TechNation - June 2015 by MD Publishing

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VOL 6

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

JUNE 2015

THE IMPORTANCE OF

BATTER ES A PROGRAM OF MANAGEMENT

Biomed Adventures Cambodia – A Learning Experience

The Roundtable Infusion Therapy

In Memoriam Myron Hartman

Radiological SeRvice TRaining inSTiTuTe

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

THE ROUNDTABLE - INFUSION THERAPY Infusion therapy devices are important tools when it comes to delivering quality health care with positive outcomes. Legislation and new technology are factors our panel of roundtable experts address when discussing infusion pumps and infusion therapy devices. Next monthâ&#x20AC;&#x2122;s Roundtable article: Nuclear Medicine

THE IMPORTANCE OF BATTERIES: A PROGRAM OF MANAGEMENT The use of batteries can be a life and death situation in a health care setting. Batteries are a constant on the list of issues that HTM professionals believe require attention. There is also the scrutiny of CMS and The Joint Commission when it comes to battery-related incidents. As a patient safety issue, getting battery management right is paramount. The relentless drive of technology toward more computer chip-reliant and compact designs has increased the number of battery-dependent medical devices. Next monthâ&#x20AC;&#x2122;s Feature article: Promote Efficiency

TechNation (Vol. 6, Issue #6) June 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.

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Andrew Parker

ART DEPARTMENT

Jonathan Riley Jessica Laurain

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

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

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Kim Callahan

P.12 SPOTLIGHT p.12 p.14 p.18

Company Showcase: Renovo Solutions Department Profile: Tanner Medical Center Biomed Adventures: Cambodia: A Learning Experience p.22 Company Showcase: When Quality Matters-AIV p.25 Scholarship Winner: Jason Brunner p.26 Professional of the Month: Hands – on Learning Ideal for Journeyman Biomed

P.30 THE BENCH p.30 p.33 p.34 p.37 p.38 p.41

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

P.57 EXPERT ADVICE

EDITORIAL BOARD

p.57 Tribute to Myron Hartman p.58 Career Center p.60 Ultrasound Tech Expert Sponsored by Conquest Imaging p.62 David Scott p.64 Karen Waninger p.66 Patrick Lynch p.68 The Future: Roger Bowles p.70 Roman Review

Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us

P.74 BREAKROOM

Manny Roman: manny.roman@me.com

Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com Eddie Acosta: A Clinical Systems Engineer at Kaiser Permanente, Northern California, Fastedy99@yahoo.com John Noblitt: Program Director at Caldwell Community College & Technical Institute in North Carolina jnoblitt@cccti.edu

p.74 p.76 p.78 p.80 p.86

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

p.85 Index Like us on Facebook, www.facebook.com/TechNationMag

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

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COMPANY SHOWCASE Renovo Solutions

enovo Solutions isn’t the first company of its kind, but its laser-like focus on quality and excellent customer service makes it a beacon in the crowded sea of medical equipment asset management services enterprises in the United States.

An experienced clinical engineering workforce from ownership down along with its freedom to operate without pausing to consider stockholders’ concerns provides Renovo Solutions LLC the ability to meet its customers’ needs again and again without fail. The company’s roots are planted in a humble beginning and even from the start management focused on doing things right before advancing to the next step. “Renovo Solutions was founded in early 2009 when there were already numerous national and regional independent service organizations offering medical equipment asset management services,” said Chief Executive Officer Sandy D. Morford, CCE. “As a privatelyowned service organization, the four owners of the company are all experienced veterans in the medical equipment service industry, all of which have over 30-plus years of experience, and most importantly, everyone is a professional clinical engineer.” “After spending the initial two years following its formation developing a proprietary, web-based information management system and laying the foundation for providing a high-quality service, Renovo has become one of the fastest growing asset management fi rms in the industry,” Morford added. Renovo Solutions has achieved growth in excess of 50 percent in business volume year-over-year, while maintaining an industry-high 99 percent customer retention, Morford said. He attributes Renovo Solutions success in

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JUNE 2015

customer satisfaction to the fact that it is not a publicly traded company. “Unlike many of our publicly-owned OEM and ISO competitors, our focus is on quality of service and customer satisfaction, not shareholder profits,” he explained. “Our management culture has always been ‘focus your efforts on taking excellent care of the client, and fi nancial success will follow.’ ” Morford said additional reasons for selecting Renovo Solutions include the fact that “clinical and diagnostic imaging equipment management is our only business.” “We have successfully implemented and professionally managed over 300 such programs over the past 30 years,” he added. “We provide true transparency and open-book access to all operational and cost information with RENOVOLive®, our proprietary CMMS system.” Renovo Solutions is also a popular choice because it provides clients with flexible contract terms that illustrate the high level of confidence the company has in its services. Renovo Solutions is an expert with respect to CE-IT integration, and the only company to pioneer the development of a software tool to comply with IEC 80001 for the risk management of networked medical devices in CE-ITLive®. Also, Renovo Solutions collaborates with clients to develop a customized Service Delivery Plan that meets their needs. And, since Renovo Solutions is not an OEM the company’s highly trained clinical engineers provide

Sandy D. Morford, CCE, is the Chief Executive Oﬃcer of Renovo Solutions LLC.

“Our number one objective is to keep their equipment safe, reliable and to help them make smart financial decisions regarding their maintenance.”

Figure 1

INTEGRATED SYSTEMS MANAGEMENT Systems Management Configuration Management Incident Management Problem Management Change Management Security Management

Risk Management

Asset Management

Risk Assessment

Planning and Acquisition

Risk Mitigation

Inventory Control

Risk Control Maintenance Management

Project Management Project Development

Availability and Utilization Safety Monitoring

Project Deployment Project Monitoring

Financial Management

Project Documentation

Disposable Management

Renovo Solutions has created an industry leading comprehensive suite of service management tools and programs within RENOVOLive® that transports the medical equipment management program into the future of integrated systems.

unbiased and objective technology management advice. Perhaps the most important reason for the company’s continued growth and success is that every employee at Renovo Solutions operates based on its business philosophy “Promises Made, Promises Kept.” “And, we always remind our customers that ‘The bitterness of poor quality remains long after the sweetness of low price is forgotten,’ ” Morford said. Renovo Solutions impressive growth has many benefits, but it also presented a challenge as management refused to compromise its standards when the need arose to increase its workforce to keep up with the demand for high-quality service. “With over a 60 percent growth in our business volume last year alone, we were faced with starting up new contracts in various states across the country, and ensuring these clients made the right decision to partner with Renovo,” Morford said. “Finding qualified managers and technicians, with the ability to fit into our corporate culture of ‘the customer comes

first, and financial success comes second,’ has been a significant challenge. We recognize that our employees on the front line at each and every client site are a major factor contributing to our success as an organization, which is why we take great care in selecting only the best of the best in our profession.” “Finding the right candidate for these critical front line positions with RENOVO is a task we do not take for granted,” he added. Quality employees are important because Renovo Solutions provides the ability to manage the complete lifecycle of complex medical devices, which the company refers to as “Integrated Systems Management,” as illustrated in Figure 1. The continued shift in the delivery of health care in the United States is a factor Renovo Solutions is monitoring and is in position to help facilities adjust and excel in the future. “Our company continues to grow year after year, not because we are the least expensive supplier in the marketplace, but because I believe we offer the best value,”

Morford said. “Hospitals and health systems today are demanding less cost from their suppliers, but they don’t want to sacrifice quality for reduced cost.” “In addition to many other economic pressures that a hospital has to deal with, we feel one of the biggest and most misunderstood challenges is managing the multitude and diversity of medical equipment that is used in the delivery of patient care,” he added. “Unfortunately, many clinical department managers are tasked with not only taking care of their patient’s needs, but are oftentimes also charged with managing their equipment maintenance. We take this burden off of these individual clinical departments by centralizing the management responsibilities and bearing that burden ourselves. Our clients are also looking for us to provide them with data to help them deliver better patient care, in the form of cost data, quality data and utilization data. “Our number one objective is to keep their equipment safe, reliable and to help them make smart financial decisions regarding their maintenance,” Morford said. Renovo Solutions’ proven approach will continue to be a popular option for health care facilities just as it has been for the past three decades. “Over the past 30 years, I have seen all too often companies in our marketplace over promise and under deliver, and mostly because by actually delivering what they committed to deliver, it ends up costing them more money than what they planned,” Morford explained. “We believe customers want a service company who will stand by what they committed to do, even if the company’s profit margin isn’t what they expected it to be. For us, it’s not all about financial success, it’s about ‘Promises Made - Promises Kept.’” FOR MORE INFORMATION about Renovo Solutions LLC, visit www.Renovo1.com.

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SPOTLIGHT

DEPARTMENT PROFILE Tanner Medical Center By John Wallace

he five-man clinical engineering department under the leadership of Aramark’s John Shore, CBET, at Tanner Medical Center in Carrollton, Georgia, plays an important role in delivering quality health care to residents of west Georgia and east Alabama. The crew serves several medical facilities within about a 60-mile radius from its headquarters just a few blocks from the historic Carroll County Courthouse. The Tanner system is comprised of several facilities including the 201-bed acute care facility in Carrollton, a 40-bed acute bed hospital in Villa Rica, Georgia, a 25-bed critical access hospital in Bremen, Georgia, and Willowbrooke at Tanner, an 82-bed inpatient behavioral health facility serving adults, adolescents and children in Villa Rica. Tanner also operates Tanner Medical Group. The group is made up of more than 25 medical practices located in Carroll, Douglas, Haralson, Heard and Paulding counties in Georgia and Randolph County in Alabama. The health system includes a range of other services. “We have two acute care hospitals, one critical access hospital, and one behavioral health facility. These total to be about 350 beds within a 20-mile triangle,” Shore said. “We also have about 30 practices and urgent care facilities that we successfully maintain.” “We have 5,500 pieces on inventory. This includes seven CTs, four MRs, three complete labs, etcetera,” Shore added. It is a large system serving a diverse population with more than 300 physicians representing 34 medical specialities. The Tanner system boasts more than 2,800 employees making it one of the largest employers in Carroll County, Georgia. The vastness of the health system is matched by its dedication to quality and service. Twice in the past three years, Tanner has been named one of the Top 15 Health Systems in the nation by Truven Health Analytics.

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JUNE 2015

TANNER’S SUPERHEROES Shore is quick to praise the work of his Aramark team and credits them for the clinical engineering department’s outstanding success through the years. The “superheroes” on his staff are Eric Dotson, CBET, Ted Harris, Michael Bachelor, CBET, and Josh Statham. “We have been at this facility for 34 years and have collectively 112 years of experience, more than half of which is at this hospital,” Shore said. “My philosophy has always been that we will do our best to serve the needs of our hospital and everything else will take care of itself. This also includes taking care of our employee’s needs. We have had 0 percent turnover for the last seven years, a benefit of Aramark’s focus on enriching and nourishing lives.” The department’s work does not go unnoticed. It is common for a clinician to contact Shore and praise team members for their work. The valuable working relationship the department has with its vendors is another strongpoint it has cultivated. “We consistently receive very high marks for our customer service, it is probably our greatest strength,” Shore said. “We work hard to have a partnership with the hospital and our vendor service reps. This has helped us out of many a jam late at night.” “As a four-facility rural health care system, we rely heavily on our Clinical Engineering Team,” Melissa Robinson, Director of Nursing at the Carrollton facility said. “They are responsive and an

Tanner Medical Center in Villa Rica, Georgia, is one of several facilities serviced by the clinical engineering department.

effective part of our Tanner Team. Without their help and support we could not provide the quality care our institution strives to accomplish.” Debra Moshiri, a Philips Patient Care and Monitoring Account Manager, agreed. “I have worked with the clinical engineering department of Tanner Health Systems for nearly 15 years,” Moshiri said. “The knowledge base of John, Eric, Ted and Josh regarding Philips monitoring allows us to work together to develop the best solution for the hospital. They are dedicated, reliable and eternally upbeat regardless of the pressures at hand. At a recent ICU installation where a mounting/cabling solution became an issue, they worked all day to resolve the issue and assist with an ‘out of the box’ solution to ensure that the end users were happy. It is a pleasure to work with a customer in a

Josh Statham works on a vital signs monitor in the biomed shop inside Tanner Medical Center.

collaborative manner where we all can focus on providing better patient care and patient experience.” Being an Aramark crew also has its benefits and helps the five-man clinical engineering department bring additional value to the Tanner system. “We have access to our own intranet of approximately 500 hospitals to network with. We also enjoy some savings through this that we can pass along to our hospital,” Shore explained. “For instance, we purchase our CT glass on a program with the manufacturer that provides a huge savings over a straight purchase. We also have subject matter experts to rely on in different modalities. Lastly, we have an equipment management program that is proven to meet the needs and requirements of the facility and The Joint Commission.” The department has a sizeable training budget and that helps the technicians stay up to date on the latest trends. “We normally try to get schools included with equipment purchases. Within the last four months we have had people attend schools on a CT, anesthesia machines and IV pumps,” Shore said. “We also had a tech attend a school on the CRES certification. We have been very involved with the North Carolina Biomedical Association and

The members of the clinical engineering department at Tanner Medical Center in Carrollton, Georgia, are (from left to right) Ted Harris; Eric Dotson, CBET; Josh Statham; Michael Bachelor, CBET; and John Shore, CBET. The five-man crew maintains more than 5,000 medical devices.

receive training and great networking at their annual symposiums.” Shore also recently attended the MD Expo in Nashville. “I have been attending the NCBA symposium for 35 years and thought it was tops other than AAMI. I think (MD Expo) has to be in my rotation from now on,” he said. “(It is a) great show with great value.” “It has been many years since I have been to a show other than the NCBA,” he added. “I connected with quite a few people I haven’t seen in a long time. I saw a solution at the AIV booth to a problem we are experiencing. I believe we are actually about to purchase several dozen of them.”

TEAM PLAYERS The five-man team is also very active in the bigger picture at the hospitals that they serve. Shore said they are active in equipment acquisition and work closely with the IT department. “We are very involved with equipment acquisition,” Shore explained. “Two months ago, we started working on a new five-year plan.” He said it is great to be a part of the planning and to work with leaders who see the advantages of foresight and spending money when it is the best

course of action. “Tanner has an extremely sharp administration,” Shore said. “They have taken care of things. They don’t spend money if they don’t have to, but they are not scared to spend it if they need to.” Shore’s team is crucial when it comes to cost savings for Tanner. “One of our department’s objectives every month is to keep a list of eight examples of cost savings on a spreadsheet and to keep up with it,” Shore said. One example that Shore shared was when the department searched for alternative sources for parts and generated cost savings of about $250,000 over six months. Ted Harris shared a story that summed up the clinical engineering team at Tanner Medical Center. He said a group of vendors were visiting from Tokyo. They were taking a tour and getting a better idea of everything the clinical engineering department does for the health system. “They said, ‘If we can take this shop with us, we will sign the contract today,’” Harris said.

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BIOMED ADVENTURES Cambodia: A Learning Experience Staff Reports

n online news item posted on the AAMI website planted a seed in the mind of veteran biomed Philip Camillocci. The idea grew and became a mission for the Technical Training Developer-Biomedical for GE Healthcare. It is a mission that he will never regret. “My journey with Engineering World Health (EWH) started in August 2014 when I read an article about EWH in an Association for the Advancement of Medical Instrumentation (AAMI) news post titled ‘Inspiring, Educating, and Empowering the biomedical engineering community to improve health care delivery in the developing world,’ ” Philip Camillocci says. In developing countries there is a lack of skilled biomedical technicians who can install, maintain or repair medical equipment. It is estimated that 40 percent of medical equipment in developing countries is in need of repair or replacement at any one time, Camillocci says. EWH has a few programs that focus on growing biomedical technicians’ talents in developing countries. There is one program at EWH called the Summer Institute where engineering and biomedical science college students volunteer to go to countries such as Nicaragua, Rwanda and Tanzania to spend the summer immersed in local culture learning and repairing life-saving medical equipment. The visiting instructor program allows

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JUNE 2015

an experienced biomedical technician or BMET to travel to Cambodia, Ghana, Honduras or Rwanda for EWH and help train biomedical engineering students to service and maintain medical equipment in their country. “After reading the article and visiting the EWH website to gather more information, I thought about what I could contribute,” Camillocci says. “With my educational background at the U.S. Army Medical Equipment and Optical School and my 30 years of experience working on just about every type of medical equipment both as a field service technician and in-house biomed, I decided to go online to the EWH website and complete the guest instructor application because the program felt like a great fit for me.” Camillocci explained that Ed Hutton, Chief Operating Officer (COO) for EWH, and an Army-trained Biomedical Technician, approved him for one of the instructor programs in Cambodia. “I was then put in touch with Steve Goeby, the BMET Coordinator for Cambodia,” Camillocci says. “We exchanged a few emails getting to know each other, and he provided more

Phillip Camillocci helped educate biomeds in Cambodia.

information about the program. With my 30 years of experience as a BMET, I have had a few opportunities over the years to train other BMETs including as a part-time adjunct professor of Biomedical Electronics at a technical college in South Carolina, where I taught students at night.” During his 12 years of active duty in the Army, Camillocci also spent four years stationed at a medical research laboratory in Bangkok, Thailand. He had traveled most of Thailand, Malaysia, Singapore, Japan, Hong Kong and Philippines.

A group of students pose for a group photo. Phillip Camillocci helped teach them through the Engineering World Health Program.

EWH partnered with the University of Puthisastra in Phnom Penh, Cambodia to create the biomedical training program.

The more he thought about the program, the more he wanted to be involved. “I decided to use what vacation time I had left for 2014 to volunteer for this important program,” Camillocci says. “Steve and I discussed the program in Cambodia in greater detail. He forwarded me some already developed course material covering electrical safety, suction devices and sterilizers. We created a Dropbox account so that we could exchange files,” Camillocci says. “Steve uploaded the training material he wanted me to review. In my spare time at night and on weekends, I reviewed the material to become familiar with it. I also made some suggestions to update and improve the content of the material, and then I reloaded the lessons to the Dropbox file so Steve would have time to review the updates and get them reviewed by a translator.” All of the volunteer work paid off. Lessons are presented in English via PowerPoint, handouts and videos. A translation into Khmer is printed in a student handbook, which is provided

during the course. A translator is present in the class during all courses to assist with any English/Khmer translations. The lesson starts with a short history of the technology, terms and definitions. The lesson then transitions into providing more detailed information about the device, like suction units, going over the types of suction units and their operation. Next, the class advances to hands-on learning. “We then move on to working with actual suction units: taking the suction units apart and learning how they operate, basic maintenance requirements and troubleshooting. We then place faults in the device and let the students do some troubleshooting,” Camillocci says. “At the end of the lesson, the class receives a test to see what they learned and if any areas need to be gone over again. Currently there are two groups of students in the program; Group 1 has 12 students and Group 2 has 28 students.” EWH partnered with the University of Puthisastra in Phnom Penh, Cambodia to create the biomedical training program. The university is a private school and helps support the students from rural hospitals. The students are hospital employees from 28 provinces who are sent to attend the biomed program at the university. The University of Puthisastra also offers a number of courses in health sciences that include medicine, nursing, mid-wife training, dentistry, pharmacy and laboratory tech, to name a few. Students receive a salary from their hospitals and an allowance from the EWH to help defray living expenses while they study. The course of study is 244 days over three years and students get to return to their homes for the weekends. Upon completion of training,

SPOTLIGHT

Students at the University of Puthisastra work on medical equipment during a hands-on lab experience.

they can return to the health care facilities in their home province and maintain the equipment, reducing downtime and improving patient care. In October 2014, the inauguration of Cambodia’s first National Center of Excellence (COE) for Biomedical Equipment Technology was launched. The COE, located at Calmette Hospital – the nation’s premier public hospital— was established in collaboration with the GE Foundation. The purpose of the COE is to train, mentor and professionally develop and support technicians from all around the country. The COE will give biomed techs from national and provincial hospitals an opportunity to gain supervised, hands-on experience working with a large variety of medical equipment in a well-managed workshop. Students from the university shadow and train at the COE as part of their training. Camillocci spent part of the winter in Asia serving EWH. “I flew out on Saturday, December 6 to Atlanta and then had a 15-hour Korean Air flight that would take me non-stop from Atlanta to Seoul, South Korean and then, finally, a 5-hour flight from Seoul to Phnom Penh, Cambodia,” Camillocci says. “I arrived at 11:40 p.m. on Sunday, December 7 local time, as

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we crossed the International Date Line on our trip west. I was met at the airport and taken to the guest house that they use for visitors.” “My first few days, I was working through the jet lag while teaching,” he adds. “My first group of students started December 8 with 28 students. EWH has a great crew of six people working locally with translators. Three EWH volunteers came in from Australia to help teach English, which was the first course of the day for the students.” Camillocci was able to meet Hutton in person while he was in Cambodia. “The EWH COO Ed Hutton was on site during my visit to do a site review and get progress reports from the local team. He also took the time to present a class on mobile X-ray service that included preventive maintenance actions and common equipment faults. I helped with presenting basic electronics, electrical safety, ECG monitoring, suction pumps and sterilizers,” Camillocci says. The program is very intense and the students are dedicated to expanding their education. The students start at 8 a.m. and break for lunch from noon to 2 p.m. A two-hour lunch break is the norm in the country. The class returns and continues

to 5 p.m. On Fridays, the students received some class material in the morning and take tests on the material they studied that week. At noon, they are dismissed to return home for the weekend. Camillocci says the experience is one he will not soon forget and he plans to participate again. “December 26 came with my vacation time ending and I had to return home. My stay was very rewarding; the EWH team was supportive and went out of their way to help me with anything I needed to present the course material,” Camillocci says. “Students were really eager to learn the material and apply hands-on what was taught. I learned a lot about Cambodia, the Khmer people and some of the history of the area.” “I am already planning for my next visit to support this great program,” he adds. “Hopefully, after you have had a chance to read this, you too will consider donating your time and experience to EWH or another great program either locally as close as your local school or as far away as a developing country.”

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COMPANY SHOWCASE When Quality Matters - AIV

or over 30 years, AIV has supported the biomedical and clinical engineering community in two distinct areas. AIV directly assists biomedical professionals with parts and repair services, while also serving individual service organizations (ISOs), and other third-party medical companies. The growth of AIV and the quantity of services provided is a testament to hard work and stellar integrity. What began as a dialysis repair facility in 1983 has expanded into a manufacturing and repair company that specializes in a full range of infusion pump solutions, fetal monitoring accessories, patient monitoring parts and repairs, and power distribution products. “We have been able to thrive in this industry through innovation and quality products,” AIV Sales Director Jeff Taltavull says. “Anything that leaves our facility comes with a warranty, and we make it a priority to ensure our customers are satisfied.” Innovation is another hallmark of AIV and the company provides it at an attractive price point for health care facilities. “Our engineering department has rapid-prototyping capabilities to aid us in getting new products quickly to market,” Taltavull adds. “We offer services and repairs our customers can count on at prices that help them control their costs for maintaining medical equipment.” In its decades of growth, AIV has also worked to achieve high standards. “In 2007, we upgraded to ISO 13485 control standards to bring the engineering and production of our parts into our regulated quality system,” Taltavull explains. “All of the parts we

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JUNE 2015

manufacture, as well as all of the repairs that are performed, are held to this standard. We are able to quickly design and create new AIV-manufactured replacement parts for many popular acute care devices. Our engineering department’s rapid prototyping

five years after the OEM discontinued support,” Taltavull says. “This offers our customers a quality, cost-effective solution to keep their current infusion pumps running safely and correctly.” A focus on infusion therapy devices lets customers know that they have options

“At AIV our motto is ‘When Quality Matters.’ What that means is quality is in the forefront of everything we do from the design and manufacture of parts, to the repairs and other depot services we offer.”

capabilities enable us to ‘print’ prototype parts in house to begin the validation/fit process for new items.” These quality measures have helped propel AIV to a leadership role when it comes to providing support for devices. “We specialize in end-of-life support for many popular infusion pump models. We are committed to providing quality AIV-manufactured replacement parts and repair services for many Baxter, B. Braun, Medfusion and Hospira pumps for at least

and can save money by repairing devices instead of being forced to buy new infusion pumps. AIV works to create a service option that is right for each client. “We give our customers options for their infusion pump service. We have a full line of individual replacement parts which enable facilities to make necessary repairs in-house,” he adds. “Customers can also send pumps to us for repair. We offer a flat rate repair program and traditional parts and labor services.

Ben Lam, Senior Sales Associate, strives to help customers.

Travis Turnage, Device Repair Tech, fixes an infusion pump.

Chris Metz, Engineering Technician, fixes a MMS Module.

Most customers now use our flat rate program which covers labor and all parts. This speeds up the return of the pump by eliminating the back and forth of estimates and approvals. It also allows departments to accurately forecast their repair budgets.” “We also offer a full line of AIVcertified refurbished pumps. Customers can buy an infusion device that is safe and patient-ready out of the box while paying a fraction of what a new pump would cost,” Taltavull says. AIV is also now offering replacement kits for popular telemetry units. These kits are easy to use, fix many problems and are a very cost-efficient solution. The kits provide cost savings and reduce downtime. “In addition to new parts and services for newer infusion devices, we are excited to now offer our replacement case kits for GE telemetry units,” Taltavull says. “These kits allow the replacement of the exterior casing, switch membranes and labels in less than six minutes. The kits cost about one third of a traditional transmitter repair, and the swap can be done in house with three simple tools, lessening equipment down time.”

AIV continues to develop solutions for the many issues health care providers face today as well as the ones they will face in the near future. “At AIV, we are always looking for what our customers need. We will continue to listen to their suggestions for new parts and repair options,” Taltavull says. “We didn’t grow to be the company we are today without exploring new markets. Two years ago, we branched out into the parameter module/telemetry transmitter parts and service arena.” AIV is constantly finding ways to provide a helping hand and that usually results in growth for the company. “We are always looking to grow our business into areas that can better serve our customers, and in 2015 we will continue to look to our customer base to decide what new products to develop,” Taltavull says. “We intend to expand our product lines for newer infusion pumps in the hospital and home health markets, as well as expand our service options for monitoring equipment.” The employees are a major reason behind the company’s continued success. Success that is a reflection of the advances employees have had within the company.

“Our employees are the backbone of everything that happens at AIV. When dealing with medical devices you assume a measure of risk that makes it essential to have quality, dedicated employees,” Taltavull says. “We encourage each employee to develop professionally in areas that interest them, and make it a point to promote from within. The entire AIV senior management team has been at the company for over a decade in various roles within the organization.” “At AIV our motto is ‘When Quality Matters.’ What that means is quality is in the forefront of everything we do from the design and manufacture of parts, to the repairs and other depot services we offer. We strive to provide our customers with the highest quality parts and services they can use, while still maintaining a reasonable cost to provide these items,” Taltavull says. FOR MORE INFORMATION about AIV, visit aiv-inc.com

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SPOTLIGHT

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JUNE 2015

2015 SCHOLARSHIP WINNER Jason Brunner

echNation and Penn State’s College of Engineering have teamed up to create an essay competition to recognize dedicated students in the university’s Biomedical Engineering Technology program. The winner of the essay contest receives a $500 scholarship to be put toward their education. The award is named for the late Myron Hartman. He was the program coordinator and senior instructor of the Biomedical Engineering Technology program for Penn State University at the New Kensington campus for more than 13 years after returning to his alma mater in 2001 to teach future generations of biomeds after serving in the field for several years. The Penn State’s College of Engineering staff screened the essays and they were judged on creativity, organization and writing skills. Jason Brunner is the winner of the 2015 essay competition. His winning essay is printed below.

THE THIRD TIME IS THE CHARM BY JASON BRUNNER I had always been impressed with those people that knew what they wanted to do with their lives at an early age. My earliest recollections are of me wanting to be an astronaut. I have felt “lost” at times, but as I have matured my sense of direction in life has become clearer. This newfound clarity is a far cry from the 5-year-old boy who wanted to go to the moon. Fast-forward 13 years when I headed to college, for the first time, to become a civil engineer. I chose engineering because I tested well in the appropriate areas associated with becoming an engineer. I also enjoyed, sometimes to the chagrin of my parents, taking objects apart and trying to discern how they functioned. Many of my “experiments” were already broken, so my tinkering did not add further damage. More often than not, I could understand how things were assembled and how they were designed to operate. However, I vividly remember always having “leftover parts.” I was not ready to grow up and I left school

after just one year. After a few years of “fumbling around” trying to figure out what I wanted to be when I “grew up,” my younger brother’s illness gave me some direction. The advancement of his muscular dystrophy had placed my brother in the hospital. During a visit, I saw the therapy department and really saw myself helping others for a living. So, I went back to school. Fortunately, I was able to get my associate degree in physical therapy. Over the next 18 years, I was able to meet and assist many different people. When asked if I liked physical therapy, I would respond truthfully, “I’m blessed; I get paid to help others for a living.” There are very few things that feel as good as watching a patient go home after an extended stay in a hospital or nursing home, knowing that you had a hand in their recovery. During the “therapy years,” I continued to tinker with mechanically troubled items. Wheelchairs, braces, computers and, printers were among the few objects that kept the engineering part of me alive. In fact, my friend and co-worker would often joke that the person who hated seeing me leave a building the most was the maintenance man, because I could fix just about everything that broke in our department, freeing him up. This was the best of both worlds, or so I thought. While working as a physical therapist assistant, I met my wife. We got married and moved into our house in Schwenksville, Pennsylvania. A few years later, new neighbors moved in, and in no time we became friends. One day during the topic of occupations, I found out that he was a biomedical engineering specialist. After helping my neighbor with various home

Jason Brunner is the recipient of the 2015 Myron Hartman Scholarship.

projects and continued questioning on my behalf, my neighbor suggested that I would make a good match for biomedical engineering technology. At first, I thought he was crazy. I really loved therapy, but the seed was planted. The world is an ever-evolving entity. I have seen major corporate powerhouses crumble and fade into thin air because they refuse to adapt. I have witnessed small ideas blossom into world-changing designs. I’m no longer considered a young man, unless I’m being compared to some of my patients, but I’ve heard the expression, “Some of the most fascinating people didn’t know what they wanted to do until later in life.” I am hoping to be one of those people, and that is why I have chosen to return to college and become a biomedical engineering technologist. In my new career, I can continue to help others and feed that never-ending desire to fix things, hopefully with fewer “leftover parts.” Am I still impressed with those who have a clear cut path for their life? Absolutely. But to quote Robert Frost, “Two roads diverged in a wood, and I took the one less traveled by, And that has made all the difference.”

SPOTLIGHT

PROFESSIONAL OF THE MONTH

Hands-on Learning Ideal for Journeyman Biomed By John Wallace

ourneyman Biomed Mark Bowley took a unique path to his career of choice and did it all without leaving the area where he grew up in rural Pennsylvania. Bowley is a service technician with KMA Remarketing in DuBois, Pennsylvania. His workbench isn’t far from the small town where he grew up on his parents’ land hunting and fishing. It also isn’t far from his current home in Falls Creek, Pennsylvania. The rural setting is a special place for Bowley, but the scenic hunting and fishing lands that he sees as a positive have made it difficult for KMA to recruit and hire biomeds. KMA President Dana Smith decided to recruit from within in the community and found a win-win situation via a federal apprenticeship program. Smith said it took about 18 months to develop the program and have it approved by the Department of Labor. Once it was approved, Smith used his background in education to train Bowley to become a biomed. Smith said a two-year associate degree is a quality education, but the four-year apprenticeship program takes a comprehensive approach that adds a significant amount of hands-on work to the student’s education.

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JUNE 2015

Another difference is that an apprentice is paid an hourly wage during his education with a raise each year instead of paying for classes and often incurring student loan debt. The program is also designed to prepare the apprentice for the CBET exam upon completion of the program. Bowley, as part of the program, also agreed to a three-year commitment to work at KMA after completing his education. The idea of working basically in his hometown is an added plus for Bowley, who is engaged to be married this year. The program also made Bowley a Journeyman which means he can now train an apprentice through the program.

STARTING AT ZERO Like a lot of biomeds, Bowley grew up fixing things even if that meant taking them apart just so he could put them back together. His experimenting led him to some exciting work as a mechanic working on race cars. “I got my knowledge of mechanics from my first job. I worked at BGR motorsports as a mechanic, metal fabricator and jack man,” Bowley explains. “During the week I worked in the shop preparing the cars and on the weekend would perform pit stops as a jack man. Benny Gordon was the driver and we ran the Hooters Cup, NASCAR Craftsman Truck and NASCAR Nationwide Series.” Working on cars helped give him the chassis on which to add talents and education to become a biomed.

Mark Bowley enjoys the outdoors when he isn’t repairing medical equipment.

“When I first started at KMA I was at zero,” Bowley says. “To be honest, I knew nothing about the biomed profession before I started at KMA. I was offered the job, took it, and never looked back,” he adds. “The four-year apprentice program helped me learn the field and all the equipment we encounter. I was always into mechanics and liked to tinker around with things. The two things came together and now I’m making a profession out of it.” It was an involved process and Bowley is thankful for the many hours others gave to help him become a Biomed. “I received a ton of knowledge and guidance from my boss Justin Ross,” he

Mark Bowley works on a light.

Dana Smith, KAM CEO, left, and Resident Biomed Manager, Justin Ross, right, present Mark Bowley, center, with his Biomedical Equipment Technician Journeyman certificate.

“ I’m a goal driven person. I like to see the job done right the first time. I’m very lucky to have gotten the opportunity to be involved with KMA and the apprentice program.” says. “He has been in the field for 10 years. So, he has seen a lot. There was one class I took that really helped me. It was an introduction to biomed equipment. It was a one-week class taught through DITEC (Diagnostic Imaging Technical Education Center). The class was held at Penn State New Kensington and Myron Hartman was the instructor. It helped me get a basic understanding of the equipment and how they are used in the field. Other than that, it was very hands on. I feel that I learn better that way. You can read manuals all day long, but until you actually get the problem in your hands you don’t begin to absorb it.” Bowley says being a biomed is rewarding because you still have the opportunity to

learn something new every day. “Every day working as a biomed you encounter new and difficult challenges. It is humbling when you think you know everything about a piece of equipment and it will find some new way to break down on you,” he says. “That’s what’s great about this job. It will keep you on your feet. You are always learning new things.”

STRONG FAMILY TIES Life is good for Bowley. He has a new career he enjoys, a woman he loves and strong family support nearby. “I am engaged to my girlfriend, Dayna, and plan to get married in the near future. Dayna has two children, Zhane and Jayda,” Bowley says. “My mom, dad, brother and sister live in the same town as I do so we are always together.” He also still has lots of opportunities to explore nature in rural Pennsylvania where he can go hunting and fishing when he needs a break from work. “I grew up in the country outside of the small town of Reynoldsville, Pennsylvania. I now live in Falls Creek, Pennsylvania, which is about 10 miles from Reynoldsville,” Bowley says. “Living in the country, hunting and fishing was not only a hobby but a way to pass the time. A lot of my earliest and best memories are of some outdoor adventure. My parents’ house sits on a 120-acre lot and is prime white tail

(deer) habitat. Also on the property there is a three-acre pond and creek that flows the length of the property.” “I’m very lucky to have such a nice outdoor preserve,” he adds. Bowley says he is also lucky to have a great career and a bright future. “I’m a goal driven person. I like to see the job done right the first time. I’m very lucky to have gotten the opportunity to be involved with KMA and the apprentice program,” Bowley says.

FAVORITE MOVIE: Legends of the Fall

FAVORITE FOOD: Steak

HIDDEN TALENT:

I am a pretty good cook, not just on the grill but in the kitchen.

FAVORITE PART OF BEING A BIOMED:

Being able to interact with so many different people each day.

WHAT’S ON MY BENCH •laptop • toolbox • library of service manuals • radio • bottle of water

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ECRI UPDATE

Developments in Magnetic Resonance Technology: Will it pull you in?

number of recent developments in magnetic resonance (MR) technology can allow hospitals to improve their systems. Such improvements include increasing the number of clinical applications available, improving the image quality, adding more automation to the scanning process, or reducing the amount of time it takes to scan a patient.

Some improvements, such as increasing the MR system’s field strength or bore size, necessitate replacing the entire MR system at great expense. But many others do not – rather, they can be obtained through software upgrades, installation of new electronics, or small hardware purchases. When possible, upgrading the system is often a better option than replacing it. The cost of upgrading, though it can still be considerable, will usually be substantially lower than the cost of a new system installation. This is because installing a new system will always require replacement of the magnet, which is the most expensive component of the system and which always entails substantial building renovation and rigging costs. Unless a facility seeks to increase the system’s field strength, it doesn’t make sense to replace the magnet, since the performance of the magnet does not degrade over time and since any additional capabilities that would be provided by replacing the magnet will usually be available through a less expensive system upgrade. Of course, not all upgrades or options will benefit all facilities. Hospitals will have to weigh the cost of the upgrades against the actual benefit they will provide. Here’s a look at some of the recent developments in MR technology, along with

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ECRI Institute’s perspectives on whether hospitals should consider investing in them.

IMPROVEMENTS TO RF SYSTEMS, CHANNELS, AND COILS Availability of General-Purpose Multi-element Coils In MR imaging, coils are used to detect the radio-frequency (RF) signals emitted from the patient; the signal is then amplified and digitized by the RF channel. Each coil is made up of one or more coil elements, and is positioned as close as possible to the anatomy being imaged. In the past, hospitals had to purchase a wide range of dedicated anatomical coils, and technologists had to select the most appropriate coil for the study they were performing. As a result, certain dedicated coils would be underutilized because their clinical applications were performed only rarely. Today, general-purpose coils are available that contain multiple elements and that, because of this design, are flexible and can conform to almost any anatomical region. As a result, facilities need fewer coils to perform their studies, and anatomy-specific dedicated coils are no longer needed. Another benefit of these new multielement coils is that, unlike previous coil designs, they include

microprocessors that make them more versatile, more complex, and easier to use. The increased number of coil elements allows levels of automation not possible a few years ago. It can take less time to set up the system and scan the patient because the technologist no longer has to select the appropriate coils and elements for the study or change coils during an exam. The bottom line: For new systems, ECRI Institute recommends purchasing general-purpose multi-element coils. For existing systems, upgrading to general-purpose multi-element coils is often an option. Such an upgrade would require major hardware changes; additionally, the new coils cost more than the older ones. However, though expensive, this upgrade would add significant benefits, particularly for hospitals looking to improve patient throughput. The higher cost of the coils can often be offset by the cost savings that would be achieved through the reduced scan time and by the fact that fewer coils will be needed.

Moving the RF Digitization Closer to the Patient Image quality is affected by the location of the RF digitization electronics. In the past, MR manufacturers placed most of the digitization electronics in an equipment room that was adjacent to the scanner, rather than in the same room as the scanner. This distance between the electronics and the scanner often resulted in increased signal losses and reduced image quality. To improve image quality, manufacturers have begun miniaturizing the electronics so that the RF digitizer can be embedded into the scanner or, in one case, onto a coil. The bottom line. For most new systems, this technology is now standard; for existing systems, this technology is often available as a major system upgrade. The cost of upgrading a system in this way is likely to be on par with the cost of a new MR system, minus the facility construction or renovation costs. The improvements in clinical capability that result from this feature enhancement are unlikely to justify the cost. Therefore, this upgrade should be considered only as part of a major system refurbishment in which all or most other components on the gantry (except the magnet) are replaced. Adding More Coil Elements and Channels Each of the coils used to detect patient RF signals is made up of one or more coil elements. In most systems, the number of elements is limited by the number of RF channels the system has, since each coil element must be connected to a channel. Most new systems have at least 16 channels; higher-end systems have about 100. Increasing the number of coil elements will improve the image quality, particularly for parallel imaging, which is an accelerated image acquisition technique that enables many advanced MR applications. To perform parallel imaging, a system must have at least eight channels; however, the benefits of parallel imaging at only eight channels would be limited. Regardless of the number of channels a system has, in order to improve either the image quality or the

effectiveness of the systemâ&#x20AC;&#x2122;s parallel imaging capability, the number must be increased by a factor of two. ECRI Institute recommends that new or upgraded MR systems have a minimum of 16 channels. Although MR manufacturers are increasingly producing systems with more and more channels, ECRI does not expect that the improvements in image quality will be as significant when going above 16 channels. Also, note that there is a limit to how many coil elements can be used on a patient, depending on the size of the anatomy being scanned. The main advantage of higher-channel systems comes in exam setup: The increased number of channels means that many of the selections previously made manually by the technologist can be automated. One manufacturer has changed the discussion by embedding the digitization electronics into each coil element; with this arrangement, the number of coil elements used is no longer limited by the number of channels. If widely adopted, this technology would make the number of channels a system has almost irrelevant as a selection factor. The bottom line. For new system purchases, hospitals should consider at least a 16-channel system. Systems with more than 16 channels should be considered if high patient throughput and advanced applications are expected. For existing systems, the difficulty and cost of adding more coil elements and channels will depend on the age of the system. Some more recent systems are designed to allow for easier and less expensive channel upgrades.

EFFICIENT SCAN SETUP Adding More Automation to the Scanning Process Health care facilities are being pressured to perform more studies in less time. However, MR image acquisition is a very complex process, and the study time and quality of the final images will depend on a multitude of scan parameter selections and decisions made by the technologist. For a typical study, the technologist must first select the scan type, correctly and safely position the patient, and select and position

the coils. The technologist must then select the slice location, slice orientation, slice spacing, and slice thickness, and must choose the specific coil elements. To help speed up the process, MR manufacturers have added more automated steps and scanning parameter selections to their systems. An automated system not only streamlines and shortens the setup process, but also produces images that are more consistent between patients. Without automation, a technologist has to align the slices in a standard plane consistently for all patients undergoing similar studies, which can take time depending on the experience of the technologist. Adding automation to this process means that radiologists do not need to spend as much time adjusting images to meet their needs. The bottom line. These capabilities exist as software options for both new and existing systems, and the cost is similar for both. The decision to purchase these features will likely depend on the desired patient throughput, the experience level of the technologists, and feedback from radiologists. The efficiency improvement is hard to predict, though reducing the average schedule slot from 45 minutes to 35 minutes may be feasible; this would translate to three more patients per eight-hour shift. Of course, this will depend on factors such as the experience of the technologists, the types of patients being scanned, and the types of studies being performed.

THIS ARTICLE IS EXCERPTED FROM A DIGITAL STORY posted 3/4/15 on ECRI Instituteâ&#x20AC;&#x2122;s membership website. The full article features additional information on patient movement suppression, improving patient comfort, and software-based acoustic noise reduction. To learn more, visit www.ecri.org; call (610) 825-6000; or e-mail communications@ecri.org.

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AAMI UPDATE

Endoscope Reprocessing Standard Makes Debut

n recognition of the need for additional guidance on the reprocessing of flexible and semi-rigid endoscopes, AAMI has unveiled a new standard that brings together information from various sources into a single resource.

The standard, titled “ANSI/AAMI ST91:2015, Comprehensive guide to flexible and semi-rigid endoscope processing in health care facilities,” comes at a time of heightened public concern about the cleanliness and decontamination of these devices. Difficult-to-treat infections caused by the carbapenem-resistant Enterobacteriaceae (CRE) have been reported in North Carolina, Pittsburgh, Los Angeles, Chicago and Seattle. These infections have been linked to a complex type of endoscope. “Health care personnel are constantly facing challenges with the new, sophisticated devices being developed for patient care,” said Nancy Chobin, vice president for Sterile Processing Services, Barnabas Health, West Orange, N.J. Cleaning, sterilizing and disinfecting flexible endoscopes are particularly challenging due to their numerous lumens and channels, she added. There was no single document to turn to for guidance, and existing resources sometimes contradicted one another. “ST91 compiles all the information practitioners need for processing flexible and semi-rigid endoscopes, and for the first time, serves as a national standard of practice,” Chobin added. “This should lead to less confusion and to set a standard for patient safety.” This standard gives guidance on

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JUNE 2015

precleaning, leak-testing, cleaning, packaging, storage, high-level disinfecting and sterilizing of flexible endoscopes used in a range of procedures. Initially, the document was going to be a technical information report; however, the working group determined there was a need for more extensive guidance and revised it into a standard. “I believe ST91 will be one of those ‘must have’ documents for hospitals,” said Sue Klacik, the International Association of Healthcare Central Service Material Management representative on AAMI committees dealing with sterilization standards. “It will be like ST79 and ST58 — highly sought after because of an ongoing need. Furthermore, it will contain all of this great information in one location.” ST79 and ST58 are two popular and highly regarded standards, the first dealing with steam sterilization and the second dealing with chemical sterilization. ST91 is available for purchase at www.aami.org/store.

REVISED GUIDE COVERS ELECTRICAL SAFETY STANDARDS IN HEALTH CARE FACILITIES A manual intended for those responsible for electrical safety in health care facilities — including health care

technology management (HTM) and facilities engineering professionals — has been updated. Authored by consultant Matt Baretich, president of Baretich Engineering Inc., in Fort Collins, Colorado, the “Electrical Safety Manual, 2015” outlines the key components of an electrical safety program for medical devices and how to implement such a program. It also provides an overview of important codes, standards and regulations that affect medical devices. “A key objective of this manual is to provide a single publication that pulls together critical material from the full range of applicable codes and standards,” Baretich writes in the introduction. As it has before, the manual emphasizes that health care facilities must ensure that electrically powered devices are as free as possible from hazards. The manual notes that electrical safety in general has been enhanced over the years with improvements to the design of medical devices and stronger maintenance programs. At the same time, there are more rules dealing with electrical safety testing than ever before, underscoring the need for a comprehensive resource. To that end, the manual covers a lot of ground. For example, one entire chapter provides a rundown on all the applicable codes, standards and regulations. And there are separate chapters on equipmentrelated safety requirements versus facility-related safety requirements. Additionally, it provides guidance for a number of challenges, such as how to manage medical device-related incidents and how to handle device recalls.

Two major changes from the 2008 edition are the inclusion of material regarding facility-related electrical safety — particularly information on isolated power systems — and the 2012 update to the National Fire Protection Association 99 Health Care Facilities Code. The updated resource is available at www.aami.org/store.

JOIN THE AAMI A LIST AAMI is launching a new service to help facilitate communications between medical device manufacturers and the HTM professionals who purchase and maintain such equipment in hospitals. The AAMI A List will enable technicians, engineers and other HTM professionals to provide feedback to manufacturers about medical device products and services — and learn about new products and services. Several times through the year, device manufacturers and service providers

approach AAMI about wanting to get in touch with clinical engineers, biomedical equipment technicians, and other HTM professionals. In many cases, the companies and service providers want to get input from HTM professionals about a particular issue or publicize a new product or service. But as a matter of policy, AAMI does not sell or rent its email or mailing list. By joining the AAMI A List, HTM professionals can opt to receive one or two emails each month about a manufacturer, service provider, product or service. The emails are sent by AAMI, so email addresses will not be distributed to others. To sign up for the AAMI A List, visit www.surveymonkey.com/s/ B82T9ZW. Companies interested in distributing information through the AAMI A List should contact Jane Richardson, AAMI’s advertising manager, at jrichardson@ aami.org.

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Webinar

Wednesday

WEBINAR WEDNESDAY Explores Biomedical Test Equipment By John Wallace, Editor

est equipment is vital for the HTM community. Biomeds rely on these high-tech devices to maintain medical equipment. TechNation understands the importance of these tools and organized an elite panel for the roundtable webinar “What’s New With Biomedical Test Equipment?” More than 300 people attended the webinar and gave it one of the best reviews ever in the Webinar Wednesday series with a 4.2 rating on a 5-point scale. Attendees shared what makes the Webinar Wednesday series a popular training tool in their post-webinar survey. “Please keep the webinars coming! Thank you for bringing the different vendors together to present all at the same time, this is helpful to obtain lots of information efficiently,” Amanda B. wrote. “(It is) great having multiple manufacturers present at one time,” Frank B. wrote. “This was a great webinar covering new items being offered in our trade. I would like to see more of this,” Kreg S. wrote. The webinar examined the fast-evolving world of biomedical test equipment and attendees were able to hear insightful answers to their questions. The panel included experts from Fluke Biomedical, RIGEL Medical and Pronk Technologies. Jerry Zion, Global Training Manager at Fluke Biomedical, discussed the company’s new test automation software Ansur 3.0 during his presentation. He pointed out its new features that include access levels, user signatures and device data. Ansur 3.0 is compatible with a wide range of Fluke Biomedical products.

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For more information about Ansur 3.0 and Fluke Biomedical, visit www. FlukeBiomedical.com. Webinar attendees were also treated to an exclusive first look at the new Advantage Training Center offered by Fluke Biomedical. For more information, visit www.flukebiomedical.com/ AdvantageTraining. Jack Barrett, National Business Development Manager at RIGEL Medical, focused on two electrical safety analyzers – the 288 and the 62353. He said manufacturers are moving toward recommending IEC 62353. He addressed the concept of IEC 62353:2014 and the differences between the standards. The 288 Electrical Safety Analyzer by RIGEL Medical is a handheld device with internal memory for up to 10,000 devices, Barrett said. He pointed out that it can be used in automatic or manual mode and features Bluetooth capabilities. The 62353 Electrical Safety Analyzer is a handheld device manufactured by RIGEL with the ability to customize test sequences. It conforms to the IEC 62353 and includes the NFPA-99 test standard.

Barrett said the 288 and 62353 both have updated enhancements before discussing some different testing procedures. RIGEL Medical offers a range of devices including performance analyzers, electrical safety analyzers and vital signs simulators. For more information about RIGEL Medical, visit www.seaward-groupusa.com. Greg Alkire, Vice President, Sales and Marketing for Pronk Technologies, provided an in-depth view of a variety of test equipment available from Pronk Technologies. He pointed out that the company has more than a decade of experience making rugged, easy-to-use test equipment. The mission is to design portable “palm-sized” devices with one-button operation. He said that all equipment comes with a four-year warranty. In his presentation, Alkire discussed the world’s first plam-sized NIBP simulator — the SimCube. He also reviewed the features of the OxSim SpO2 simulator and the SimSlim multiparameter simulator. Pronk Technologies offers a Clinical Education Simulator and the FlowTrax IV pump analyzer. The HydroBalance is a new product from Pronk Technologies designed to help make IV testing easier. Pronk Technologies also has a new website where more information is available at www.pronktech.com. A RECORDING OF THE WEBINAR is available on the I Am TechNation website at http://iamtechnation.com/webinars. FOR MORE INFORMATION about the Webinar Wednesday series, visit www.IAmTechNation.com.

JUNE 2015

1TECHNATION.COM

BIOMED 101

ESU Principals, Safety and Testing

By Boyd S. Campbell, CBET, CRES

he concept of cautery as a medical practice has been around for hundreds of years. In ancient times, rocks heated in a fire were used to seal off wounds. Modern medical electorsurgery uses this principle of cautery, but uses heat generated by electric current rather than hot stones. The first electrosurgical unit (ESU) was invented in the early 1900s by William Bovie. The name Bovie remains widely popular in the electrosurgical industry today, and many people still refer to ESUs as Bovies. WHAT DOES AN ESU DO? Electrosurgical units are used in surgical procedures for cutting and coagulating tissue. There are many applications from small units used in dermatology to remove skin lesions, to more powerful units that may be used during procedures such as open heart surgery.

MODES OF ELECTROSURGERY There are two primary modes used in electrosurgery: cut and coagulation. Cut simply uses electrical current passed through an active electrode, also referred to as a hand piece, to cut through tissue. There are two types of cut modes: blended cut and pure cut. In pure cut mode, the surgeon achieves a clean cut, very similar to an incision produced by a scalpel. In pure cut mode, there is no process to stop bleeding, also known as hemostasis. Coag, short for coagulation, is a technique used to control bleeding. In coag mode, the tissue is cauterized between contact with the hand piece. Both cut and coag may be performed at the same time using a blend setting. Blend refers to the ability to both cut tissue and simultaneously coagulate at the surgical site. Figure 1 illustrates the effects of voltage and time in different modes.

1TECHNATION.COM

JUNE 2015 2015

In addition to cut and coag, there are also two primary methods used to deliver energy: monopolar and bipolar operation. Monopolar uses a common return of electricity from a dispersive electrode, and is typically placed on an area of the body that allows for a larger area of current density such as the thigh or buttocks. Bipolar operation does not require the use of a dispersive electrode. In bipolar operation, the surgeon may use a hand piece that is similar to a pair of tweezers where the current is passed directly between the two points, thus heating the tissue to achieve the desired effect. There are also multiple techniques the surgeon may use during procedure. Fulguration is one of these techniques, performed when the surgeon does not allow the active electrode to come in direct contact with the tissue. The ionization of the air between the active electrode and tissue produces a spark, giving more of a charring effect typically used for ablations where layers of tissue are destroyed with minimal bleeding. A second technique is desiccation, where the active electrode is used in close proximity or direct contact with the tissue. This causes a thermal effect in which the tissue heats up and the fluid within the tissue cells is turned into steam.

This technique has deeper effect in the tissue than fulguration. Safety is of the utmost importance when working with an ESU. The ESU units may produce small controlled sparks when in use, causing a potential fire hazard. Staff must be aware of flammable solutions, such as alcohol, that may be in the surgical field as well as the proximity to oxygen. Moistened sponges or towels should be readily available to extinguish a fire if necessary. With many units, two active electrodes may be used at once. When one active electrode is energized, the unused may be active as well. When an active electrode is not is use it needs to be holstered to prevent unintended patient burns. Another crucial step to prevent patient burns is making sure that the dispersive electrode is placed appropriately on the

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FIGURE 1

patient, avoiding areas that may have excessive hair, scars or bone. As a biomedical technician, it is our responsibility to ensure all our devices are operating and within specifications. In order to accomplish this there are several standard tests that must be performed during routine preventive maintenance. Since this is a device that delivers an output to the patient it is important to test the power levels and the multiple outputs that may be available. Here are tests that need to be performed during routine preventive maintenance: Power Output Test – Measuring the amount of energy delivered during cut and coag modes when using the monopolar function and also the energy delivered using the bipolar functions. These energy levels need to be tested across a range of the available power settings from low to high. Power Distribution Test – Measuring the output at multiple loads to ensure that the impedance sensing circuits are functioning properly. RF Leakage Current Test – In this test we are measuring the amount of current that is present on the conductive surfaces of the ESU during activation of the unit. This is a critical parameter because it will indicate dielectric breakdown at the power output of the ESU and may lead to patient burns. IEC standard 60601-2-2 states that a maximum

of 4.5 watts measured with a 200 ohm inductive load may not be exceeded. Return Electrode Monitor Test – During this test we are verifying that the return electrode monitoring circuits are working correctly by applying different resistances that simulate the patient’s connection to the dispersive electrode

CONCLUSION While electrosurgical units can be dangerous if used incorrectly or poorly maintained, they perform a vital function during surgical procedures. They allow quicker recovery times for patients, and can reduce the time spent under anesthesia. It is crucial that ESUs are routinely inspected and maintained to ensure the safety of patients and staff. TO LEARN MORE about electrosurgical unit preventive maintenance best practices, download the free white paper, “10 Best Practices for Electrosurgical Unit Preventive Maintenance.” BOYD CAMPBELL, CBET, CRES, has 28 years of experience in the biomedical ﬁeld and is co-founder of Southeastern Biomedical. He possesses biomedical experience of multiple capacities, from technical to managerial. He is an active member of the North Carolina Biomedical Association and is a two-time past president of the organization. Campbell has also assisted numerous biomedical organizations by providing training and education.

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SHOP TALK Q:

Who out there is using the Alaris/ Carefusion 8000 Series IV pumps with the model 8100 pump-modules? I am curious to know if other users are having problems with the door hinges breaking on the modules?

McLeod Health has more than 1,300 Alaris (Carefusion) Model 8100 Pump Modules. The hinge areas on the doors of the 8100 and on its bezel assembly are a weak point. That said though, the Alaris 8100 pump modules are very easy to work on.

We have 1,434 of the 8100 units and the door hinges are definitely a weak point and constantly cracking. We bought the extended plastics protection program with the units which covers the parts, but when that runs out, we are likely going to be buying from Elite Biomedical Solutions. They use a higher grade of plastic for their parts.

I work out of Mount Sinai Hospital in N.Y. We have an Alaris system inventory of nearly 3,000 pieces (i.e. PC, modules). I have encountered some door hinge failures, however my major problem has been the IUI interconnects and door latch assemblies. Right now, we’re in the process of replacing all of our IUI connectors because of repeated communication errors. These communications faults have caused the infusion pump modules to fail, while in use, causing patient incidents.

THE BENCH

We got the pumps about two months ago and have the same problem. Also, we are getting error 800.8000.0 PCU15 general_OS_failure, Wi-Fi connection lost and, of course, the staff cannot find any modules.

You can use the CareFusion software to show at any given moment how many units are not in use. I used this when they started talking about not having enough units to prove we had way more than enough devices, they just were in the wrong place when needed and this forced nursing to take some ownership and come up with a process.

I hope all of you understand this is a reportable event. File a 3500 online at FDA.gov, Med Watch.

That has been one of the biggest problems for years. Cardinal Health will tell you it has to do with cleaning solution breaking down the plastic. In my opinion, they are just a weak link.

Yes, hinge breakage is a regular occurrence here at Johns Hopkins. We also have the problems with the IUIs, as we did at University of Maryland Medical Center. We find that the IV fluid drops down into the connector and shorts the leads. We haven’t figured out how to solve that problem. That’s our most frequent repair.

I am looking for comments on the iLogic electromagnetic navigation bronchoscopy system.

We have had our superDimension system for about a year now and have had zero problems. We signed a partnership agreement with the purchase that enables us to complete the PM/ calibration on the system. Covidien was not part of Medtronic when we bought it. So, if the past is any indication, they will find a way to lock us out of doing any service to the unit or somehow make more money on service than Covidien was. Medtronic has done this to us on several occasions. They buy a company that formerly did not charge for the consignment equipment if you bought their disposables, but then Medtronic bought them and changed the rules now wanting to charge us thousands of dollars a year for service on equipment we don’t even own. Negotiate your service strategy up front before you order your unit. The PMs are not difficult, but do take a little time. I would encourage you to try to support the unit using in-house biomed support if that option is still offered.

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.

JUNE 2015

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JUNE 2015

1TECHNATION.COM

ROUNDTABLE: Infusion Therapy

1TECHNATION.

NOVEMBER JUNE 2015 2014

nfusion therapy devices are important tools when it comes to delivering quality health care with positive outcomes. Legislation and new technology are factors our panel of roundtable experts pointed out when discussing infusion pumps and infusion therapy devices. The expert panel is made up of Jorge Perez, CBET, Unique BioMedical Services; Nate Smith, Co-Owner/Vice President of Elite Biomedical Solutions; Sarah Stem, Director of Sales & Marketing, J2S Medical; and Jeff Taltavull, Director of Sales, AIV Inc.

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN INFUSION THERAPY AND IN THE INFUSION THERAPY MARKET?

to be recorded for legal purposes.

HOW WILL NEW TECHNOLOGY AND OTHER ADVANCES IMPACT THE MAINTENANCE OF INFUSION THERAPY DEVICES?

PEREZ: A lot of newer infusion pumps are now communicating wirelessly and sending all information straight to electronic medical records for each patient.

PEREZ: Maintenance will be slower, but reports will be better. SMITH: Utilizing statistical tools, software and materials currently available, Elite Biomedical Solutions is applying these tools to offer long-term solutions to meet the current needs of biomedical engineering departments.

SMITH: The infusion therapy market has expanded to incorporate smart technology to allow institutions to tailor programs to meet delivery protocols specific to each patient infusion. STEM: Legislation surrounding expanded reimbursement from managed care with regards to patients leaving the acute setting with a prescription for home infusion by device will bring significant change to the homecare side of the market. The latest advancement on the device side is the incorporation of “smart” technology across all OEM platforms (ambulatory to pole mounted); integrating patient safety software with EMR while keeping in line with HIPPA requirements. TALTAVULL: More integration with wireless delivery and monitoring systems will become more prevalent as the technology becomes more accessible/affordable.

HOW WILL THOSE CHANGES IMPACT THE INFUSION THERAPY MARKET IN THE FUTURE? PEREZ: These changes will provide better

JORGE PEREZ

CBET, Unique BioMedical Services

patient care, less paperwork and safer equipment. SMITH: These changes will improve the safety and efficiency of each patient infusion and allow institutions to document delivery protocols and monitor the efficacy of drug delivery. STEM: Expanded reimbursement on the homecare side will provide additional benefits to the patient who will receive elevated care from their providers who will be able to afford more supplies and continuing education. “Smart” technology also benefits the patient who receives peace of mind when hearing the facility is using software that could prevent a patient incident from occurring. Additionally, the facility benefits with biomed features that allow all key presses

STEM: New IV pump technology promises to help with efficiency in regards to preventative maintenance schedules as well as ensure proper testing procedures are adhered to, improving patient safety. In addition, the biomed must understand this technology and how it is utilized in a clinical setting, in order to help keep devices patient ready. TALTAVULL: With any new technology, the people working on them will need to be properly trained on the ways to use and fix these new systems.

HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE INFUSION THERAPY NEEDS OF TODAY? PEREZ: Rent pumps while setting a budget to maybe upgrade a few units at a time.

THE ROUNDTABLE

SMITH: We are offering high-quality, cost-effective solutions to allow institutions to maintain and service with minimal downtime. Our goal is to provide repair parts so these devices can be repaired right the first time and thus eliminate the need for multiple replacements for the same issue on each device.

SMITH: We believe to be considered as a provider in the marketplace, a vendor should have the knowledge and experience base to provide solutions and products that have been thoroughly tested and can meet the demands of the environment. The vendor should be able to demonstrate these capabilities and provide documentation to support the due diligence during development of the product being offered.

STEM: An easy way to incorporate new technology on a limited budget is to buy pre-owned equipment one department at a time and slowly integrate, as budgets will allow. This is especially cost effective when considering equipment that utilizes the same disposables providing no change to the long term-cost. Additionally, asking for an extended warranty to be built into a price can provide a greater return for a cost-conscious buyer. TALTAVULL: Facilities with limited budgets can take advantage of the third-party refurbished pump market. At AIV, we bring the used equipment back to like-new condition; enabling facilities to meet all of their infusion therapy needs for a fraction of the cost of a new pump.

WHAT DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING INFUSION THERAPY? PEREZ: They should be sure to try out any pumps before purchasing them and make sure parts and service are available here in the USA. Ask your biomed/ service technician for their opinion before you buy it. SMITH: When considering a vendor, select a vendor that has the experience with the capability to evaluate and implement long-term solutions. STEM: Most importantly readers should consider how a company that promotes

1TECHNATION.

LILA STEM

Director of Sales & Marketing, J2S Medical

infusion therapy sales and service positions themselves, an ISO should always have the customer’s needs at hand, that is what sets them apart from the big box OEM. My opinion is that the customer experience always comes first and catering to a customer is not found across all providers on the market. TALTAVULL: Have a good partner. Whether it’s the OEM or a third-party vendor, use someone you trust to handle the work that you need to send out of your biomed shop. Being on a first-name basis with your service provider enables both of you to understand and anticipate the needs of your facility together.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REPUTABLE THIRD-PARTY INFUSION THERAPY PROVIDER? PEREZ: The most important things to look for in a third-party provider are communication, service, turnaround time and price – but always remember, “You get what you pay for!”

NOVEMBER JUNE 2015 2014

STEM: The most important things to look for are warranty, liability insurance coverage, in the event it’s needed, and references. My opinion is that the ultimate compliment comes in the form of a customer referral. Reliable customer service should be at the heart of any reputable third-party infusion therapy provider. TALTAVULL: Quality and longevity. Chances are a company that has been around for 30-plus years is doing things right when it comes to your biomedical needs. You should also see what others are saying about third-party vendors through your local biomed/HTM organizations.

HOW IS THE GROWTH OF THE HOME HEALTH CARE MARKET IMPACTING THE SALES AND SERVICE OF INFUSION THERAPY DEVICES? PEREZ: Sales are probably great, but home health care and smaller medical clinics tend to not have their equipment serviced and maintained properly. At least that is what we have seen. We try to let administrators and/or maintenance supervisors know their equipment needs preventive maintenance or, at least, an electrical safety test to make sure equipment is safe to use on a patient. SMITH: The additional growth has been extremely positive. We are evaluating and incorporating these products in our

product portfolio. STEM: Impacts include, pharmacies renting long-term to fill orders while avoiding capital shrinkage. Spikes in homecare use after flu-season mean supplies go on backorder so planning is essential in keeping customers satisfied. Requests for new technology is very high right now with pharmacies looking to upgrade so they can market to their consumer base that they are current; this also means addressing education at the visiting nurse level and overnight troubleshooting calls to service providers. TALTAVULL: Advancements in infusion technologies allow more infusion processes to be done outside of the traditional acute care setting. With more home health infusion available, we are seeing increased growth in this market.

HOW CAN PURCHASERS ENSURE THEY ARE MAKING A WISE INVESTMENT IN INFUSION THERAPY DEVICES? HOW CAN THEY ENSURE THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS? PEREZ: They should compare and try the units first. They should get the biomedâ&#x20AC;&#x2122;s opinion, too. On any equipment purchase always ask to include an extended warranty, in-service training for staff and service technicians, operator manuals, service manuals for service technicians to use for any service needed and one or two biomed service training schools with all expenses paid. SMITH: We are constantly incorporating new tools, training and processes to assist customers in cost-effective, long-term solutions. The goal is to provide a long-term solution and minimize recurring repairs thus reducing device down-time, cost and labor. We are constantly reviewing and acquiring available literature for these products, attending

JEFF TALTAVULL

NATE SMITH

Director of Sales, AIV Inc.

Co-Owner/Vice President, Elite Biomedical Solutions

IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT INFUSION THERAPY DEVICES?

training programs and can provide these to customers for product support. STEM: Purchasers should always inquire about the warranty that comes with the equipment they are buying. It should be matched to that of the OEM as well as inquire on what standards of testing prior to shipment the equipment receives. All equipment should be tested in accordance with OEM specifications with PM paperwork included in each shipment. Training tools and literature should be easy to access either by way of the sellerâ&#x20AC;&#x2122;s website or come furnished at the point of sale. TALTAVULL: Having the knowledge to purchase exactly what you need is always a benefit. When looking into infusion devices, take into consideration your needs and how long the pumps have been on the market. For older units, does the OEM still support them? If not, is there a third-party that still provides parts and services to keep them running?

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK

PEREZ: Old pumps are almost gone and new smart pumps are here! Biomed/ service technicians will need to be trained on how to maintain/operate them, connect to network, troubleshoot them, repair them and keep maintenance/repair reports on file. SMITH: When selecting a vendor, analyze the total cost and make the selection based on the provider that can provide a long-term, high-quality, cost-effective solution. STEM: Provided parts are available, both new and end-of-life infusion equipment can be maintained at a cost effective rate. TALTAVULL: The world of infusion therapy is constantly evolving. Staying on top of the rules, regulations and technologies is essential to keeping infusion therapy safe for patients. Taking advantage of trade shows and meetings that offer CE credits is a great way to keep you on top of

THE ROUNDTABLE

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THE IMPORTANCE OF

BATTER ES A PROGRAM OF MANAGEMENT By K. Richard Douglas

1TECHNATION.COM

JUNE 2015

he Energizer Bunny keeps going and going, but not all medical devices, regardless of battery brand, can be as dependable. Batteries have made the list, time and again, of issues that HTM professionals believe require attention. There is the scrutiny of CMS and The Joint Commission as well, that a battery-related incident may invite. As a patient safety issue, getting battery management right is paramount, since a dead battery can ruin somebodyâ&#x20AC;&#x2122;s day.

THE IMPORTANCE OF BATTERIES

balance need with supply, costs are kept in check and the useable life of batteries is extended as long as it safely can be. Conscientious recycling is a part of these programs also. JOE PADILLA

JONATHAN GAEV

National Sales Manager, Interstate Battery

Business Line Manager, ECRI Institute

An Italian physicist, Count Alessandro Volta, built a crude battery in 1799. British researcher John Frederich Daniell developed a more practical battery in 1820. It was dear old Ben Franklin, brilliant in so many ways, who first coined the term “battery” in 1748. While Franklin was referring to an array of charged glass plates, the structures and ingredients that made up batteries continued to be tweaked and improved. A number of inventors contributed to the development of the battery, right up to Thomas Edison, who invented the alkaline storage battery. Other innovations happened throughout the 19th and 20th centuries.

Batteries have a clearly definable lifespan, a predictable amount of “juice” and specific applications based on design. The relentless drive of technology toward more computer chip-reliant and compact designs has increased the number of battery-dependent medical devices. The HTM professional is faced with developing a set of protocols for dealing with this increased dependence on batteries. Noticing that something has stopped working because the last vestige of energy has been drained off isn’t always an option either; proactive battery management is an integral part of every HTM operation. Battery management also means that battery inventories make sense and

The amount of testing is determined by the criticality of the situation. Testing, properly done, is the way to minimize risk and liability, or as I see it, providing performance assurance. - David Marlow

1TECHNATION.COM

JUNE 2015

IT DOESN’T HAVE TO BE OEM The failure of a battery to do what’s expected of it can be caused by some inherent problem with the battery as well as human-caused. A battery replaced with the wrong replacement type, a loose connection, leakage, the lack of a power source for recharging or the simple oversight of not plugging in a plug to recharge a battery can all lead to premature depletion. Survey respondents have told AAMI that battery management has been an even greater concern for HTM professionals than alarm management. The issue has been vexing to HTM departments on many levels. The batteries used to power medical devices don’t necessarily have to last for a prescribed number of hours or months. “There is no specific requirement by CMS/TJC regarding battery life. Some HTM departments are very concerned about liability issues, and for that reason, either don’t use non-OEM batteries or only use them in ‘non life-support’ equipment,” says Jonathan Gaev, Business Line Manger, BioMed, HD Project Engineers at ECRI Institute. “Significant savings may still be achieved by using non-OEM batteries for that type of equipment – such as mobile imaging equipment and uninterruptable power supplies (UPS),” he says. “Use third – party batteries and you may save up to 40 percent of the cost when compared to OEM products.” “According to a survey that ECRI Institute conducted last year, the types

of problems with batteries, such as not fitting properly and swelling, seem to be the same for OEM as for non-OEM batteries. Some organizations have had experiences where they felt that nonOEM batteries didn’t last as long as OEM batteries,” Gaev says. Is there an acceptable method to predict battery life? “Yes, the method I accept is by testing; all batteries fail sometime,” says David Marlow, CBET, senior biomedical technician, with the University of Michigan Health System in Ann Arbor. “Type of battery, quality of battery, freshness, storage conditions, temperature exposure, cycle usage, charging; these are all significant factors determining battery life.” “The amount of testing is determined by the criticality of the situation. Testing, properly done, is the way to minimize risk and liability, or as I see it, providing performance assurance. In the case of ‘smart batteries,’ they are constantly checking themselves, so having the ability to see what they have to say will drastically reduce the need for testing of these,” Marlow says. A scientific approach can be taken to assure that after-market batteries can stand up to the rigors of whatever application they are used in. Battery manufacturers are ready to prove that point. “Interstate Batteries has the tools, and software, to help hospitals predict when the specific batteries are reaching end of life. In addition, Interstate can use this technology to increase the life of some batteries, depending on the chemistry and application,” says Joe Padilla, National Sales Manager, Interstate All Battery. “This is evidence-based maintenance, complete with data driven reports and serial number tracking of each battery,” he adds.

“The issue isn’t as cut and dry for all devices in a hospital” says Alan Lipschultz, CCE, PE, CSP, President of HealthCare Technology Consulting LLC in North Bethesda, Maryland. “There is a definite cost versus quality issue when specifying batteries. For ‘critical’ equipment – CMMS and TJC now require facilities to define which of their equipment is critical – I do not suggest making an attempt to purchase batteries from anyone other than the original manufacturer without a thorough, documented analysis that is approved by the appropriate committee in your organization,” Lipschultz says. Lipschultz had earlier presented findings of an Aramark study that included OEM versus non-OEM battery analysis at an FDA workshop on batterypowered medical devices in 2013. “I make this suggestion because any cost savings on the battery side are unlikely to offset the risk involved with increased downtime or unexpected failure of a critical piece of equipment. For non-critical equipment, I suggest dealing with a battery distributor who advertises their batteries as being suitable for the medical device involved and is ISO 9001 certified,” Lipschultz says. “If a decision is made to switch to a new vendor for batteries, I think it behooves the organization to have a baseline of battery replacement experience and do a review of experience with the new battery vendor after 30 days, 90 days and one year after making the switch. This presumes that you have a means of tracking service experience with the new style batteries and comparing that experience with your baseline,” he adds. As pointed out in an AAMI publication (BI&T), charging can also be a troublesome problem for HTM

According to a survey that ECRI Institute conducted last year, the types of problems with batteries, such as not fitting properly and swelling, seem to be the same for OEM as for non-OEM batteries. Some organizations have had experiences where they felt that non-OEM batteries didn’t last as long as OEM batteries. - Jonathan Gaev

If a decision is made to switch to a new vendor for batteries, I think it behooves the organization to have a baseline of battery replacement experience and do a review of experience with the new battery vendor after 30 days, 90 days and one year after making the switch. - Alan Lipschulz

1TECHNATION.COM

JUNE 2015

departments. Under or over-charging batteries can both be problematic. Overcharging can lead to leakage, damage to the battery or the device it is powering, or worse; explosion. Undercharging can lead to premature depletion of power. Depending on the battery type, the approach to charging may differ. Additionally, it should be determined if a manufacturer’s warranty requires the use of an OEM battery. “It is difficult to get the same life out of every battery, even if it is the same chemistry in the same application,” Padilla says. “The ever changing environment of a hospital is hard on batteries, however, through the use of our life cycle management program, Interstate can use data and algorithms from across the country to predict within a few months when a battery will need to be replaced.” “How does a method fit with risk/liability concerns? The proper maintenance program can greatly reduce the risk associated with some batteries,” Padilla adds. “In the event a Class III application fails, a regular battery maintenance program can demonstrate the hospital was proactive in their approach to managing life critical equipment.”

BATTERY MAINTENANCE PROGRAM: JUST DO IT “HTM departments can structure better maintenance programs by finding the time. When Interstate Batteries conducts on-site classes at HTM meetings, it’s universally acknowledged these programs are necessary, however, HTM personnel suggest time is the number one obstacle to implementation,” Padilla explains.

“It is wise to first determine how much the HTM department is currently spending on batteries and then break that figure down into the annual spending in the main equipment categories such as defibrillators, mobile X-ray, UPS and infusion pumps,” Gaev recommends. “Start with ‘non-life support’ equipment and develop a relationship with a supplier of non-OEM batteries.” He suggests tracking the performance of non-OEM batteries to ascertain that there is not a pattern of problems that are different or more frequent than those seen in OEM batteries. “Then, you can extend the program to cover additional equipment categories. You may also be able to negotiate a better deal with the OEM after you are sure that non-OEM batteries will work well for you,” Gaev adds. “A few HTM departments — probably less than 25 percent — test their batteries upon receipt and/or before replacing them. In order to properly interpret the results of tests on nonOEM batteries, you first need to test your OEM batteries so that you will be able to compare the results,” Gaev says. Lipschultz says that HTM departments should determine who is their local “battery expert.” That person should have a good understanding of the differing battery chemistries and specifications. “For starters, I recommend http:// batteryuniversity.com/buy/. Batteries are complicated devices that can have a major impact on your medical devices. The battery maintenance program for rechargeable batteries – usually the biggest headache for HTM departments – often starts with making it easy for users to plug in the device when not in use,” he says. “HTM groups should also set up a means of tracking what battery life they

HTM can reduce the overall costs of batteries by understanding and managing the complete life cycle of a battery. Too often batteries are not thought of until the application it powers no longer works - Joe Padilla

are actually getting on an equipment manufacturer/model basis; this data should enable them to spot problem areas and identify when they have a problem,” Lipschultz says. “When a problem is identified, they need to keep track of when an intervention is taken to attempt to fix the problem and if that ‘fix’ really helped or not. There are many failure points when dealing with battery issues.” It also requires the right tools for the job. “I find that having the equipment and knowledge how to use it to test most of the batteries is the key; otherwise depending on OEMs as a source and following their recommendations is the only other justifiable, but not as reliable option,” Marlow says.

ALAN LIPSCHULZ

President, Healthcare Technology Consulting LLC

He adds that finding a good third-party battery supplier, that provides excellent support, along with the ability to provide custom battery packs, is important. “We have three primary ones that we use; Unipower, R&D Battery and a local Batteries Plus store. These can supply most of our battery needs at one-half to onethird the cost of the OEMs. We still do purchase some batteries from the OEMs in special cases.” He says that they still test critical batteries, even if purchased from the OEM; before, and in some cases during and after use. “That way, you will have a good idea of when, how and why they fail, and can prevent defective ones from being installed,” Marlow explains. “If a battery is found to be failing prematurely, I try and find out why, as I see performance assurance as more important than just saving money.” “HTM can reduce the overall costs of batteries by understanding and managing the complete life cycle of a battery. Too often batteries are not thought of until the application it powers no longer works,” Padilla says. “This leads to a cascading effect of wasted money and time. HTM needs to think different about batteries. The process of sourcing, logistics, usage, and disposal have many hidden costs, which

DAVID MARLOW

Senior Biomed Tech, University of Michigan Health System

negatively impact a hospital’s budget.” He says that his company can help with “finding the right chemistry, eliminating shipping costs, increasing battery life, and properly recycling the battery in a sustainable manner.” He also suggests using his firm’s “no cost, just in time delivery,” maintaining inventory levels that more accurately reflect needs; without waste. “Interstate also has the technology to identify when a battery is starting to reach end of life,” Padilla explains. “This allows the hospital to better budget for batteries and replace only the ones that need it. Recycling of batteries is not only the right thing to do, it’s the law. Interstate has free recycling programs that properly dispose of batteries and provide closed loop documentation.” Marlow summarizes his battery management approach this way; “Acquire the equipment and obtain the knowledge and experience needed. Minimize and monitor battery stock. Track the battery history in devices. In critical devices, replace the batteries before they may fail – but not too much before.” Much of the useful life of a battery isn’t necessarily determined by what device makers predict, but based on the behaviors of users. This is yet another component of a comprehensive battery management program; part science, part behavior.

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JUNE 2015

IN MEMORIAM Myron Hartman

he Biomedical Engineering Technology community lost one of its greats with the death of Myron David Hartman, 56, on May 4, 2015.

A loving family man, Myron passed away surrounded by loved ones. His family and countless others mourned the loss. “I know I’m not the only one grieving, because Myron touched so many lives and was well known in so many states and countries,” his wife Amy Hartman said. “I know this is God’s will, but I can’t understand it in any way. The world has lost a wonderful, loving, caring, giving, understanding, compassionate, and Christian man, husband, father, nephew, teacher, and friend.” As a professor at Penn State University, New Kensington, Myron did more than share his knowledge. He connected with young adults serving as a mentor and a friend. “To me, Myron was a teacher, a mentor, a friend, and a role model,” former student Jacob Hetu said. “He was someone I respected, and still do very much. He took me under his wing when I wasn’t sure what I wanted to do with my life and gave me direction.” His reach extended across oceans. In 2011, Myron went to the Republic of Liberia to repair medical equipment and train personnel at local hospitals. The trip

resulted in a program to send Liberian technicians to the United States to train under Myron. The technicians stayed with the Hartman family and acquired the education and skills to teach their fellow technicians at Liberian hospitals. Prior to Penn State, he was the director of clinical engineering at South Hills Health System and for many years taught at the DITEC Teaching Facility. He authored articles relating to the biomedical field in TechNation and was an editorial board member for Medical Dealer and TechNation. MD Publishing President and Founder John Krieg said Myron Hartman’s legacy is one of quality education and leadership. “Myron was the professor of Biomedical Engineering Technology who is going to leave an indelible mark on the field for up and coming generations,” Krieg said. His professional accomplishments include many awards, among them the PSEAS Outstanding Teacher Award, Best of 2011 Biomedical Professionals, Biomed of the Month and the Donald M. Sauerman Award. Myron worked closely with DITEC Founder Manny Roman and became a close family friend of Manny and his wife, Ruth.

“On Monday, May 4, our industry lost an educator, a leader, a spokesman and a great influence in the HTM industry, Myron Hartman. He touched and enhanced many lives,” the Romans said in an email. “Myron will be dearly missed, not only by his wife, Amy, and children, Brian, Scott, Katie, but also by anyone fortunate enough to have known him. He embodied the phrase: ‘Always Leave Others Better For Having Known You.’” “Although rarely in the limelight, Myron was instrumental in enhancing the industry to where it is today,” they added. “He was our dear friend and mentor. We shall miss him.” Stephen Maull, President and CEO of Maull Biomedical Training LLC, said words cannot describe the emptiness felt in the wake of Myron’s death. “He positively affected more people in this industry than probably any of us,” Maull said. “He will be missed, so missed. I will miss him professionally and personally at a magnitude I’m not sure I can even comprehend right now. A finer friend, husband and father did not walk amongst us. Our world was a better place with him and because of him, and we are now lesser without him. Godspeed, Myron.” FOR AN EXTENDED VERSION OF THIS ARTICLE, visit www.1technation.com/ memoriam-myron-hartman

JUNE 2015

1TECHNATION.COM

CAREER CEN-

How A Job Seeker Should Keep Track Of His Applications By Todd Rogers

epending on your age, you may or may not know what a checkbook register is. For the millenials out there, once upon a time (before PayPal and online banking), everyone paid their bills with a paper check. For those who were responsible, they recorded that payment in a little book that was usually attached to one’s checkbook.

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

1TECHNATION.COM

JUNE 2015

It looks like a little Excel spreadsheet and you would write a check, then flip open the register, and write down basically the same information that you wrote on the check. You would do a little math and at the bottom of the register you knew exactly how much money you had left in your checking account. There’s nothing magical about this. It’s perhaps the simplest aspect of personal finance and if you do it consistently, you stay out of trouble. Every now and then something bad would happen: you would skip the math part or make an error and a few days later you’d make the embarrassing discovery that you bounced a check and got penalized for it. Ouch! $35 gone. When you apply for a job, you’re doing something very much like writing a check; you’re sending out information about personal matters and you’re involved in the accounting practice of your own career. Today, I want to introduce you to the idea and discipline of keeping a jobs-applied register. I’ll explain why this simple habit can help you in your pursuits of your next career or keep you from being “bounced” from consideration for a job because you didn’t keep track of your resume. In the current talent market, most employers use recruiting software; we call it applicant tracking software. This is the

software that makes you create a user name and password. It requires you to upload a resume. It asks you questions about all sorts of things, most of which are typical employment application questions but some are highly specific to a job that you’re applying for. I am not a fan of big data and I am discomforted with the idea that there is a hefty amount of information about me stored in massive databases. At the expense of sounding Orwellian, Big Brother knows a lot more about you than you could possibly imagine. Potential employers know a lot about you, as well. We make decisions about applicants based on the information that we collect. You should be collecting and maintaining a similar amount of application information. Why should you do this? What good could possibly come from keeping an organized journal of where you’ve applied and where you are in the process? What information should you track? How should you track it? In no specific order, here are some answers to those questions. I’ve boiled this down to simple items that should not require a lot of time nor a tremendous amount of critical thinking. Create an Excel spreadsheet. From left to right, you’re going to create columns. The columns are labeled company name, job title, where you first heard about the

“ It’s gotten to the point that there is so much information involved in the job search that the human brain simply struggles to keep track of it all and this is mechanism that will help you avoid making simple mistakes that could cost you a job offer. The cold simple truth is, an error or simple oversight on a job application or in some step in the process could reasonably appear to be an act of dishonesty.” job, the company website, the career page website, the date you discovered the job, the date that the job was first published, the date that you applied to the job, the username and password that you used to create your job-seeker account, the version of the resume that you supplied, the version of the cover letter that you supplied, unusual questions that may have been asked of you during the application process, the answers that you supplied to those questions, the names of anyone that you know who works at that company, a box for you to collect on-going notes about your interviews or interactions, and finally, a box that describes next steps in the process. Quite candidly, I can think of at least a dozen more columns that should be included but I’ve listed the essential elements of your job-seeker database. The bottom line is this: you need to become a big-data of your own sorts and this is how you build your employer big-database. Why would this be helpful? The short answer is that the job-seeking process is complicated and has lots of moving parts. It’s gotten to the point that there is so much information involved in the job search that the human brain simply struggles to keep track of it all and this is mechanism that will help you avoid making simple mistakes that could cost you a job offer. The cold simple truth is,

an error or simple oversight on a job application or in some step in the process could reasonably appear to be an act of dishonesty. It could appear to be an act of omission of relevant information. It could appear as simple carelessness. It could appear to be any number of things which taken alone could be grounds for dismissal from consideration; and you won’t ever know why you didn’t get a call back. How unfortunate would that be? You could be the right person for the job but one simple mess up or tracking error could spell the difference between an income and an unemployment check. Timing is another critical aspect. If you’ve been keeping a good record of where you’ve applied and what you’ve supplied, when you receive the callback for an interview, you’ll be ahead of the other candidates under consideration. Familiarity is also critical. I can’t tell you how many times I make the initial contact with someone and upon introducing myself, the person on the other end of the phone, sounding clueless, asks questions that signal he or she is not prepared. There is only one chance to make a first impression and using phrases such as, “Who are you?” and “What does your company do?” just don’t get the job done. Conversely, when someone says something such as, “one moment, I want to retrieve my notes … ah, yes, TriMedx,

I applied to a position in Southern California on April 5th. Thank you for calling … ” that person is scoring serious points. That’s a sign of professionalism that indicates I’m likely dealing with someone who’s got his or her act together; most employers tend to like those attributes. You will also benefit from tracking your inputs. Job seeking is work and it is typically coupled with frustration and limited gratification. You put in a lot of time and it always seems that up until you actually land a job, there is no positive stimulation other than your own thoughts. Those thoughts can also be depressing. But, if you keep an activity log you will always know exactly where you stand on your inputs and efforts and you’ll have at least some idea on the outcomes of your efforts. If you are spinning your wheels and hit a stall (which you will) you will at least have somewhere to go to check on what you’re doing so you can make tweaks as necessary. Finally, save your database in a place where you can easily retrieve it. I recommend that every time you make updates to it, that you email it to yourself. This way, you will always have the most current version stored and accessible so long as you have access to an Internet connection.

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