TechNation - January 2015 by MD Publishing

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VOL.1

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

JANUARY 2015

WHEN DISASTER STRIKES DEALING WITH THE UNEXPECTED

Biomed Adventures Stage and Steed

The Roundtable RTLS

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

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

THE ROUNDTABLE - RTLS As Real-Time Locating Systems become more common it is important to stay informed about the latest technology. TechNation reached out to manufacturers and technicians to find out about these complex systems.. Next month’s Roundtable article: Digital Radiography

WHEN DISASTER STRIKES — DEALING WITH NATURAL DISASTERS HTM professionals can have a stressful day any day with the demands of their work. Patient safety and high-quality healthcare depends on the work of biomeds as much as it does the nurses and doctors. What happens when a disaster or tragedy strikes and you need to step up and handle the unexpected? TechNation shares the stories of those who have been there and what it takes to survive. Next month’s Feature article: Cost-Saving Measures- Equipment Replacement Strategies

TechNation (Vol. 6, Issue #1) January 2015 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.

JANUARY 2015

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Bio Stag

The RTL

Wh Hig of H

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Sharon Farley Warren Kaufman Jayme McKelvey Andrew Parker

p.12 Department Profile: Banner Health Technology Management Department p.14 Biomed Adventures: Stage and Steed p.18 Professional of the Month: Steve Reid

ART DEPARTMENT

Jonathan Riley Jessica Laurain

P.22 THE BENCH

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

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

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Sue Cinq-Mars

P.12 SPOTLIGHT

p.22 p.24 p.26 p.28 p.31 p.33

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

P.50 EXPERT ADVICE

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

P.60 BREAKROOM EDITORIAL BOARD

Manny Roman: manny.roman@me.com Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com

p.60 p.62 p.65 p.66 p.70

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

p.69 Index

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

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DEPARTMENT PROFILE Banner Health Technology Management Department By K. Richard Douglas

n the course of profiling many HTM departments around the country, TechNation has encountered every size from one-person operations to those surpassing 100 technicians. Banner Health, which operates 29 core facilities spanning seven states, has a contingent of HTM professionals that might take the cake.

Spread over four separate divisions; Clinical Technology Assessment and Planning, Diagnostic Imaging Service, Clinical Engineering Service and ENTECH, the Banner Health Technology Management Department includes 250 personnel. Their purpose is to facilitate a comprehensive medical equipment life cycle program. That goal supports Banner Health’s mission statement; “We exist to make a difference in people’s lives through excellent patient care.” Steering this big ship is a leadership team that includes Vice President of Technology Management Tim Riehm, Senior Director of Clinical Engineering Frank Cabrera, Senior Director of Diagnostic Imaging Services Steve Letourneau, Senior Director of Clinical Technology Assessment and Planning Perry Kirwan and Senior Director of ENTECH Shane Gilman. The 29 facilities that the department handles include 5,500 beds and 220 operating rooms. They range from 25-bed rural access facilities to 700-bed academic/ trauma centers, according to Cabrera. The four divisions within the Technology Management department are important components of making it all work. Headquartered in Phoenix, Banner Health is a nonprofit that operates 25 hospitals and other healthcare facilities in seven states. The health system celebrated its 15-year anniversary last year. The healthcare system’s Technology Management Department has embraced the unifying name for the profession as its official title.

DIVISIONS MAKE IT WORK “Diagnostic Imaging Service is a

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JANUARY 2015

The Banner Health Technology Management Department services a CT unit.

corporate-based department that provides in-house service support for all imaging equipment across the entire Banner Health network of facilities,” Cabrera says. “In addition, Imaging Services provides the development and implementation of all service delivery strategies for each location and device type. This includes the creation and development of standardized vendor contract features designed to provide long-term cost containment across all Banner Health facilities.” “Our goal is to create and maintain superb vendor partnerships that work seamlessly and collaboratively toward our collective goal of achieving optimal service delivery and quality patient care on a 24/7 basis,” he says. The department is also comprised of the anchor Clinical Engineering Service, which provides support for technology refreshes

and departmental expansion and renovation to new facility builds, along with most traditional services. With the potential for real purchasing power, the Clinical Technology Assessment and Planning (CTAP) division can rely on atypical leverage in negotiating deals. The department has some impressive results that have been achieved since its implementation. “The infrastructure is built, in place, and leverages a Computerized Maintenance Management System, financial and operational data,” Cabrera says. “Scoring matrices are developed for imaging and non-imaging clinical technologies and are embedded into the Banner Health’s capital prioritization processes.” Cabrera says that CTAP standardization processes are fully operationalized and have saved $58.75 million since their inception in 2009.

“These savings are on top of the results that we receive through the ECRI quote analysis services,” he says. “New technology processes are fully operationalized. ECRI’s Select Plus, HTAIS, and Market Intelligence reports play a vital role in the outcomes of this process,” Cabrera explains. “Banner Health CTAP has taken a large, complex organization that serves many markets across a large, geographical area and developed processes that have enabled clinical and business stakeholders to work together to support a common mission,” he adds. The ENTECH division is an independent service organization that supports over 400 contracted customers. “All medical equipment service agreements are centrally managed through the Technology Management Department,” Cabrera says. “This provides opportunities to leverage geography, as well as economies of scale, with respect to vendor relationships.” The legal portion of the agreements have been hashed out using a comprehensive service-focused boilerplate developed by the health system’s legal department. “In parallel of the legal process, the operational service component — payment schedules, discount structures — are also being negotiated,” Cabrera explains. “In my opinion, this single program has assisted greatly in maintaining a relatively flat annual service budget for the past several years,” he says. “This is even more impactful when we look at the overall incremental service growth over the past three years as Banner Health has added greater than $250 million in equipment in support of the following initiatives: Thunderbird South Tower expansion (150 bed), Estrella tower expansion (100 bed), Good Samaritan OR renovation (15 additional ORs) as well as the building of new facilities at Ironwood (40 bed), Gold Field (25 bed) and MD Anderson Cancer Center.”

MAJOR INITIATIVES It may come as no surprise that a big department can take on big projects. The Banner HTM department has addressed some of the leading-edge challenges in HTM with measurable success. One of those has been the implementation of telemedicine.

Members of the Banner HTM Department repair an ultrasound device.

Cabrera says that translating the available technology used for video conferencing to telemedicine has been a “tricky proposition.” He points to achieving the technical aspects of the service while maintaining HIPAA compliance as one example. “But, also more practical ones, like finding the right use cases and even the right tools to do the job at hand,” he says. “Also at odds with the adoption, the high cost and almost dedicated nature of the solutions available on the market today.” “Banner Health asked Technology Management’s CTAP/Telematics team to develop low-cost systems for telemedicine,” Cabrera explains. “Of all of the barriers that Banner experienced regarding adoption, cost was the largest one. The cost of dedicated carts prohibited both access and, just as important, the ability to iterate the design of the delivery systems to best suit the clinical use cases.” He says that the Telematics team defined the clinical, technical and business requirements, analyzed the market for potential suppliers that met those requirements and vetted the suppliers and made recommendations for products. After much work and review, the result was a “framework of products that could be adapted to fit the unique requirements of each telemedicine use case.” “The team has developed six unique fixed and mobile designs that enable the following clinical services – tele-psychiatry, tele-stroke, tele-neurology, tele-pediatrics, eSNF (eskilled

nursing facilities) and patient-centered medical home. Each one of these systems is designed around a specific set of tasks that achieve objectives such as time to diagnose, prevention of transfers, patient safety and ongoing patient monitoring,” Cabrera adds. The team at Banner also tackled bringing surgical instrument services in-house. “The goal of this 18-month journey was to reduce outsourced service expense for hand-held surgical instruments; rigid endoscopes, flexible endoscopes and surgical power tools,” Cabrera says. “Historically, the service for this product line has been decentralized through individual departments: Supply Chain, Endoscopy, Central Sterile Processing and Perioperative.” “This program has exceeded expectations by delivering greater than 20 percent expense reductions as well as leveraging Original Equipment Manufacturer (OEM) relationships to greater levels. As a direct result, Stryker Surgical has facilitated a very aggressive service offering with value adds exceeding $1 million,” he says. Banner Health Technology Management has been heavily involved with the Arizona Medical Instrumentation Association (AZMIA). Tim Riehm, the department’s vice president, is the current president of the AZMIA. The department also has members who make up several leadership positions in the association. The department moves forward with an unremitting mandate for managing a lot of technical expertise along with a massive amount of equipment.

SPOTLIGHT

BIOMED ADVENTURES Stage and Steed By K. Richard Douglas

t may seem like an unusual pairing; motoring down the road on a big touring motorcycle and reciting lines written by William Shakespeare on the stage of a theater; but one HTM professional enjoys both activities.

“When I was going through Army basic training at Fort Sill, Okla. in 1980, it was cheaper to rent a motorcycle than a car when I was on a weekend pass. I found it exhilarating. I still have great memories of riding a rental through the Wichita Mountain Wildlife Refuge outside of the post,” recalls Dean Stephens, EET, CBET, supervisor of the Biomedical Engineering Department at Penn Highlands Elk, a part of Penn Highlands Healthcare in central Pennsylvania. When Stephens finished his enlistment as a Pershing nuclear missile crewman/ computer operator, he bought his first motorcycle – a 1980 Harley-Davidson Sportster. “This was on May 21, 1984. That bike had 3,280 miles on it when I bought it from a friend,” Stephens says. By that August, the next time the friend saw it, the motorcycle had over 19,000 miles on it. “I can remember him asking me if I ever got off of it. I was hooked for life. Two weeks after I bought the Sportster, my dad bought his first bike.” Stephens’ dad’s purchase of a motorcycle had significance that will be soon seen.

OWNING AND ADVOCATING Stephens rode his Harley Sportster everywhere, including a trip from Kansas City, Mo., to Panama City, Fla., and back

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JANUARY 2015

in 1988. He also travelled throughout the Midwest on it. “I shelled the engine in it in the ‘90s and ended up going through a couple of old 750 Hondas and a Yamaha FZR 1000 crotch rocket. None of these made any real distance trips, but they were all ridden as much as I could when the snow was gone,” he says. “In June 2010, I had sold them all, including the Sportster, in order to build up enough to buy something that would handle trips again — yes, I owned my first bike for a little over 26 years. I wanted to find a Kawasaki Vulcan Nomad, but couldn’t find anything in my price range,” he recalls. “I found a 2003 Vulcan 1500 Classic at a good price and bought it.” While Stephens was waiting in the shop for the new ownership paperwork for his new toy, his dad called. He had news that was more than coincidental; he had just purchased a 2005 Kawasaki 1600 Vulcan Classic. Although Stephens and his dad were a thousand miles apart during that call, they had basically both bought the same motorcycle on the same day. The only difference between the two bikes was that the manufacture year was two years apart. “Three months after I bought the Classic, I found a Nomad listed on eBay. It was at the dealership six miles from my house. I rode my Classic down, struck a

Dean Stephens is seen in an OR where he was performing preventive maintenance on medical devices.

deal, and completed the trade the next day. I wanted that model to get the factory hard saddlebags. I wanted it bad enough that I ended up with one in my least favorite paint scheme; two-tone beige,” Stephens remembers. “That winter, I changed the exhaust, added an aftermarket intake to increase flow, and also added an aftermarket fuel injection controller to increase the fuel flow to match the huge increase in air flow I now had. This also gave the horsepower and torque a big boost,” he says. All those miles on the back of a motorcycle made Stephens a real fan and gave him a sense to advocate for his fellow motorcyclists. One way he supported the passion for motorcycles for his fellow

Dean Stephens in the role of “Walt Waldowski” in M*A*S*H in 2009. Pictured with him is Jessalyn Penvose.

riders was to become a motorcycle safety instructor. He has also taken an active role in organized motorcycle activities. “I am currently the treasurer of the Laurel Highlands Vulcan Riders. I am the former National Secretary of the Vulcan Riders Association (VRA) USA and am the current National Vice-President. The VRA is an international organization of Kawasaki Vulcan riders and enthusiasts with chapters in over 23 countries,” Stephens says.

MEMORIZING LINES What might seem like a real stretch is the pairing of Stephens’ other hobby with his time on a big touring bike. Waxing poetically on a theater stage is a country mile from the rumbling of a motorcycle engine, but Stephens is accomplished at both. “I was first in theater, speech, and debate while in junior high school. I took those as electives all the way through my senior year. After that, life intervened until 2009, when one of my co-workers found that I had an interest,” he says. “His wife was doing auditions for a play she was directing at the community theater in our town; M*A*S*H. I auditioned and ended up with the role of Walt Waldowski.” The following year, Stephens earned the role of Kenny in the Neil Simon play “Laughter on the 23rd Floor.” He does

Dean Stephens and his wife are seen riding in the Flight 93 Memorial in Pennsylvania during the 2015 VER USA national rally that his chapter hosted.

about one play a year and has been in six or seven productions. “Our venue is the Reitz Theater in Du Bois, Pa.,” he says. “Once rehearsals start, I have no life at night other than the play. This goes on for at least two months, as you start with basic read-throughs sitting at a table, to blocking out the movements, entrances, exits, etcetera on an empty stage, while reading lines from the script.” The reaction of audiences never gets old for him.

OFF THE BIKE AND STAGE The current position that pays the bills, when not tooling down the open road or gracing a stage, is working as a supervisor; a position Stephens has held since December of 2013. “I started as a biomed after meeting my former boss in college in 2002. He was going for his degree in Biomedical Engineering while I was pursuing mine in Electrical Engineering. He and I hit it

off good, and I applied with his company in 2007. They hired someone else, but I was called back in 2008. With my mechanical, electrical, and machining background it was a great fit,” Stephens says. He worked as a traveling technician for more than five years and gained experience with the maintenance and repair of STERIS sterilization equipment. Since the company was a large reseller of medical equipment, along with being a third-party service provider, he gained a broad-based knowledge of all makes and models of equipment. “After I had been with the company a year, I registered for the CBET exam and took a prep webinar that Myron Hartman of Biomed Ed offered. The webinar was the best thing I could have done; I passed the exam on my first attempt,” he says. The certification is just another feather in his cap or another patch on his black leather jacket.

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PROFESSIONAL OF THE MONTH Steve Reid By K. Richard Douglas

midst the festivities, presenters and vendors, at the second annual conference of the Oregon Biomedical Association (OBA) in October, was the announcement of the Biomedical Engineering Technician of the Year. That honor went to an HTM professional who works for the Veterans Affairs Medical Center in Portland, Ore. In announcing the winner, OBA President Russ Magoon, CBET, MBA, said that Steve Reid “is regarded as one of the most technically savvy biomed equipment support specialists by his colleagues.”

“I didn’t even know I was nominated for it,” says Reid. A lot of students, who have done internships at Reid’s facility, have gone on to be full-time biomeds. Reid suspects some of those students may have nominated him for the OBA award. Reid, a biomedical engineering technician, is still fairly new to the profession, but he has made a positive impact on colleagues. He started out wanting to take his skill set further by learning to be a biomed. His entry into the field was after things began to transition to the high-tech state they are in today. “I wanted to expand on my existing mechanical/electrical troubleshooting and repair background. Biomedical engineering was the perfect direction for me to go because the technology is always advancing and the challenge of networking these complex systems was something that I was very interested in taking on,” he says. Earlier in his career, he had been a diesel mechanic, which is where he picked up skills in mechanical and electrical troubleshooting.

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JANUARY 2015

STEVE REID

OBA’s Biomedical Engineering Technician of the Year

“I found biomed when I was going to college,” he says. He started out pursuing radiology, but there was going to be a wait to get into a radiology program.

Completing one of the quintessential biomed degrees, Reid entered an internship program. “I took care of my prerequisite classes at Clark College and Portland Community College between 20052007,” he says. “Upon completion of the prerequisites, I started the AAS Biomedical Engineering Program at Portland Community College between 2007-2009. I graduated with an AAS degree in Biomedical Engineering in the spring of 2009 and interned at the Portland VAMC until winter 2009.” “I interned for awhile and then I went into volunteer status for a little bit while I was looking around,” he says. “Then, they did want to recruit me and I got hired about three months after that. There was about a nine month to a year period that I was here interning and volunteering.” As a technician, Reid’s regular duties include clinical lab, anatomic pathology, research, dialysis, dental, audiology, speech pathology, ophthalmology, optometry, orthopedics, ENT, dermatology, primary care clinics, prosthetics, rehab

“If I can’t buy a part, I’ll build it.” – Steve Reid medicine, EMG, pharmacy, and Omnicell. Within these duties, his areas of specialty are clinical lab, anatomic pathology, research, dialysis and dental. Recently, he took a spectrum photometer that hadn’t worked in years and was able to get it up and running without a manual or any instructions. The device will improve protein analysis and DNA for research. The Portland VA, in affiliation with the Oregon Health and Science University (OHSU), operates the Northwest Veterans Affairs Cancer Research Center. Not only was Reid’s ability to repair the photometer useful to the research done there, but his ability to fabricate metal helps with research equipment. Funding for research from grants doesn’t always leave a lot of funding for equipment or parts. “If I can’t buy a part, I’ll build it,” he says. Another project Reid helped with was connecting an Olympus BX40 microscope in the lab conference room to a large smart TV to allow pathologists to hold their tumor boards there and view slides with greater acuity. Previously, they had to use a CRT. He has also assisted with multiple networking projects. “The activation of our new community-based clinics, that went from five to 10 thousand square feet up to 26,500 square feet, adding modalities and different services and networking,” Reid says. One attribute of Reid that no doubt

caught the attention of the Oregon Biomedical Association was his willingness to pay it forward as a mentor to some of the profession’s newest biomeds. In Magoon’s remarks about Reid at the OBA convention, he said; “He has championed the work study mentorship program at the Portland VA and has dedicated much of his valuable time instructing and building the skills of new biomeds.” Passing those skills to the next generation of biomeds may be one of the more important things that an HTM professional can do. “Students who come through, I try to mentor them; show them the ropes to see what real biomed work is like,” Reid says. “When the students are in the biomed classes, they always have a field trip and come up to the hospital. I will rip apart a dialysis machine and let them see what the inside of one looks like. I would be there doing PMs anyway. I still do it when they want to come by.” Interns who have worked with Reid, and who went to school at Portland Community College, have ended up at hospitals in the area like St. Charles, Salem Hospital, Providence, OHSU and Legacy, according to Reid.

FAMILY Away from work, Reid enjoys fishing, camping, cooking and gardening. He has a fiancée, two step-children and three children of his own. Reid is a U.S. Army veteran. He served from 1990 to 1996.

It may come as no surprise that Reid won biomed of the year honors. He sums up what TechNation readers should know about him this way; “Hard working, punctual, technical skills are sound and I enjoy mentoring students in the biomedical engineering program at one of our local colleges.” What more needs to be said?

FAVORITE BOOK: Any science fiction

FAVORITE MOVIE: Also, any science fiction

FAVORITE FOOD: Surf and turf

HIDDEN TALENT: Fabrication

FAVORITE PART OF BEING A BIOMED: Learning and seeing something new every day in a field where the technology changes so quickly.

FAVORITE MUSIC: Richard Meyer/ Andrea Bocelli

FAVORITE DRINK: Water

WHAT’S ON MY BENCH? Soldering/desoldering station, computer, oscilloscope, tools, TI-89 calculator and many tech manuals

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IT’S ELECTRIC!

Discussing Electrical Safety in Healthcare

nsuring electrical safety is a key responsibility of healthcare technology management personnel. ECRI Institute regularly provides guidance to members who ask us how best to manage the challenges of protecting patients and staff from electrical hazards. This article covers topics related to how leakage current limits are established and how they should be applied in special cases. TOUCH AND LEAKAGE CURRENT LIMITS The term leakage current refers to currents, not intended to be applied to the patient, that flow from exposed conductive portions of a device to ground (earth). These currents normally flow harmlessly through the power cord grounding conductor. However, if there is a break in the grounding path or some other failure, these currents can flow through a person in contact with the device, possibly causing injury. Leakage currents may flow from the chassis or enclosure of a device, from patient probes and electrodes to ground, or from a part of a device through the patient or operator to another part of the device. To help protect patients and staff, standards organizations have established leakage current limits for electrically powered equipment used in the healthcare environment. These limits are designed to ensure that leakage current from such devices will not harm individuals who come into contact with them, even in the event of a grounding failure or other reasonably likely failure. The leakage current limits established in the primary standards that apply to equipment used in healthcare facilities — the National Fire Protection Association’s NFPA 99 and the International Electrotechnical Commission’s IEC 60601-1 — are based on limited experimentation in humans and the results of similar tests on animals. These studies examine the level of current flowing through the heart required to cause

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ventricular fibrillation. The greatest risk exists with conductive intracardiac catheters. The allowable limit for leakage current through an intracardiac connector is 10 μA, which is considered acceptably safe by NFPA and IEC. Higher currents are allowed under certain fault conditions, such as when the line cord grounding conductor is open. Although exposure to these currents may pose greater risk to the patient, there is a lower risk that they will be applied to the patient in such cases. Therefore, the overall risk of ventricular fibrillation is kept low. The widely accepted limit for touch current — the term newer standards use for leakage currents from the equipment case or enclosure of patient care medical equipment — is 500 μA. Because these currents are unlikely to flow directly through the heart, they do not pose a significant risk to patients or users — though some patients or users may feel a small shock or tingle when these currents flow through their skin. Perhaps the most important thing for healthcare facilities to understand when assessing leakage currents is that leakage current limits are based on very limited data and risk approximations. Therefore, small deviations above acceptable limits do not suddenly make a device unsafe. In addition to leakage currents, patients are exposed to other nontherapeutic currents from devices. In most cases, these intentional currents pose less risk to the patient than leakage currents: Whereas

leakage currents often have frequencies of 50 or 60, intentional nontherapeutic currents have higher frequencies, to which the heart is less susceptible. The standards account for reduced concern at higher frequencies by allowing higher currents at these frequencies.

APPLYING LEAKAGE CURRENT LIMITS IN SPECIAL CASES PERMANENTLY WIRED EQUIPMENT For both patient-contact and nonpatient-contact hardwired equipment, leakage current, before any grounds are connected, should not exceed 10 mA (10,000 μA) measured with power conductors connected with correct polarity. Before 2012, 5 mA was required in U.S. standards. The high reliability of a hardwired ground justifies the higher limit. According to IEC 62353, if protective measures have been taken and regular testing performed in compliance with IEC 60364-7-710:2002, periodic leakage current measurements are not necessary.

EQUIPMENT IN CLINICAL LABS AND OTHER LOCATIONS OUTSIDE THE PATIENT VICINITY ECRI Institute recommends that leakage currents up to 3,500 µA (with the ground open) be considered appropriate for equipment that will not be used in the patient care vicinity. Although such high leakage currents may be felt by an individual exposed to them, or may even cause an involuntary reaction, they are allowed in some standards that apply to nonmedical products or to clinical laboratory equipment or other products not used in the patient care vicinity; we base our recommended limit, in part, on these standards. The 3,500 µA limit would apply to devices such as centrifuges and laboratory analyzers as well as equipment in diagnostic imaging workstations, nurses’ workstations, and monitoring central stations. However, if the device may be brought into the patient care vicinity, its leakage current (with the ground open) should be 500 μA or less. The IEC 60601-1 and IEC 62353 standards do not apply to devices outside the patient environment.

DEVICES WITH REDUNDANT GROUNDING Some devices have redundant grounding when they are installed; examples include bedside monitors connected to central station displays and whirlpool bath turbines grounded through the associated plumbing. Verify that these devices meet appropriate touch current requirements before installation or connection to ground during acceptance inspection.

MULTIPLE DEVICES ON ONE POWER CORD In some instances, multiple devices may be powered through a single line cord, because, for example, accessory outlets of one device are used or because multiple devices are plugged into a relocatable power tap (RPT). The touch current of such an assembly of devices will depend on all the devices that are powered by the single line cord plugged into the wall power outlet. If these devices are

normally used in this configuration, touch current measurements should be made using the single line cord, and the entire assembly of devices should meet the appropriate limit (i.e., 500 µA). Alternatively, the assembly can be powered by an isolation transformer to limit total touch current regardless of which devices are plugged in.

DEVICES WITH NO EXPOSED CONDUCTIVE SURFACES ECRI Institute does not recommend making touch current measurements of devices with no exposed conductive surfaces. Such devices should ideally be listed as double insulated. If it is necessary to verify touch current from such a device, do so by placing a 10 × 20 cm (3.9 × 7.8 inch) piece of bare metal foil in contact with the device and then measuring “chassis” current from the foil as it is moved along the surface of the enclosure.

DEVICES WITH HIGH TOUCH CURRENT While most medical devices on the market meet appropriate electrical safety standards, some older devices or specialized equipment may fail to meet healthcare facility touch current criteria. When there is no equivalent alternative, or when such a device offers unique, highly desirable features, the device should not be rejected simply because of high touch current. Failure to meet leakage current limits does not necessitate discontinuing use of older equipment, provided that the equipment is otherwise still functional and reliable. The resulting small increase in safety achieved by newer equipment would not justify the substantial cost of replacement. In fact, by requiring the diversion of funds slated for other areas and newer technologies, replacing such equipment may even prove counterproductive to the delivery of quality healthcare. Consider each piece of equipment on its own merits, keeping in mind the extent to which the device exceeds the touch current limit and the steps that can be taken to minimize the possibility that leakage current will flow through patients or personnel. Remember that touch current

does not normally contact patients or personnel — it drains off harmlessly through grounding. Touch current limits are a backup or redundant protective measure. These limits were established so that if the grounding of a device should fail (such a failure is usually not evident), injury would be unlikely if a person touched the chassis of that device while in contact with grounded metal. Safety is primarily based on having good grounding (or double insulation). If a device has always had a touch current just slightly above the limit but performs as designed, it should be used without hesitation. ECRI Institute recommends that equipment that exceeds the touch current requirements by just 10 percent or 20 percent be used without hesitation or modification. This will not pose a hazard to patients or staff. Be sure that it has a good-quality plug and that users are aware of the need for grounding. Consider whether periodic testing of grounding resistance should be performed. Consistent with NFPA 99, Annex A, when a device has excessive leakage current, use of a small isolation transformer to bring device leakage current to an acceptable level or use of redundant grounding of the device (most practical for equipment that is kept in one spot) is permissible. If installing an isolation transformer, use one with an adequate current capacity for the intended purpose. Relatively inexpensive 1:1 transformers are available and will meet most facilities’ needs; some transformers offer a greater degree of isolation than is necessary and are very expensive and heavy. THIS ARTICLE is an excerpt from a Health Devices article posted on ECRI Institute’s membership websites on November 5, 2014. The full article includes more guidance on double insulation, ground-fault circuit interrupters, and isolation. For guidance related to hospital electrical safety issues, to purchase the full 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 Foundation Promotes Continuous Monitoring of Patients on Opioids

ith the support of key industry partners, the AAMI Foundation has launched a multiyear initiative to highlight a potentially devastating patient safety problem — and to make the case for a solution that can save lives.

For patients in pain, the use of opioids can be invaluable to their well-being and healing. However, their use comes with risks, and can result in respiratory depression and even death. The solution? Continuous monitoring of all patients on opioids. Late last year, the AAMI Foundation assembled The National Coalition to Promote Continuous Monitoring of Patients on Opioids at a kick-off event in Chicago. Patient safety advocates, researchers, executives in the medical device industry, clinicians, hospital administrators, healthcare technology professionals, representatives from stakeholder-professional societies, and families who have lost loved ones gathered to build the case for continuous monitoring of all patients receiving opioids. “We have a problem that stems from the best of intentions — easing the suffering of patients. However, some patients suffer severe respiratory depression from the use of opioids,” said Marilyn Neder Flack, senior vice president of patient safety initiatives at AAMI and executive director of the AAMI Foundation, which runs the Healthcare Technology Safety Institute. “Since it is currently not possible to predict which patients will have this type of reaction, periodic monitoring of these patients will not detect the early onset of when the patient starts to be in trouble. Failure to

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promptly detect this change in the patient’s condition can be deadly. The good news is that a solution is out there — continuous electronic monitoring.” The campaign is expected to unfold in phases over several years. Coalition

Patient Safety Council, Connexall, Sotera Wireless, and Early Sense. Others are expected to join the coalition soon. These companies are contributing their time and money to support the work of this new coalition.

“ We have a problem that stems from the best of intentions — easing the suffering of patients. However, some patients suffer severe respiratory depression from the use of opioids.” – Marilyn Neder Flack members will use resources, such as webinars, publications, online resources, conference proceedings, and general outreach, members of the coalition hope to rally the entire healthcare community behind the idea that continuous monitoring must become standard operating procedure for patients on opioids. “The change won’t happen overnight, but it must happen,” Flack said. “And, working together, we can make it happen.” The current industry partners for this initiative are Covidien, Masimo, Respiratory Motion, the San Diego

For more information about the coalition and its plans, please visit www. aami.org/htsi/opioids/index.html.

SPOTLIGHT SHINES ON SUSTAINABILITY FOR MEDICAL DEVICES Sustainability is becoming an increasingly important issue for the healthcare industry. An AAMI standards committee is seeking members to help develop a technical information report (TIR) that addresses what environmental, health and safety implications medical device manufacturers should take into account when developing their products.

“The committee has developed a draft TIR after coming together both in person and virtually to work on the document over the past year,” said Suzanne Fiorino, a member of the AAMI Sustainability Committee, which includes device manufacturers, users and regulators. “Currently, the TIR draft is being circulated for comments among the members.” Already, the committee has examined some sustainability issues — including disposing of waste and avoiding harmful chemicals during the design phase of a product — in a white paper released in November 2013. “Elements of a Responsible Product Life Cycle” can be downloaded for free from AAMI’s Hot Topics page, which features standards information and other resources, located at www.aami.org/hottopics/sustainability. AAMI members who are interested in participating on the AAMI Sustainability Committee are encouraged to contact Cliff Bernier, director of standards, at cbernier@aami.org.

GETTING READY FOR AAMI 2015 The AAMI 2015 Conference & Expo in Philadelphia, featured a new look and a host of informative education sessions designed for healthcare technology and medical device professionals. Building on that success, the association is looking to be even bolder this year. Scheduled for June 5-8 in Denver, AAMI

2015 will feature some surprises for those who have attended past conferences. Among those changes is a revamped schedule that will be consistent from day to day, so attendees won’t have to guess when the next sessions will start. Those looking for more opportunities to visit the Expo Hall will see a bigger array of displays. Plus, the hall will be open at lunch, giving attendees more opportunities to see the latest in healthcare innovations. Another big change will be to the awards ceremony, which will be split off from the Harken Lecture. Awards will be distributed in a special reception on Saturday, while the Harken Lecture will become a general session. For those with a digital bent, the mobile app will feature a polling function so the audience can participate more actively in sessions. An expanded Interoperability Showcase, sponsored by Healthcare Information and Management Systems Society (HIMSS), will allow for more hands-on engagement, with attendees getting the chance to understand more about interoperability through a life-sized operating room and home healthcare setting. Finally, as always, AAMI’s receptions will offer attendees the opportunity to unwind and discuss all that they learned with their peers. For more information, visit www.aami.org/ac.

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TOOLS OF THE TRADE Flexible Inspection Scope

ealthmark has announced the addition of the Flexible Inspection Scope to its Prosys Optical Inspection line of products. The Flexible Inspection Scope includes a distal tip composed of a light source and camera lens at the end of a 50cm, ďŹ&#x201A;exible shaft. It is designed for instruments 3.2mm in diameter or larger. The camera and light are powered by the USB connection on a PC. It is compatible with both Windows XP and Windows 7, the included software allows viewing and recording from most computers. Paired with the optional Flex Arm, the Flexible Inspection Scope can be securely fastened to a workstation to free both hands for manipulation of the scope and the target medical device. It is the perfect tool to visually inspect any device after cleaning, particularly those with internal channels and lumens. FOR DETAILS, visit www.hmark.com/FIS.php?pmc=FIS-PR.

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BIOMED 101

Service Contract or No Service Contract By Sharon Wray

contract is an agreement between two or more parties that outlines the business arrangement for the supply of goods or services at an agreed upon price in an agreed upon response time.

When medical equipment is purchased, a decision has to be made as to how the equipment will be kept in working order. Usually the decision is between the biomedical staff maintaining equipment or purchasing a service agreement with the Original Equipment Manufacturer (OEM) or a third-party vendor. There are many factors to consider when deciding to purchase a service agreement or not. Questions to consider are: • Are the biomed employees trained to repair the equipment? • If the employees are not trained, is training available? • What is the cost of the agreement? • What is included in the agreement? • Is there technical support and phone support? • How complex is the equipment? • Is a loaner available and if so at what cost? • How quick is the response? • Is the agreement part of a purchase deal? Once the decision has been made to purchase an agreement, the next step is deciding what type of contract you will need for the equipment. The type of contract needed is usually based on the complexity of the equipment, service history and duplication of equipment in the inventory.

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TYPES OF SERVICE CONTRACTS Comprehensive, Platinum, Gold or Silver Agreements – OEMs offer various types of coverage for their equipment. The most expensive coverage is the full coverage and it offers coverage 24 hours a day, 365 days a year. Then, there are agreements that are Monday thru Friday during normal business hours of 8 to 5. Preventative Maintenance Plans – Vendor performs preventative maintenance and all repairs are an extra expense, if needed. First response agreements – Employees have had some training and will go take a look to see if they can repair the equipment before calling the vendor in for service. Parts Only Agreement – Under this agreement, the technicians have been fully trained by the OEM. As part of the agreement, the parts for repairs are sold at a discounted price. Master agreements – These are a good way to save money. If you can negotiate an agreement that covers all of that manufacturer’s equipment on one agreement, you usually have the benefit of a great savings because of efficiencies in invoicing and negotiating agreements as well as guaranteeing the vendor service agreement monies.

SHARON WRAY Program Manager, Department of Clinical Engineering, University of Virginia Health System, Charlottesville, VA

Insurance Plan – There are companies willing to offer less costly service coverage on equipment because the cost risk is spread over the pool of equipment. If you look closely at the service costs versus the service agreement costs, you will see many times that the service agreement cost is two to three times the cost of repairs or maintenance on the equipment so the insurance plan is a good option. Instead of calling the OEM for repair, you would call the insurance company. You can negotiate to receive money at the end of the agreement, if the pool of money was not spent on repairs.

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NEGOTIATION If it is decided that a service agreement is necessary for the equipment, it is good to look at the response time and what is covered or not covered under the agreement. Many times a preventative

Another important part of the negotiation is asking about training for the user as well as the biomedical technicians. Many times the OEM will offer biomedical training at a reduced cost or free when negotiating the agreement at the point of sale.

Another important part of the negotiation is asking about training for the user as well as the biomedical technicians. maintenance visit will require batteries and filters that are not part of the agreement so you should try to negotiate better pricing for those items when you are negotiating the agreement, especially if you have many pieces of equipment that will require parts that are not covered. Sometimes a company will offer a preventative maintenance agreement at a low cost, but you have to buy the $1,000 battery and if you had known this you could have negotiated this into the agreement. It is good to talk to the technicians to see what is breaking the most on equipment. Sometimes you can negotiate that part into the agreement because it is a design flaw. When negotiating agreements, you should ask for multi-year and multi-unit discounts. Many times companies will offer a discount if you negotiate a multi-year agreement and even more of a discount if you have more than one unit.

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SUMMARY Before entering into service agreements, it is good to take the time to look at all options available. Make sure you talk to the biomedical technicians who take care of the equipment. Many times they have some insight into what is a problem with the equipment as well as the cost of items needed during repairs and maintenance. Look at the service history of the equipment to make good business decisions. Sometimes it is cheaper to pay for time and materials rather than a service agreement. Make sure you look at how many pieces of equipment you have and whether you plan to keep the equipment for a while longer or not. If there is training available, take advantage of the training and it will help the biomedical employees take care of the equipment as well as save money for the institution.

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WEBINAR WEDNESDAY Continues to Break Records By John Wallace, Editor

he RPI-sponsored “A Primer on Tabletop Sterilizer Repair and Maintenance” webinar set a new Webinar Wednesday record in November. Neil Blagman’s session on Nov. 12 set a new attendance record with 590 people registered and 436 people logged on to view the presentation.

Blagman, a product development engineer at RPI, provided expert insights on sterilizers. He touched on the three parameters used to produce sterilization before discussing the cycle steps of the sterilization process in detail. He concluded the webinar with an insightful look at troubleshooting tips, PM steps and techniques for common repairs. One of the highlights of the webinar was the outstanding interaction between Blagman and the attendees. He answered questions throughout the webinar and welcomed attendees to call him if they had additional questions or needed more information. The webinar was one of the best ever for the Webinar Wednesday series. Attendees gave the webinar high marks with an overall rating of 4.5 on a 5-point scale. Attendees also raved about the webinar in a survey sent to attendees at the conclusion of the educational session. “The Webinar from TechNation, presented by RPI, was an amazingly valuable session for our techs. I can’t thank you enough for your time and effort organizing this,” The Sierra BioMedical Team wrote. “I highly recommend this for anyone – from brushing up, to learning for the first time.” “The RPI webinar on autoclave theory and repair provided the ISO technician with the tools necessary to troubleshoot many of the common problems found with the Midmark

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“ The presenter was very thorough and well-versed on all subject matter. I especially enjoyed having the animated visuals to go along with the lecture.” –Chad J. M9/11 autoclaves that are frequently encountered,” Robert P. wrote. “Today’s presentation was superb, good mixture of visual aides and speaking along with questions/answers moving around the various aspects of the presentation. As always, TechNation’s webinar series has been excellently set up, topics are of current technologies or issues affecting our industry and has allowed us in the field that do not get as ample opportunities to travel out for service training and education due to budget constraints or manpower issues (to acquire continuing education),” Albert R. wrote. “The presenter was very thorough and well-versed on all subject matter. I especially enjoyed having the animated visuals to go along with the lecture,” Chad J. wrote. One attendee praised the entire Webinar Wednesday series as well as Blagman’s presentation. “TechNation’s webinar series is a good way to keep up to date with continuing education that is very practical to our everyday tasks as HTMs,” Brian T. wrote in his survey. A recording of the webinar is

available at IAmTechNation.com and a copy of the presentation slides can be downloaded at www.rpiparts.com. The Webinar Wednesday series kicked off in January 2015 and 16 sessions have been held through November 2015 with an average attendance of 154 people per webinar. “Overall, TechNation’s free, ASRT certified, monthly Webinar Wednesday series has far exceeded my expectations,” Jayme Lynn McKelvey, Webinar Wednesday Coordinator said. “Due to its success we started a similar series for our OR Today community in September, and we are already scheduling webinars for 2015 with leading companies in the medical equipment industry. I am truly excited to see what 2015 has in store for Webinar Wednesday!” FOR MORE INFORMATION about upcoming webinars visit IAmTechNation. com and click on the “Upcoming Webinars” tab at the top of the page. For sponsorship opportunities, email webinar@mdpublishing.com or call 800-906-3373.

JANUARY 2015

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SHOP TALK Q:

I have been tasked with finding equipment to make our secure E.R. room safer and less “damageable.” One of the senior nursing staff remembers seeing to a long clear plastic cover mounted over medical gas outlets and locked closed to prevent psychiatric patients from being able to insert items into the ports and either damaging the ports or freely flowing O2 into the room and wants something like that. Any ideas, manufacturers, or websites out there?

You might consider using a security headwall (see http:// modularservices.com/productsservices/security-headwalls). These are designed for use in a psychiatric setting. Follow Up: I appreciate it, but they are trying to do this without having to break the gas lines. They are also stuck on the clear plastic covers.

At our 5-plus year old facility they have all the ports recessed in the wall with locking doors covering them. Maybe your facility can work with a local cabinetmaker to come up with something to encase them off with staff access and allow the lines to come out through bottom ports.

Q: A:

What is your New Year resolution for work?

I would like to find time to pursue my A+ and Networking+ certifications. It has been on my to do list, but time is always at a premium.

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I have actual examinations from A+ and Net +. There is also lots of free study material online.

I was wondering how many of you are interested in either of the two new certifications from AAMI that were announced in September. One is for quality systems experts and the other is for HTM managers. Both are supposed to become available in the first quarter of 2015. Are any of you planning on pursuing either of these? Why or why not? I’m planning on taking the HTM manager exam because it’s the logical next step for me career-wise.

A: A:

I would like to be the first to take the HTM manager’s exam.

I would be interested in the manager exam. Where can you find more information about this?

There are several hard-at-work HTM professionals working on the examination content. As this exam rolls out, it is my hope that it will serve similar purposes that the technical certifications, such as CBET, serve for managers.

A: Q: A:

I hope to have certification #1 for the managers certification. Has anybody done anything to prepare for Ebola?

Since our department is the designated Incident Commander we have done quite a bit of table-top planning. Specific voluntary action

teams have been formed as well as a variety of plans dependent on specific cases. We did not want to limit our focus on Ebola, but come up with contingencies for any infectious outbreak.

Sutter Health has set up a staging area and wards in anticipation of an Ebola-related event.

We have created an isolated unit should the need arise. Also, we have verified what ventilation equipment we have that is not a re-breather, so we can minimize possible contamination impact.

I need a source for 2-foot and 3-foot hospital grade power cords, any suggestions?

Interpower makes any type of length and configuration of power cords.

Google is your friend ... this one’s a little pricey but they have 84 in stock at www.cablestogo. com/product/48014.

RPI has 1 1/2-foot and 3-foot power cords available. No 2-foot cords are listed. The direct address for their complete cord listing is www.rpiparts.com/PartsList. asp?equip=25&oem=201&model=6

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.

JANUARY 2015

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ROUNDTABLE

RTLS systems more common, but are they right for your facility?

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JANUARY 2015

he use of a Real-Time Locating System (RTLS) has many benefits for healthcare facilities.The ability to track medical devices helps prevent loss and has a positive impact on patient safety and patient satisfaction. RTLS is becoming more common in the industry and TechNation reached out to manufacturers and technicians to find out the latest about these complex systems. The panel of contributors for this roundtable discussion includes Bill Bailey, Enterprise Architect-Technical Services, ProHealth Care; Kurt Burner, MBA, CBET, Biomedical Engineering Manager, Akron General Health System; Adam Peck, Director of Marketing, CenTrak; and Jon Poshywak, Vice President and General Manager, TeleTracking Technologies Inc.

Peck: Over the last year, the use of hybrid clinical-grade locating technologies to support advanced RTLS use cases including automating mobile medical equipment maintenance and management. The Department of Veterans Affairs standardization on a hybrid, clinical-grade RTLS is helping to drive adoption in healthcare. There has also been increased interest and adoption

HOW WILL THOSE CHANGES IMPACT THE REAL-TIME LOCATING SYSTEMS MARKET IN THE FUTURE?

Burner: A tag that can go through sterilization with the OR instruments will enable the OR or Central Sterile to track where in the cleaning process a certain tray is anywhere in the facility.

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN REAL-TIME LOCATING SYSTEMS IN THE PAST YEAR?

Burner: A tag that can go through sterilization with the OR instruments.

Bailey: Selling an enterprise solution by communicating value to multiple business owners.

Bailey: Some of the latest advances and significant changes are applications integration and organizational utility level services. Also, the ending reign of single application implementations.

management systems to track functions in real time and provide instant performance data. Operational platforms coupled with robust business analytics are allowing caregivers and service support teams to make real-time decisions that have a tremendous impact on the way hospitals operate and impact key metrics like patient length of stay and staff productivity.

ADAM PECK

Director of Marketing, CenTrak

of RTLS for the purposes of automating clinical workflow – particularly in the OR and ED use cases where capacity management and patient throughput is most critical. Poshywak: Through stronger application integrations, RTLS systems now power the automation of the entire operational side of the hospital by enabling integrated workflow and capacity

Peck: We’re seeing greater demand for clinical-grade infrastructure – specifically room-, bed-, chair-, and shelf-level accuracy with rapid location updates and extreme battery life. This infrastructure can truly automate location-ready healthcare applications (like CMMS, Nurse Call, patient flow solutions and EMRs). Finally, the ability to leverage a facilities existing Wi-Fi infrastructure is reducing the initial capital investment required to gain the benefit of an asset visibility application. Poshywak: Less than 20 percent of the U.S. healthcare market has adopted RTLS-enabled operational management systems to date, so the upside potential is large. Companies that step to the forefront of merging RTLS enabled data with operational platform applications will be well positioned to drive meaningful growth in the RTLS market.

THE ROUNDTABLE

HOW CAN A FACILITY WITH A LIMITED BUDGET MEET ITS REAL-TIME LOCATING SYSTEMS NEEDS? Bailey: Develop vision for applications and integrations, but execute in a prioritized manner starting with the largest return on investment in labor and materials. Collaborate with others in your own industry to validate return on investments. Basically, you can’t afford to fail. Burner: Start with a needs assessment, and a cost benefit analysis. Remember to place soft costs in there as well (sometimes not easy to quantify) and then get buy in from all departments. We charge each department that would like a tag for them so the cost is spread throughout many different cost centers. 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 lowfrequency RF provides the framework required for advanced asset management use cases such as PARlevel management, improved asset utilization and reduction of shrinkage – making the technology investment pay for itself in a matter of months. Poshywak: Looking at RTLS projects that have a lower beginning level of investment and implementation complexity, but drive a significant ROI based on the operational workflow that is automated, is an optimal starting point for facilities that want to invest in RTLS technology but have a limited budget.

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING REAL-TIME LOCATING SYSTEMS? Bailey: It’s not about the technology, but process and ownership. Partner and vendor selection is key. You will need

1TECHNATION.COM

JON POSHYWAK

Vice President and General Manager, TeleTracking Technologies, Inc.

their practical experience from other deployments with similar organizations. Discuss the technology management and responsibilities. Burner: They are not a set and forget system, they take continual care and maintenance of tags, tweaking reports, addition and removal of tags in the system, and finally the dreaded Friday night call that a refrigerator alarm is going off because they forgot to tell someone that they decided to defrost it over the weekend. Peck: To determine the feasibility that an RTLS deployment will deliver substantial benefit to an organization, I recommend considering the following factors. Step 1: Identify use case requirements by forming an evaluation committee consisting of Biomed, IT, Nursing, C-level executives, Surgical Services, ED, Patient Safety, Risk Management, Security, and Infection Prevention.

NOVEMBER JANUARY 2015 2015

Step 2: Agree upon specifications. Ensure that there is a common understanding and definition of various accuracy levels (room-, bed-, bay-, chair-level). Also make certain that all battery life expectations are clearly documented with detailed assumptions related to the activitylevel for each tag and infrastructure update speeds. Step 3: Focus on integration and scalability. Identify the role that the existing Wi-Fi network will play in the deployment. Examine the capabilities of the technologies currently owned and expose gaps that may require the acquisition of niche RTLS application functionality. Project the number of tags in future states and ensure that the recommended architecture will be capable of supporting the targeted use cases well into the future. Poshywak: RTLS is capable of having much greater impact on a hospital’s bottom line beyond tracking medical devices and refrigerator temperatures. Make sure you examine those broader capabilities before buying a system that is limited to those tracking functions.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REAL-TIME LOCATING SYSTEM? Bailey: Fundamental matching solutions to the need; accuracy, speed and physical characteristics. Several other factors are important, but it first has to meet technical objectives. Burner: Ease of use in reporting and automatic generation of reports. Battery life of the tags. Proper implementation at the start! Peck: The website www. clinicalgradelocating.com has a great summary of what healthcare leaders should look for when considering an RTLS system.

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT REAL-TIME LOCATING SYSTEMS?

Poshywak: A technology choice that is scalable where simple workflows and use cases can be initially supported, but grow over time to provide more distinct granularity. This means you can start with a deployment that is less granular or accurate for the initial problems you need to solve. For example, simple asset locating can be done with lower levels of granularity as a start; but then granularity can be added to achieve room or sub-room levels of accuracy for more sophisticated capabilities.

Bailey: Partner with other departments like Facilities and IT to support the system and extend the value to the organization. Build a wide enough collaboration and governance team to envision success criteria and goals. Burner: Again, it is a time-consuming endeavor so be prepared to spend time making changes, writing policies and for the upkeep of the tags.

HOW CAN PURCHASERS ENSURE THEY ARE MAKING A WISE INVESTMENT IN A REAL-TIME LOCATING SYSTEM? HOW CAN THEY MAKE SURE THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS FOR THEIR REALTIME LOCATING SYSTEMS? Bailey: Select the correct integration partner and make sure the process includes customer interviews and site visits. Burner: Get all those that will be using any portion of the system to give input – there are many different options even with the tags themselves. Keep up with the seminars or group meetings put on by the manufacturers. I tend to look at our manufacturer’s website frequently for any new postings, and receive emails when a bug might be found in the software. Finally, like everything, the everyday use – build a training webinar for your hospital – no better way to learn something than having to teach it. Peck: I recommend purchasers calculate the true cost. They should consider all of the following factors when selecting an RTLS: wiring expenses (ethernet, 110v power); patient room closure; additional access points, location appliances and network redesign; re-calibration, periodic tuning; battery replacement and management; ongoing maintenance and future use cases; look beyond the initial tag purchase; and tag cleaning and re-use.

BILL BAILEY

Enterprise Architect-Technical Services, ProHealth Care

Poshywak: Any vendor worth dealing with will provide upfront ROI estimates and provide the training and backup support needed to meet those estimates, provided clients follow that direction explicitly. Start with the end in mind and look to the solution versus the technology. 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. Find an RTLS provider who wants to be your facility’s long-term partner for success. Find a provider who will objectively assess your needs and customize the optimal solution. Speak with your peers to research who is buying what and why. Calculate the ROI because your executive team will ask. Purchase from an experienced RTLS provider to avoid surprises. Factor in wiring, patient room closures, network redesign, battery replacement, etc.

Peck: A request for training and literature should be included with the deployment. Most RTLS manufacturers are offering training courses to enable internal teams to manage the system post-install. Poshywak: Your buying decision has the potential to deliver millions of dollars in savings and new revenue to the bottom line, so it is important to think beyond your own department and enlist input and support from colleagues who are focused on improving the entire operational performance of your institution.

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WHEN DISASTER STRIKES DEALING WITH THE UNEXPECTED

hat happens when another day on the job is not just another day? While no two days are ever exactly the same for an HTM professional, what do you do when life throws you a curve ball? What do you do when you are removed from your comfort zone; when a disaster or tragedy strikes and you need to step up and handle the unexpected? There are those who have gone before you. Their story is one of resolve, learning on the fly, resourcefulness and courage.

Working on a device may come with its own level of stress when the problem is not apparent or there is an urgent need for the device, but that is all in a dayâ&#x20AC;&#x2122;s work for HTM professionals everywhere. Add to that stress the dangers of a tornado, hurricane or terrorist attack, and you have the makings for a very bad day.

The emotions of a typical day on the job might include frustration, accomplishment, joy or slight anxiety. But, what happens when those emotions include fear, uncertainty or even terror? This is important information we hope you will never need. Making it through the disaster often brings with it major challenges. It also brings lessons learned.

WHEN DISASTER STRIKES

THE SUDDEN TERROR The nation saw the wasteland left by an EF-5 tornado in Moore, Okla., in May of 2013. The travails of the Norman Regional Health System’s clinical engineering department were covered in a TechNation profile in April of last year. The Moore Medical Center, part of Norman Regional, was heavily damaged by the twister. In the days and months after the disaster, the department’s manager, Rich Dubord, extracted some wisdom from the experience. “The first order of business should be the safety of the HCT (Health Care Technology) staff and their families, as well as your own. Have daily huddles with HCT staff to communicate individual/family needs. Once you have established a ‘baseline,’ follow your facility’s disaster plan,” he says. “Communicate status with frequent updates to your facility leadership team. Develop a ‘team atmosphere’ within

RICH DUBORD Department Manager at The Moore Medical Center in Oklahoma

your department and those whom you serve. Stay focused on the task at hand, and have faith that you and your team will overcome,” Dubord suggests. One of the department’s biomeds was actually in the Moore Medical Center when the tornado hit. The same biomed’s home had extensive damage, as did the homes of two other members of the department. Apart from the advice about dealing with the emotional toll of disaster, Dubord also learned first-hand about the other big challenge; damaged and displaced equipment. With first-hand

knowledge, he lays out a rational blueprint. “Assess the damage; develop a ‘triage’ plan,” he says. “If your HCT department is overwhelmed, do not hesitate to reach out for assistance. In a disaster situation, people are always willing to help, especially fellow BMETs.” “Having an accurate inventory by department is extremely important in the aftermath of a disaster. Take lots of pictures of the damaged equipment, note location and damage. If possible or necessary, move equipment to a secure area such as a warehouse that is well ventilated, with AC/ heat [and] utilities,” he says. “Develop a plan to go through all of the equipment. Sort it into categories such as ‘salvage,’ ‘repairable’ and ‘return to service.’ The use of tags with colored dots, representing each of the categories, such as red for salvage, yellow for repairable [and] green for return to service, is very useful,” he adds. Dubord also suggests developing a relationship and partnering with your facilities insurance adjuster. “Set up a simple ‘disaster’ filing system to capture the results of the work performed — disinfecting, testing, electrical safety — on each piece of equipment. Work with your facility’s Materials Management department to obtain replacement cost quotes for equipment,” he says.

An EF5 tornado ripped through Moore, Okla., damaging the Moore Medical Center, a 45-bed hospital. The clinical engineering department played a role in helping the hospital in the aftermath of the storm.

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The experience brought about an even greater emphasis on safety and awareness says Dubord. It has also produced some shared goals for everyone affected. “The employees and community have bonded together in support of building the new hospital and everyone is excited,” Dubord shares. “Local support for the 270 hospital employees that were directly impacted has been overwhelming.” “A temporary ED has been built to support the needs of the community. Construction has begun on a new permanent facility with a scheduled opening in mid-2016,” he continues. “Everyone is excited and looking forward to the rebuilding and a new beginning.”

“The water never really made it to us. The old roofs with the tar and the gravel, we had those, and of course the gravel became projectiles, so, we had to evacuate patients from those rooms — with windows — and make sure they were safe,” said Dale Latimer, a CBET at the time. Latimer’s home was destroyed by Katrina and he had to live in his office at the hospital for a month. He slept on a cot. “Our primary responsibilities are medical systems, but in this instance, we ended up doing a lot of different things, wherever we were needed,” Latimer said. “We were running around moving patients out of the rooms into the hallways. It was quite a fiasco for quite a

ROBIN BAILEY CBET, Radiation/Imaging Specialist at Memorial Hospital Gulfport

“If your HCT department is overwhelmed, do not hesitate to reach out for assistance. In a disaster situation, people are always willing to help, especially fellow BMETs.” - Rich Dubord

THE OTHER VICTIM One of the worst disasters of the past century was the devastation left by Hurricane Katrina after it hit the Gulf States. Most of the focus was on New Orleans, in the aftermath of the hurricane, but there was another city that took a more direct hit – Gulfport, Miss. While the nation saw the devastation to Memorial Hospital in New Orleans, there was another Memorial Hospital affected that day and there were biomeds on duty who experienced the power of the monster hurricane. The biomedical engineering department at Memorial Hospital in Gulfport learned that there was nowhere in the vastness of the hospital that would muffle the sound of Katrina.

number of hours for everyone.” Working in a location that can be threatened by hurricanes provides an additional list of protocols that not all HTM professionals have to think about. Jim Walmsley, another CBET in the department, explained the realities of working as a biomed in one of those locations. “During the hurricane season, we have biomeds that are assigned to the hurricane team. If our hospital comes in the cone, where they are predicting that the hurricane is going to hit, then our administration makes the decision when we are going to lock down,” he said. Walmsley said that once the hospital is locked down, the biomeds, who are on that schedule, check in with the

command post so they can be available to do anything that is needed. “If it’s helping the engineers secure windows or moving the biomed equipment away from the glass or maybe a patient needs special care with a piece of equipment, we’re here to do that,” he said. “We have to usher mops and brooms and buckets, we do what has to be done in the middle of a contingency and we work as a team. You’re locked down, so you’re finding a place to sleep right here in the hospital. You bring some clean clothes with you. You can shower and it may become kind of cramped.” One hospital biomed department in Charleston, S.C., added back-up batteries to all ventilators and life

WHEN DISASTER STRIKES

support equipment after Hurricane Hugo. Improvements to the switching system and emergency system grid also resulted from the giant hurricane after the emergency generators were flooded. Power to the Children’s Hospital was quickly furnished by the adjacent main hospital, but the experience pointed to areas for improvement. For biomeds who might work on the Gulf Coast or the Atlantic Coast, or to a lesser degree, on the Pacific Coast, the advice from fellow biomeds who have faced a hurricane can be instructive. Along with what Walmsley and Latimer suggest, another colleague speaks from first-hand knowledge. “Be prepared in advance. There is no such thing as being too prepared,” says Robin Bailey, CBET, radiation/imaging specialist at Memorial Hospital Gulfport. “You prepare your family ahead of time because it may come that you’re stuck at work for days or longer with no communication with them.” “The only communication I had was

text (message), and it was delayed for hours. The cell service was overwhelmed and no back up batteries. You can’t be obsessed with your family and concentrate on your job. Bring extra food and water with you because things can run short quick,” Bailey says. “I have been in quite a few hurricanes and lately I have been researching the net on survival techniques.” Bailey also suggests carrying a “bug out bag” in your vehicle. The bag could be a backpack with food, water, a knife and other essentials. “I have spent weeks without electricity and water after a storm. You get creative and prep more every time,” Bailey says. Bailey points out the changes that can result from experiencing a disastrous situation. Some practical things are learned to prepare for future events. He also bore witness to one of Latimer’s observations. “We have had rock on the roof for years. That is the way roofers installed

“Our primary responsibilities are medical systems, but in this instance, we ended up doing a lot of different things, wherever we were needed.” - Dale Latimer and repaired it. After the last hurricane, someone finally got the great idea of removing them. The rocks became like machine guns flying around and breaking hundreds of windows (and) letting in the wind and rain, not to mention scaring the staff and guests,” Bailey says. “Buildings are being built higher above any chance of water intrusion,” Bailey says. “The power to the hospital

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JANUARY 2015

is always being improved. We have always kept a box of call bells to temporarily take the place of a down nurse call system. The old manual bell is a good backup when the power drops out. Extra extension cords, flashlights, batteries and anything along those lines are good to keep handy.”

DEALING WITH A BOMBING The bombings at the Boston Marathon put the city on high alert, and one of the healthcare providers to step up to the plate was the Boston Medical Center. The facility and its staff were prepared and so was the clinical engineering department. The hospital’s preparation came from practicing for emergency events. The department gained insights useful to their HTM counterparts from the frightening experience. “I strongly encourage others to take part in their organization’s Emergency Preparedness team,” says Jim Piepenbrink, director of the Clinical Engineering Department at the Boston Medical Center. “HTM professionals have critical thinking capabilities that are essential when dealing with disasters and quite often we have a very good understanding of how the organization is laid out and how different departments operate.” “My team serves two roles on our Emergency Preparedness Team – Planning Chief and Logistics Team member. Each of these roles enables us to leverage the knowledge we have about the organization, as well as the

JIM PIEPENBRINK Director of the Clinical Engineering Department at Boston Medical Center

“Disasters oftentimes are swift and immediate, but the effects can be felt for days if not weeks and ensuring that we can provide clinicians with technology to do their work is a valuable and essential piece of managing the effects of a disaster and helping return the organization to normal operations” - Jim Piepenbrink

technologies used to support patient care, and we can assist in ensuring that we can handle a surge of patients as well as identifying the duration of a disaster and what the impact of the event will require in terms of support, both short term and long term,” Piepenbrink explains. “Disasters oftentimes are swift and immediate, but the effects can be felt for days if not weeks — maybe longer — and ensuring that we can provide clinicians with technology to do their work is a valuable and essential piece of managing the effects of a disaster and helping return the organization to normal operations,” he says. Piepenbrink points out that HTM professionals have the ability to work with vendors, as well as colleagues outside the organization, to request additional technology or assistance. “Additionally, with the proliferation of technology under HTM’s control, we have the best lens into what the capabilities are and how these devices may be mobilized in the event that a temporary area needs to be established,” he says. With the unusual experience of what happened that day in Boston, the hospital and CE department learned lessons. “We have a renewed focus on increasing the number of people who will participate in disaster management, especially at the command team level,” Piepenbrink says. “Disasters can last for days and we have worked at ensuring that we have a better bullpen of people we can draw from to ensure that people limit their shift so that they are making effective decisions and not getting burned out.” “Additionally, we have beefed up our software solution to better capture necessary information so that we have a single lens into the activities during a disaster instead of manual and electronic monitoring of the situation,” he adds. “We learned quite a bit from a few

incidents we have managed and with each one we have a critical after action meeting to discuss what we did well, where we may have struggled and how we can improve on the management of events,” he continues. “These sessions are essential because experience is the best teacher and as we create improvements in the process and the technology we create a more robust program.”

NOWHERE TO ESCAPE The enormity of some disasters doesn’t end at the door of the hospital. The devastation wrought by an EF-5 tornado that hit Joplin, Mo., on a Sunday in May of 2011 was hard to escape. The towers of the hospital were extensively damaged and six public schools were destroyed. “The experience is taken home with each individual. Some staff members only deal with the devastation at work. Others lost their homes, family and friends,” says Don Allen, director of Clinical Engineering for Mercy Hospitals in Joplin. Allen may not have been there on the day of the tornado, but he has lived with many of the consequences during the intervening time period. His team and co-workers have relived that day also. “The mental and emotional toll is great,” Allen says. “Time and compassion is required when dealing with the co-workers that have experienced personal loss.” The tornado plowed a path more than 22 miles long. It was three quarters of a mile wide. One hundred and sixty-one lives were lost that day and more than a

WHEN DISASTER STRIKES

“I see preparation as two items: business and personal. The personal preparation is the hardest.” - Don Allen

DON ALLEN Director of Clinical Engineering at Mercy Hospitals in Joplin

thousand others were injured. More than 18,000 vehicles were destroyed and 8,000 structures were damaged. Allen’s employer, one of several Mercy Health System facilities in Missouri, was destroyed by the giant tornado. At the time, the hospital was known as St. John’s Regional Medical Center. A temporary tent hospital was erected days later and a modular hospital opened in August. In 2012, a new hospital was opened with a full-scale emergency department and birthing facility. The facility was engineered to be 30 percent stronger than the original facility. The opening of a new 600,000-square-foot hospital will occur in March. Allen says preparation is the key to weathering a disaster. “I see preparation as two items: business and personal,” he says. “The personal preparation is the hardest. It is easy to procrastinate and extremely difficult to anticipate the full toll on you and your staff. Business preparation is much the same. Although very few will experience a total loss, it is important to be prepared. Make

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sure your database is accurate.” Allen says planning should be outside the box. “One of our biggest challenges has been location. Because the hospital was destroyed, our departments are scattered across all of Joplin. The high-priority patient care areas were accommodated in our temporary hospital, but the ancillary support departments and lower priority clinical departments are not,” he explains. “Every piece of rental property was snatched up and Clinical Engineering now shares a warehouse with Materials Management, Histology and Microbiology. Logistically, it’s difficult to manage. Joplin isn’t a huge city, but a mile between departments is far greater than a floor or two,” Allen adds. Along with those other unwilling participants in disasters, those designing the new Mercy facility in Joplin applied lessons learned to be more prepared in the future. “We have windows that will withstand wind speeds of 90 mph, 140 mph and 250 mph – all location specific based upon acuity of patient – it was a lesson

learned from the storm,” Allen says. “We have also built the hospital to withstand an earthquake, relocated the backup electrical generators and have three each boilers, cooling pumps, cooling towers and electrical generators. All lessons from the tornado.” The department has had to deal with the big job of cleanup, three hospital moves and a forth move coming up. Allen says that the real story in the aftermath of the disaster is what has been accomplished through sheer determination. “How many hospital projects have you seen that have gone from acquiring the land to occupying the space three years later? May 22, 2011, the tornado hit. January 2012 we began moving dirt — without finalized hospital plans. March 22, 2015 we will occupy. That’s a testament to our resilience, cooperation, commitment and our faith,” Allen says. And that is the lesson learned; preparation is important and the human spirit perseveres.

WHEN DISASTER STRIKES

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CAREER CENTER

Resume Strategies To Get You Noticed By Cindy Stephens

s a professional recruiting firm, we filter through hundreds of resumes each month. Most are unique in how they are formatted and how they market the candidate to a hiring organization. Because of the importance of the resume, it is no surprise the market is saturated with books and articles offering advice on successfully writing a professional resume. So it might surprise you at how many poorly written resumes we work with on a daily basis. This article is not intended to replace any of the amazing resources out there, but to simply give readers a quick guide to easy strategies to get your resume noticed. Consider your resume an advertisement of your greatest asset – you! A well-written resume entices the reader to learn more about you and invites them to personally contact you. The goal of your resume is to secure an interview. Don’t feel pressured to convince the manager to hire you through a resume. Your opportunity to expand on what is in your resume will come at the interview. At this stage, you want to accurately demonstrate who you are and what skills you have to share. Your resume is the first attempt to make a strong first

Cindy Stephens Stephens International Recruiting Inc.

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impression and should convince employers that you won’t be a short-term investment. Hiring managers want to know what sets you apart from competitors. Start out by asking yourself that same question – Why you? Brainstorm and review your professional and personal achievements. We are often our hardest critics so if you struggle to start this process, pull out your current job description. Chances are you are doing all the things on that list and much more. Make a list for each organization you have worked for. At this point, do not worry about formatting, just let the words flow! Once you feel you have a good list for each organization you worked for, you are ready to build your resume. A basic resume should include up to five different sections: header, objective, professional experience, education and recognitions. While a cover letter and reference list are very important and may be included in an employment package, they are not part of the actual resume. HEADER: Create a header that includes your full name, address, phone number and email address. Consider your email address. If it can in anyway be misunderstood as inappropriate, get a new one. OBJECTIVE OR SUMMARY: Because this is the most difficult for most of us to complete accurately, we recommend doing this last! Choose to include either an

objective or a summary statement at the beginning of your resume (or both). Objectives are your personal goal for your professional career, while a summary is a statement highlighting specific qualifications, skills and years of experience. Regardless of the option you choose, this is a wonderful place to customize one to two sentences you want to stand out to your prospective employer. PROFESSIONAL EXPERIENCE: This will be the longest section in your resume as it provides details of your employment history. Begin with the most recent position and work back through your employment history. At the top of each position, include your dates of employment, name of the organization, location (city, state) and the title of your position. Do not write paragraphs. Keep it simple with a list of bulleted highlights. It is now time to pull out your list of brainstorming for each position. For each of the positions, group similar job duties together. For example, if at one position you were responsible for maintaining seven different pieces of equipment, then list those as one bullet point. TRAINING & EDUCATION: Include your most recent education and list the date, the degree, major and institution attended. Mention any academic honors and specific certification activities. If you are applying

directly for a position that requires specific training, list it here. AWARDS & ACHIEVEMENTS: Perhaps even more important than your employment record is showing your performance and accomplishments throughout your career. This section should focus on your skills such as what you have done to improve operations, reduce costs, enhance procedures, upgrade technologies, improve services, etc. You might not think much about how your resume is formatted, but please do! • Avoid using resume templates. When resumes are uploaded onto websites or online databases, headers are dropped and the resume is put in a plain text format. This means text boxes are lost leaving a jumbled mess of dates and positions without formatting. • Keep your resume to a maximum of two pages that are clearly written. • If printing, use a high-quality white or cream paper. • To ensure readability, use the same font throughout and keep the size to 11 or 12 point. • Use a bolded and slightly larger font for headings so they stand out. Save bold and italics for headings only, and avoid underlining. • Be consistent in the format for writing phone numbers and dates throughout the resume. • Check your spelling and grammar carefully. It counts! • Present yourself accurately and positively. Avoid embellishments. • Keep it professional and do not include desired salary, slang, text symbols, hobbies or personal information (kids, family, etc.). Review and edit your resume the first time with key words in mind. Look for opportunities to use strong action words (managed, coached, planned, directed, etc.) to clearly communicate your achievements. Remove complicated sentences, jargon and “buzz words.” Utilize documented numbers or percentages when conveying achievements. Replace “reduced costs” with “Reduced service contracts on sterilizers $100,000 annually by training in-house.” Many recruiters and HR professionals rely on key words to find candidates. If you are specialized in certain areas such as imaging, use key words that apply to your field and avoid acronyms. Remember you may know what you do but someone in HR who searches for candidates ranging from accountants to X-ray service technicians does not. Review and edit your resume a final time to ensure it reflects you as a person an employer wants to hire. Be critical of everything from the layout to language used. Ensure everything is accurate including your name, phone numbers, address, email, dates of employment … everything. When you “think” you are ready, ask someone else proof it. While a well-written resume cannot guarantee an interview, one that is poorly written can put you at the bottom of the pile fast. We wish you well in your career!

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