TechNation - July 2015 by MD Publishing

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VOL 6

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

JULY 2015

g n i g a Im t n e m p i u q E e c n a n e t n i a M Best Practices for Promoting Efficiency

Biomed Adventures Artist, Musician, Craftsman

The Roundtable Nuclear Medicine

MedWrench Bulletin Board Industry Resources for Medical Equipment Professionals

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

THE ROUNDTABLE - NUCLEAR MEDICINE Nuclear medicine continues to be a very important aspect of health care in the United States and throughout the world. TechNation examines the future of the market and the best approaches to maintain and upgrade these devices with a roundtable discussion featuring industry experts. Next month’s Roundtable article: Endoscopes

IMAGING EQUIPMENT MAINTENANCE: BEST PRACTICES FOR PROMOTING EFFICIENCY Hospitals and health care systems must seek out opportunities to save money, follow best practices and seek methods that improve the bottom line while maintaining patient safety. It’s basic economics, compounded by the demands of a changing health care environment, that takes a pay for performance approach. We take a look at how the HTM department can reduce costs while improving service in the management of imaging equipment. Next month’s Feature article: Parts: A Look at Purchasing Options

TechNation (Vol. 6, Issue #7) July 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.

JULY 2015

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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 Karen Waninger

CIRCULATION

Bethany Williams

p.26 p.29 p.30 p.33 p.34 p.36 p.38

WEB DEPARTMENT

Betsy Popinga Taylor Martin

P.60 EXPERT ADVICE

ACCOUNTING

Kim Callahan

P.14 SPOTLIGHT p.14

Company Showcase: Perkins Healthcare Technologies p.16 Department Proﬁle: VA Tennessee Valley Healthcare System (TVHS) p.20 Professional of the Month: Theo Shakir p.22 Biomed Adventures: Artist, Musician, Craftsman

P.26 THE BENCH

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

p.60 Career Center p.62 Ultrasound Tech Expert Sponsored by Conquest Imaging p.64 The Future: John Noblitt p.66 Patrick Lynch p.68 Roman Review

P.72 BREAKROOM

EDITORIAL BOARD

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

p.72 p.74 p.76 p.78 p.82

Did You Know? The Vault MedWrench Bulletin Board Scrapbook Parting Shot

p.81 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 Perkins Healthcare Technologies

pioneer in its field, Perkins Healthcare Technologies provides solutions focused on improving integration, workﬂow efficiency and extending the useful life of existing capital equipment. True system neutrality and backward/forward compatibility are key elements of the company’s approach. As a result more and more hospitals are turning to Perkins. Based near Dallas, Texas, Perkins has been synonymous with innovation for almost 100 years and continues to deliver unique, industry-focused concepts and solutions. “Today, we continue to specialize exclusively in the design, development and distribution of clinical integration and workflow solutions for procedure suites and their related departments,” says Steve Plaugher, Manager/COO, Perkins Healthcare Technologies. “We offer a diverse, innovative and exciting array of products that represent the next generation of integration, control and workflow improvement tools,” Plaugher says. “These include: OR VisionTM and IPS VisionTM that bring together control of all technology and integrate seamlessly into our Customer’s ORs and Interventional Procedure Suites; and RoomVisionTM that allows for the observation of room status for improved workflow and scheduling of multiple rooms in real time.” These offerings illustrate Perkins’ ability to remain on the cutting edge. “Each Perkins solution offers common advantages that make its selection clear and implementation easy for each

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JULY 2015

hospital,” Plaugher says. He points out that the many solutions offered by Perkins Healthcare Technologies provide: • Improved Workﬂow – Our solutions deliver new workflow efficiencies that often reduce costs and improve safety. • Perkins’ Systems Neutral Approach – This means our solutions work with all equipment regardless of manufacturer or age allowing hospital staff to make best-of-breed buying decisions without being locked into a single vendor. • Forward and Backward Compatibility – This allows hospitals to more economically upgrade rooms and get an improved ROI by extending the life of existing capital equipment. When upgrading a room, Perkins can transform the room without a forklift upgrade – all at a fraction of the cost of a new room. When the hospital does buy new imaging or surgical equipment, Perkins integration solution can be repurposed with the modern equipment. In addition, Perkins continues to integrate older equipment such as a legacy ultrasound unit – saving the hospital the

STEVE PLAUGHER General Manager / COO

cost of buying new equipment. By reducing the overall cost of upgrading a room, this forward and backward compatibility streamlines the process and preserves capital asset budgets without sacrificing patient care. • Seamless Integration – Perkins integration and control solutions work seamlessly with new or existing imaging, surgical, or hybrid procedure suite equipment. Their solutions complement the customer’s existing capital equipment providing improved workflow and delivering critical patient information to the various stakeholders where and when they need it. • Comprehensive Connectivity – Perkins’ solutions allow hospitals to connect and share real-time information improving efficiency and documentation control. That connectivity extends to the ability to observe and communicate among multiple rooms for clinical collaboration

as well as improved scheduling, enterprise-wide. Collaboration can also be extended beyond the hospital to remote resources, regardless of location, providing increased communications and education. • Customized Solutions – Perkins looks at each hospital’s integration needs and objectives as unique. The company customizes its solutions to meet those needs. Plaugher says he is excited about the future, especially after the launch of game-changing new products like RoomVision. “Providing automated situational awareness of each procedure suite status allows staff to adjust schedules proactively in real-time resulting in improved efficiencies” Plaugher says about RoomVision. “One example: room cleaning can be alerted as closing begins so room turnover times can be improved. This can result in an additional procedure per room, per day. The revenue potential of this is significant. Another advantage is alerting all parties to scheduling adjustments, especially delays, and allowing them to react accordingly. This is a significant advantage for staff and patients.” Looking at both a given day and data over a wider period, department managers and senior management can also move to balance room usage. This “smoothing” of room usage and making sure certain rooms aren’t underutilized means efficiency, improved patient and staff experiences and potential increases in revenue – again by increasing the number of procedures handled facility-wide, per day. Plaugher also said he is excited about Perkins’ 8MP collaged displays. “These large HD displays, up to 60 inches, allow information to be organized and displayed in an efficient, userselectable way on a single monitor,” Plaugher says about the 8MP collaged displays. “The reduced number of screens needed and the way information is shared has significant advantages in Interventional

“Providing automated situational awareness of each procedure suite status allows staff to adjust schedules proactively in real-time resulting in improved efficiencies.” Procedure and Hybrid Suites as well as Control Rooms.” Meeting the needs of customers, sometimes before the customers even know what their true needs are, is nothing new for Perkins. It is a part of the company’s mission to provide exceptional products and outstanding service. These traits are among the reasons Plaugher and the rest of the team at Perkins are excited about the future. “As we work with our client-hospitals on customizing solutions that improve workflow efficiency, reduce costs and improve safety we consistently increase our knowledge and experience base. This allows us to deliver continuously evolving – continuously improving – solutions to each hospital,” Plaugher says. “If we were just providing off-the-shelf or cookie-cutter solutions this level of evolution and improvement would not be possible.”

This razor-sharp focus and companywide dedication does not go unnoticed. Customers are quick to praise Perkins’ products and customer service. “By partnering with Perkins, we have been able to consistently improve our workflow with the ease of use of their unique integration system and our surgeons rave about the image quality on the high-definition monitors,” says Blu Baillio, RN, Director of Perioperative Services, Memorial Hermann Southeast, in Houston, Texas. “From their state-of-theart integration to their helpful, knowledgeable, friendly staff, our experiences with Perkins confirms that we have partnered with true leaders in the world of medical technology.” FOR MORE INFORMATION about Perkins Healthcare Technologies visit www.perkinshealthcaretechnologies.com.

SPECIAL ADVERTISING SECTION

SPOTLIGHT

DEPARTMENT PROFILE VA Tennessee Valley Healthcare System By K. Richard Douglas

endering medical service to our country’s veterans is the special mission of the Veterans Health Administration. The HTM professionals in America’s largest integrated health care system are an integral part of its mission. In one part of the South, this important work is being handled by a dedicated biomedical engineering department; including several members who have walked in the same shoes as the patients. The Department of Veterans Affairs Tennessee Valley Healthcare System (TVHS) is an integrated health care system comprised of medical centers that include the Alvin C. York Campus in Murfreesboro, Tennessee and the Nashville Campus and several communitybased outpatient clinics (CBOCs) in Tennessee and Kentucky. The integration of the Nashville and Murfreesboro VA Medical Centers in 2000, to the Tennessee Valley Healthcare System, brought about the current system. The original Supervisory Biomedical Engineer was Richard Kress. “Biomedical Engineering covers the main medical centers and approximately 13 CBOCs,” according to Supervisory Biomedical Engineer Geminia Hopkins, ME, VHA-CM, CCE, FAC P/PM. The team of HTM professionals strongly supports the mission of the VA, she says. In addition to Hopkins, the department is comprised of Biomedical Engineer Elizabeth Byers, MBA, CCE; Biomedical Equipment Support Specialists Pam Collins; Owens McCain; Knight Roche; Sheila Plowman; Michael King; Albert Carter, Jason Knight; Monroe Boyd; Dale Gambino; Felix Lake; and Kenneth Varbanoff. Medical Equipment Repairers Martin King and Devellion Crutcher are also key team members. The Medical Equipment Management Program at TVHS functions to “promote the safe and effective use of medical

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equipment used for the diagnosis, treatment, monitoring and care of patients,” Hopkins says. The program has processes in place for selecting and acquiring medical equipment, maintaining that equipment and keeping an inventory, to be included in the management program. The biomedical engineering department at TVHS supports more than 10,000 assets. “In FY2014, Biomedical Engineering completed 6,692 equipment repair and preventive maintenance work orders and supported almost 10,171 pieces of medical equipment,” Hopkins says. “The TVHS Medical Center Inventory is estimated to be approximately $83.8 million, including over $26.8 million of imaging equipment. Biomedical Engineering also supports an estimated $2 million in non-medical equipment. The in-house Biomedical Engineering Department’s professional services have provided a yearly cost savings of over $4 million to the Healthcare System,” Hopkins adds. The HTM professionals at TVHS also collaborate with their Information Resource Management (IRM) colleagues. Both have a common goal of caring for veterans. The biomedical engineering staff meets with the IRM staff weekly. Project updates on newly deployed medical systems, and follow up on problem resolution, are discussed. Capturing data is handled in a uniquely VA approach.

“Data collection is accomplished using a Department of Veterans Affairs Engineering Package, Automated Engineering Management System/Medical Equipment Reporting System (AEMS/ MERS),” Hopkins says. “The VHA Healthcare Technology Management (HTM) Program Office provides oversight for the VA Medical Centers Biomedical Engineering programs and identified 10 key performance indicators that are collected quarterly, which include trend analyses for personnel, work load, service production, resources, benchmarking, and program value. These metrics are aggregated and distributed to VA leadership every three months,” she adds.

CURRENT YEAR PROJECTS Along with the more routine daily projects, the team at TVHS has tackled some major undertakings, including some that impact both campuses. This year, they have a full agenda. One project has them reconfiguring, expanding and upgrading their Philips Telemetry, PIIC and Network topology. This project will cover both campuses to upgrade the Philips Patient Monitoring System. “This includes expanding the current wireless monitoring capabilities of the telemetry suite,” says Hopkins. “Providing emergency room patient overview within the main telemetry suite, addressing compliance issues related to end of life for

Members of the VA Tennessee Valley Health Care System, Nashville Campus include (front row, left to right) Jason Knight, Geminia Hopkins, Owens McCain, Pamela Collins, Devellion Crutcher, (back row) Michael King, Knight Roche, Monroe Boyd, Sheila Plowman and Albert Carter (not pictured.)

construction for proper zoning to protect patients and staff, and upgrades to replace outdated imaging systems to provide optimal care for patients. In terms of service contracts, the department’s supervisory biomedical engineer manages that task. Included are more than 30 medical device service contracts, estimated at $4.1 million annually. An analysis is performed by staff to compare repair costs between in-house maintenance and OEM or third-party maintenance. “Biomedical Engineering staff develop a statement of work as the contracting officer’s technical representative (COR), detailing the expectations and requirements of need from potential vendors,” Hopkins explains. “After vendor selection is made, biomedical engineering staff monitors the work performed by the field service engineers (FSEs), and ensure medical device systems are returned to the specific manufacturer’s specifications,” she adds. “Vendor service reports are maintained for all maintenance contracts and are reviewed for payment and vendor evaluations.”

SUPPORTING COLLEAGUES

Members of the VA Tennessee Valley Health Care System, York Campus include front row (left to right) Geminia Hopkins, Elizabeth Byers, Dale Gambino, Kenneth Varbanoff, (back row) Felix Lake and Martin King.

key components within the system, and reconfiguring servers and network switches to allow for increased patient load and future expansion.” Biomedical engineering is also handling an ICU documentation system project. Also involving both campuses, it involves the acquisition and deployment of a computer information system for the ICUs, specialty areas and operating rooms,

according to Hopkins. “The system shall use advanced technological methods in the integration of health care data to improve patient quality of care, reduction of medical errors, and increase in cost savings,” she says. Imaging also has the group’s attention. The Nashville campus was the location for the replacement and upgrade of an existing MRI unit and suite. This included

“Recently, a large hospital in the Nashville area contracted out their biomedical departments to save on costs,” Hopkins relates. “VA biomedical staff reached out to their fellow biomedical employees and provided them with words of encouragement and support. A number of TVHS Biomedical Engineering staff members have served in the U.S. Military, and 32 percent of TVHS staff members are Veterans. Therefore, there is a vested interest with utilizing in-house biomedical staff to maintain these critical medical systems versus contracting out services.” Outside of work, members of the department are active in the Healthcare Technology Management AssociationMidTN and the Society of Women Engineers. “TVHS biomedical engineering staff are fulfilling the promise to care for those who have served and take pride in what they do,” Hopkins says.

SPOTLIGHT

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MODALITIES BIOMEDICAL • • • • • • • • • •

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DIAGNOSTIC IMAGING • • • • • • • • • • • • •

Batteries Cables C-Arms Cath/Angio Lab CT & PET Mammography Monitors MRI Nuclear Medicine Portables X-Ray Processor Imagers Ultrasound Probes Ultrasound

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PROFESSIONAL OF THE MONTH Airman 1st Class Theo Shakir By K. Richard Douglas

aghdad is the capital of the Republic of Iraq and boasts a population of 7.2 million people. The city has faced turmoil since the American withdrawal in 2011 and before.

In 1990, Iraqi dictator Saddam Hussein ordered the invasion and occupation of neighboring Kuwait. Operation Desert Storm commenced in January of 1991. Iraqi forces in Kuwait surrendered or left the country by the February 28 cease fire. The Iraqi war began in 2003. Escaping the sectarian violence, the on-again, off-again electricity and the assassination of an uncle was reason enough for Iraqis like Theo Shakir to flee Baghdad, and that’s what he did in 2005. His grandfather urged Shakir’s family to leave, but stayed behind himself. In the spring of 2003, Shakir could hear the gunfire from the nearby Baghdad Airport, as coalition forces took control. “I lived my entire life in Baghdad [and] left because my uncle got assassinated and it became too dangerous,” Shakir remembers. “Only a few countries were allowing Iraqis to come; one of them was Jordan. If you bought a house in Jordan, you can get a permanent residency just like a green card.” “That’s what my family did. Jordan, [in] 2006, is where I got into my first English school. My stepdad, at the time,

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was already working in Kuwait and got my mom a visa, so she left half way through the year. They worked that entire time until I finished my school year and through the summer vacation of my 7th grade. They met a person from the royal family, who heard my story, and got me a visa. (It is very hard for Iraqis to get residency in Kuwait since [the] 1990 war). I lived in Kuwait until 2008, with a couple of trips in between, for fun and vacation with family,” Shakir says. Shakir eventually landed in Greenwood, Arkansas, for six months, getting a green card in the process. He left Arkansas and returned to Kuwait to finish school and get a GCSE diploma; the high school diploma under the British system. “In 2009, my stepdad quit his job in Kuwait and moved to [the] states six months prior to my mother and I following him. In June 2010, I made it to Grand Rapids, Michigan, which is where I consider my home in the states,” he says. Shakir received his high school diploma in the U.S. “That is where I visited my first recruiter and signed up; after a few

more trips, and moving around, I shipped out to basic military training in Greenville, South Carolina,” he adds. That’s right, the young man who saw so much and experienced different education systems was now in the U.S. military; the Air Force to be exact.

AN AMERICAN CAREER Today, his official title is Airman 1st Class Shakir, 375th Medical Support Squadron, Biomedical Equipment Technician at Scott Air Force Base in Illinois. It’s been a long road from those days nervously watching the nearby battles. But, how did he choose to become an HTM professional? “It caught my interest because I love cars and it was a way for me to get better at working on advanced electronics, which is where I think the automotive industry is going, without actually having to limit myself to just being a mechanic,” he says. “I also loved hospitals, although I never knew anything about being a biomedical equipment technician. I get this feeling that I am the reason the hospital runs. I know it’s false and everyone has an equal part, but it’s nice seeing my work in the hands of doctors all around the hospital,” Shakir says. An uncle in Iraq performed similar work and Shakir had decided the job that he wanted to do in the Air Force by his junior year in high school. “I have taken on the project of making sure all the overnight

“ I would like readers to know that I didn’t know a lot about this job when I first signed up, but I quickly fell in love with it and that, with determination and hard work, anything is possible.”

Airman 1st Class Theo Shakir, 375th Medical Support Squadron biomedical equipment technician, fixes a broken piece of medical equipment in the Scott Clinic. Photo Credit: U.S. Air Force photo/Senior Airman Sarah Hall-Kirchner.

refrigerators are properly monitored and have the proper security system. This project had a total value of around $3 million and I was grateful that my shop entrusted this responsibility to me,” he says. Shakir says that the project isn’t particularly difficult, but if power should go out, the vaccines and medicine in the refrigerators have a high value and the task reminds him of how important his job is. In terms of specialization, Shakir has gained some expertise in air evacuation equipment. “I like the equipment because of the vast variety of options, but most importantly, they are absolutely crucial to saving someone’s life,” he says.

IT’S NOT ALL WORK Away from work, Shakir has other family members in the U.S. and likes to kick a white and black ball between goal posts.

“I am probably the biggest soccer fan on this base, or maybe Illinois,” he says. “I am very lucky to be on the base team with a great group of friends.” “My parents live in South Carolina and the rest of my family lives in New York. I try to see them as often as possible and they come visit every chance they get,” he adds. Shakir became a U.S. citizen last year. Working on medical equipment in Illinois is a world removed from listening to the sounds of artillery fire in Baghdad. He has learned a very American principle during his time in the U.S. He has also learned that becoming an HTM professional was the right move. “I would like readers to know that I didn’t know a lot about this job when I first signed up, but I quickly fell in love with it and that, with determination and hard work, anything is possible,” Shakir says.

FAVORITE MOVIE “Gladiator”

FAVORITE BOOK “Divergent”

FAVORITE FOOD

Quesarito from Chipotle — secret menu item. I highly recommend it.

HIDDEN TALENT

Eating, have beaten a few food challenges.

FAVORITE PART OF BEING A BIOMED

“Walking through the hospital, knowing how important my career is to patient care and the overall running of the facility. I have the opportunity to have my hands on everything and being in all the sections of the hospital with every section knowing how important our job is.”

WHAT’S ON MY BENCH Leatherman tool iPhone Google Work order listing

SPOTLIGHT

BIOMED ADVENTURES Artist, Musician, Craftsman By K. Richard Douglas

an you conceive of Super HTM man or woman? I mean, can you create a mental image of what that superhero might look like and then put it on paper? It takes a special talent to clearly conceive of an image in your head and then bring it to life on a sketchpad. Eric Dotson, CBET, a biomed with an ISO, who works at the Tanner Medical Center in Carrollton, Georgia, can handle that assignment and much more. As a comic book collector and artist, Dotson can put ink to paper with the best of them. The ability to draw did not come late to Dotson; he has been doing it since he was a kid. “I would draw everything from animals to log cabins to superheroes. I continued to draw off and on throughout high school and college,” Dotson remembers. “In college, I drew a couple of designs for some guitars that I would later make. After college, I worked as a draftsman for a structural detailing company. As far as drawing comics, I really started around 1994, when I met fellow artist Lee Jiles,” he adds. “My first comic was published in 2000. It was a four page mini comic collaboration with Lee.”

TAKING IT TO A BIGGER AUDIENCE Dotson is co-creator of About Time Comics with Jiles. Dotson’s artwork graces titles like “Godsend,” “In Flight Services” and “Dreamer.” Beyond the titles from About Time Comics, Dotson has contributed to several other works. These include “A Redneck’s Guide to Being a Christian” by Jeff Todd, “Fried Pickle Noir” and “Scairy Tales” by J.R. Mounts, “The Electrifying Lightning Man” by David

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Eric Dotson, CBET, Works on a piece of equipment at Tanner Medical Center in Carrollton, Ga.

Amorando, “A Doorknob’s Society” and “Adam Zero” by Marc Fletcher. “About Time Comics is the result of a chance meeting between Lee Jiles and myself around 1994 at a local comic shop,” Dotson says. “We kept running into each other at various conventions throughout the year and started collaborating on a comic book. After many years, failed attempts and several company name changes, we finally decided that it was ‘about time’ we got together and seriously started putting out comics. Thus ‘About Time Comics’ was born.” “Currently, we are working on three titles – “Dreamer,” “Godsend,” and “In

Flight Service.” These titles and other information can be found on our website www.abouttimecomics.com or on Facebook,” he says. Dotson has worked on other comic projects; both drawing and inking. “My drawings ranged from robots for a project for autism — ‘Bots’ by Nic Carcieri and others — to drawing a pickle detective (‘Fried Pickle Noir’ by J.R. Mounts),” he says. “But, my main passion has become inking,” Dotson explains. “Inking is where you take a person’s penciled drawing and complete it with ink, adding depth and shadow. Along with the current inking duties on my own books, I have inked numerous projects by others such as ‘The Doorknob Society’ and ‘Adam Zero’ by Marc Fletcher, ‘Pancho Villa’ by Salvador Raga and ‘A Redneck’s Guide to Being a Christian’ by Jeff Todd,” Dotson says. The Internet has provided a bridge to many other comic artists across the U.S. and around the world, which has allowed Dotson to work with many of his fellow artists, as well as writers. Comic book conventions are part of the gig as well.

MULTI-INSTRUMENT SAVVY If the talent with the pen and ink weren’t enough, Dotson has musical talents he inherited from his dad. He watched his dad play guitar in a country rock band, and his dad tried to teach him the instrument, but Dotson thought that drums were more his speed at the time. “During high school, I ended up playing drums with my dad’s band for a while. Eventually, I learned to play guitar and bass. Throughout my college years, I jammed with roommates and played in a band for one gig,” Dotson recalls. “Although I didn’t play anywhere after that, I kept practicing. It wasn’t until after

Eric Dotson pencils Captian Biomed for use in TechNation. Jeff Todd inked the artwork. The duo works on several projects together.

I moved to Georgia that I got serious about playing. Around 1995, I started playing acoustic guitar for the Southern Hills Christian Church Praise Band.” Dotson played with the praise band for about 15 years. He found the experience to be very fulfilling. “It was not only a chance to play guitar, but a privilege to play for God and hopefully, through the music, be an inspiration and bring others closer to God. Currently, I am working on music for a Christian CD with Jeff Todd,” Dotson says. Playing guitar and bass can create a real appreciation for both instruments, but building those instruments from scratch can take that appreciation to a new level. And why stop there, when you can build an instrument that isn’t seen every day.

“My major in college was Engineering Operations: Manufacturing Musical Instruments. A few of my classes involved woodworking,” Dotson says. “For my final senior project, I decided that I wanted to build a guitar that I had not seen before — a double neck solid body acoustic. After building that guitar, I went on to make an electric guitar and a bass guitar.” That was a guitar with one hollow acoustic body and one solid body. He did a short stint with Ovation guitar before graduating. The facility where Dotson works is a 201-bed acute care medical center. The facility serves west Georgia and east Alabama. Like most biomeds, he works on just about every type of medical equipment.

“I am a clinical engineering supervisor at Tanner Medical Center. I received my AAS in Biomedical Equipment repair in 1992. I started my job in 1993 and in 1996 I became a Certified Biomed Equipment Technician. From day one, my job duties weren’t limited to any specialty. I was given the opportunity to work on everything from thermometers to ventilators to X-ray units,” he says. This has allowed me to better understand the biomed world as a whole rather than one little aspect of it. Recently our department joined the IT department to better bridge the two worlds of biomed and IT.” From workbench to artist easel to music stand, this HTM professional has drawn on many experiences and illustrates what can be accomplished working with your hands.

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ECRI UPDATE

Making Waves with Point-of-Care Ultrasound Scanners

oint-of-care (POC) ultrasound — in which the treating physician scans patients instead of sending them to an imaging specialist — can speed patient management decisions, providing more timeefficient and effective patient care. A POC ultrasound exam is typically performed to answer a specific clinical question. POC ultrasound (commonly known as POC US or POCUS) is also routinely used to guide interventional procedures such as therapeutic injection of medications, as well as for a range of other applications performed by various health care providers. Outside of health care facilities, it is used at trauma sites and disaster sites, during extra-hospital patient transport, and at sporting events.

WHAT IS POINT-OF-CARE ULTRASOUND IMAGING? Diagnostic ultrasound scanners are medical imaging devices that use high-frequency sound waves to allow users to obtain information about patients’ anatomy and physiology. Point-of-care ultrasound imaging refers to the use of medical ultrasound by the treating physician — as opposed to referring the patient to an ultrasound specialist — to acquire anatomical and physiologic information at the bedside. Such exams are typically performed to answer a specific clinical question. The main benefit of POC ultrasound is that it allows physicians to quickly determine whether an abnormality is present so that they can then make patient management decisions. Because patients don’t need to be referred to imaging specialists, they don’t need to make an additional appointment for the imaging exam and wait for the diagnosis

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to be provided to their treating physician. The result is more time-efficient and effective patient care.

AN ALTERNATIVE TO TRADITIONAL PRACTICE Diagnostic ultrasound imaging has historically been, and still is, used in such clinical settings as radiology departments and freestanding imaging clinics, obstetrics and gynecology (OB/ GYN) departments, cardiology departments, and noninvasive vascular testing laboratories. Patients are typically referred to providers in these settings to receive comprehensive diagnostic ultrasound examinations, performed by trained ultrasound professionals (sonographers, echocardiographers and vascular technologists). The results of the ultrasound examinations are then interpreted by specially trained physicians, and a formal diagnostic report is provided to the referring physician, who then must decide the most appropriate course of action. Early adopters of POC ultrasound had no choice but to use the available ultrasound scanners that were originally designed for use by imaging professionals. The physical size of these conventional cart-based scanners, combined with their cost (which ranges from approximately $70,000 to more than $250,000) and the complexity of

the user interface, created barriers to the widespread clinical utilization of POC ultrasound.

WHO USES IT, AND WHY? More recently, however, ultrasound technology has become more economical to purchase and less complex to use. As a result, there has been a trend toward it being used by physicians and other non-imaging-specialist health care professionals in a wide range of medical disciplines. These new users have recognized the clinical benefits of POC ultrasound imaging, and have begun to employ it to enhance patient care. To address the needs of these users, ultrasound equipment manufacturers have developed and are currently marketing systems — primarily portable scanners — that are specifically designed for POC applications and new users. POC ultrasound is also routinely used to guide interventional procedures such as therapeutic injection of medications, and POC ultrasound scanners commonly have features that facilitate use for these interventions. While hospitals and private physician offices are the most

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STYLES OF PORTABLE SCANNERS The vast majority of POC ultrasounds are performed using portable scanners — small scanners that are not permanently mounted on wheels and that can be battery operated. These models are smaller and usually less expensive than conventional cart-based systems. Portable scanners come in three different styles: (1) handheld (or pocketsize), (2) laptop-style (in the form of a laptop computer), or (3) tablet-style (in the form of a tablet computer). Handheld scanners are compact enough to be held in one hand during use while the transducer is held in the other hand. Compared to other portable ultrasound systems, these pocket-size devices have the fewest features and imaging capabilities, and therefore have a more limited range of applications. Typically, these models do not support interchangeable transducers, nor do they possess some ultrasound modes — factors that limit the types of examinations that can be performed and the amount of information that can be obtained. Furthermore, handheld scanners do not have many of the user-adjustable parameter controls available with other types of scanners, which can limit how well the images can be optimized for a given scanning situation or patient. Handheld scanners have very small monitors (usually only three to four inches in size) and typically lack hardware and/or software features used to enhance ultrasound guidance for interventional procedures. Laptop-style scanners are the most complex type of portable scanners. They

frequently have many of the same features and capabilities found on cart-based systems such as advanced analysis packages and three-dimensional ultrasound capabilities. In some cases, the only difference between conventional cart-based scanners and laptop-style scanners is that the latter are more compact, lack certain ergonomic features (e.g., adjustable monitors), and may not be compatible with specialized transducers (e.g., transesophageal probes). Tablet-style scanners, as their name implies, resemble tablet computers and have similar user-interface features, including touchscreen-activated controls positioned around the screen on which the ultrasound image is displayed. Although tablet-style scanners can be carried from one location to another, they are commonly attached to a wheeled stand or cart to facilitate portability and ease of use. The cart provides storage space for transducers and other accessories, resulting in a relatively PUBLICATION self-contained system, and also allows MEDICAL DEALER TECHNATION the scanner to be easily positioned near the patient’s bedside during an BUYERS GUIDE OTHER examination. MONTHto handheld models, tablet Compared scanners provide the user with more options in terms of transducers, J F M A M J J A S parameter adjustments, and imaging DESIGNER: JR capabilities (e.g., pulsed Doppler with spectral analysis). However, compared to laptop-style or cart-based scanners, tablet scanners aren’t as fully featured and do not support as many different types of transducers. THIS ARTICLE IS EXCERPTED FROM A DIGITAL STORY posted 4/8/15 on ECRI Institute’s Health Devices membership website. The full article features additional information on common users of POC ultrasound with examples of how the modality is used in that specialty. To learn more, visit www.ecri.org; call (610) 825-6000; or email communications@ ecri.org.

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common setting where POC ultrasound is used, it is also utilized at trauma sites and disaster sites, during extra-hospital patient transport, and at sporting events. The use of POC ultrasound is expected to increase in many areas of medicine as the technology advances and its many clinical benefits are recognized.

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TOOLS OF THE TRADE MedWrench – My Bench

edWrench.com is a resource and sharing network for users of medical equipment. You can get answers, find information and read what others think about the equipment they use. It is free to join and easy to keep informed. You simply bookmark your favorite communities (equipment, categories, or manufactures) to your “My Bench” area and you are given an intelligent feed of information from other professionals as they help each other solve problems. Your “My Bench” page can help you: • • • • • •

Manage the equipment you’ve bookmarked and adjust how you are notified about new information. See what other professionals in your discipline are using and discussing. Ask questions and get answers about your equipment. You can provide answers too! Talk to industry experts and manufacturers directly about issues that concern you. Contribute to the community by providing accurate information about medical equipment. Connect with other medical equipment professionals and find out how they use their equipment effectively.

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AAMI UPDATE

AAMI Unveils Complimentary Device Integration Resource

n 2012, Luis Melendez agreed to author a guide that would explain medical device integration for professionals in the field. The ambitious compendium, titled “Medical Device Integration and Informatics” is now available as a free resource from the AAMI website. “Writing the compendium is roughly the equivalent of capturing everything I know about medical device integration in about 50 pages,” said Melendez, who is associate director of clinical device/biomedical device integration with Partners HealthCare in Boston. “What made this most difficult, besides having a demanding full-time job and family responsibilities, was the challenge of distilling all of the information. It reminded me of the line attributed to Mark Twain, ‘I didn’t have time to write a short letter, so I wrote a long one instead.’ The compendium would have been easier to write – and may have taken less time – if it were hundreds of pages long versus 50.” “Medical Device Integration and Informatics” covers the fundamental concepts of multi-vendor device integration, medical device data archival systems, and room automation systems. “This compendium’s focus is the integration of medical devices with [electronic health records] EHRs – a topic of keen interest right now – and the burgeoning subspecialty of medical device integration and informatics (MDII), a hybrid of health care technology management (HTM)

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and information systems (IS) skills and abilities,” Melendez wrote in the executive summary. The compendium provides insights for planning, implementing, and sustaining integration initiatives. It covers regulations and standards, organizational structure, project management, system selection and implementation, security, and operations and support. A complimentary copy of the compendium is available at http:// s3.amazonaws.com/rdcms-aami/files/ production/public/FileDownloads/ HTM/MDII_Compendium.pdf.

AAMI RELEASES UPDATED STUDY GUIDE, PRACTICUM Last month at the AAMI Conference & Expo, two new resources to enhance the skills of HTM professionals made their debut. One resource, the revised and expanded “BMET Study Guide” has 850 interactive questions and answers – each with a detailed explanation. Covering topics ranging from anatomy and physiology, to electricity and electronics, this is a popular resource for those preparing for the certification exams, but equally valuable for those just seeking to

reinforce their knowledge. “We had a much larger team working on this revision than any previous edition,” said Ethan Hertz, a clinical engineer at the Duke University Health System and project manager. “Questions were written by a team of seven writers and independently reviewed by several HTM professionals. We want to make sure that this edition of the study guide helps those who are interested in taking the CBET exam feel as if they are well prepared.” AAMI would like to thank TriMedx, Stephens International Recruiting, and Universal Hospital Services for their sponsorship. The other resource, the second edition of the “Practicum for Healthcare Technology Management,” covers everything from health care facility management and medical device safety to human factors engineering and evidence-based medical equipment maintenance management. Based on Les Atles’ “A Practicum for Biomedical Engineering and Technology Management Issues,” the book includes chapters on benchmarking, customer satisfaction, use errors, wireless spectrum management, and more. “When Les passed away in February 2013, I resolved to ensure that his passion for motivating and assisting the new generation of HTM professionals become better at what they do would live on,” said Malcolm Ridgway, a former chief clinical engineer at Aramark Healthcare

Technologies. “We thank our colleagues who have made this continuation of Les’s vision possible.” To purchase these resources, visit www.aami.org/store.

JOHNSON & JOHNSON DONATES STERILIZATION CONFERENCE PROCEEDINGS TO AAMI Johnson & Johnson (J&J) has donated the published proceedings from conferences on sterilization of medical products to AAMI, which will make the material available online as a complimentary service to the sterilization community. Primarily, the proceedings come from what are known as the Kilmer Conferences, events that brought together leaders in sterility assurance and sterilization. Held every two to three years between 1976 and 2003, the Kilmer Conferences were organized and hosted by J&J, a reflection of the company’s commitment to advancing sterilization science and related health issues. Joyce Hansen, vice president of J&J sterility assurance, donated the archived material during AAMI’s Sterilization Standards Week, which ran April 27-30 in Annapolis, Maryland. Additionally, Johnson & Johnson announced that the Kilmer Conference – an invitation-only event – would return in the spring of 2016. Specifically, J&J will host the next Kilmer Conference on May 2-6, 2016 in New Brunswick, New Jersey. The conference, Hansen said, will focus on manufacturers’ needs and considerations with sterilization, looking at the total life cycle of a product. AAMI has agreed to serve as a supporting organization to the conference and will develop a separate workshop focusing on some industrial sterilization basics in conjunction with that conference. The Parenteral Drug Association will also serve as a

supporting organization. AAMI President Mary Logan thanked J&J, saying the donation of the conference proceedings and the reinstatement of the Kilmer Conference reflects an appreciation for the fact that the sterilization community must do more to groom the next generation of leaders in this field. “AAMI is very committed to supporting a strong community of experts in the field of sterility assurance, and we feel fortunate to work with partners such as Johnson & Johnson,” Logan said, noting that AAMI is developing certifications for industrial sterilization professionals. Additionally, AAMI published “Industrial Sterilization: Research from the Field” in 2013. A second edition of that publication is now in the works. Finally, AAMI University offers several courses and programs that cover industrial sterilization topics, such as ethylene oxide fundamentals and radiation sterilization for medical devices. The proceedings from the Kilmer Conferences have been published in eight separate volumes, and they are rich in what they cover. Topics include: environmental controls in manufacturing; the importance of bioburden in sterile processing; pyrogen testing; ethylene oxide sterilization; regulatory considerations; gamma sterilization; and validation challenges. Presenters at the conferences came from a variety of backgrounds, both nationally and internationally. J&J also donated two volumes of material on sterilization by ionizing radiation. AAMI is creating a website to showcase the material and will announce its availability at a later date.

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Webinar

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WEBINAR WEDNESDAY

Free Series Addresses Nuclear Imaging By John Wallace, Editor

he TechNation Webinar Wednesday series continues to be popular with clinical engineers and HTM professionals everywhere. More than 2,000 people have attended webinars featured in the 2015 series with an average attendance of 329. The most recent webinar “Improve Your Nuclear Imaging Clinical Care and Business Potential” by Nik Iwaniw, MM, RT, CNMT, provided insightful information about medical imaging devices. The webinar was sponsored by Universal Medical Resources Inc. (UMRi) and attendance was eligible for 0.1 credits from the ICC. The series continues to receive praise from HTM professionals. “TechNation webinars go direct to the point with very detailed information, excellent material use by the coordinators,” Jorge J. said in a post-webinar survey. Iwaniw began with a basic overview of molecular imaging and nuclear imaging. He defined and compared SPECT, X-ray, ultrasound, CT and MRI. He said SPECT is a safe, painless and cost-effective means of medical imaging that uses very small amounts of radioactive material or radiopharmaceuticals to diagnose and treat disease. There is a multitude of different nuclear medicine imaging procedures available and development of new

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radiopharmaceuticals that target specific disease continues to fuel the use of these procedures. SPECT and planar nuclear medicine are used for the treatment of heart disease and cancer. They are also used for diagnosing diseases in organ systems, including liver/gall bladder/GI, lung, kidney, thyroid and brian. Iwaniw discussed common challenges and approaches to overcome those obstacles. He touched on how to better serve a patient community by aligning the community and its common diseases using epidemiological data. He explored avenues for streamlining clinical care in a nuclear imaging department. Iwaniw said clinical needs and budget issues must be addressed when considering nuclear medicine purchases and upgrades. Iwaniw shared examples on how to assist medical staff in defining clinical applications for SPECT and non-SPECT nuclear imaging and how to streamline clinical care in a nuclear imaging department for greater throughput. The discussion addressed ways to partner with a

nuclear imaging camera provider to maximize clinical operation and business potential. He also discussed the importance of a collaborative effort between clinical engineering/biomed departments and nuclear medicine departments to make sure imaging equipment and accessories remain functional in order to assist physicians and health care providers in the delivery of effective care. An informative Q&A session followed the presentation. Iwaniw is the Vice President of Marketing & Services/Clinical Support Specialist at Universal Medical Resources Inc (UMRi). He received his bachelor’s of science in nuclear medicine technology and a master’s of management from Aquinas College. He was joined by Charles Lovell Jr., CEO of Caldwell Medical Center. Lovell is participating in a walk to raise awareness about rural health care. To draw attention to rural health care, “The Walk” began in Belhaven, North Carolina, on June 1 and concluded on the steps of the U.S. Capitol on June 15. TO REGISTER for the next free Webinar Wednesday session, visit IAmTechNation.com. Recordings of previous webinars are available on the website.

JULY 2015

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BIOMED 101

Examining the Past to Better Service the Future By Anthony J. Coronado

ith the advancement of technology in the design and integration of medical devices, health care personnel have obtained the needed resources to better patient care. With this advancement, new vulnerabilities have been brought to light making it necessary for the clinical engineering profession to evolve and develop new techniques and assessment. The introduction of Failure Mode and Effects Analysis (FEMA) to Medical Equipment Management Plan at Methodist Hospital of Southern California has helped the Clinical Engineering Department identify these new vulnerabilities. FEMA is conducted by examining the history of the device and providing a qualitative analysis of its function, design, and reliability allowing for better servicing of these medical devices. The Joint Commission has added the usage of Alternate Equipment Management (AEM) programs for 2015 and requiring Clinical Engineering departments to identify any failure modes. AEM programs review incident histories on medical devices and determine how serious and/or prevalent is harm from the equipment should it fail or malfunction (Commision, 2014). The Joint Commission recognizes the need to go beyond manufacturer specifications and develop alternative maintenance strategies to better service the technology of today. As a part of the FEMA process at Methodist Hospital of Southern California, these concerns are addressed. FEMA identifies potential design inadequacies that may adversely affect safety and performance (Whitemore, 2012). It also allows for the analysis of past failures that compromised patient safety and the development of failure trends, resulting in establishing medical equipment service plans for the future.

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Failure Mode and Effects Analysis has been utilized by reliability engineers since the late 1940s and is applicable to help establish a more thorough service plan for the technology of today. The Methodist Hospital of Southern California Biomedical Engineering Department has utilized Failure Mode and Effects Analysis on major medical device purchases and has developed service plans and performance improvement goals based on the outcomes of the assessment. The goals of the FEMA are to look at failure modes based on global incident history, recalls, and alerts. Utilizing resources from agencies like the FDA, ECRI Institute and manufacturers, an alternative risk-based maintenance strategy can be developed. At Methodist Hospital of Southern California, the process of risk analysis starts with a completed FEMA worksheet consisting of a chronological detailed assessment of all incidents, recalls and alerts for a particular medical

ANTHONY J. CORONADO Biomedical Engineering Manager Methodist Hospital of Southern California Renovo Solutions LLC

device. Each event is then assessed and evaluated for trends. The worksheet is also accompanied by an executive

medical devices. Another area of focus with FEMA involves evaluating the Probability of Failure. With a FEMA, all the potential causes of failure mode are identified and PROOFSome APPROVED NEEDED documented. examples of CHANGES failure are operator error, manufacturing CLIENT SIGN–OFF: induced faults, wear and tear, training PLEASE CONFIRM deficiency, software related or THAT due toTHE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS faulty accessories. A “Probability Ranking” is then developed using the information attained. Using the probability ranking, a “Severity of Failure” is then used to determine the worst-case scenario. By determining the Probability and Severity of Failure, not only are vulnerabilities identified, but preventive measures of failure can be established. Also, identification of these vulnerabilities can help develop a complete risk management program. At Methodist Hospital of Southern California, the Clinical Engineering Department has utilized FEMA on capital equipment purchases such as Carefusion infusion devices, Karl Storz integrated operating equipment, Hill-Rom critical care beds and others. Health care personnel are dedicated to identifying risks associated with medical devices and patient safety. The addition of Failure Mode and Effects Analysis can strengthen a program and help promote patient safety. With the combination of function, design, and reliability assessments, an alternate equipment management plan can be established and a clinical engineering department can be better prepared for technology of the future.

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summary that identifies any significant failure modes and mitigation that are needed. By evaluating the failure modes of the past, preventive maintenance procedures can be fine tuned and performance improvement goals can be catered towards increasing patient safety. With a focus on the function failures, a clinical engineer can determine how serious the harm can be from the medical devices if the function is compromised. An educational plan can be established by evaluating all past incidents, the service plan and performance improvement goals. Another aspect of failure mode analysis focuses on the design of medical devices. By examining recalls, design errors can be identified and service plans can be developed with the intent to ensure that these errors have been eliminated and avoided. For example, a battery recall can establish a targeted preventive maintenance procedure that will focus on battery operation. Another example would be the constant physical damage and cracking of a device’s casing can help develop a focus on clinical education of handling of a particular device. In addition, technology of today consists of integration and wireless connectivity as part of their design. This advancement in technology can develop failure modes that can jeopardize electronic patient information and create new threats to patient safety. Establishing a FEMA for equipment design can help health care organizations address new vulnerabilities like integration and cybersecurity for

FUTURE BIOMED

Biomed student shares insights By Jennifer Gentry

he biomedical field was completely unknown to me before I began my search for a new career path. I learned of its existence while visiting Brown Mackie College (BMC) almost two years ago and I was immediately intrigued! It simply never occurred to me that there were people who specialized in medical equipment repair. Sure, I knew the machines existed, but who thinks about the one taking care of the equipment? I certainly didn’t. Unless you are surrounded by it or using it every day, it does not cross one’s mind. It became almost an obsession. I gave Google the workout of its life that week. I scoured the Internet, feeding my craving for more knowledge about this curious career. I will say that there really is not very much out there about it and I found that I had to search different names such as HTM and metrology. After much consideration, I chose biomed. Or maybe biomed chose me. I enjoy helping people and decided that this would be one way to do it. The vast array of specialty fields that I can pursue is an added bonus. My first MD Expo was in Orlando, Florida, where I learned just how amazing this can be for me. I met many great people who were willing to help me and offered their cards for future reference. I realized the amplitude of generosity, intelligence and a real family feel to the whole organization. I initially had some reservations and fears because I have several visible tattoos on my arms. You can not take back the past and I was honestly relieved when it was met head on with acceptance. I feared being viewed as immature or even a risk. My favorite response to date was when one potential employer told me “As long as it is not like Mike Tyson’s facial tattoo, it will be fine.” Then, there was the age concern. I am a 38-year-old college student. I was worried that the younger generation would have

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preference over my slightly aged brain. I quickly learned that wisdom is appreciated. I will not go over the thousands of encouraging comments rained upon me, but I feel great about it. This is going to work! And I am going to be great at it! Everyone involved wants me to succeed and that is a great feeling. It feels like a giant bear hug. Whether we ever meet again, or work closely together, these people are my coworkers. I can depend on them and they can depend on me. Who could ask for anything more? Life as a BMET student has been fairly challenging, but I would not have it any other way. What fun is a free ride with no thinking? Being a biomed is going to keep my mind sharp, I can stop doing The New York Times crossword puzzles! At the MD Expo Nashville my class attended a 90-minute tour of AllParts Medical. Wow! That was an eye-opening experience. Seeing the component level repair stations and the harvesting room was great. Those positions had never

JENNIFER GENTRY Future Biomed

occurred to me! Then, they took us to the rooms where the CT machines were being repaired and it caused an immediate chilling sensation. This felt so much bigger than me. What an amazing piece of machinery. Next was the ultrasound room, there were so many. Everywhere! My mind was spinning with the possibilities. We even saw running MRI machines which, I will admit, intimidated me to a certain extent. We left the tour with new hopes, ideas and wide-eyed wonderment. I am on the last leg of my schooling and I am feeling very confident in myself and my abilities. I am definitely excited about doing my externship. Though quite unnerving, it is going to be my first dip into the biomedical technical pool. My craving for learning is intense, so I am certain it will be my bread board. I have always had a hand in computers and mechanical work, so this makes sense for me. I am hoping to secure a field service position at first. I have learned that many facilities want

Need to find facilities with certain equipment installed? to train their new employees to their own way of doing things, and I think a budding fresh student is the perfect opportunity for that. Currently, we have study groups for taking the CBET next year and that is going to be a fabulous addition to my resumé. The CBET is quite intimidating, but through determination and my willingness to learn, I will persevere. One of my classmates, Zena Alem, actually won a set of CBET learning software from Stephens International Recruiting at MD Expo Nashville. I am very much looking forward to the next MD Expo in October in Las Vegas. By then I will be a lightly seasoned graduate, willing and ready for opportunity, hungry for experience. The last two MD Expos I attended afforded me a plethora of contacts. The classes and newly offered product demonstrations were fantastic. The field

is constantly growing and the new technology alongside the old stuff, there is a never ending need for continuing education, which is fantastic. The field is saturated in such a wealth of knowledge and ambition. I am learning that networking (IT) is quickly becoming a large part of a BMET’s job, so I am going to have to go back and get a degree in networking. It was covered in our computer classes, but I think a more in-depth look at it would be beneficial to budding BMET students. The possibilities are endless and opportunity is flowing. The field is constantly growing and the job outlook is beautiful! I could not have dreamed of a better future for my family and myself. All it took was a fleeting moment of curiousity and a feeling of being unsettled to seal my fate. I am looking forward to the future and will embrace the new experiences with open arms.

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SHOP TALK Q:

I have a request from a director on record storage of service reports. How long should the service records be kept? The device in question has been out of service for 7 years and has been removed from the building.

Does anyone have any suggestions on the best interview questions to ask Biomedical Engineers and Biomedical Technicians to get a good understanding of a person’s technical experience?

If the device in question is used in patient care we treat it like patient record. From a litigation standpoint a claim could be preferred against the health care organization, that may include the possibility of patient harm resulting directly or indirectly from equipment failure. Because of that we retain the records for 20 years as this is the required retention period for a minor patient in our state. engineering records, calibration records, instrument calibration records performed in accordance with manufacturer’s instructions. Current year plus 3 years • Engineering records, equipment inspection and maintenance records, records relating to equipment inspection and required maintenance. Current year plus 3 years • Engineering records, inspection reports of grounds and buildings. Current year plus 3 years. • Engineering records, work orders, 2 years. • Engineering records, thermometer charts. Current year plus 3 years • Engineering records, permits and licenses, includes health permits, boiler permits, fire inspection permits, FCC license, etc. Until expiration plus 3 years.

1TECHNATION.COM

JULY 2015

the sockets where the only apparent cure is to replace the input board/socket assembly.

A: A:

I would like to know how their customer service skills are.

I would try to assess a person’s technical experience by their ability to problem solve in real-life situations, more than a formal electronics test or specific technical questions. Example: If a nurse calls up and says her ECG monitor isn’t working, and you tell her to change the patient cable and lead wires, and she says “The patient cable and lead wires are new” – what’s the most likely problem with the monitor. Of course, the answer is, the patient cable and the lead wires.

Years ago I was interviewed for a job, and the supervisor of the shop did three things. First, he opened a print and described a problem and asked me where I would start looking to resolve it. Including which device DVM or scope I would use. Second, he put various components/parts in front of me and asked if I knew what they were. These included lead sets, rj 45/11 phone jacks, (biomed did the phone system there), ultrasound probes, toco transducers, doppler probes, etc. Third, he asked me to walk around with him on a “service call” and asked my suggestions on what to do. He was an extremely solid guy, and he just wanted to see how I would handle a call. I did get the job and spent many years there, and worked with some very solid techs. I have been very blessed to have worked with some great service people. I have found that the environment of an organization and leadership is critical to a successful biomed department.

I have three. 1. Describe for me an example of one of your most challenging repair experiences. 2. Which type of equipment repair (mechanical, electromechanical, or electronic) do you feel reflects your greatest strengths and abilities, and why? 3. Could you demonstrate for me how to replace a hospital grade plug? This requires providing the applicant with a power cord, plug and some basic tools.

Not necessarily the lead wires, I’ve seen my fair share of electrodes (patches and tabs) that the nurse has claimed to have just replaced, and they are not conducting due to dry gel. Another trend that’s started to rear its ugly head is the Philips MMS or X2 module misbehaving due to damage to

The other issue I have is training, they don’t teach equipment use as much anymore and the nurses do not know to look in the upper left hand corner to see which lead on a Philips ECG is having the issue. They don’t know about skin prep or they will have a patient with compromised skin, especially

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basic hand tools. If they don’t know how to replace a plug on a power cord (and leave extra slack for the ground), you’ll be cleaning up behind them, should you choose to hire them. 2. Always ask about networking skills, because so much of our equipment is networked. Why hire someone new who doesn’t even know what an IP address is? 3. Also ask about personal skills. How would they handle In addition to having one person meet them in the lobby to run them themselves in a confrontation with a nurse, doctor, patient, coworker, etc. 4. It up the stairwell to the fourth floor, where would be good to know how articulate the other Biomeds are ready to interview theyNEEDED are with their communication – both them while they’re catching their breath; PROOF APPROVED CHANGES written and verbal. Oh, and spelling here are some suggestions. 1. Hand them counts, too! a power cord and a new plug to put on CLIENT SIGN–OFF: the end of it, along with wire cutters/ strippers and a screwdriver. It’sTHAT a simpleTHE FOLLOWING THESE POSTS are from PLEASE CONFIRM ARETechNation’s CORRECT enough task, and you’ll see how ListServ. Go to www.1technation.com to LOGO PHONE NUMBERﬁnd out WEBSITE ADDRESS comfortable they are using just these how you can join and be part of the discussion. with the leg. Our feeling is we can train the technical part, so our focus is to see how the individual fits in with our staff, their ability to think on their feet and how they present themselves. Curiosity and the ability to learn are talents that don’t show up on a resumé.

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ROUNDTABLE Nuclear Medicine

uclear medicine continues to be a very important aspect of health care in the United States and throughout the world. TechNation examines the future of the market and the best approaches to maintain and upgrade these devices with a roundtable Q&A discussion.

1TECHNATION.

NOVEMBER JULY 2015 2014

The experts on the roundtable panel are Michael Eaton, Field Service Engineer at

Southeast Nuclear Electronics; Danny Hamm, Vice President of Sales, InterMed Nuclear Medicine Services; Nik Iwaniw, MM, RT, CNMT, Vice President, Marketing and Services, Universal Medical Resources Inc.; Eric Langsfeld, owner, E.L. Parts LLC; Will Martinez, Director of Field Service, Global Medical Imaging; Don McCormack, Chief Executive Office, Southwest Medical Resources; Josh Nunez, Molecular Imaging Product Manager, Block Imaging; and John Shaw, Service Engineer, Northeast Electronics Inc.

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN NUCLEAR MEDICINE?

Eaton: Although not a new concept, hybrid modalities such as SPECT/CT are gaining popularity in clinics and hospitals. Many of these systems are approaching the end of their OEM warranty, if they haven’t already. Hamm: The latest advance that has the most significant impact on nuclear medicine is Wide Beam Construction software. It has the ability to acquire images in about half the time as standard software, enables the study to be performed with half the dosage of isotopes, or both at the same time (depending on the version and type of software). Iwaniw: Not unlike other imaging modalities, technical advances in nuclear medicine continue to be introduced to improve clinical decisions for physicians and patients. Some of these are related to improved SPECT, SPECT/CT, and PET/CT systems. In addition, due to budget restraints, imaging providers are searching for less costly nuclear imaging system alternatives. However, advances in creating new disease specific radiopharmaceuticals will be a driver for nuclear medicine utilization. Also, Appropriate Use Criteria (AUC), radiation dose reduction, and maintaining a consistent supply of Mo-99 for Tc-99m will impact the future of nuclear medicine.

Langsfeld: As a parts vendor, we have noticed a rise in the demand for parts on the hybrid systems of SPECT/CT and PET/CT. As more of these systems are coming off OEM warranty, the third-party market has stepped in with service and support offerings for these systems while raising the demand for quality used or refurbished parts and technical support. Martinez: Circuits are getting smaller, so things can be packed into smaller, thinner packages. There are digital detectors, but the usable yield of producing CZT crystals is less than 20 percent per batch. The size of the good yield is still only for small FOV (Field of View) detectors. Overall resolusion has not significantly improved for the past 10-plus years. If you check detector specs between a Siemens eCam and the newest Symbia, there is no improvement. Only post processing has improved with half time imaging being the chief advancement. McCormack: Nuclear medicine has changed over the years in the way it handles data. On the hardware end of things, different types of collimators, hybrid imaging, and workflow enhancements have allowed health care providers to deliver information to patients in ways never seen before. New radiopharmaceuticals are also in the pipeline that will potentially offer clinicians better ways to analyze disease both qualitatively and quantitatively. Nunez: One of the main advances in nuclear medicine is the introduction of

Cadmium Zinc Telluride (CZT) detectors by Spectrum Dynamics and later by GE. These are faster and have higher resolution than previous sodium-based detectors. They are also very expensive. Another significant advancement in nuclear cameras is the spread of hybrid imaging in the form of SPECT/CT. It broadens the ability of nuclear cameras into areas where the hybrid study can stand alone and cover more areas of diagnosis. Shaw: Nuclear medicine has seen quite a few changes over the past few years mostly by adding another modality (hybrid) to the SPECT system such as SPECT/CT. PET imaging, also a form of nuclear medicine, has made many advances in oncology and cardiology. The basic gamma camera has not changed much in the past 10 years.

HOW WILL THOSE CHANGES IMPACT THE NUCLEAR MEDICINE MARKET IN THE FUTURE?

Eaton: According to Dr. Schwaiger of the Technical University of Munich, the border between the imaging modalities “will have disappeared” by 2020. The trend seems to be shifting away from a modality-specific focus, onto organ or disease specific groups. This will certainly impact the parameters in which imaging equipment is purchased and utilized. Hamm: The main benefit to physicians, hospitals, and other medical providers is that it allows a facility to perform

THE ROUNDTABLE

studies on more patients within the same timeframe. This enables the facility to increase the amount of revenue generated without increasing any additional costs or time needed to perform the studies.

still be around but the hybrid systems seem to be the future at this point.

HOW WILL NEW TECHNOLOGY AND OTHER ADVANCES IMPACT THE MAINTENANCE OF NUCLEAR MEDICINE DEVICES?

Iwaniw: Most predictions forecast growth in the nuclear medicine market. A favorite saying of mine is “The best way to predict your future is to create it.” In order to better create our future, proactive measures such as AUC that communicates to CMS about costeffective treatment algorithms, especially for nuclear cardiology, are intended to justify reimbursement. The aging population will also support the effective outcomes provided by nuclear medicine imaging procedures. Budget restraints support the sale of reconditioned systems that can be upgraded in the future. Langsfeld: There will always be a market for used and refurbished parts whether it be strictly nuclear medicine or for a hybrid system. Users of the equipment are always looking for a less expensive but quality option to support their equipment. While many facilities are moving toward hybrids, there are still several facilities that do not have the budget or need for them. So, the standalone nuclear market will still exist. Martinez: When CZT yield and size improve, detector overall size will significantly decrease. The digital nature may open more possibilities with the use of ever improving software control. The half time imaging software algorithm will likely improve in sync with the acquisition control software. McCormack: As nuclear medicine becomes more efficient and is able to offer greater information, doctors will continue to turn to this modality for the answers they need. Nuclear medicine has been and always will be the only way to image physiology, or functional process. With the ability to quantify

1TECHNATION.

Eaton: From a maintenance standpoint; hybrid systems will require a broader knowledge in theory of operation in what may have previously been foreign territory. From an end user standpoint, your cost of ownership analysis may require some revaluation.

MICHAEL EATON

Field Service Engineer at Southeast Nuclear Electronics

tumors, for example, we are able to better understand where the patient needs to be in the treatment process. No other modality can really do this like nuclear medicine. Nunez: Widespread use of the higher-resolution detectors will bring the unit cost on these down. In addition, the higher resolution and higher sensitivity will enable nuclear cameras to expand into studies and uses that have been traditionally part of the domain of PET and PET/CT. It can’t replace these other modalities, but is becoming a viable alternative in some circumstances and markets. Shaw: Nuclear medicine has been considered a dying modality since I entered the field in 1982. First the word was that CT will do the studies that nuclear formally did, then it was MRI, then it was PET. Nuclear medicine departments still seem to be an important modality in spite of the death that I had always been warned about. In the future, the basic gamma camera will

NOVEMBER JULY 2015 2014

Hamm: Nuclear cameras are more software-driven than ever before. The newer cameras have fewer moving parts, are more accessible to service from an engineer’s perspective, and allow for more detailed and thorough diagnostics through the workstation/computer; minimizing some of the mechanical diagnostic aspects, which are generally more time consuming and costly. Iwaniw: They shouldn’t drastically affect the maintenance standards that are already in place. It will be vitally important that thorough preventive maintenance is performed on a regular basis. The technology for SPECT cameras will tend to be geared toward software technology versus actual camera technology, which would require clinical engineers and field service engineers to be more computer savvy. Langsfeld: Preventative maintenance has always been and will continue to be very important for any system. PM checks are recommended on all systems, and the OEM guidelines should be followed no matter who is servicing the machine. Some facilities try to save money by ignoring PM, but in the end, it will lead to more costly repairs. Martinez: The smaller lighter overall size of the machine will allow for better

systems are harvested for parts and the engineering expertise on them grows. On the other hand, for hybrid technologies like the SPECT/CT, we have engineers familiar with both halves of that product, so there is no delay in being able to service and maintain them.

DANNY HAMM

Vice President of Sales, InterMed Nuclear Medicine Services

mechanical reliability of the gantry system. The smaller electronics will be more integrated. Fewer PCBs will allow for faster troubleshooting. Software will be the chief troubleshooting aid. McCormack: As the technology advances, the local service engineers need to be trained so that they can repair the equipment. Workflow enhancements like automatic quality control are fairly new concepts in the industry and bring with it the need to have a little more knowledge of radiation safety when handling radioactive sources. In addition, these systems are becoming more advanced mechanically which means there is more potential for things to go wrong. Nunez: Brand new technologies may take a while for the knowledge and access to spare parts to trickle down from the OEM. CZT detectors are a case in point. We have not seen many nuclear cameras with the newer detectors on the market. We have no parts for them. This will change in a couple of years as

Shaw: Gamma cameras are now driven by computers and software. Many manufactures will boast about repairs done remotely and some repairs can be done this way. Detector tuning and maintenance is all done through software programs to tune the PMTs and align the offsets in the detector. The service engineer of the future will need to be more computer savvy but the electromechanical portion of the system will never go away so the engineer needs to also be a mechanic.

HOW CAN A FACILITY WITH A LIMITED BUDGET MEET ITS NUCLEAR MEDICINE NEEDS? Eaton: If a facility is looking to add or replace a nuclear medicine system, I suggest researching third-party refurbished systems. A reputable company can provide OEM quality systems and service at a fraction of the cost. Ask about renting/leasing as well. For a facility looking to maintain a department on a budget, a bi-annual preventative maintenance schedule is your best ally. Skipping one or two PMs may save a little in the short term, but this practice usually ends up costing more than you save. Hamm: Initially they should buy a reconditioned camera from a reputable company. This will save significant dollars on the front end, and a properly reconditioned camera should come with the same warranty as a new camera. In addition, adding half-time imaging software will allow the facility to maximize patient throughput on the days they are scanning patients. Also minimizing the indirect costs by having a

NIK IWANIW

MM, RT, CNMT, Vice President, Marketing and Services, Universal Medical Resources Inc.

quality service provider will maximize the overall efficiency of the nuclear program. By performing thorough preventative maintenance, offering quick response times, and having competent engineers, the camera will be running and generating revenue a larger percentage of the time. This equates to scanning more patients and minimizing the need to reschedule studies. Iwaniw: Limited budgets support the purchase of refurbished/reconditioned nuclear medicine systems. It is important that the reconditioning process is comprehensive in order to provide a camera system that an imaging provider can rely on for many years. Flexible financing options are also important for the imaging provider to be able to afford updated camera systems. Langsfeld: Making sure the facility is purchasing the correct system for their needs is important. When first purchasing a system, everyone affected by the transaction should be involved to ensure the correct system and options

THE ROUNDTABLE

that is lower than that of the OEM. These systems have previously been used by other hospitals but we remove them, replace old and damaged parts, and re-install them into other facilities. With the care that third parties provide, these devices will continue to produce the diagnostic images that physicians require for a long time. Nunez: Consider used or refurbished equipment. Nuclear medicine is a great place to save money in your imaging facility. There are several high-quality companies in America that can provide refurbished or reconditioned nuclear cameras and SPECT/CTs that will meet or exceed OEM specifications when new.

DON MCCORMIK

Chief Executive Office, Southwest Medical Resources

are included to meet the current and future demands without buying unnecessary equipment or purchasing something that won’t support the needs. Finding a reputable service and parts vendor is also very important in maintaining a budget. Based on usage and availability of parts, discussing service contract options or time and material support with your vendor will be helpful. Martinez: Easy. Buy reputable reconditioned equipment with updated processing workstations. As mentioned earlier, there has not been any significant improvement in acquisition resolution. New systems are great if you can afford it. It does perpetuate what we are doing in the third-party arena and we need to appreciate that OEMs are continually releasing new products. If you are on a limited budget, a good reconditioned system will give you the same diagnostic quality. McCormack: Well, that’s where we come in. We can offer these same products to health care providers at a price point

1TECHNATION.

Shaw: Many rural facilities are looking for good quality refurbished equipment to fulfill their nuclear medicine needs. This has been a great option for hospitals and clinics for over 40 years. Most manufactures have moved to hybrid systems that are very expensive and will leave the small hospitals and clinics out. You don’t need a hybrid SPECT/CT system to do general nuclear medicine procedures. There are also fusion programs that allow the user to overlay one modality over the other. Hybrid systems are not needed to do this.

WHAT DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING NUCLEAR MEDICINE EQUIPMENT? Eaton: Don’t allow yourself to be over sold. It is posable to purchase quality equipment and produce desirable results without breaking the bank. A good service/sales company should be able to provide viable solutions at a reasonable cost. Hamm: Find a camera that fits their specific needs and a service provider they can rely on. For example, if a facility only performs cardiac studies, they would be better off going with a

NOVEMBER JULY 2015 2014

JOHN SHAW

Service Engineer, Northeast Electronics Inc.

designated cardiac camera as opposed to a larger variable-angle system. They take up less space, use less power, cost less to service, and tend to be more reliable. Though both cameras perform the same function, one is much better suited for a specialty practice, and they want to partner with a company that has their best interest in mind. When they have a service agreement, the practice should be confident that their service provider will effectively maintain their equipment so they don’t have to worry about that aspect of their business and they can focus on patient care. Iwaniw: They should look for a camera/ service provider who is able to provide effective, timely service, has a ready inventory of parts, and can offer flexible service contract options. They should also be partnering with nuclear medicine camera providers that can offer flexible financing options in order to meet their budgetary needs. They may wish to take into consideration the provider’s ability to offer training for in-house clinical engineers.

Langsfeld: While price is important, it should not be the first deciding factor. I would recommend asking questions to ensure you are getting the best value for your equipment, service and parts. Any good vendor will take the time that is necessary to make certain you are getting exactly what you need the first time.

engineers. Whether or not they have a Radioactive Materials License; this is important when reconditioning cameras so they may be tested with sources to ensure all parts of the cameras are functioning properly. Lastly, I would say to check customer references; reach out to some facilities who have used the third-party for service and ask them about their experiences. All cameras will inevitably go down at some point, it’s how prompt, professional, competent, and thorough the service provider is when things do go down that separates the top third-party companies from the rest.

Martinez: When purchasing equipment, whether new or reconditioned, service options are imperative. Your unit will require repair and general maintenance no matter what. Be sure that you are not limited to a make/model that has a limited install base. McCormack: Purchasing capital equipment is a big deal. In many cases, the room needs to meet specific requirements, and the equipment and maintenance throughout the life of the system can be quite costly. I suggest doing your research on the camera and serviceability of the system you want. The big equipment manufactures all provide ways to acquire patient data but it’s the bells and whistles that tend to set them apart. These bells and whistles can, in some cases, add challenges to the way the systems are serviced so these things need to be looked at. Nunez: If you are not looking at an almost unlimited budget or a large grant to buy a nuclear camera or SPECT/CT, consider looking on the secondary market. We are seeing a good number of quality used systems coming out as first-tier establishments order the latest and greatest. Shaw: TechNation readers/purchasers should start with the facility’s radiology manager and nuclear medicine technologists. These are the front line people using the equipment every day and know what is available for procedures and what their referring physicians are requesting. Service can be a tough spot for the clinical engineer. Many ISO companies will offer training

Iwaniw: Technical competency with your system, readily available parts, response time, technical phone support capability and accessibility, comprehensive refurbishment process, and customer service culture to name a few.

ERIC LANGSFIELD

Owner, E.L. Parts LLC

and some sort of “first look” program that would allow the facility to save money. It is often stated, by the biomed engineer, that nuclear medicine is a real thorn in their side. The training is great if you work on the system regularly but is easily forgotten if you don’t get to touch the system for a year or so.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REPUTABLE THIRD-PARTY NUCLEAR MEDICINE PROVIDER? Eaton: Knowledge of your specific system(s), immediate access to inventory, and enthusiasm. A dazzling website and/ or expensive advertising does not necessarily translate into quality service. Take the time to have a conversation and ask questions. Personally, I love what I do, and enjoy discussing it with customers and prospects alike. Hamm: How long they have been doing business, and how much of the camera reconditioning, relocations, installation, and service is performed with their own

Langsfeld: Seeking referrals is a good start to finding out the reputation of a provider. You can also research the company online and see if there have been any issues or concerns reported on forums or with the Better Business Bureau. But most importantly, do not be afraid to ask questions; if they are unwilling to provide information or take the time to address your concerns, then they may not be the right fit for you. Martinez: Many third-party providers do all major OEM models that are highly installed. While this is true, most providers have a bread-and-butter line that they do best. Find out what that is. McCormack: Knowing that your service provider has an adequate number of engineers with the knowledge needed for servicing your equipment is probably the most important. There are a lot of companies out there claiming they can service nuclear medicine, but many will only manage your asset without having direct knowledge of the equipment. Parts availability, facilities, and strategic proximity to their supply chains are also

THE ROUNDTABLE

important things to think about. McCormack: Service is about having proper knowledge of the equipment. Purchasers need to make sure they are buying from companies that have the resources at their disposal and not just a middleman. All the systems we sell and service come with customer manuals and if there are ever questions, we offer tech support over the phone as well as onsite training once systems are installed.

Nunez: We tell our customers that the nuclear medicine world is very small. You can’t run from a bad reputation. You want to work with someone who has the resources to fix things if they go wrong. Things can happen to any system, but can your nuclear camera provider cover those if it ends up being a loss for them? You need to know that they aren’t just willing to provide your imaging needs, but that they are capable of supporting them as well. Shaw: Third-party organizations are always required to perform better than the OEM, one slip up and you’re out. OEMs are almost never thrown out unless it is for saving money. The best reference is other facilities that have used the ISO and can give a recommendation. Nuclear medicine is a very small community, almost all technologists know each other and this would be the best way to compare notes.

HOW CAN PURCHASERS ENSURE THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS WHEN PURCHASING NUCLEAR MEDICINE DEVICES? Eaton: Don’t be afraid to ask questions and be engaged. Nobody knows your business like you do. Be sure to communicate your needs and expectations before, during, and after the buying process. Hamm: Any reputable company should provide the purchaser with all applicable literature relating to their camera and should be able to offer detailed applications training. The better the nuclear tech knows how to operate the camera, the better it is for everyone involved, so that should be a priority of the company selling and servicing the equipment.

1TECHNATION.

Nunez: Manuals, system demonstration, and extensive applications training are all available with any system we sell. However, we find most customers don’t need a lot of training. If we schedule three days of applications training, many sites will feel comfortable in two days. JOSH NUNEZ

Moleculat Imaging Product Manager, Block Imaging

Iwaniw: Service manuals can be a challenge as these are generally proprietary. General system operating manuals and software operating manuals should be part of the system purchase (these can be hard copy for older systems and within the software for newer systems). I would encourage the purchaser to inquire into whether the third-party provider offers formal training classes. Langsfeld: When purchasing a system, always make sure to request operating manuals and software disks, if applicable. Ask about training and support offerings to ensure a level of comfort for use. If you do encounter a problem, you want to make certain that the seller will be available and willing to help you seek a resolution. Martinez: The literature is generally available from the original point of sale - the OEM. There is no lack of highly capable applications specialist in the third-party market. The selling third-party company should be able to answer this upon the initial consult.

NOVEMBER JULY 2015 2014

Shaw: Facility purchasers should require training and technical manuals when ordering their systems. If the OEM or ISO will not provide these items then they should look at another vendor. A large facility will have much more clout than the small facility and that can be quite a hurdle for the small group. Finding leverage in order to get the vendor to comply is always a challenge. Don’t rule out ISO companies when looking at new systems. Many ISO groups offer new cameras along with high-quality refurbished systems.

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT NUCLEAR MEDICINE DEVICES? Eaton: Listen to your technologists! These men and women spend more time with this equipment than anyone else. Their input is a valuable resource that all too often remains untapped. Hamm: Nuclear cameras are a different animal than other diagnostic imaging systems, so find a company with a long-standing, positive reputation within the industry so they have confidence the

purchase to a service repair or full system integration, seeking a partnership is critical. Every system has differences, and depending on what is needed for the repair, re-tuning and calibrations must be performed by a trained and qualified engineer to guarantee your system remains up and running. Martinez: Nuclear medicine requires the most patience of all the imaging modalities. Sometimes the bad result doesn’t come for two or three hours. The usual remedy is to just start over. Appreciate your service engineer.

E PLA TE H T O T P U P STE

a good source to contact. Applications support is always important for the nuclear medicine technologist.

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camera will be maintained and function as efficiently as possible. Find a full service company that can perform all aspects of nuclear medicine services with their own engineers and also has the same goals and focus of taking care of their customer. Once they find a company they trust who is like-minded in the delivery of quality service, together they can exceed the customer’s expectations and ensure a long-term, mutually beneficial relationship. Iwaniw: Nuclear medicine systems remain a technical service challenge for biomedical engineers/clinical engineers. With the evolution of clinical engineering departments becoming responsible for the budget to maintain their nuclear medicine systems, it is extremely important for them to develop a mutually beneficial partnership with their third-party service provider. This should be a collaborative effort to work together for cost effective and reliable system maintenance. Langsfeld: Finding the right vendor is very important. From your first part

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McCormack: I would say that these devices are quite different from other modalities in radiology. The physics are quite different from one device to the next. In my experience, most engineers don’t understand or even like nuclear medicine. That’s why we are here to provide our expertise. Nunez: I think most biomeds are comfortable with nuclear camera equipment in general, but if their facility has ever purchased a nuclear camera from an unqualified vendor then they likely have some concerns about second-hand equipment. It’s critical to find a reputable vendor. Shaw: Clinical engineering departments should consider training, applications and technical phone support at the top of their list. If the clinical engineering department is big enough to take on the nuclear department it is best to train one person so he is proficient and will be able to cross train other engineers. Training is out there and many companies, especially ISOs, are very willing to work with clinical engineering departments in order to get in the door even if it is only a small piece of the pie. Once in, and the vendor can gain the confidence of the technologist and the clinical engineering department, this can make for a win-win relationship and will make the job for the technologist and biomed engineer much easier if they have

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g n i g a Im t n e m p i u Eq e c n a n e t n i a M Best Practices for Promoting Efficiency

DOUGLAS D R A H IC R BY K.

1TECHNATION.COM

JULY 2015

orporat ions of ten rely to tell on con them h sultants ow to s last dro queeze p of e every f fi c ie of the ncy out ir syste and em ms, met ployees hodolog . They p ies large fe ay thes es beca e c onsulta use an nts percent improve or two ment o fa can res that mo u l t in re than cost sa vings make up for the expense . Hospita ls and h ealth c motivat are syst ion; to ems hav s e e a sim e k o efficie ut oppo ilar ncy, sav rtunitie e mone s for and see y , f o llow bes k meth t pract o d s t hat imp line whil ices rove th e maint e botto aining p m econom a t ie n t safet ics, com y. It’s b pounde asic a chang d b y the dem ing hea ands of lth care takes a e nvironm pay for ent, tha p erform t Efficie ance ap ncy isn’ proach. t an op the me t io n; it’s a trics ar necessit e every y and where t o measu re it.

IMAGING MAINTENANCE

“It can’t be over-emphasized, the importance

Perry Kirwan, MSE, CCE, Senior Director of Clinical Technology Assessment and Planning at Banner Health

If you are an HTM professional and find yourself shaking your head and muttering something along the lines of “no kidding dude,” as you read these words, then you have learned this reality firsthand. Health care systems have to work so efficiently that sometimes you can hear them squeak; the tolerances have been set that tight. We take a look at how the HTM department can reduce costs while improving service in the management of imaging equipment. There are ideas and concepts that can be derived from the management of imaging equipment and employed in the management of all other equipment; we highlight each. “It can’t be over-emphasized, the importance of securing the HTM department’s seat at the table when diagnostic imaging technology is purchased,” says Perry Kirwan, MSE, CCE, senior director of Clinical Technology Assessment and Planning at Banner Health. “The ability to influence a few variables at the front end of the life cycle can pay tremendous dividends over the total life cycle.” “Technology standardization enables an organization to leverage the full extent of its purchasing power while at the same time reducing clinical variation on the patient care delivery side. Clear purchasing requirements prevent the opportunity for under-utilized technology to be procured. Extended warranties, more favorable service terms, service training and enhanced clinical training are all things that are better negotiated before the purchase is made,” Kirwan says.

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JULY 2015

of securing the HTM department’s seat at the table when diagnostic imaging technology is purchased. The ability to influence a few variables at the front end of the life cycle can pay tremendous dividends over the total life cycle. ” - Perry Kirwan

for Renovo Solutions LLC. Each suggest that the work culture and expectations are important. Also, the expectations for bringing imaging services in-house requires a goal of service quality that aims to exceed the OEM service. “In addition to utilizing the same industry standard service metrics, productivity and efficiency is a major factor. Many in-house organizations that have 10 or more facilities still use the same formation as their in-house BMET counterparts do where they are assigned to one facility,” Letourneau says, from the perspective of a large health care system. “Banner uses field deployable imaging engineers who are not assigned to one facility. Our BMET department does the same thing with specialty trades within the BMET area,” he explains. “The service personnel are commonly dispatched from home and have over 10 different facility responsibilities within a given territory.” Letourneau says that the most common issue with having engineers deployed or allocated to one facility is that they tend to only be trained on equipment at that one particular facility. He says that with imaging service, this especially becomes a LE USING AVAILAB problem when the goal is to provide on-call 24/7 service, where the imaging engineer RESOURCES can receive a call from any facility and “Set the bar high,” suggests Steve may have to service a variety of makes and Letourneau, senior director of diagnostic models of multiple OEM manufacturers. imaging services for Banner Health. F. Mike Busdicker, MBA, system “It all comes down to changing the director, Clinical Engineering culture within a facility,” adds Anthony Intermountain Support Services/Supply Coronado, biomedical engineering Chain at Intermountain Healthcare manager at Methodist Hospital of remembers that his health care system Southern California and account manager

Ownership of the budget is a key area of leverage for strengthening the negotiation and leadership position of the HTM department. “One important event that allowed for us to better manage and negotiate improved strategies for service was when we took over the organization’s maintenance and service budget,” says Steven Bowers, CET, manager of Biomedical Engineering at Rex Healthcare in Raleigh, North Carolina. “Previously, each clinical and imaging area had their own maintenance account to manage and utilize. Having the full budget line for service meant that vendors developed stronger working relationships with our team, felt that they knew what was expected from them, and were more inclined to adjust to our specific needs and requirements.” “As we made it known that all service reports were to be scrutinized and matched specifically to invoicing, accountability improved as well as responsiveness to delivery of field reports,” Bowers says.

faced the issue of reducing costs and improving service in the management of imaging equipment when they started their imaging equipment service program in 2012. “At the start, organizational leadership created an Imaging Services Guidance Council, and one of their tasks was to oversee implementation of the service program and to track program performance,” he says. “Of course, the first thing we needed to do was understand the current state of the program in relation to things like customer service expectations, equipment uptime, service level agreements, response times, service cost, total cost of ownership, and strategic planning,” he adds. “Once we had concrete data in these areas, we could start building a business plan to focus on implementing and delivering an internal service program at levels equal to, or better, than those being delivered in the current model.” Busdicker says that they were sure to include all areas of service and not focus strictly on reducing the cost of service. “It is important to deliver a high-quality product to the stakeholders at a financially responsible level for the organization,” he says. “As we remained focused in these areas, it helped build trust in our service program. We gained the trust of personnel across the organization from the frontline staff to system level leadership and included most of our service providers.” “We continuously evaluate the specific needs and requirements of each system, look at vendor options for economic, effective service plans and our own inhouse team capabilities in order to make customized choices for each imaging platform,” Bowers says. Bowers says that often, his biomeds are able to “train up” via a vendor provided or other service training option to take maintenance requirements in-house and reduce costs while still providing quality service and uptimes. “Over time we have developed first look, shared, PM only and parts only agreements to keep costs down, yet still maintain vendor assistance and support,”

Steve Letourneau Senior Director of Diagnostic Imaging Services for Banner Health

he says. “We lobby hard with our finance and executive staff during fiscal budget planning for training and technical education budget dollars as we have found and promote that investing in ourselves not only improves on-site response times but also provides cost savings year after year.”

MAKING THE TRANSITION

“Transitioning from full- service contracts to an in-house support model involves trust at all levels. This includes open dialogue with internal customers, organizational leadership, and with current service providers. In order to build a successful in-house program it will require buy-in at all levels of the organization and a collaborative effort with service suppliers,” Busdicker says. Busdicker points out that perspective is important in cultivating a relationship with outside service providers. Outside providers are still necessary in some cases. He says that the relationship with those providers begins with viewing them as suppliers and not vendors. “A vendor is someone that sells hot dogs and popcorn at ball games and exists mainly on a transactional basis. In our business, a supplier is someone who works with you to deliver a product that provides a win for health care as a whole,” Busdicker says. “It is imperative everyone be involved with the process and the focus is on the end result of providing the best service possible to our patients. It is not about cutting out the supplier and strictly

Steven Bowers CET, Manager of Bio medical Engineering at Rex Healthcare

“We lobby hard with our finance and executive staff during fiscal budget planning for training and technical education budget dollars as we have found and promote that investing in ourselves not only improves on-site response times but also provides cost savings year after year.” -Steven Bowers

IMAGING MAINTENANCE

Mike Busdicker, MBA,

System Director, Clinical Engineering Intermountain Support Services/Supply Chain at Intermountain Healthcare

“It is important to deliver a highquality product to the stakeholders at a financially responsible level for the organization. As we remained focused in these areas, it helped build trust in our service program. We gained the trust of personnel across the organization from the front-line staff to system level leadership and included most of our service providers.” - Mike Busdicker

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JULY 2015

reducing costs, it is about providing the best possible solution that will enhance patient care without driving up the overall cost of health care. This means we must work in a collaborative relationship with our suppliers to ensure we achieve our overall goal.” “It is all about creating internal standards and metrics that allow for successful growth and implementation of programs,” says Tim Riehm, vice president of Technology Management at Banner Health. Riehm says that the transition to inhouse service doesn’t mean completely excluding all OEM service. He says that you have to look at the value your team brings to the equation and which functions can be improved by doing them internally. “A great example would be high-end proprietary glassware,” he says. “Chances are that your team can’t produce glassware and the current after-market costs for the proprietary glassware are far too costly.” The likelihood of a better cost model through the OEM in this area requires sharpening your pencil, according to Riehm. “It is highly likely that you could negotiate a much better cost model working with the OEM to cover this area as opposed to being exposed to huge one-time costs,” he adds. “In order to effectively do this, you will need to understand the costs of doing this function by each option using historical data to support your decision. Utilizing this data will enable you to more effectively negotiate the glassware with the OEM or third-party based on factual data and the need to further reduce those expenses using volume.” “Having a solution in place for glassware will also improve uptime for the systems since you won’t be searching for tubes and will likely have some on-site or close by your hospital,” Riehm points out. “We have managed to reduce costs and downtime by more than 50 percent since negotiating the glassware options of our partnership agreements.” “It all depends on the relationship that is established with the HTM department

and the radiology department,” Coronado says. “Trust is the key for transition for the change of service to in-house and with the HTM personnel you are going to train.” When transitioning to in-house support, the oversight to measure those metrics is the key to making it work. “Early in the process, we established a sub-committee to focus on program implementation, identifying milestones, and maintaining program oversight,” Busdicker says. “Part of their tasks included identifying key metrics used to measure the success of program implementation and ongoing management. This group developed a five-year plan outlining manpower projections, equipment transitions, and metrics to track successful service delivery. This plan has been a key to the successful implementation of the program and ongoing monitoring of performance.” Kirwan says that an important piece of the puzzle for a contract conversion is to have a clear and defined mission in the beginning to help set tactical strategies for the HTM department. That strategy should include touchpoints in every aspect of a given technology’s life cycle. He says there are resources that can be used during the pre-procurement phases when assessing new technology, for developing technology standards that are undefined and for standards enforcement on those that are defined. There are also resources that work during the procurement process, he suggests, to ensure that technology is “right-sized” relative to the organization’s strategy. The goal is to “bring business intelligence skills to the table to help set thresholds” for what an organization is willing to pay for technology. “HTM departments possess the data and experience to provide that kind of insight which is extremely valuable to the purchasing process,” he says. “With the above processes in place, it is also important to have feedback loops from implementation and on-going support perspective back to the preprocurement and procurement processes. This feedback has the power to influence

“Partnerships allow for creative approaches to creating a new model for future service delivery. [They offer a] great ability to reduce costs far below any of the other models.” - Tim Riehm standards, strengthen programs already in place [and] gap analysis of program elements that need to be addressed moving forward,” Kirwan adds.

COMPARING MODELS

In dissecting the three primary service models, Letourneau says that two have some downfalls, while the third offers the right balance for his employer. According to Letourneau, full OEM contracts provide no opportunity for cost savings, may contain additional hidden costs – OT, CT slice count overages, etcetera, and provide no control over service outcomes. Time and materials has the potential for huge variation in cost and service delivery quality, comes up short because of a lack of vendor support – diagnostics, training, and technical support. It also requires the need for high aggregate volumes to make the risk model work financially. “This model does not work well when there are very expensive consumables such as X-ray tubes, flat panels, etcetera,” he adds. Then, there is the hybrid-partnership model. This is the model that Banner employs. “We have also seen where some companies will use a mix of all three leaving the high-end equipment under a full-term OEM contract. The problem with using all three is the fact that most of your higher cost contracts will come from the high-end devices and the cost reduction is not fully optimized,” Letourneau explains. “Many of the models we see do not have solid OEM partnerships and this limits their ability to provide fully

Tim Riehm,

Vice President of Technolo competent engineers who have all the tools gy Management at Banner Health. necessary to perform their jobs,” he says. “Many in-house service organizations bill individual departments based on each Inevitable change demands that the service event and occurrence, Banner HTM professional take a central role. spreads this cost over all of the Banner “We are going to see continuous facilities and allocates a fixed cost to each changes in health care over the new few facility. This cost allocation is based on years and the HTM department needs to each facility size. Nobody takes a hit for be a proactive part of the change process; any one-service incident. This greatly not reactive. It is time for our field, inimproves the sometimes bitterness between house programs and service suppliers, to in-house service and the end-users.” step up and be part of the solution process Riehm adds that with full service for health care,” Busdicker says. agreements, there is no chance to further “This means working together to collaborate on options, they make it find solutions and then implementing difficult to manage service escalation, these solutions in our organizations and difficult to manage response time, and they sharing the outcomes with the Healthcare typically identify every system the same Technology Management field,” he adds. regardless of criticality or importance to Finally, going back to our original the hospital. assertion about incremental cost savings, “Time and materials — complete lack of the true impact of efficiency that can support by anyone. Essentially these are no originate in the HTM department more than an internal insurance model for is summed up in this example by medical equipment. Requires a significant Letourneau. amount of effort for very little reward,” “If you think about what the ratio of Riehm says. revenue to margin is today, in the health He says that first pass contracts are care business, and how much actual essentially just a larger discount on a revenue is needed to scratch out a small contract that allows the local staff to take margin, that ratio might be 20 to 1. So a first look at the system and then call in essence, if we were able to save $20 the vendor in for service. Riehm says that million dollars in operational costs, this this model delays service and increases would be equivalent to not having to downtime while having a minimal impact produce $400 million dollars in more to the overall cost structure. revenue to provide the same impact,” he “The vendor expects very little from says. “This is especially important when the local staff and prices the model health care in general is continually subject accordingly,” he says. to many outside influences that negatively “Partnerships allow for creative impact revenue across the board.” approaches to creating a new model for That is how the HTM department gets future service delivery. [They offer a] great the attention of the C-suite. ability to reduce costs far below any of the other models,” Riehm says.

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CAREER CENTER Business Etiquette and Manners Are Important By Cindy Stephens

e had a dinner party over the Memorial Day weekend and one friend asked me why I set the place settings a certain way. I told her my Mom was very savvy on proper etiquette even when setting a table. Whether for a quick meal or a formal dinner, the table was set a very specific way and we never started eating until everyone was seated and said a prayer. As we talked more about etiquette and manners, my friend laughed and said she was taught the normal “please, thank you, and excuse me,” but never specific table etiquette or manners as most of it was “common sense.”

Cindy Stephens Stephens International Recruiting, Inc.

1TECHNATION.COM

JULY 2015

When most people think about good manners, it’s mostly an afterthought – something your mother drilled into you when you were a child. Most of us think manners are automatic by the time you’re an adult and should be common sense. But that’s not necessarily true. Of course everyone knows about “please” and “thank you,” but anyone who interacts with other people in the business world needs to know more about manners. Respect, kindness, and consideration form the basis of good manners and are virtues that can be learned – and they also need to be practiced so that they become second nature. In the normal course of our Healthcare Technology Management (HTM) business, we see the lack of good business etiquette and manners, especially when it comes to the use of cellphones, social media and common courtesies. Manners and etiquette go hand in hand, but are not the same. One

dictionary defines business etiquette as generally accepted behavior, or formal manners and rules that are followed in social or professional settings that help people be civil and act accordingly. Etiquette becomes the language of manners. Rules of etiquette are the guiding codes that enable us to practice good manners. Etiquette is not just about knowing which fork or knife to use. True etiquette goes well beyond that. It’s a fundamental quality that comes from within and encompasses many aspects: kindness, empathy, courtesy – a consideration for those who are around us. We may need an etiquette book to learn which utensils to use, but we don’t need an etiquette book to learn to be civil or use common courtesies. There are social guidelines and manners to be followed in business situations when dealing with others. Writing a thank you note is one example of good etiquette. An example of a lack of business etiquette is when someone is late for a meeting or a business appointment, showing a lack of respect. Within the first few minutes of meeting someone, they will form a first impression that will likely be longlasting and hard to change. Those who show care in the way they behave when others are around them display the qualities of leadership. They quietly guide others by their examples. Courteous and respectful manners don’t go unnoticed. We see them because they stand out and are appreciated. Unfortunately, technology advancements have created situations

where many people do not use good business etiquette and manners or even common sense courtesies. One of the top pet peeves today is the noise most people make when they thoughtlessly use their cellphones in enclosed public spaces. Speaking loudly on your cellphone in the proximity of other people who are trying to enjoy their meal, for example, is the technological equivalent of slurping your soup. Some of the biggest complaints I hear are about phone conversations in an office or on a cellphone. Social calls are never a wise thing to do during work hours, especially if you are in close proximity to others. Text messaging has also grown tremendously, along with the abuse of texting – whether doing it secretly under the table during a meeting or in a restaurant or openly while with others shows disrespect. Constantly checking your phone for messages is another growing problem. Never check messages while you are actually talking to someone. Have the courtesy to give your partner in conversation your full attention. Ringtones no longer seem to be for the sole purpose of signaling an incoming call. For many people, they are a way to attract attention to themselves and their hipness, and all it really does is annoy others in close proximity. If your ringtone falls in this category, consider changing it. Don’t be offensive with your camera. Consider where you are and refrain from taking those silly photos or selfies for a time when you are not in a professional setting or restaurant! Don’t leave voicemails that are longer than 30 seconds. Often a person leaves a voicemail that starts with mumbling his or her name too quickly for us to catch it, then leaving a long, rambling message, with the phone number mumbled too quickly at the end. Practice consideration by slowing down slightly at the beginning of the message, enunciating your name and phone number before going into your message. Conclude your message by briefly restating your name and phone number.

With the difficult job market and tough competition today, you need to stand out from the others and make a good impression. It is not enough to be technically savvy, educated and experienced to succeed in today’s workplace. If your technical skills are comparable with your peers or your competitors, then the use of common courtesies, good business etiquette and manners, along with excellent communication skills can put you ahead and ensure you stand out in a very competitive market. You would be surprised that in the world of social media and high-tech tools, the use of common courtesies has declined, especially in a candidate’s job search process. Thank you letters fall in the category of common courtesies that few candidates think about doing. I am a bit old fashioned and I still believe in thanking people even for the little things they do whether it is in business or in my personal life. I am constantly surprised that only a few people bother to thank the people who helped them along the way. Many people don’t even bother to write thank you notes after telephone interviews, or even worse, after face-toface interviews for new jobs. Yes, there is a difference between etiquette and manners. Whether opening a door for someone or not contributing to office gossip, demonstrating good manners simply shows respect for others. Anyone can learn the rules of etiquette, but the true business professional knows proper respect and kindness. I am so thankful that my mom instilled excellent manners and etiquette in our family, which we have handed down to our children and use daily in our business and personal lives. Even my 9-year-old grandson has excellent table manners and etiquette. Showcasing proper business etiquette and good manners in our fast-paced and technical culture says a lot about you as a leader. To succeed in today’s HTM workplace, use good business etiquette and professional courtesies to gain a competitive edge and stand out from the others.

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