental field service and extensive inventory of fully reconditioned parts and probes will ensure your team has all the support needed for a successful and costeffective program. Migrating ultrasound service in-house is a great way to save scarce funds and improve service delivery but should be planned and executed as a project and should involve the experts when looking for a partner to assist you.

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THE FUTURE Preparing a student for a Career as an HTM professional By John Noblitt

n a previous issue of TechNation, I wrote about the AAMI Core Curriculum project and the conundrum of implementing such a program. I asked if anyone had a solution. Well, either no one read the article (doubtful) or no one had any useful strategies to teach all the information in the Core Curriculum project. However, after writing the last article, I was amazed at how much of the information from the core curriculum project was already being covered in the many program courses taught in the current program of study. I’m sure many BMET program directors struggle with how to teach all the information in the core curriculum project. Another area of difficulty in the educational realm of biomedical technology is providing students with hands-on experience with the different technologies. Everyone reading this article knows of the high cost of medical equipment in today’s healthcare system. Imagine spending that kind of money on a piece of equipment and having no real way to recoup the expense of new equipment purchases. A hospital will be billing patients for the use of the technology to provide a return on the investment. One could argue the educational system can pay for investments in educational materials with tuition payments. However, the repayment rate from an insurance company to a service provider would be considerably more than what could be collected from a student for a learning experience, and rightfully so. But, how does an educational institution provide state-of-the-art education on a technology that costs much more than a budget can afford? A good example of this problem would be teaching the technology of anesthesia. A new anesthesia machine can run between $15,000 and $50,000 depending on many different factors. These prices would only cover the

JOHN NOBLITT M.A.Ed., CBET

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OCTOBER 2014

machine and not all the consumables that would be needed to operate the equipment. So, if a BMET program teaches this technology with a new piece of equipment and you had one unit for every 5-6 students and a program of 20 students you can see that the outlay of money could be upwards of $60,000 with the least expensive units. These prices only cover the equipment and not the expensive test equipment needed to service the technology. I can’t speak for other programs in the country, but I know my equipment budget per year is only a couple thousand dollars. Usually the budget is about $5,000 a year and must cover the program’s many needs. Implementing AAMI’s new core curriculum standards is not only a challenge in covering the many areas of knowledge a graduate needs to possess for entry-level employment, but it is also a challenge for the educational institutions to pay for the technologies that need to be taught. I can only assume most public institutions or nonprofit institutions are in the same predicament as I am when it comes to budgets and student learning outcomes. I would also assume the program directors of BMET programs across the country rely on help from many avenues to fill in the gaps

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between budgets and student learning goals. So, how do programs obtain the newer technologies to teach with such limited budgets? This is an area where the readers of TechNation can help replenish the ranks with competent graduates. I know I have many resources that help the Caldwell Community College program teach newer technologies with newer equipment. Past graduates from the program keep me informed about equipment their facility may have which could be donated or sold at a very reasonable price. I believe this is an area where everyone can help programs across the nation. I strongly urge each of you to keep in mind the many BMET programs and help them secure equipment that may be used for hands-on instruction in the laboratory setting. Having the latest and greatest in medical instrumentation would be wonderful to teach on, but not budget feasible. With the help of past graduates and other professionals in the HTM field, many programs in the country will be helped in providing the very best educational experience with actual equipment a student may see once they begin their career. I’m extremely pleased and grateful for the help I receive in securing medical devices from either former students or other concerned individuals and organizations with a vested interest in having competent technicians in the HTM field. So, I remind each TechNation reader that you too can become instrumental in providing opportunities for students wishing to embark into the exciting field of healthcare technology management by providing equipment for experiential learning opportunities. This act alone will help ensure we replenish the ranks in this career field with technicians who have been exposed to newer technologies and have the skills to navigate a HTM career.

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Rethinking Service, ReSOURCING Service? By Karen Waninger

f it was easy, anyone could do it! How many times have you reminded yourself of that, as you are trying to solve a complex issue with a piece of equipment, or trying to find a better process for managing a challenging situation? There are some circumstances where finding “something better” requires taking a few steps back and looking at everything from a different perspective. It seems we are often resistant to changing our old ways of thinking and doing, even if others show us opportunities for improvement in whatever it is that we do. Maybe it goes back to the standard line about not fixing things that aren’t broken? That leads to a hard question. If something is working, but it could work better by changing a few things, is it actually broken after all? Now let’s look at that in the context of Healthcare Technology Management.

KAREN WANINGER Director of Clinical Engineering for Community Health Network

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The demand for cost reduction, without any compromise to the quality and the quantity of service provided, continues to be at the top of the list of challenges for healthcare organizations. From what I am seeing, the Affordable Care Act has not made healthcare affordable for anyone. The costs for delivering healthcare to the public are going up, while the revenues for the healthcare providers are decreasing. That means every healthcare organization is constantly looking for cost reduction opportunities, especially if there is anything they have not already tried recently. Healthcare organizations seem to follow a periodic cycle of looking at outsourcing their HTM program, or if outsourced already, then looking at bringing it back “in-house.” The idea of any one solution being right for all organizations, or for a single organization for all time, is long gone. I have been in my current role for about seven years, and in that time we have evaluated other service options, restructured, and modified our scope of service at least seven times. It is a constant process, as we look for ways to improve our program and still save money for the hospitals. During these seven years,

a few effective process improvement ideas have originated in our own department, allowing us to continue to demonstrate our value within the organization. Many other times, there have been “suggestions” presented to us from administration or via outside business consultants. There have been some consistent results from these outside proposals: a drain on resources and energy, and at least a temporary lack of engagement from the members of my team. It has all seemed very counterproductive, especially when any of those external proposals would have driven our costs up by millions of dollars each year. As Pat Lynch has consistently tried to communicate, the best way to keep running your program the way you want to run it is to have excellent documentation of what you do, how you do it, and how much it saves your organization. If you do that, it puts you in an excellent position to make decisions driven by data and logic, instead of making decisions driven by emotion or by whim. That has traditionally worked well, only this time I seem to be facing a new challenge.

What are we supposed to do if the data and logic tell us that it may be time to rethink our service delivery strategies? It is one of those situations where we don’t think we are broken, but what if we could get even better? That is exactly the issue we are facing, and there certainly is no easy answer. We are experiencing yet another round of new hospital administrators who are not yet familiar with what we do here. They decided we should look at what they did where they were before. I don’t believe it hurts to look at options, but I also know enough about this industry to not just accept the propaganda from any of the service companies (or equipment vendors claiming to be service companies). The administrative team identified the organizations they had worked with in the past. Just to have a valid comparison, I asked for a proposal from another organization. We defined the rules they would all be expected to play by, and decided what information to give them to start with. Of course there were the predicted attempts from certain organizations to do end-runs directly to the presidents when they did not like our rules. Those were blocked, at least initially, and the proposals came to us to evaluate, not to the presidents and the finance team. Most of them were what I expected, the fluff and stuff with a bottom line that excluded everything unpleasant to manage, and still would cost several million dollars more per year for our organization. One proposal, however, was very comprehensive and similar to our current program, with some added opportunities to help manage costs in the future. I am not sure we could do the same on our own. That forced me to do a deep inner evaluation of my beliefs regarding service delivery, customer relationships, employee development and long-term costcontainment. I came back to a very basic realization. I enjoy this profession tremendously because I believe we are passionate not only about technology, but about building relationships, working together to help others, driving costs down for our organizations, and having some fun while we are learning and improving. The next phase for my team, to achieve that next improvement in our service delivery

strategy, may require resources that we don’t currently have access to. Within the hospitals, we have seen the transition of senior leaders, and have worked to educate each new group of them, only to go through the same thing again when they all change two years later. We have written business plans to add positions, only to have them eliminated when the next consultants come in. What if we have the opportunity to partner with an organization that understands our core function, has developed processes to drive more costs out of service delivery, and demonstrates a sense of commitment to our employees and our customers? Is it possible to enhance our program, even if we are already performing well above average? If you have heard that we are being taken over, eliminated, or outsourced, that may all very well be true in the end. As of the time I am writing this article, though, we are seriously looking at ways to resource our service delivery model. If the goal is still to deliver excellent service at a competitive and sustainable cost ratio, then it is worth having a really open mind and taking a serious look at any legitimate business proposal that can help us. My rediscovered realization is very simple. It is imperative to have the right people doing the right work for the right reasons. The customers and the employees need to feel valued. The source of the compensation is not as important as the fact that recognition and appreciation are bestowed when and where deserved, and that individuals receive the intrinsic benefit of contributing to a worthwhile objective. You may know the outcome of our process before this article gets printed. Whatever that outcome is, we know that what we do is not easy, and that not just anyone can do it. The proposals from most of the other companies validated that for us, again. We remain fully committed to continuous improvement, though, so we cannot just stop where we are. We need to be open to looking at new arrangements for achieving better outcomes, even if that means wearing shirts with the name of a different organization on them. Watch for a group of us at MD Expo in Orlando, and maybe we will know our future direction by then!

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BEYOND CERTIFICATION By David Scott

DAVID SCOTT Biomedical Technician, Children’s Hospital Colorado; CABMET Study Group Organizer

n some of my previous columns I have written about how to best earn CE points toward renewing your certification. We have discussed other types of certification that relate to the HTM field.

Most entry-level tech jobs require either an associate degree or military training. Some higher level tech jobs require an associate of science degree degree plus certification or certification is recommended. Some of this was outlined in the AAMI Career Ladder document discussed in a previous “Beyond Certification” column. What if you want to move from being a tech into management? Most management jobs require a bachelor’s degree. Some supervisor roles also require a bachelor’s degree. That seems to be what the market is moving toward. When moving into an even higher level management role such as director or vice president even higher degrees may be required.

BACHELOR’S DEGREE How do you get there from where you are now? When I was at the AAMI Conference in Philadelphia earlier this year I had a chance to talk to Barbara Christe, Ph.D., from Indiana UniversityPurdue University Indianapolis. IUPUI has an outstanding degree program for associates and bachelor’s degrees in “Healthcare Engineering Technology Management.” Search their website using this description and you will find more information about this highly touted program. Their associate degree program can “provide the training you

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OCTOBER 2014

need to launch your career.” The bachelor’s degree can build on your associate degree (IUPUI or other) and many courses are available via distance learning. This bachelor’s degree is offered to students who have experience or training in the HTM discipline. We also discussed other options. Barbara is a wealth of knowledge when it comes to furthering your education and I am thankful for the time she spent with me. Another school we discussed is Thomas Edison State College. Thomas Edison offers a Bachelor of Science in Applied Science and Technology (BSAST) degree in Biomedical Electronics. One of the nice things about Thomas Edison is they offer credit evaluation. You can send them any credits you have from previous college or life experience and they will evaluate it (for a fee) and allow you to transfer those previously earned credits up to a limit. Thomas Edison also enables military members to earn maximum credit for military training and education. Depending on your military training, Thomas Edison State College can apply college credit to your degree program.

MASTER’S DEGREE Having a bachelor’s degree is a good first step toward working in management. Once in management if you want to

advance a master’s degree is usually preferred. At the hospital where I work, everyone in upper management has a master’s degree or a higher-level degree. In HTM, what degree programs would be most beneficial? Master’s of Healthcare Administration (MHA) and Master’s of Business Administration (MBA) are two of the most common mater’s degrees in healthcare. I live in Colorado and Colorado State University has a “global campus.” So anyone, anywhere can enroll at CSU to earn a MHA degree. I’m sure other online degree programs are available. The MBA degree is a little different in that it is not healthcare specific. It is business related. Running a HTM department is very similar to running a business so an MBA makes good sense. There is no preferred degree for master’s level in HTM. By the time most people get to this level they have a good idea what they want their master’s in. If you are looking to direct your career toward management check into these different degrees and start working toward them. It is a long process and some employers have tuition reimbursement that may make it a little more affordable. Until next time … keep your journal up to date!

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PM and Repair Kits for a Traveling Repairman By Patrick Lynch

am trying to be better organized as I travel overseas to perform repairs and training of local biomeds. When we travel overseas, we do not know exactly what types of equipment we will work on, much less what different manufacturers, models or vintages of equipment we will find. Even more than this, we are not sure which nation of origin the equipment we find will be from –Israel, Germany, Korea, China?

PATRICK K. LYNCH, CBET, CCE Biomedical Support Specialist for GMI

In order to have everything we need, I have stumbled upon a concept of putting together a traveling PM/Repair kit for the major types of medical equipment we will find overseas. My idea is to put together a suitcase for each type of medical equipment, for example Patient Monitor. In this suitcase will be everything that a biomed could possibly need to test the performance of any type of patient monitor they might find. It should also include many of the commonly found replaceable parts that wear out, like filters. For example, in a Patient Monitor Kit, one would certainly need an ECG simulator, a wide assortment of patient cables and lead wires, an NIBP simulator, NIBP hoses and cuffs and adapters and the appropriate simulators for pulse oximetry and invasive pressure, as well as temperature. In my plan, there would be a Kit for: • • • • • • • • • •

Anesthesia Ventilators (may be the same as Anesthesia) Infant Incubators and Warmers Infusion and Syringe Pumps Sterilizers (tabletop and large) Electrosurgery and cautery devices X-ray (rad and portable) X-ray (C-Arm and R&F) Laboratory, basic (centrifuges warmers, microscopes) OR lights and tables

I have a list, but am asking for help from TechNation readers. If you are a specialist in

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OCTOBER 2014

any of these areas and had to travel to another country, without knowing what models you would find, put together a list of things you would want to carry with you. Play this game. The rules of the game are:

1 2

Human life depends upon your success, so you need to be successful.

You may only use what you carry with you. This includes tools, test devices, chemicals, test jigs, hardware, rubber goods.

You will have access to the equipment only. Do not count on having any of the accessory cables, cords or external consumables to make it work.

4 5 6

You will have a strict budget to purchase items. You will have a baggage limit.

You will not have access to any stores (Lowe’s or Radio Shack) or other resources. The goal of the game is to assemble a complete list of items that you would take with you to assure maximum success on the widest possible models of equipment. Do you accept the challenge? If so send your idea to BWOB@plynch.us. The first 50 people to submit a list will receive a $5 Amazon gift card from TechNation.

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THE ROMAN REVIEW

Fear of Speaking

By Manny Roman

was reviewing a presentation that I developed and began thinking about how studies show that most people fear public speaking more than they fear death itself. This is a pretty intense feeling. I’m sure they mean being dead not being killed, although to some, being asked to make a presentation may equate to being killed.

MANNY ROMAN Manny.Roman@me.com

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OCTOBER 2014

Being a naturally shy individual, I can empathize with the fear of public speaking. I will discuss some items that may aid those of you who are apprehensive regarding being the center of attention of an audience. First, realize that the audience will not base their trust and acceptance by performing a critical analysis of what you say. It will be based on an intuitive assessment of what the audience believed you truly meant by what you said. The audience will rely on your nonverbal cues to make the determination to accept and trust. This is how we are wired. We are all hardwired to look for these nonverbal cues and to quickly understand their meaning. This hardwiring has been programmed into all of us since cave men grunted at each other and had to resort to nonverbal communication. Body language is in the eye of the beholder, just like beauty. The belief of what you intend, and how that perception guides reaction, determines how the audience will respond. Second, realize that the first reaction is always emotional. Functional Magnetic Resonance brain imaging shows that the primitive part of our brains makes a decision as much as 10 seconds before the conscious brain is aware that the decision has been made. These studies demonstrate that logical processes are often only rational justifications for emotional decisions. The decision to respond in a certain way is made way

before you prove them right or wrong. Third, realize that you control the presentation, thus you are in control of the perception and thus the reaction. This is the key to a successful presentation. So what can we do? Prepare. Prepare. Prepare. When you think you’re done, take an extra step. You set the stage by the description you write about your presentation. Make sure that it clearly states what you expect the audience to do as a result of attending your presentation. Try to leave no room for alternate interpretations. Make sure that you are considered the subject matter expert even before you enter the room. This invokes a very powerful trigger to acceptance called the authority trigger. The authority trigger will prepare the audience to accept that you know of what you speak and they should listen to you. Concentrate less on the dissemination of the facts and more on the nonverbal cues and audience interaction. Great slides command emotional responses so make sure that the slides cause emotional interaction. However, don’t let the slides be the communicator, you are the communicator. The slides are actually there to cue you on what to say next. Make sure that you frame the presentation to your particular audience. Use words, slides and anything else in such a way that they make sense to the audience. We have all sat through presentation where we felt that the

presenter was talking another language or to the wrong group. Remember that your message is carried by the way you say what you say and the accompanying body language. Make sure your body language does not disagree with what you say. Your audience will most likely be unaware of why they feel the way they do about you and your presentation. That feeling will be based on your body language. Why you exhibit a particular body language cue does not matter. It is the audience perception that matters. Examples: Do not hide your hands, especially your palms, if you are attempting to show honesty or the audience will believe that you are hiding something. Do not cross your arms when you invite audience participation or the audience will instinctively perceive that you do not want questions. Prepare yourself and your presentation to convey the desired emotional message. Frame the message so it makes sense to this particular audience. Deliver the message ensuring that you have congruent body language. Close the message with a good review and a request for action. Donâ&#x20AC;&#x2122;t just inform and educate your audience, gain their execution of what you want as a result of your presentation. Do these things and I am confident that you will make a great presentation, receive a standing ovation and money and fame will flow your way. Or, take the alternative â&#x20AC;&#x201C; DEATH.

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DID YOU KNOW? Science Matters

New spacecraft’s maiden flight Late in 2014, NASA plans to send its Orion spacecraft on a crewless two-orbit flight and soft landing at sea. The capsule was designed for flights to the moon, asteroids and Mars.

1 Launch from Cape

4 Highest altitude: About 3,600 mi.

Canaveral, Fla.

(5,800 km) – 15 times higher than International Space Station

5 Landing in Pacific Ocean

Abort system for quick escape during takeoff

Orion crew capsule Built to carry four astronauts on a seven-month flight; weighs about 10 tons

Service module By European Space Agency; carries propulsion, power, temperature control, water and oxygen supplies

stage fires

5 1

2 3

3 Second

orbit begins

Upper stage Liquid-fuel rocket boosts spacecraft into orbit

Delta IV Heavy rocket

Back to the moon

Hydrogen-oxygen liquid fuel rocket

NASA’s current objectives

Side boosters separate before center booster releases its load

2017: Crewless lunar flyby; return into Earth atmosphere at 24,600 mph (32,600 kph) – the fastest re-entry ever After 2020: Two astronauts fly to meet captured asteroid in moon orbit

2 Upper

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OCTOBER 2014

BREAKROOM

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THE VAULT

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 Amazon gift card and will be entered to win a $25 gift card. To submit your answer, visit 1technation.com/vault-october-2014/. Good luck!

LAST MONTH’S PHOTO was an old angiogram system. The photo was submitted by Russell Snow CBET, CLRT, Clinical Engineering, Community Health Network. To find out who won a $25 gift card for correctly identifying the medical device visit 1technation.com.

SUBMIT A PHOTO Send 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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OCTOBER 2014

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WHAT’S ON YOUR BENCH?