TechNation - November 2014 by MD Publishing

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EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

NOVEMBER 2014

FINDING SERVICE SOLUTIONS FOR OLDER EQUIPMENT

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VOL.11

Biomed Adventures Restoring a Classic

The Roundtable Computed Tomography

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

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

THE ROUNDTABLE - COMPUTED TOMOGRAPHY The CT market is undergoing a shift and Medicare reimbursements are impacting change for these important healthcare devices. TechNation reaches out to industry leaders for their insights regarding CTs and what we can expect in the near future. Next month’s Roundtable article: Test Equipment

FINDING SERVICE SOLUTIONS FOR OLDER EQUIPMENT Knowledge is power and the cure when it comes to maintaining older medical devices. As more and more HTM professionals retire keeping older pieces of medical equipment up and running is more of a challenge. Experienced biomeds, a network of experts and online resources are vital when it comes to maintaining devices as they near end of life status.

Next month’s Feature article: TechNation’s Best of the Best

TechNation (Vol. 5, Issue #11) November 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.

NOVEMBER 2014

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INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Sharon Farley Warren Kaufman Jayme McKelvey Andrew Parker

ART DEPARTMENT

Jonathan Riley 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.24 p.26 p.29 p.30 p.33 p.34

CIRCULATION

Bethany Williams

P.50 EXPERT ADVICE

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Sue Cinq-Mars

EDITORIAL BOARD

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

P.12 SPOTLIGHT

p.12 Department Profile: Ann & Robert H Lurie Children’s Hospital of Chicago Biomedical Engineering Department p.15 CEAI Awards Five Scholorships p.16 Biomed Adventures: Restoring a Classic p.20 Professional of the Month: Todd Frederick

P.24 THE BENCH

ECRI Institute Update AAMI Update Tools of the Trade Biomed 101 Webinar Wednesday: Myth Buster Webinar Shop Talk

p.50 Career Center p.52 Ultrasound Tech Expert Sponsored by Conquest Imaging p.54 The Future p.56 Patrick Lynch p.58 The Roman Review

P.60 BREAKROOM p.60 p.62 p.64 p.66 p.70

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

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

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

Ann & Robert H. Lurie Children’s Hospital of Chicago Biomedical Engineering Department By K. Richard Douglas

nn & Robert H. Lurie Children’s Hospital of Chicago is a highly rated pediatric care facility with a 130 year history. The hospital has a staff of clinicians that includes 1,245 physicians in 70 pediatric specialties. U.S. News and World Report ranked Lurie Children’s within the top 10 hospitals in the country in five pediatric specialty categories in their 2014-15 children’s hospital rankings. Since September 2009, the biomedical engineering department at Lurie Children’s has been outsourced to Crothall Healthcare Technology Solutions. The 12-member department handles 11,400 assets at the main hospital in downtown Chicago and 10 outpatient locations. Team members include Director Kelley Harris and Assistant Director Victor Rojo. The group’s Office Manager is Eugenia Bradford. Biomedical techs include Chris Pedrak, Crystal Lott, Dominik Kieca, Israel Gallardo, John Dispensa, Ramadan Kehayov and Victor Sanyn. Imaging techs are Josh Deery and David Leonard. The team also plans to add a medical device integration specialist. Leadership has the optimal mix of experiences and strengths to lead their team and respond to the needs of a top-notch pediatric organization. Rojo has a broad technical, hands-on skill-set in both biomedical and medical imaging modalities. Harris has an academic technical background, with strengths in the areas of finance, strategy, team development, and building strong customer relationships. The combination works well for the department and the institution. Ken Gray, administrator of Patient Care Support Services, has direct oversight of the Biomedical Engineering program. “Kelley and Victor provide the department with the passionate, patientfocused leadership our mission-driven

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The kid-friendly Fishbowl Room includes a digital radiology X-ray system maintained by the biomedical engineering department.

organization demands. They are true partners, and an invaluable component of the Lurie Children’s patient care support services team,” says Gray.

GOING BEYOND Crothall collaborated with teams throughout the hospital, when the new facility was built in 2012, to aid in the acquisition and deployment process. The biomed team helped in acquiring equipment that is uniquely well-suited to pediatric patients. “We provide management and oversight of the hospital’s entire life cycle of medical devices and clinical technologies, including

NOVEMBER 2014

safety, risk management, technical support, financial stewardship, and management of healthcare technologies that are integrated and interoperable,” Harris says. Subsequent to the transition to the new facility, a significant challenge was identified by the Crothall leadership team. The medical imaging service program was lacking in customer service as well as in skill-set level. In 2014, Kelley and Victor went to work to make change for this service. “We hired two new imaging technicians, implemented weekly meetings with our department to discuss ongoing issues, as well as to clean up a backlog of

The members of the Ann & Robert H Lurie Children’s Hospital of Chicago Biomedical Engineering Department are, front row from left, Kelley Harris, Crystal Lott, Dominik Kieca, Joshua Deery, Victor Sanyn, Ramadan Kehayov, Israel Gallardo, Victor Rojo, back row, Chris Pedrak, John Dispensa, Eugenia Bradford and David Leonard.

documentation and service contracts.” The changes implemented by Kelley and Victor have now paid dividends and the satisfaction of the program are at an all-time high with the imaging director and the imaging staff.

HIGH-TECH PROJECTS In addition to the group’s more routine tasks, they have tackled some special projects. One of those has been to help ensure the security of PHI in their inventory of devices that store it. To accomplish this, they are leading a medical device security project. They are evaluating all devices to determine what is currently encrypted. They engage the OEMs to obtain MDS2 forms and determine whether the devices can be encrypted through upgrade or with third-party software. For those devices not able to accept encryption, the team will provide options such as RFID and physical lock-down. All information will be documented in the CMMS and findings will be provided to the Lurie Children’s audit committee. The most complex project for the team currently is bringing a middleware product online to integrate communication tools. “Connexall is an event notification management middleware that will be integrated with our current Philips Monitoring system, Voalte phones and Rauland Nurse Call device to meet the needs of our healthcare organization by managing our patient alarm systems, minimize patient fatigue and facilitate the clinical staff response,” Harris says. The biomed department also keeps on top of evolving technology requirements by working alongside their IT counterparts. “We have weekly CE/IT integration meetings which involve current projects and incoming projects for the hospital that

Biomedical Technician Crystal Lott repairs an infant incubator.

Biomedical Technician Dominik Kieca is focused on quality as he works on an imaging system.

involve medical device integration with the hospital’s network,” Rojo says. Crystal Lott is currently completing networking training and recently achieved A+ certification. Lott plays a big role in medical device integration projects. Lott is the primary technologist for physiological monitoring system integration with the EPIC EMR and other ancillary database products. “The new hospital opened in June 2012, so we have a large number of long-term point-of-sale service contracts we are managing,” Harris says. “All service contracts are monitored by our department and service calls are tracked and recorded in our CMMS.” “We work very closely with all departments to ensure we are knowledgeable of all service calls. Our goal is to eliminate extra work, such as tracking down a field service technician, for the equipment users. We have a huge task ahead of us to get our team trained and ready to take on the equipment service as service contracts expire,” Harris adds. The hospital institutes a strict objective of self-audit and self-examination. Biomedical Engineering has worked hard

to fully align its business model with that paradigm. This has helped the team reflect the exacting standards that have elevated Lurie Children’s reputation. The department is focused on optimizing its use of technology, improving its professional image and even changing the department name. The hospital is in constant readiness mode and the department endeavors to reflect that approach. Harris explains that since the hospital is one of the top-ranked providers of pediatric care, the department should be one of the topranked HTM departments. Another goal of the department’s leadership is to get everyone certified within 24 months. “We have a robust training plan for the year. One of the big initiatives is to have everyone certified,” Harris says. Some of the department members are attending formal classes, provided by Crothall Healthcare for its coworkers, and others are starting study groups. A top-ranked hospital deserves a top-ranked biomedical engineering department and that is what this group of HTM professionals strives for every day.

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NOVEMBER 2014 2014

CEAI AWARDS FIVE SCHOLOARSHIPS By John Wallace

uccess can be measured in a variety of ways. No matter which measure is used, the 2014 Clinical Engineering Association of Illinois annual conference was a success.

It was the largest show ever for the rapidly growing organization. More than 400 attendees joined 62 exhibitors in the Chicago area for the annual conference. The educational offerings were outstanding with special presentations by DNV and The Joint Commission as well as a keynote address by GE Healthcare’s Aaron J. Goryl. Bart Richards from the Claro Group delivered an excellent presentation at the Current Trends in Healthcare Scholarship Luncheon. CEAI, along with sponsors MD Publishing and Renovo Solutions, awarded $4,000 in scholarship funds to five deserving students. Saulo Solis, Estelle Kemegne Fowoue and Eleazar Camacho were each awarded a $1,000 scholarship for the 2014-15 academic year. Kulsoom Ahmed and AnnaMaria Lambidis, both on track to graduate at the conclusion of the fall semester, earned a $500 scholarship each.

CEAI Scholarship Winners from left to right: Saulo Solis, Estelle Kemegne Fowoue, Eleazar Camacho, AnnaMaria Lambidis and Kulsoom Ahmed

Al Moretti, CEAI Executive Trustee and Scholarship Committee Chairman, said the organization has awarded more than $10,000 in scholarships to date. “We provide scholarships to deserving students who are pursuing studies in Healthcare Technology Management,” CEAI President Suraj Soudagar said earlier this year. “We are building the next generation of HTM leaders within the organization so the organization continues to provide a path for future members.” Applications for the 2015-16 scholarship program will soon be available at the CEAI website www. CEAIweb.org.

Bart Richards speaks at the CEAI scholarship luncheon.

SPOTLIGHT

BIOMED ADVENTURES Restoring a Classic By K. Richard Douglas

he concept of the ambulance goes back to 900 AD according to historians, who say that a chariot assumed this role. The first motorized ambulance was put into service in 1899 in Chicago. The gasoline-powered version came along not long afterwards and the first mass-produced ambulance rolled out onto the streets in 1909.

Greg Graves, a biomedical engineering specialist at Texas Children’s Hospital Pavilion For Women, didn’t set out to find an ambulance to restore. It was not even a thought when he came across a gray, elongated vehicle on the website of a classic car dealer. It was sitting in a field behind a Jeep and he knew that it wasn’t a station wagon. He recognized it as a 1957 Chevy and he thought it looked like an ambulance. His quest was originally for a more run-of-the-mill classic Chevy. “Ever since I was eight years old, I loved 1955 Chevrolets. I scraped together $200 to buy a Bel Air two-door hardtop in 1965, spent all summer getting it running to go to college, but the Vietnam conflict caused me to serve in the Air Force,” Graves remembers. “I came back from the Philippines to find my parents had sold the car. All I had was the dream: no car, no money. So life happened and I finally got to a point where I thought I could realize my childhood dream. I was searching for a replacement ’55 and saw this really long gray car in the background of a photo on a site with many old cars.” Graves kept searching that website for several months and finally saw that long gray car for sale. He debated whether or not to purchase it. Then, it disappeared from the site again. “I was heartbroken when it went off the site. Two months later it re-appeared on the site; this time painted red and white. Better than that, the price was reduced. My wife encouraged me to take the four-hour trip to at least go see it. Something told me to

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Greg Graves bought and restored a 1957 Chevrolet ambulance.

measure the 20 foot garage before we went. Needless to say, we bought it. At 19 feet 4 inches long, it just fits in the garage.” Once he bought the old ambulance, reality sunk in. It had been sitting in a field for many years. “The interior had a bench seat and not much more; not even door panels. It had new paint, but it was done in a hurry without quality body work,” he says. Among the problems he encountered were broken glass; all the windows except the windshield. The brakes needed replacing, the carburetor leaked and the fuel lines and gas tank were rusted. One bit of luck was that “the motor turned over and sounded good.”

NOVEMBER 2014

In 1957, ambulances did dual duty: carrying patients and carrying the deceased. Why use two vehicles when one long one will serve both purposes? During the mid-1950s, there were only about 24 ambulances produced from Chevys. The typical ambulance was a converted Cadillac or Oldsmobile. Graves nicknamed his restored classic “Amby.”

BRINGING BACK THE PAST Graves went about the process of bringing the old ambulance back to life. “The drive-train is a 283-cubic-inch V-8 with a 1990 700R4 transmission — replaced when the original automatic

transmission gave up the ghost — and a stock ’57 Chevy rear end,” he says. “We think the motor is not original, but it is still a ’57 Chevy 283 V-8. When I had front end work done, the owner of the shop said there was evidence of front end damage that was excellently repaired,” Graves adds. “The body is all original.” “My own restoration efforts were to install the driver compartment partition wall as well as replacing the rear floor deck making it ready to carry stretchers or caskets. I used shower paneling to make door panels. Updated front disc brakes were necessary to stop the weight of 5,000 pounds,” he says. The old ambulance turned out to have an interesting history. Before it landed in a field, it had been called into service for several years. “My research included reading the cowl tag on the vehicle to determine that it was built in the Chevrolet plant in Norwood, Ohio, in November of 1956,” Graves says. “It is a series A (1512), Model 150.” Research verified that the Chevy was originally labeled as a two-door utility sedan and began life painted Onyx Black with a black vinyl interior trimmed with black and gray patterned cloth. “When my wife, Marti, told her sister that we bought an ambulance, she sent a YouTube video of a similar vehicle,” Graves says. “Luckily, the guy’s email was on the video and I was able to contact him. He is a retired EMT in British Columbia, Canada, and he told me that I had one of seven combination vehicles — hearse/ambulance — built at the National Body Manufactur-

The 1957 Chevy has a 283-Cubic-inch V-8 under the hood.

ing Company in Knightstown, Ind.” He also learned that they had extended the frame 30 inches by cutting the vehicle in half behind the front door. “They custom made a larger back door for ease of access for attendants, thus making the wheelbase a total of 144 inches,” Graves says. “The overall length is 19 feet 4 inches. The base price was $1,850, the conversion cost $1,995.” A title search through the Texas Department of Motor Vehicles turned up more history. “They sent me all the owners once the vehicle arrived in Texas. This is how I found out Amby spent 29 years in Fort Irwin, Calif, at the Army National Training Center in the Mojave Desert and has been in Texas since October of 1986. The title surrendered to Texas had it registered as a hearse with 21,123 miles,” Graves explains. “It was even used to deliver furniture for a few years. We think that is how the back windows were cracked. The odometer is not original, so we do not know the exact mileage.”

ON THE JOB At Texas Children’s Hospital, Graves works in the area of diagnostic imaging

and is assigned to ultrasound machines and fetal monitoring in the labor and delivery department. “I decided to go back to technical school at age 40, after taking care of my father through all stages of throat and oral cancer. I was mechanically inclined and had worked in the petrochemical and machinist industries. I had some electronics experience in down-hole drilling systems,” he says. “In the late ’80s, I saw the medical field had a need for electronics technology. A counselor told me ‘You are going to be 40 with or without an education,’ so I enrolled in a biomedical electronics technology program,” Graves says. “Good thing I did, that is where I met my current wife. I started this career working on sterilizers as a field service engineer, but have worked in hospitals in three states doing a wide variety of in-house biomedical services. I have been at TCH for 16 years.” In the meantime, Graves enjoys taking Amby to car shows almost every weekend in the spring and fall and has been in a couple of small-town parades.

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In Memory Richard “Rick” Alonzo Sagadin January 18, 1957 – September 17, 2014

ichard “Rick” Alonzo Sagadin, 57, of WinstonSalem, N.C., died Wednesday, September 17, 2014, at Wake Forest University Baptist Medical Center. He was the founder and co-owner of Carolina Medical Parts and a respected businessman in the healthcare industry. Sagadin was known for his friendly and positive attitude. He was always quick with a smile and an encouraging word. “Our heartfelt condolences go out to his family,” MD Publishing President John Krieg said. “He meant a lot to the industry. MD Publishing and the industry will miss him.” “He was one of the good guys,” Krieg added. Fellow businessmen, who valued his ethical business practices, will also miss him. “I have had the pleasure of knowing Rick for some years, and appreciated that he was both a savvy and

ethical competitor in the MRI coil repair arena,” said Randy Jones, ScanMed President and CEO. “It is good clean competition that makes businesses better; hence, we all will miss Rick’s influence. My condolences to his friends and family.” Longtime industry veterans Rick and Kay Sagadin founded Carolina Medical Parts in 2004. The company was successful and expanded over the years. It is now housed in a 20,000-square-foot, customdesigned test facility in Winston Salem. In 2005, a second generation joined the company when daughter Katrina and her husband Chuck Winn came aboard as sales consultants. Recently, a third generation of the family became a part of the business when grandson Kyle joined the company on a part-time basis while attending high school. Kyle’s younger brothers Jason and Alex are waiting in the wings to continue the family business in the future. •

PROFESSIONAL OF THE MONTH Todd Frederick, BS, CBET By K. Richard Douglas

t’s not news that biomeds are having to learn more about networking and other tasks that have traditionally been part of the IT world. With training, they have had to evolve along with the integration of medical devices. What may be less commonly seen is when someone with expertise on the IT side comes over to the biomed side, putting the ITtrained HTM professional in a unique position.

One biomed, who started out working as a system administrator in Wisconsin, made the move and enjoys the HTM life. “I was originally hired to work as a Server Administrator in our Clinical Engineering department,” says Todd Frederick, BS, CBET, a clinical engineering technician in the IS Clinical Engineering department with Gundersen Health System in La Crosse, Wis. Gundersen Health includes a diverse mix of hospitals, regional medical clinics, nursing homes, breast care centers, dialysis centers, pharmacies, along with a health plan. The system’s reach extends into Iowa and Minnesota. The department that Frederick belongs to includes a manager, two dialysis techs, eight biomeds, four imaging techs, one equipment tech and one hybrid tech (biomed/IT). “I was responsible for getting devices to connect to our EMR system and maintaining system uptime. I decided to change roles after a year and transferred into a biomed position in our department,” he says. “I started my career as a Technical Systems Administrator with Gundersen

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applications. It is a great position as I get to work on all different types of equipment — except imaging, we have a different team for that.” Frederick was always interested in technology. He built a computer while in high school and worked in a consumer electronics store while in college. When he graduated from college, there were not any traditional biomed jobs available locally. The position at Gundersen, working with servers, required a bachelor’s degree and proved to be a great opportunity to get a foot in the door. The clinical engineering department is under Information Systems at Gundersen. The team Frederick joined was a hybrid group that connects medical equipment to computer systems. The role of an IT person in the biomed group provided the perfect background for a modern-day HTM professional.

EDUCATION

When not working, Todd Frederick likes to hit the open road.

Lutheran — now Gundersen Health System — in March of 2012. In May 2013, I took my current position of clinical engineering technician in the clinical engineering department,” he says. “In this role, I maintain our biomedical equipment and still assist with many computer integrations and some

NOVEMBER 2014

Frederick attended the University of Wisconsin at La Crosse and worked on a bachelor’s degree in biomedical science. The program included a lot of chemistry and biology with classes covering cancer biology and genetics. “The biomed field really caught my attention as it was a combination of technology and biology,” he says. “My plan was always to go into biology/ healthcare but I also had learned so much about computers and new technology that this field was the best of both worlds.” He obtained his CBET certification in March “once I had the two years of experience,” Frederick says.

Todd Frederick working on an Olympus cart.

Beyond general biomed duties, Frederick has some areas of concentration. “I work a lot with our staff paging system, ophthalmology and optometry, and Central Service equipment. I’m also one of the guys others go to regarding networking/IT issues. I also manage some projects for our department,” he says. The out-of-the-ordinary projects that have challenged Frederick since becoming a biomed have also been the bane of many HTM pros, although he has the right attitude about them. “I have been on some really cool projects since I started my career. The biggest one was our move into our new hospital. I assisted with a lot of the ‘child’ projects to make sure the move was successful; all in one day. One of the projects I did was a conversion to Masimo SpO2 technology. I had to track down all our non-Masimo monitors — over 250 — and collect them to be upgraded on-site,” Frederick explains. The field service person performed the software upgrades. The new hospital was built near the old one and connects to a clinic and the old hospital.

Todd Frederick and his wife, Tera, recently visited Glacier National Park.

AWAY FROM WORK When not on the job, Frederick likes to go on adventures in the virtual world and in the real one. “I’m a pretty avid computer gamer. Me and some other coworkers get together and have LAN parties whenever our personal schedules align,” he says. “I really enjoy playing volleyball. I also enjoy camping and taking our motorcycle out for rides.” He is a newlywed having married his wife, Tera, in July. The couple began dating in 2009. “I owe a great debt to her for keeping me on track to complete both of my degrees,” he says. “We don’t have any children yet, but have a Great Dane named Jax.” Frederick is known for his problemsolving skills and teamwork at Gundersen. “I’m usually cracking a joke and have great interactions with my coworkers and departments. The staff has given me High Five awards — our in-house recognition — for problems I have fixed for them or the time I have taken to fully explain what needs to be done to resolve their issue,” he says. “I wear many hats in our department and find that people will contact me because ‘Todd will know what to do.’ ”

FAVORITE BOOK: “To Kill a Mockingbird” by Harper Lee

FAVORITE MOVIE: “The Dark Knight”

FAVORITE FOOD: Cheeseburger Pie

HIDDEN TALENT: I do pretty good impersonations (mostly of people in our shop).

FAVORITE PART OF BEING A BIOMED: “Every day is different! It’s nice being able work on so many types of equipment.”

WHAT’S ON MY BENCH? • • • • •

Nalgene water bottle My iPhone My Nexus 7 tablet “Got Bon Jovi?” coffee cup Work laptop

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IN DEPTH:

Dose Error Reduction Systems

ose error reduction systems (DERS) are life-saving safety features that help prevent infusion pump medication errors. Here’s a comprehensive guide to how DERS operate.

Dose error reduction systems (DERS) allow infusion pumps to warn users of incorrect medication orders, calculation errors, or misprogramming that would result in significant under- or overdelivery of a drug, electrolyte, or other fluid. These systems are an important part of a facility’s defenses against medication errors and are available on large-volume (also known as general-purpose), syringe, patient-controlled analgesic (PCA), and ambulatory pumps. Infusion pumps that have a DERS are often referred to as “smart” pumps. ECRI Institute does not recommend using an infusion pump without a DERS for general patient care. However, they recognize that many hospitals use very basic pumps that do not have a DERS for some specific applications in which the precise rate is not important (e.g., administration of antibiotics, fluid maintenance); this practice is safe as long as the hospital takes precautions to ensure that more potent medications are not administered with these devices. DERS technology has advanced since the early systems that consisted of a simple drug library that had to be manually loaded onto each pump. Since the introduction of DERS in large-volume pumps, there has been a steady stream of advancements, including:

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• Larger drug libraries • Wireless connectivity to push new drug libraries (and in some cases, dosing information) to, and pull event logs from, the pumps • Log-analysis software for tracking near misses and gaining insight into clinical practices • Increasing integration between a pump server and third-party information systems

clinical application or location (e.g., epidural, neonatal intensive care unit [NICU], medical/surgical). If the programmed dose is outside the limits, the pump alerts clinicians and can either require confirmation before beginning delivery (referred to as a soft limit) or not allow delivery at all (referred to as a hard limit). DRUG LIBRARIES At the core of a DERS is a drug library, which stores dosing limits, along with drug names and other programming information. Clinical staff — typically nursing, pharmacy, and internal medicine — collaborate to develop a custom drug library to match a facility’s particular care practices. The library is created on a centralized server or computer and then

“These systems are an important part of a facility’s defenses against medication errors ... ” As the feedback from increasingly savvy clinical users grows, many suppliers are now offering regular software upgrades, new features, and are refining existing ones.

HOW THEY WORK DERS warn clinicians of potential over- or underdelivery of fluid by checking programmed doses against preset limits specific to a drug and to a

NOVEMBER 2014

stored on each pump, and should be updated regularly as new drugs or new uses for existing drugs emerge. Most facilities find that they need to revise their drug libraries every few months or so to add new drugs and to shift dosing limits to better fit clinical practice. The drug library is based on the facility’s dosing protocols and consists of a list of drug entities organized by subcategories that are identified by the

facility. Although these subcategories are usually referred to informally as “clinical locations,” they can be designated however the facility chooses: While they often match care areas (e.g., NICU, medical/surgical), they can also be named according to physical locations in the hospital (e.g., 5 West) or according to the therapy type (e.g., epidural). Each drug entity consists of a drug name and its associated default values for concentration, dosing unit, and dosing limits. When a user selects a drug entity from the library, the pump uses the associated defaults along with additional user input to program the infusion. In this way, well-designed libraries help control dosing errors by reducing the need for manual input and calculations. Early DERS-equipped pumps often had drug libraries that were “opt-in,” meaning that users needed to locate and enter the drug library through a menu. This often led to low compliance when opting in to the drug library was seen as overly onerous. In contrast, most modern pumps with DERS have drug libraries that are “opt-out”: when turning on the pump, users are guided to the drug library, with an option to exit (opt out) if traditional rate-volume programming is necessary. ECRI Institute believes that drug libraries should be opt-out instead of opt-in to improve compliance and ease of use. Some libraries don’t default to either behavior, and instead force the user to choose whether or not to use the library before allowing him/her to program the pump. We refer to such a design as “forced choice” and consider it acceptable, if less desirable than opt-out. LOG ANALYSIS Pumps with DERS also include a log that records data for doses that trigger dose limit warnings. Clinicians later use log-analysis software to aggregate the alert information from multiple pumps’ logs to find opportunities to improve clinical practice and decide whether they

need to revise the drug library. The information garnered from such log analysis can be especially useful for performing the proactive risk assessments of high-risk processes that The Joint Commission mandates for U.S. healthcare facilities. Further, log analysis allows facilities to check the results of changes that have been implemented.

THE STATE OF DERS TECHNOLOGY DERS technologies have become popular in many types of infusion pumps, although with different adoption rates. DERS were first popularized (and have perhaps undergone the most technological advancement) in the large-volume pump market. All largevolume pumps, pole-mounted PCA pumps, and syringe pumps that have entered the market since 2006 have at least some type of drug library. In addition, many models offer wireless connectivity and a server-based

architecture with extensive libraryediting and log-analysis software. Some vendors will, for a fee, analyze a hospital’s log data and provide reports (consulting services); additionally, vendors may offer workshops to teach users how to analyze their data and/or provide benchmarking programs in which hospitals can submit their data to a central location and see (deidentified) data from other participating institutions. THIS ARTICLE is an excerpt from a Health Devices article posted on ECRI Institute’s membership websites on June 4, 2014. The full article includes more guidance on Dose Error Reduction Systems including other DERS features. For help evaluating infusion pump cost and safety, to purchase this article, or to learn more about membership programs, visit www.ecri.org, contact clientservices@ecri.org, or call (610) 825-6000, ext. 5891.

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AAMI UPDATE

AAMI/FDA Ventilator Summit Shines Light On Common Terminology, Training

reating a culture of safety, having a common ventilator taxonomy, and ensuring competency training for healthcare professionals are three areas that need to be addressed to improve the treatment of patients, according to participants at an AAMI/FDA summit.

The audience discussed what culture changes are needed to shift to a better training model. Suggestions included having a standard certification process of training, changing to a risk-based model, and making it acceptable for a healthcare professional to say he or she doesn’t know how to use a piece of equipment.

Attendees, who included clinicians, regulators, healthcare technology professionals, and industry executives, discussed these and other issues during the two-day ventilator technology summit, held Sept. 16-17 in Herndon, Va. The summit began with a call for the creation of a culture of safety — a theme echoed by several speakers. “Healthy work environments don’t just happen,” said Connie Barden, chief clinical officer with the American Association of Critical-Care Nurses. “The onus is on us as leaders to promote a culture of safety.” Barden said communication is key to ensuring patient safety. She cited statistics from The Joint Commission showing that 65 percent of all sentinel events are caused by communication issues. “We’ve got to bust up the hierarchies and traditions in healthcare,” she said, adding that having a happier healthcare workforce leads to better patient care. She cited a study in the Journal of Nursing Administration that found that patients who are cared for in “better” working environments had a lower chance of dying. The audience agreed that enhanced communications are needed. Several suggested an information exchange between organizations to share not only evidence and best practices, but also near misses to

AAMI INTRODUCES FREE HEALTHCARE TECHNOLOGY PODCASTS

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help others avoid similar incidents. Participants emphasized the need for consistent terminology. This inconsistency results in compromised patient safety, a lack of comparative effectiveness data, and confusion over how to order and use various pieces of equipment. The potential for further confusion is compounded when pieces of equipment are labeled “ventilator,” when they are something else, such as a resuscitator, said Dario Rodriquez, health services and public health research manager at the U.S. Air Force School of Aerospace Medicine. “Nomenclature can get in the way of giving the appropriate level of care,” he added. He also pointed out that clinicians may not have adequate exposure to ventilators, so having standardized terminology would help them. Training also was a recurring theme throughout the summit. Scott Colburn, director of the standards program at the FDA’s Center for Devices and Radiological Health (CDRH), pointed out that healthcare professionals face a difficult situation with the sheer number of ventilator types. “I could be trained on this one ventilator, and turn to another and not know how to use it,” he said.

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AAMI has launched a series of free podcasts that will feature lively and informative interviews with leaders and experts in healthcare technology. Produced by Healthcare Tech Talk, the series already has featured an interview with AAMI President Mary Logan, who discussed the benefits of this resource for members and those interested in the safe and effective delivery of care. “We have great publications; we have great educational sessions; and we have great content,” said Logan. “However, people are different in terms of how they want to receive information. We really didn’t feel as if we were maximizing all of the opportunities that we have to disseminate content on subjects people are passionate about. These podcasts are yet another way to help our audience learn more about pressing healthcare technology safety issues that have a direct impact on them.” She also discussed the dangers of tubing misconnections and The Joint Commission’s Sentinel Event Alert highlighting the changes coming to the design of small-bore connectors. This important safety topic will be the topic of a future AAMI podcast. The second podcast examined the topic of the joint AAMI and U.S. Food

and Drug Administration summit: ventilator technology. AAMI’s partner in the podcast series is Healthcare Tech Talk, a show hosted by healthcare veterans Terry Baker and Kelley Hill. The podcasts reflect a commitment by AAMI to offer its members and others in the healthcare technology community new and creative ways to stay engaged and informed about trends and topics that affect their jobs and professional interests. ALL AAMI PODCASTS will be available on a new page on the AAMI website. Additionally, the podcasts can be accessed through three major podcast distributors: iTunes, TuneIn, and Stitcher.

Working Group, which developed the TIR. “The definitions of these and how they are utilized are explained very well in the document.” Because TIR34 has two audiences, it includes information for each group in separate sections. While the main text covers information for personnel involved in medical device reprocessing, annexes provide technical information for water maintenance personnel. Annex A includes questions users should ask when selecting a water treatment section. It also names the steps needed in a validation plan. “Another notable addition to the TIR is

the informative annex that addresses poor water quality and the impact on medical device reprocessing with pictorial examples, along with recommendations for investigation and correction,” added Jackie Daley, director of Infection Prevention and Control at Sinai Hospital of Baltimore, Md., and co-chair of the working group. “An extensive reference list is provided for further reading. Therefore, if water quality is important to you, then this TIR is a must-have reference.” The revised TIR will be included in the updated “Sterilization Part 1: Sterilization in Health Care Facilities.”

UPDATED GUIDE PROVIDES ANSWERS TO WATER QUALITY QUESTIONS Water is a critical component in the various stages of medical device reprocessing. How can those in charge of reprocessing devices ensure they are using water of the proper quality? A revised technical information report (TIR) from AAMI can help.TIR34:2014, “Water for the Reprocessing of Medical Devices,” addresses water treatment equipment, water distribution and storage, quality control procedures for monitoring quality, strategies for bacterial control, and environmental and personnel considerations. Intended for personnel who reprocess medical devices and those who maintain the water treatment system, the document is an update to a 2007 version. “The biggest change in this document is that we now have two categories of water: critical and utility,” said Emily Mitzel, laboratory manager at Nelson Labs and co-chair of AAMI’s Water Quality for Medical Device Reprocessing

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BIOMED 101

Soft Skills Are Important For Biomeds By Steve Smith CBET, A+

n the biomed community there are several skill sets that will make a person stand out from the crowd: organizational skills, troubleshooting, mechanical, knowledge with computers, punctuality, etc. But the one set of skills that are most often overlooked, and the hardest to teach in a classroom environment, are “soft skills” or “interpersonal skills.” Interpersonal skills are the life skills we use every day to communicate and interact with other people, both individually and in groups. These are as necessary to your career advancement as any of the other skills mentioned. Being able to communicate on issues to a nurse in a rushed environment and keep your cool is essential in separating yourself from the rest of the HTM professionals. Sometimes all it takes to escalate a tense situation is something as small as the expression on your face or your body language. As a technician you need to keep your audience in mind when explaining an issue. Very few nurses or doctors will want a long drawn out technical explanation of an issue. All they want to know is, “Can you fix it?” By being brief and to the point, we can often ease a tense situation. One time in particular, I was called into surgery with a child on the table. As soon as I walked into the surgical suite the doctor started to berate me and let me know, in no uncertain terms, that he was not happy that the monitor was not working. I calmly let him know, “I understand and I’m here to help.” I proceeded to find and fix the issue (the monitor had become unplugged). Later that day, the doctor sought me out and

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apologized for his outburst. He stated that it was my calm demeanor that made the difference and he thanked me for my work. He let me know that it takes a team and the work we do as biomeds has an impact on patient care. I will never forget that. Another phrase often thrown around is “networking.” No, I am not referring to computer networks. I am talking about people networking. It doesn’t matter how great a technician you are, or how well you know how to troubleshoot down to the component level, what people remember is how you handled yourself and how they were treated. It’s not only about fixing the equipment but also fixing the customer. If you really want to advance your career, keep this in mind at all times: You never know who your next client will be, or your next manager, or better yet, who you will be talking to at your next job interview. Always treat others with respect and dignity, as you would want to be treated. Because at the end of the day, your job really may depend on it. I will end with an example.

NOVEMBER 2014

STEVE SMITH Vice President of Sales for iMED Biomedical

I know of a person that I worked with when I was a Tech 1. He was the first one in the organization to pass his CBET. He was soon promoted to Tech 2, much to the chagrin of his fellow techs. One other tech and I were the only two people in our shop who congratulated this young man and we were truly happy for his accomplishment. It inspired both of us to study and pass our CBET also. We went on to become friends. Long story short, he is now the manager of a clinical engineering shop with 20 technicians at a major hospital in Fort Worth Texas, and a customer of mine. The moral of the story is, “Be nice to everyone, because you never know how things will work out.”

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NOVEMBER 2014

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WEBINAR WEDNESDAY

Myth Buster Webinar Is A Gigantic Success! By John Wallace, Editor

ore than 400 people registered to attend the Fluke Biomedicalsponsored webinar “The 5 Most Common Pulse Oximetry Testing Myths” presented by Andrew Clay. Clay hit on several myths and discussed whether they are fact or fiction during his informative presentation approved for 0.5 ASRT CE credits. He also focused on calibration and testing equipment before opening the floor to questions from attendees. Some topics discussed during the question-and-answer portion of the webinar included the best place to place the sensor on a patient for an accurate reading and the appropriate test range for these devices. Attendees were asked to submit questions via Twitter to @FlukeBiomedical #OximetryMyths. The string of tweets (questions and answers) can be found on Twitter. Fluke also provided a free whitepaper for attendees. An overwhelming number of attendees praised Clay’s presentation and the Webinar Wednesday series. Attendees shared their thoughts in a post-webinar survey that was emailed to participants. Rusty Black, a CE Tech at Cincinnati Children’s Hospital was thankful for Clay’s presentation and said it was “very relevant to the way we test and troubleshoot” pulse oximetry devices. Biomedical Technician Matthew Brentlinger said the webinar did a great job of providing valuable information.

“I thought this webinar was beneficial. It gave a good background on how the simulators and testers work as well as the theory behind it.” - Matthew Brentlinger Albert Rock, Associate Clinical Engineering Manager at Valley Baptist Medical Center, oversees the daily operations of the facility’s preventative maintenance program and the corrective maintenances performed under a contracted equipment maintenance program. He said the webinars provide a much-needed avenue for continuing education.

“Once again, I am very appreciative to TechNation and its staff members, OEMs and vendors who make this type of webinar possible at little to no cost at all. With our current economics, unfortunately training is one area of our budget that can be manipulated or chopped to nothing and it can mean that technicians and managers alike may miss out on important training and abilities to interact with questions and answers during and after these presentations,” Rock wrote in his survey. Jessica Mikhail, a biomed at South Peninsula Hospital, applauded the Webinar Wednesday program in her evaluation. “Thanks for the webinars. Keep them coming,” she wrote. A recording of the webinar can be accessed online at www.IAmTechNation.com where the Webinar Wednesday schedule of upcoming sessions is also available. All of the webinars are free and many offer CE credits. FOR MORE INFORMATION about Webinar Wednesday, visit www.IAmTechNation.com.

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SHOP TALK

Conversations From the TechNation Community

Before we jump though too many flaming hoops on this power strip ban announcement, has anyone actually seen a document from CMS that supports the claim that they have completely banned all power strips in patient care areas? So far, we have been unable to locate any such documentation, but I have no doubt that George Mills knew what he was talking about. We wanted to show something in writing to our OR leadership that supports us removing all their power strips, but basing the decision on a statement made by one individual without seeing it directly from the purported source does not seem advisable or reasonable. If anyone has a written copy of a statement from CMS or a URL where I can see this information online, I would really appreciate you sharing it.

CMS has not made a statement. Their comments (made through George Mills) were that they are merely enforcing the existing code requirements in the 2005 NFPA-99. If they would update their reference to the 2012 edition, RTPs are allowed, with proper planning and ongoing surveillance. One HTM director in California asked their local CMS inspector how he

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planned to enforce RTPs. His reply was that unless they are obviously unkempt, hanging in mid-air, or daisy chained together, he was not going to pay attention to them. While this is not a definitive or nationwide guidance, it does indicate that it is not going to be as big a deal as everyone expects. Also, even if they do note it, are they going to jeopardize your accreditation because of a few RTPs? I think not. By the way, you can eliminate 90 percent of your extension cords, RTPs, Octopuses (Octopi?), and outlet strips if you just replace your detachable power cords with custom-made ones that are 15 to 20 feet long. Several companies will make power cords any length, wire gauge, and connector type you wish. Replacing all detachable power cords allows the necessary length for every machine to reach any available outlet. I did this, and it is cheap, and has no negative implications, either from regulatory, safety, tripping or leakage aspects. FOLLOW UP: Thank you for that clarification. We recently received a statement from DHEC that seemed to allow RTPs if handled correctly, but they too are using an outdated version of the NFPA codes so what is a person to do? I think our approach is going to be, inventory them and document annual

NOVEMBER 2014

inspection and testing of them. If that is not good enough, we can go to the next step.

We made the difference years ago. After replacing power cords damaged by beds, carts, etc. rolling over them. We bought 8-foot power strips and had facilities mount them above headwalls. The power cords for Steris surgery tables are 20 feet long, with a 90-degree plug.

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I know that InterPower will make any quantity power cord that you need, to any specification.

Here is an important breaking news story. It is of vital interest to all Biomeds and HTM professionals. We are all familiar with the recent CMS and Joint Commission statements outlawing multi-outlet strips in patient care areas of hospitals. All hospitals are having difficulty complying in a cost-effective manner. A recent waiver retracts their original position. Everyone needs to read the entire waiver because there are some stipulations required for the use of outlet strips. You may download it from the HTMA-SC website. (www.htma-sc.org )

There is a flowmeter attached to an air/oxygen blender. The question is: What color should the flowmeter be? This is green (oxygen), but the output is not pure oxygen. Should it be yellow (air)? The flowmeter calibration is not an issue, just the color of the flowmeter.

I’d say that there are a couple of factors involved with this decision. First, does this facility ever use any air-only (yellow) regulators? Second, what percent O2 would the blender be routinely set at? If the answer to the first questions is “no” and if the answer to the second question is a low percentage, then I would be tempted to say go with the air, yellow, body of the regulator. If the answer to the first question is “yes,” and the answer to the second question is “all over the place,” I would say go with the O2, green, body of the regulator. It’s the nursing/technician recognition of something that might be different, and what is being delivered.

I would say that since you are able to give 100 percent oxygen, the flowmeters must be green. What is the need for the Y connector on the output? Are they trying to use the same blender for two different patients or do they just want a backup flowmeter? NFPA 99 doesn’t specifically give anything on this, and CGA C7 only specifies cylinders and containers, not delivery systems. According to that standard, if you were going to be completely within the “sense” of what’s out there, you would use flowmeters that were green and yellow. That would be the technical standard if you were putting a blend of oxygen and air in a cylinder; use both colors. Both standards also caution not to trust by color alone at any time. They both state, “Color coding shall not be utilized as a primary method of determining

cylinder or container content.” You would think that having the oxygen flowmeters connected directly to a blender would key the administering staff that it is not necessarily pure oxygen, but that would be making an assumption. We all know how those go! FOLLOW UP: Thanks for the replies. I assume the dual flowmeter is to serve two patients simultaneously. The consensus seems to be that green is best.

Flowmeters that are attached to blenders should be green as they can deliver 100 percent O2. Yellow should only be used where 21 percent air is the only possible output delivered. Safety-wise the yellow flowmeter should have a different DISS/quick connect connector on it that can’t be connected to a blender. In my opinion, yellow flowmeters should only be used on air tanks and wall air output connectors. It is not unusual for some ICUs to use a Y-connector on a blender that can only provide a blended output from one side of it.

Based on the American Academy of Pediatrics (AAP) and the Neonatal Resuscitation Program (NRP), this is a typical setup for neonates. One blender is 15 lpm and the other is 3 lpm. You would not use two different patients on the same blender because the physician prescribes the output. And you would not be able to change each percentage independently. As far as color, the therapy that you are delivering is oxygen. Whether it is at 100 percent, 21 percent or somewhere in between, it is still oxygen. Therefore the color must be green. THESE POSTS are from TechNation’s ListServ. Go to www.1technation.com to find out how you can join and be part of the discussion.

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ROUNDTABLE

COMPUTED TOMOGRAPHY

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NOVEMBER 2014

he CT market is undergoing a shift as dose reduction becomes more and more important. Medicare reimbursements are also impacting change for these important healthcare devices. TechNation reached out to industry leaders for their insights regarding CTs and what we can expect in the near future. The panel for this roundtable is made up of President of International Medical Equipment and Service Inc. Trey McIntyre, M.I.T. Vice President of Sales Sarah Player and Technical Prospects CEO Jeremy Probst.

HOW WILL THE MARKET FOR CT EQUIPMENT EVOLVE OVER THE NEXT FIVE YEARS? MCINTYRE: Technology’s race to more slices has already given way to chasing lower-dose systems, and that will likely continue. OEMs may find ways to offer plug-ins and low-cost system upgrades so they can stay under their customers’ spending thresholds. The secondary market will continue to see prices fall even as good equipment gets harder and harder to find. PLAYER: One way the market will evolve is the new law being passed in 2016 for dose reduction and Medicare reimbursements. The really old equipment will not be able to meet these standards so if the customer wants Medicare reimbursements they will have to update their equipment. Another way the market will change a little bit is the fact that parts for the older, single-slice CTs are going to start becoming really hard to find. People with those CTs will probably have to start thinking about updating. PROBST: Dose reduction and measurement is still very high on the list of targeted specifications to review, however the slice wars seem to be over. High-quality refurbished equipment with third-party support will be among the highest of demands followed.

WHAT ARE SOME OF THE BIGGEST CHALLENGES OF PURCHASING AND MAINTAINING CT EQUIPMENT TODAY?

Trey McIntyre

President of International Medical Equipment and Service Inc.

MCINTYRE: With capital budgets being constrained — often paralyzed — it is difficult to find quality equipment and a cost-effective plan to maintain it. But it’s absolutely still possible to get great equipment, and finding the right parts provider to partner with you will make maintenance easy and affordable. PLAYER: The biggest challenge is making sure you get a good reputable company. I have customers who have used third-party companies that don’t have any training or are a one-man company and they have been burned. It makes them question using them again. It is a challenge. Customers need to make sure they do research, research and research before buying an expensive piece of equipment or signing a multiple-year service contract.

PROBST: The largest challenge in the selection process that has become very prevalent in the industry is the availability of alternative to OEM “new” or “pre-owned” X-ray tubes. This can be the first, and often the most expensive, cost of ownership failure point. Other challenges are the availability of third-party parts, training and technical support. In a market where cost of ownership reduction is a primary measurement of purchasing refurbished products, buyers need to research the market as many alternatives to OEM companies have solutions. If you are selecting a new CT from an OEM, you may want to consider negotiating training and discounted parts in the initial contract and when the warranty or service contract ends you will be happy you did.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REPUTABLE THIRD-PARTY CT EQUIPMENT PROVIDER?

MCINTYRE: Quality has to be the first priority, followed by reliability at a close second. There’s no use in being a reliable partner when the quality isn’t there; you add no value to the customer. Can you test and scan with the system before purchasing? Does the provider have true expertise and experience you can depend on? PLAYER: Make sure you call references. Don’t just ask how good they are at service, ask how often the CT they bought goes down and then you will know if they do a

THE ROUNDTABLE

things right if there was any miscommunication or misunderstanding during the purchasing process. PLAYER: If you purchase through a third-party company, the company will offer some kind of applications training. Some people will ask you to pay for it, some will have it included in the quoted price. You need to make sure, if that is something your techs need, that you ask if it is included or not.

Sarah Player

Vice President of Sales at M.I.T.

thorough refurb or if they just paint the covers. PROBST: An in-depth review of their quality management system and the qualifications of their engineers who will be servicing your CT. If you are procuring a refurbished CT take a tour and spend some up front time reviewing the supplier’s processes. Many third-party CT equipment providers rely on outside vendors for parts, training and support. Having a solid network that provides this service will help to ensure uptime guarantees.

HOW CAN PURCHASERS ENSURE THAT THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS? MCINTYRE: That’s the importance of working with a provider that you trust, and making sure these types of concerns are discussed before delivery. A good provider will stay with you long after the purchase, and will make

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PROBST: Buyers should be asking about applications training and if the CT will fall under shared service. They should look for training of their in-house engineering team. Operations manuals usually are acquired from the facility that the CT was removed from. In many cases, service manuals will not be at the site that they purchase the CT from as they often are keep off site or are unavailable.

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING CT EQUIPMENT? PLAYER: Go with a third-party company. It will save you a lot of money in the long run. Make sure you do your homework on them and call references because there are a few out there that do not do a good job and it gives the rest of them a bad name.

PROBST: There are many options available. Conduct market research and select the right partner that meets your short- and long-term goals of the department. Third-party parts, training and technical support will become paramount to their success if they choose to service the equipment in house.

NOVEMBER 2014

Jeremy Probst

CEO of Technical Prospects

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT CT EQUIPMENT? MCINTYRE: You can actually improve the performance and reduce maintenance needs by having your techs up to date with applications training. Bad habits can be formed when trying to keep up with patient flow — and those habits can add wear to certain CT systems. A little applications refresher course can be a big help. PLAYER: If you do good PMs on them and keep them clean (dust free), the CT equipment should run really well and not have problems too often.

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NOVEMBER 2014

FINDING SERVICE

SOLUTIONS FOR OLDER EQUIPMENT

“K FIND

By K. Richard Douglas

nowledge is power” was first uttered by the philosopher Francis Bacon during the early 17th century. Bacon wrote about both science and politics and his words are timeless.

“Information is power” is another common saying that can be applied to many situations. It finds applications in many ways, including the knowledge needed to repair older equipment. That knowledge can be gleaned from forums or the insights of seasoned colleagues. The Internet and networking at biomed associations can also be sources. Hospital budgeting is not new, but with recent healthcare reform. The C-suite is extra vigilant regarding cost management. As long as patient outcomes are not jeopardized, targeted savings is part of the new mantra. A focus on savings often means that older medical equipment has a longer life cycle than in previous years. Clinical engineers are often charged with keeping older medical equipment running as long as possible. The task brings about challenges such as finding adequate replacement parts, professionals who know how to service dated technology, and creating a maintenance plan to help the device go the distance. Resources include websites like MedWrench.com and networks of clinical engineers on sites like the TechNation Community. Independent service organizations can sometimes provide a wealth of knowledge and the ability to source service manuals and hard-to-find parts. The experiences of a number of HTM professionals was sought to determine what resources are commonly used. Consistent themes, and a few unique suggestions, are what follow.

FINDING SERVICE SOLUTIONS

RESOURCES The ability to find parts and repair information has been aided by technology in recent years. As pointed out by Michael O’Brien, CBET, biomedical technician with Kaiser Permanente Westside Medical Center in Hillsboro, Ore., the methodology has improved thanks to resources available on the Internet. “It’s changed a lot over the years with so much information available instantly online now. Many manufacturers have detailed information readily available,” O’Brien says. “There are still a lot who do not provide any information though. Not that long ago, I relied on forums such as Biomedtalk to pose questions and reply to people who were looking for assistance with something. Often, it was regarding equipment no longer supported, or not well supported.” O’Brien doesn’t have occasion to work with much in the way of older equipment in his current position, but garnered some experience in a previous role. “There are still a few sites like Biomedtalk, MedWrench, for example, but I don’t use them as much in my current role. I’m now working at a new hospital with all new equipment so this is not something I’ve had to do for the last few years,” he explains.

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Partnering with service organizations that share your vision and zeal for customer satisfaction and equipment uptime is a suggestion from Walter Barrionuevo, MBA, CMLSO, CMRP, director of clinical engineering services for BayCare Health System. “We receive parts consumption/usage reports, along with warranty/out of box failures,” he says. “Being active in the local biomed society allows our technical staff to network with other HTM professionals, to not only obtain and share information regarding quality service/parts vendors, but to also share best practices,” Barrionuevo says. Duane L. Hart, MA, BS, CBET, says that the most important resource is not necessarily technology, but human resources. “Within my experience, the go to resources for mature equipment is a mature service professional. One challenge is the ‘graying’ of our service force and that knowledge base retiring,” Hart says. “There are few, if any,

opportunities to capture and share experiences in a structured format — think the Wikipedia of service experience.” “Our service professionals look ahead, with insight to the capital budget trends, and identify end-of-life devices which we will maintain in the fleet,” Hart says. “We work with our equipment broker to secure an inventory of donor devices for parts support.” “Stock up” says Russ Magoon, CBET, MBA, an imaging service engineer at Legacy Health in Portland, Ore., and president of the Oregon Biomedical Association. “I buy stock when a unit is not going to be supported any longer. I get all of the most commonly broken parts. Stock up before something is no longer supported. When I find a reliable supplier, I build a good relationship,” he says. “First, utilize existing service manuals if you have them on hand. If not, reach out to your network and also check with the manufacturer to see if they have service manuals available,” says Jeff

MIKE O’BRIEN

ANDY ARMENTA

CBET, Biomedical Technician, Kaiser Permanente Westside Medical Center

Account Coordinator West Anaheim Medical Center

NOVEMBER 2014

“Being active in the local biomed society allows our technical staff to network with other HTM professionals, to not only obtain and share information regarding quality service/parts vendors, but to also share best practices” -Walter Barrionuevo

Ruiz, biomedical engineering manager at Holland Hospital in Holland, Mich. “If no service information is available, seek comparable test requirements for similar devices and get approval from your EOC or Safety Committee to approve.” “An important note to keep in mind, verify if the device is needed for patient care. Part of our responsibility is to make sure to identify if there is any end-of-life or end-of-support letters issued,” he says. “If so, we should be communicating to our customers that they should be aware of the end of support and should have a capital replacement plan for the device.” Ruiz says that listservs, search engines such as Google and other biomed departments are all potential resources. He also cites MedWrench as a valuable resource. Andy Armenta, account coordinator in biomedical services at West Anaheim Medical Center, starts out with a status notification. “First of all, I send a memo to the department manager indicating I may not be able to repair the equipment in a timely manner as a result of the

WALTER BARRIONUEVO MBA, CMLSO, CMRP, Director of Clinical Engineering Services at BayCare Health System

equipment being obsolete. I also copy our Chief Nursing Operator so there will be no further emergency issues with this equipment. They will either purchase a new device, where parts are available, or

they can take a chance on downtime issues. They usually request to purchase a new device,” he says. When the older device is maintained, Armenta has had some luck with third-party suppliers. “I sometimes go through vendor Tenacore Holdings when my equipment is obsolete and I can’t find parts,” he says. “Tenacore is able to get my obsolete equipment repaired.” Armenta says RPI (Replacement Parts Industries) is also a good source for parts. “There are occasional semiconductors out there that are used in different OEM devices and these are mostly locatable on the Internet or at the local electronic parts store,” Armenta says. “For mechanical parts, most of the time, the OEM is listed on the mechanical parts and these are also locatable whether through the Internet or even the local Grainger dealer.” “But, older boards are difficult to locate in some of these obsolete devices,” he says. “But being that I am a biomed instructor and the fact that I have put many biomeds into the local medical vendors, I can sometimes locate a used part from one of the local medical companies who deal with used medical equipment.” “I also look onto the Dotmed, Medwrench, or eBay websites to locate the vendor who may want to part out the same equipment found on there,” Armenta continues. “I also have a couple of used equipment dealers I use from time to time. They buy up equipment from online auctions and also travel around the country to attend live auctions. They can also locate equipment and parts for me as well. They have business associates that help locate the parts and in turn sell them to me once located.” “I would assume everyone is using sites such as MedWrench,” Ruiz says. “Also, if you are part of a multiple

FINDING FINDING SERVICE SERVICE INFORMATION SOLUTIONS

OTHANIEL WILLIAMS

RUSS MAGOON

Senior Biomedical Equipment Tech Baylor Medical Center

CBET, MBA, Imaging Service Engineer at Legacy Health

“First, utilize existing service manuals if you have them on hand. If not, reach out to your network and also check with the manufacturer to see if they have service manuals available” -Jeff Ruiz

hospital or bigger organization, use your organization’s network for resources. If you come from a single hospital, utilize your local biomedical association for helpful resources. I would also check out Frank’s Hospital Workshop (http://www. frankshospitalworkshop.com). The site focuses on supporting older equipment both for the United States and with other countries.” Carl Jones II, biomedical equipment technician, and Othaniel Williams, senior biomedical equipment technician, both with the Baylor Medical Center in Garland, Texas, agree with Ruiz. “The MedWrench biomed forum has been a great resource for me, also FranksHospitalWorkshop.com has tons of old service and operator manuals,” Jones says.

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Jones likes another source also. “Mouser is a great source for electronics components very reasonably priced. Most biomeds tinker in some way and are probably already aware,” he says. “Forums are a great resource. Really helped me with an Eagle sterilizer repair,” Williams says. “Keep older units — at least one for parts [for] future repairs or when the unit is beyond repair, salvage whatever internal components you can and store them before disposing of the unit,” Jones adds. “The best insurance is a contingent capital funding resource which can be utilized when it finally meets the end. Keeping it working is a balance between want, need and risk,” says Hart.

NOVEMBER 2014

ONLINE RESOURCE Several HTM professionals suggested MedWrench as a resource. The service offers a number of options including product information, forums and a bulletin board. It is a product-focused social networking site that also provides a shared network for users of medical equipment and instruments. “MedWrench is a great source for FINDING SERVICE SOLUTIONS and/or manuals for older systems,” says MedWrench Media Manager Jonathan Payne. “MedWrench is a product-focused support network geared towards HTM professionals. The purpose of our website is to provide a platform for medical equipment professionals to interact and help one another solve service-related issues,” Payne says. “This includes, but is not limited to, sharing of service manuals, specification documents [and] answering service related questions.” The service also provides additional product information such as FDA alerts, PM tips, videos, archived discussions and more. “There is even information on

JONATHAN PAYNE Media Manager at MedWrench

“MedWrench is a product-focused support network geared towards HTM professionals. The purpose of our website is to provide a platform for medical equipment professionals to interact and help one another solve servicerelated issues ... ” -Jonathan Payne

continuing education, when available,” Payne says. “If you can’t find what you are looking for, just post a question in our Q&A forums.” “MedWrench covers all types of medical equipment, so chances are if you are experiencing an error with a system — even an obsolete model — we have it featured on our website,” he adds. “MedWrench houses a tremendous amount of specifications documents, brochures, as well as service manuals; however, we clearly do not have all manuals listed on our website.” Payne points out that the networking aspect of MedWrench comes in handy when somebody needs to find a manual. With 22,000 registered users, there is a good chance that someone who uses our site has it, he says. “If you use MedWrench properly, you will always be able to make connections with other HTM professionals who either have the manual or have experienced the same issue,” Payne says. One benefit of Internet searches is being able to hone in on a specific topic or search-string. The ability to do a very specific search is another benefit of one of the MedWrench site’s features. “One of our most valuable resources is the ‘My Bench’ feature,” Payne says. “As a member of the site, users can subscribe to communities — categories, products, and manufacturers — that they have an interest in. Using this feature allows HTM professionals to stay connected and receive instant access to anything related to what is benched on their profile.” “Another aspect the average user may not be aware of is the ability to compare systems. If your healthcare facility is looking to purchase a newer/different system, you can compare models side by side to gauge the pros and cons of each,”

Payne adds. “When making a purchasing decision, it is always imperative to educate yourself fully before making any permanent decisions. Comparing models allows you to really narrow down which system is the right fit for your facility.” The Bulletin Board on MedWrench is one of the site’s newest resources. It can be found at: www.medwrench. com/?blogs.BulletinBoard. “Visitors can find a weekly blog, expo/ events, continuing education information and a career board,” Payne says. “Having an accurate asset management program in place, which not only tracks the useful life, equipment failures, but also any end-of-support notices by the OEMs, prevents any mid-year equipment replacement surprises if no repair parts are available,” Barrionuevo says. “Being able to accurately forecast equipment replacement before repair parts are no longer available is the best strategy.” Knowledge may not always be power. Sometimes it just makes life easier.

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CAREER CENTER How NOT to Get Hired By Tim Hopkins

n today’s tight job market, it is critical that you standout in your job search. Unfortunately, a large number of job seekers standout for all the wrong reasons.

TIM HOPKINS Stephens International Recruiting Inc.

1TECHNATION.COM

In 12 years of recruiting for Stephens International, I have encountered a wide range of situations when placing technicians and managers. Frequently, I am asked what it takes to land a new position. The answer is not just one quality, but a combination of experience, education, timing, personality, first impressions and even luck. Of all these components, the first impression is often overlooked, yet one of the most critical. Many quality job applicants are ruled out by simple mistakes and without even being aware of it. The bottom line is, “You cannot land a job in 10 seconds, but you can certainly be ruled out in five.” Regardless of the field you are in, writing a resume is the beginning of the job search. Typically, the chronological resume (with the most recent date listed first) is standard. Your resume is the first impression that a potential employer has. On a regular basis, hiring authorities see a large quantity of resumes. The reality is that they do not spend a lot of time reading each of them because they simply do not have the time. It is imperative that your resume is easy to read and clearly communicates that you are qualified and competent. Take advantage and utilize resources such as published books and articles that provide resume writing tips. Anything longer than a two-page resume will get lost in the shuffle and will not be read. The most common mistake I encounter on resumes is misspelled words or typographical errors. We all make mistakes. However, when submitting your resume, a simple error in spelling can cost you. Proof it yourself

NOVEMBER 2014

by reading it out loud. Then, have someone you trust read over the resume and look for spelling or grammatical errors. Using the “spell checker” is helpful but it will not find a misused word if it is spelled correctly (i.e., their or there). A fresh set of eyes will go a long way. Believe it or not, a very common mistake is to include incomplete or incorrect contact information. What does this say about the applicant? It could have been a simple mistake or will it appear that the candidate is just not organized. It is not uncommon for people to keep old resumes on file and update them over time. If you have moved or changed your telephone number or email address, make sure it is up to date. Additionally, ensure your email address is professional and appropriate in a business environment. Consider changing your email address before completing your resume. If I were to list some of the unprofessional and often inappropriate email addresses we encounter, this article could not have been published. When it comes time to submit your resume, email it and follow any directions the company provides. Do not fax your resume. Yes, we still receive faxed resumes and they are often not considered. It is much easier to keep track of a resume electronically over a hard copy and many companies do not appreciate the use of additional paper. If the resume is well written and the qualifications are a match, the next first impression will be a telephone interview. It is a good idea to make sure your voicemail greeting reflects

professionalism on both your cellphone and home phone. If you have a song, funny message, or unique response, consider changing it during the time you are seeking a job. Respond to messages as soon as possible. I have worked with candidates who take a week to reply to emails and messages. I question their motivation and sincerity. If you are serious about looking for work, it should not take

part of the decision process. The most critical part of the hiring process is the face-to-face interview. Always be on time and dress professional. I suggest wearing a suit or at least slacks and a professional shirt. It is better to be over dressed than under dressed. If you walk into an interview and are over dressed, you can always take a jacket off. If you show up under dressed, there is no turning back. I

â&#x20AC;&#x153;The bottom line is, you cannot land a job in 10 seconds, but you can certainly be ruled out in five.â&#x20AC;? - Tim Hopkins

longer than 24-48 hours to respond. When you do speak with potential employers, always remain positive and never bad mouth former employers. Remember, biomed is a very small industry. The person you speak negatively about might be connected to the hiring decision. It is also important to be energetic and upbeat. If you do not make a positive impression at this point, you will not make it to a face-to-face interview. Social networking sites are a great way to keep up with old friends and network within the biomed field. They are also used by human resource departments to discover more about potential hires. Keep your accounts private unless you want them to become

learned that lesson the hard way early in my career. I set up an interview for a candidate with 15 years of experience and assumed he knew how to dress. He showed up in jeans and a T-shirt. He was qualified and the client liked him. However, the client could not get past his attire during the interview and it cost him the job. Be aware of your body language and eye contact with those you meet. Candidates often believe the hiring decision is made in the interview room. Remember everyone is in on the hiring decision, including office administrators. Candidates have lost job opportunities by being rude to the receptionist. During an interview, the hiring team has set aside time during busy schedules

to focus their attention on you. Your body language and how you react during an interview is an enormous indicator of your interest and willingness to fit in. For example, if you cross your arms after being introduced to someone, it could be construed that you are not open to communicating. Never bring your phone, or other device, into the interview and certainly do not accept any calls. Yes, this actually happened, and that candidate was quickly dismissed from the interview process. Expect that a complete criminal background and reference check will be performed before an offer letter is presented. During this process, be honest and disclose any issues that might surface. References are another important, but often overlooked area. Candidates too often take for granted their list of references will give a positive review. The reality is this is not always the case. Contact potential references prior to listing them and not only ask permission to include them on your resume, but ask if they will give a positive review of your performance. Do not assume anything with a previous employer. I have called references provided by candidates and the feedback was not always flattering. Competition for jobs is at an all-time high and you must standout in every category. The hiring process will go much smoother if common sense and thoughtfulness are applied. It is a challenge for anyone to find a new position today, so do not overlook the simple things.

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