TechNation - April 2016 by MD Publishing

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VOL. 7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

APRIL 2016

ECRIâ&#x20AC;&#x2122;S LIST OF TECH HAZARDS

Company Showcase Fluke Biomedical and Raysafe

Roundtable Test Equipment for Imaging Devices

Whats on Your Bench? Highlighting the Workbenches of HTM Professionals

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46 54

TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

THE ROUNDTABLE : TEST EQUIPMENT FOR IMAGING DEVICES HTM professionals must keep medical devices in working order to a standard that ensures patient safety. Test equipment for diagnostic imaging devices is just one category of important tools HTM professionals use to safeguard patients. TechNation reached out to a panel of experts to discover what to look for in imaging test equipment.

STAY ALERT: ECRI’S LIST OF TECH HAZARDS The ECRI Institute’s list of the “Top 10 Health Technology Hazards for 2016” includes topics of interest for HTM professionals. We dive deeper into the list and share information about these hazards and how HTM departments can help avoid common pitfalls. Next month’s Feature article: Guide to AAMI 2016 Conference & Expo

Next month’s Roundtable article: Endoscopes TechNation (Vol. 7, Issue #43) April 2016 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.

APRIL 2016

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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 Kara Pelley

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas Patrick K. Lynch John Noblitt Todd Rogers Manny Roman David Scott Cindy Stephens Karen Waninger Steven Yelton

WEB DEPARTMENT

Betsy Popinga Taylor Martin Adam Pickney

ACCOUNTING

Kim Callahan

CIRCULATION

Lisa Cover Laura Mullen

EDITORIAL BOARD

Eddie Acosta, Clinical Systems Engineer at Kaiser Permanente Manny Roman, CRES, Founding Member of I.C.E. Karen Waninger, MBA, CBET Robert Preston, CBET, A+, 2014 Salim Kai, MSPSL, CBET, Clinical Safety Engineer University of Michigan Health System James R. Fedele, Director, Biomedical Engineering Izabella Gieras, MS, MBA, CCE, Director of Clinical Technology, Huntington Memorial Hospital Inhel Rekik, Biomedical Engineer, MS, Clinical Engineer

P.12 SPOTLIGHT

p.12 Department of the Month: WJB Dorn VA Medical Center Biomedical Engineering Department p.14 Company Showcase: Fluke p.18 Professional of the Month: Jerry Schauss, p. 20 Biomed Adventures: Developing Good Cadets p.24 Company Showcase: Tri-Imaging

P.26 INDUSTRY UPDATES

p.26 News and Notes: Updates from the HTM Industry p.32 ECRI Institute Update p.34 AAMI Update

P.38 THE BENCH p.38 p.40 p.42 p.44

Biomed 101 Tools of the Trade Shop Talk Webinar Wednesday

P.62 EXPERT ADVICE

p.62 Career Center p.64 Ultrasound Tech Expert Sponsored by Conquest Imaging p.66 The Future p.68 Karen Waniger p.70 Al Moretti p.72 Roman Review

P.74 BREAKROOM

p.74 Did You Know? p.76 The Vault p.82 What’s on your bench p.86 Index Like us on Facebook, www.facebook.com/TechNationMag

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APRIL 2016

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DEPARTMENT PROFILE WJB Dorn VA Medical Center Biomedical Engineering Department By K. Richard Douglas

he HTM departments within the Veterans Affairs health system are made up of biomeds dedicated to the health of patients, specifically focused on those who have served their country in the U.S. Armed Forces. They often emphasize that taking care of veterans is important to them.

Serving veterans in Columbia, Anderson, Florence, Greenville, Rock Hill, Orangeburg, Spartanburg and Sumter, South Carolina is the William Jennings Bryan Dorn VA Medical Center (Dorn VAMC). The main hospital is a 206-bed facility located in Columbia and the other areas are served by communitybased outpatient clinics. The Columbia location opened its doors in 1932. Dorn VAMC is a level 1C teaching hospital, with the Veterans Benefits Administration and the University of South Carolina School of Medicine both located on the main campus. The 1C rating of the facility refers to the level of complexity of the patient population, clinical services offered and educational and research missions and administrative complexity with 1 being the highest complexity ranking and C

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referring to one of three subcategories. The hospital provides training to approximately 730 trainees per year. All facilities offer acute medical, surgical, psychiatric and long-term care. Handling the medical equipment repair and maintenance needs of the Dorn VAMC facilities is its biomedical engineering department. The department is made up of 11 members including Director of Biomedical Engineering Mahesh Shukla, eight biomedical equipment support specialists (BESS), a lead BESS and a biomedical engineer. Eight of the department’s members are veterans themselves and Shukla serves in the U.S. Army Reserve. The specialty areas of the staff include general biomed tech, network, lab, radiology and image and an engineer for projects. The department operates out of the main facility

APRIL 2016

Members of the WJB Dorn VA Medical Center Biomedical Engineering Department are, from left, Biomedical Engineer Ashley Schramm, Biomedical Equipment Support Specialist Lloyd E. Porter Jr., Biomedical Equipment Support Specialist Thomas Terry, Biomedical Equipment Support Specialist Russell “Russ” Masters, Director Biomedical Engineering Mahesh Shukla, Lead Biomedical Equipment Support Specialist Jerry “J.D.” Johnson and Biomedical Equipment Support Specialist Jason Gillespie.

with one biomed also stationed at the Anderson location. “We provide customer facing services, which include corrective maintenance, preventive maintenance (PM) and professional services that cover technology assessment, technology implementation, technology sustainment and health care consulting,” Shukla says. The department works closely with their IT counterparts to achieve networking goals along with meeting VA system metrics. “We have a great relationship with OI&T,” Shukla says. “In this technology era, most of the medical technology is being

utilized via [the] VA network, and to implement integration successfully, biomed and IT have to be a team in order to achieve the VA mission. We have various levels of involvement with IT such as network, ACL, MDIA rules, [and] 6550 VA directives.” Before service contracts are utilized, the team takes the lead. “Most of the biomeds on the staff are COR (Contracting Officer Representatives). Currently, I and [the] Lead BESS, are managing the service contracts,” Shukla says. He adds that the biomed department always acts as the primary source to diagnose the issue before calling the vendor. The team of HTM professionals are also active

Thomas Terry, left and Lloyd E. Porter Jr. perform a PM on a Welch Allyn vital signs monitor.

away from work. They serve the HTM community in a variety of ways through their involvement with AAMI and national HTM groups, according to Shukla.

DEALING WITH THE UNEXPECTED The department is constantly using data to measure its performance, employing tools that the VA has available. “We have various tools to pull data, which is helping us to improve and set up a benchmark, as a part of quality improvements such as EBERS (Enhanced Biomedical Engineering Resource Survey). We are submitting quarterly reports to the HTM office [to] compare our facility’s key performance indicators with the VISN and nationally,” Shukla says. “We have PM monitoring where we are submitting our report to the EOCC (Environment of Care Committee), so there are other reports we have from various resources,” Shukla adds. The group has also addressed special projects that have gone beyond everyday tasks. Some recent projects outside of the department’s routine work have included DECC migration, CBOC activation, VMDNS, Wi-Fi, Welch Allyn monitors, radiology X-ray room readiness,

mammography room readiness, PACS and cardiology integration, Shukla explains. On the problem-solving front, the talented staff has devoted long hours to ascertain that new equipment is installed and functioning correctly. “We worked closely with the dialysis staff to ensure that dialysis equipment is working efficiently, especially [the] central RO (reverse osmosis) water system. Biomed staff, including myself, were coming [in on] off hours almost every day, in between January 2015 and March 2015, to resolve the issue as equipment was newly installed,” Shukla says “Recently we have successfully accomplished auto disinfection of [the] equipment hoses and connectors of 16 dialysis machines. We want to make sure that biomed is involved [in] every aspect of medical equipment to reduce our turnaround time of repair, so equipment can be utilized to provide uninterrupted patient care to our veterans,” he says. Occasionally, biomed departments are called upon to address emergency or critical situations that come about because of weather conditions. This was the case in October of 2015, when Hurricane Joaquin caused extreme rainfall, producing a

disastrous and historic “thousand-year flood” that impacted the Columbia facility and presented the HTM team with a host of urgent challenges. “During the flood, our facility was impacted in so many ways,” Shukla says. “We worked as a member of Emergency and Disaster Management Team. We worked closely with the team to mitigate and complete the assigned tasks, such as replacing all the water filters in portable RO water systems, [the] central RO water system, DI (deionized water) tank in dental, lab and SPS,” he says. Shukla says that the primary challenge was the loss of public water to the facility. It was necessary to get clean water for patient needs. They were also tasked with keeping heat and humidity under control. The department also “worked with various vendors to make sure the complex medical equipment was operational per [the] manufacturers’ standards, especially the radiology department, where we have MRI, CT and gamma cameras,” he adds. In South Carolina, veterans seeking health care are well served, even during emergency conditions, by the work of the dedicated WJB Dorn VA Medical Center Biomedical Engineering Department.

SPOTLIGHT

SAFEGUARDING PATIENTS & MEDICAL PROFESSIONALS

ostering a “safety culture” is the guiding principle behind Fluke Biomedical and RaySafe, a Fluke Biomedical company. Leaders in their respective industries for several decades, the companies have supported health care providers, institutions, and medical device manufacturers with a complete portfolio of test equipment, designed to ensure the safety of medical and diagnostic imaging equipment, and conversely, the well-being of patients. “We are the market leaders globally in medical devices testing and quality assurance,” comments Eric Conley, General Manager for Fluke Biomedical. “Our fundamental mission, however, is to help make the hospital environment as safe as possible for patients and medical staff. We do this by identifying issues with medical devices before they’re used for treatment, and by alerting hospital staff to potential and actual radiation exposure.” Fluke Biomedical has a long history of keeping hospital patients and staff safe. Our Raysafe solutions help hospitals minimize radiation exposure, which can lead to short- and long-term health deterioration. The RaySafe X2 is a cutting-edge diagnostic imaging QA solution. This innovative solution minimizes the need for user interface by pairing a handheld base unit with a touchscreen interface, and series of sensors to easily and accurately measure the radiation from R/F, MAM, CT, Survey, Light, and mAs applications. “Simplicity, usability, and safety along with the ability to effortlessly measure X-ray is what distinguishes the X2 from other diagnostic imaging solutions,” explains Mats Alm, Senior Manager, RaySafe. “Taking radiation safety a step further, we developed the i2 active

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APRIL 2016

The ProSim 8 Vital Signs Patient Simulator enables complete preventive maintenance testing with one device in less than ﬁve minutes.

dosimetry system to provide physicians and other medical personnel with real-time insights about their radiation exposure.” Along with producing a full-line of radiation quality assurance solutions, including phantoms for performing image quality on digital and analog radiography and fluoroscopic X-ray systems, RaySafe is dedicated to customer education. Their core message is the “ABCs for a Radiation Safety Culture,” which espouses avoidance, behavior and control. Several years ago, RaySafe worked with the University of Rochester Medical Center

(URMC). At the time, some of the physicians in their high-dose labs had annual doses in excess of 4 rem – which is just shy of the 5 rem legal limit. The corrective measures taken included the addition and repair of shielding, modification of training programs, and adoption of real-time personal dose monitoring systems. As a result of these corrective measures, the collective dose at URMC was reduced by 50 percent in the first full year of implementation. Implemented at URMC was the RaySafe i2, a real-time dosimetry system that records the radiation exposure of medical staff, who are equipped with clip-on dosimeters. The touch-screen dose dashboard enables physicians, technologists and nurses to visualize their radiation exposure in real-time and thereby change their behavior to lower it. Helping medical staff and biomedical professionals improve their skills is important to Fluke Biomedical, which is why they introduced Advantage Training. This free training follows the curriculum developed together with the University of Vermont for their Medical Equipment Technology program. “The ability to access the training from anywhere at any time supports our commitment to helping biomedical

The INCU II Incubator/Radiant Warmer Analyzer has many time-saving features like color-coded temperature probes to simplify set-up.

professionals from around the world strengthen their skills, and also learn about the latest medical test devices,” explains Jerry Zion, Fluke Biomedical Global Training Manager. Over 3,000 professionals have registered and taken Advantage Training courses since July, 2015. Most recently, Zion conducted in-person training sessions in India and Indonesia, showcasing Fluke Biomedical’s most recently introduced products. Launched in January, the INCU II Incubator/Radiant Warmer Analyzer is an all-in-one solution, which provides everything biomedical technicians need to easily and efficiently test infant incubators, portable incubators and radiant warmers. The compact 3-pound unit can simultaneously measure relative humidity, airflow, sound, and temperature at six points, using five independently movable sensors and one k-type thermocouple for measuring contact temperature. An informative webinar about the INCU II Incubator/Radiant Warmer Analyzer can be viewed online at www.1TechNation.com/webinars In February, the QA-ES III Electrosurgical Analyzer was introduced. This next generation electrosurgical analyzer has a generator output accuracy as low as ±5 percent, making it ideal for preventive maintenance and safety testing

of all modern high-power electrosurgical units. Its eight multi-purpose ports can be accessed from the front, making it convenient to collect all measurements, including vessel sealing, patent return, contact quality monitor (CQM), highfrequency (HF) leakage, output power and power distribution measurements in single or continuous mode. The key challenge for Fluke Biomedical is the need to be highly agile in rapidly changing markets. Emerging countries recognize the need to apply the same rigor to testing their medical device infrastructures as developed countries. Simultaneously, the global medical device regulatory environment is dynamic, some countries like China have more stringent standards, while other countries are moving toward more consistency. To maintain its leadership position, Fluke Biomedical has acquired great companies and increased its investment in new products development. “We combined the best Fluke Biomedical and RaySafe in the medical quality and safety market to ensure our technology offerings meet customers’ expectations,” says Conley. “We also depend on a dedicated sales team and partners to develop long-term relationships with customers. Their goal isn’t simply to sell products, but also to deeply

understand our customers’ needs. Every day we help independent service organizations rapidly branch into new areas, hospital biomedical departments asked to do more with less, and manufacturers needing cutting-edge equipment to test medical devices under development.” Fluke Biomedical continues to invest in outstanding customer service to help customers through the entire cycle of ownership. If a customer calls with a potential issue, an engineer is often brought into the conversation to help troubleshoot and find a solution. From these interactions, applications notes are developed and shared with the broader biomedical community. With the emphasis on fostering and supporting a safety culture to make a positive impact on health care throughout the world, the future is bright for Fluke Biomedical. “Our mission shows a commitment to customers, to the health community, and patients everywhere. We deliver on that commitment by providing the best and most reliable quality assurance solutions to make medical equipment safer to use,” Conley concludes. FOR ADDITIONAL INFORMATION about Fluke Biomedical, visit www.ﬂukebiomedical.com

SPOTLIGHT

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Defibrillator Analyzers Electrical Safety Electrosurgical Testers Gas Flow Analyzers

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Incubator Analyzers Infusion Device Analyzers Patient Monitor Testing Radiation Safety

• Test Automation • X-Ray Equipment Quality Assurance

RaySafe X2

All x-ray modalities, all measurements.

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PROFESSIONAL OF THE MONTH Jerry Schauss, CBET By K. Richard Douglas

he Indiana Biomedical Society (IBS) picks a biomed of the year each year at their annual meeting. For 2015, they chose a veteran biomed, with 45 years of experience who reﬂects the best of biomed in many ways. Jerry Schauss, CBET, started working for St. Mary’s Medical Center in Evansville, Indiana, in the fall of 1977. His primary assignments there include laboratory, cardiology, ultrasound and surgery. The honor from IBS was a complete surprise to Schauss. He had no idea that he had won until they began talking about the background of the winner at the organization’s conference. His friends, who knew he had won, kept quiet for months to make sure it was a complete surprise. “It was a total surprise to me. I had no idea I had even been nominated,” Schauss says. Like many biomeds, Schauss entered the profession through happenstance. “I actually stumbled onto this profession 45 years ago while I was in the Army,” he remembers. “The Army had an exit program called Project Transition when you were getting out of the service. This was a six-week program to work with a company outside of the Army. The job was to work on medical equipment and it was with Bendix Field Engineering.” “I found this to be interesting, as I like working on equipment. I was offered a full time job with good pay of about five dollars per hour, not bad pay for the early ’70s,” he says. After leaving the U.S. Army in 1973, as a radio electronics instructor and radio transmitter operator, where he also performed repairs, he went to work for

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APRIL 2016

Raycomm Industries in Freehold, New Jersey, as a biomedical field service engineer. He performed repairs and preventive maintenance of equipment at hospitals in New Jersey, New York, Pennsylvania, Illinois and Toronto, Canada. He has seen a lot in his 45 years as a biomed, including monumental changes in technology. “When I started in the field, the guy who was doing it before me ran a TV repair shop. He had no experience in biomed,” Schauss says. “Everything was tubes back then. New devices were going to Nuvistors, which was a hybrid metal tube, to transistors, and finally to IC. So, eventually, you saw a change in how things were made and in the quality of the circuit boards as they became, not wired together, but made as a circuit board. The quality of equipment has changed a lot and so has the quality of the test equipment.” EXPERIENCE AND TRAINING A CBET since 1978, Schauss has been through dozens of OEM classes and other training opportunities to fine tune his skills. He received his A.S. from ITT Technical Institute in Evansville, Illinois, and took electronics and computer repair through CREI. “With my electronics training at Sam’s Electronic School (now ITT) and in the

Jerry Schauss, center, was presented the 2015 Indiana Biomedical Society’s Biomed of the Year Award.

military, teaching electronics in the military, being the only equipment service tech at a remote island location called Matsu, I felt ready for the challenge,” he says. “I was lucky to work with two talented guys that were willing to train me on medical equipment. One had a lab background and the other had medical equipment background. Between the two, it was like you were doing clinical training from a college,” he adds. “One of the guys had many degrees from various colleges; he was a brain.” The training paid off. Schauss has held the position of field service engineer with two companies, site manager for an ISO, has owned his own biomedical service company and continues today as an in-house biomed. “For the last 16 years, I have serviced equipment in cardiology, ultrasound, lab, and surgery,” he says. He has also been a clinical instructor for students at Madisonville Community College in Kentucky. In this capacity, he has been described as the best clinical instructor by the program’s coordinator. He meets with prospective students before the clinical period to alleviate any anxiety

FAVORITE MOVIES “Hoosiers” and “Avatar”

FAVORITE BOOK Bible

FAVORITE FOOD Brain sandwich, a good pizza

HIDDEN TALENT Sings in a choir

FAVORITE PART OF BEING A BIOMED “I like working on equipment and working with the staff in various departments. I also like teaching biomed students from Madisonville Community College in Kentucky. We learn from the students and they learn from us.”

WHAT’S ON MY BENCH Jerry Schauss also teaches at Madisonville Community College in Kentucky.

they may be experiencing prior to the actual clinical training. Schauss is also on the program’s advisory board and is highly respected by his peers on the committee. His accumulated experience has come in handy with some projects that go beyond the typical job description for a biomed. Back in the ’80s and ’90s, Schauss wrote “a few computer programs that were used for years at the hospital.” He also built some interface equipment to interface various equipment to be used for sleep studies. “I did take some courses in machine language programming at two of the local colleges. They were different languages than I was programming in, but it gave me an idea and background on programming.” “Actually, I would write them in a basic language and use an interpreter that would convert them over to machine language,” he explains. RECOGNITION AND REFLECTION In terms of recognition, he has been Employee of the Month and Employee of the Year at St. Mary’s Medical Center. Away from work, he enjoys electronics

and gardening. “I had done Heath Kits in the past and built my own test equipment, that I used for general electronics,” Schauss says. “I repaired computers in the past and other various equipment. I didn’t limit myself just to medical equipment; I repaired TVs or anything electronic that ran across my desk.” He also enjoys being an active member of his church where he sings in the choir. He has been married for 40 years and has two adult children and one grandson. “The career has changed a lot in the last 45 years. I feel as far as somebody getting into this field, it is a very good field. There’s a lot to learn. In the 45 years, I would say that there is something that I’ve always learned,” Schauss reflects. “You are always learning something because the field is always evolving and new equipment is coming out and new procedures. It keeps me interested. I really enjoy working with the equipment and the people who use the equipment.” Retirement is in Schauss’s future, but he hasn’t set an exact date. Until he retires he will continue to make certain that the students who enter the

“Better question would be; what is not on my desk? My desk looks like a landﬁll. Now my service cart is a different story. My cart carries; Biotek 501 Safety Analyzer, ECG simulator, The Cube, SAE and metric socket sets and wrenches, lab and surgery microscope service kit, vacuum cleaner, laptop for service orders, hand tools, digital multimeter, RPM meter, and various test labels.” Five key things would be: • test equipment • cellphone • laptop • microscope service kit • tools

clinical period under his guidance have their priorities straight. “It takes 15 minutes to learn how the break room works. Once you have your 15 minute break, don’t think you’re going to take a lot of 15 minute breaks throughout the day. You’re here to learn and that’s what you’re going to do, you’re going to learn,” he says. Lucky for them, they are starting their biomed careers on the right foot with an experienced mentor.

SPOTLIGHT

BIOMED ADVENTURES Developing Good Cadets K. Richard Douglas

rior to World War II, volunteer aviators urged the formation of an organization that would incorporate civilians flying planes in the defense of the U.S. They reasoned that this would put their flying skills and planes to good use. Just prior to the attack on Pearl Harbor, the Civil Air Patrol was born. The attack boosted the necessity for the new organization’s mission. Thousands of volunteers took to the skies over the U.S. to log air miles in defense of the country.

During the war, the Civil Air Patrol (CAP) sunk two enemy submarines and saved hundreds of crash victims. President Harry S. Truman signed a bill that made the organization official as a benevolent, not-for-profit organization. Two years later, Congress passed the bill, making CAP an auxiliary of the U.S. Air Force. They also recognized the three primary missions of the organization; aerospace education, cadet programs and emergency services. In pursuit of offering aerospace education, the CAP’s efforts are divided among two groups; their own volunteer members and the general public. Participation in these programs allow the group’s members to advance. The program teaches cadet level members as well as senior level members. The cadets build their knowledge of aerospace to progress through different achievement levels. The senior members are urged to use their knowledge as a resource in their local communities and school systems. Additionally, CAP offers external programs to educators. “These workshops highlight basic aerospace knowledge and focus on

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APRIL 2016

ROBIN SHEAKS

Biomedical Electronics Specialist

advances in aerospace technology,” according to the organization’s website. CAP also saves approximately 75-100 lives every year through its search and rescue missions. The group has more than 55,000 members. The cadet program focuses on aviation to train thousands of young people, ages 12 to 21. The program includes 16 steps. One of the volunteer instructors, who contributes to the success of the cadet

“ I have been in CAP for the past 10 years and have spent the majority of my time working with cadets, with some search and rescue thrown in.” training program, is an HTM professional in Fort Lauderdale, Florida. Robin Sheaks, a Biomedical Electronics Specialist in the Clinical/Biomedical Engineering Department for Broward Health has a decade of CAP experience. “I have been in CAP for the past 10 years and have spent the majority of my time working with cadets, with some search and rescue thrown in,” Sheaks says. “When I was younger I wanted to be a teacher and work with children, then

The Civil Air Patrol is an auxiliary of the U.S. Air Force. The three primary missions of the organization are aerospace education, cadet programs and emergency services.

Photo by: Susan Robertson, Civil Air Patrol NHQ Photographer

later in life I thought of joining the military. This gives me the opportunity to get a little of both and I love to volunteer.” She holds the rank of major, but says that ranks don’t really mean much. “I was never in the military but, I did try to join about 30 years ago, but I did not have a college degree at the time. I got my biomed training at Broward College in 1997,” she says. She also says that she is not a pilot and she does not fly in the CAP planes, since she has a fear of flying, although that has improved over the years. “I prefer big planes, not the little CAP planes. The three missions of CAP are Cadet Programs, Emergency Services and Aerospace Education. I actually started volunteering because my son was a member,” Sheaks says.

EXPANDING YOUNG MINDS Helping to shape the minds of the next generation of aviators, or at least instilling a knowledge and respect for aviation and much more, is one of the things that Sheaks has most concentrated on as a CAP volunteer. “Cadets can join as young as 12, and as long as they join before they are 18, they

can stay a cadet until 21,” she says. “Some of the projects I have worked on are encampments which are a one-week training mission at a military base where cadets learn many things such as drill, customs and courtesies and lots of extras depending on the base, such as repelling and leadership reaction course.” Sheaks says that cadets must attend an encampment to progress to a cadet officer rank or attend any of the special activities that are offered all over the country. She says that the cadets actually staff and run the encampment and that senior members are there for guidance. “I took a 13-member drill team to Oregon in 2009 for a national competition, where we placed third out of the (whole) country,” Sheaks says. “I was a Squadron Commander for five years and my squadron sent care packages to the 332nd Expeditionary Medical Support Squadron biomeds. I even designed our patch from theirs, even though I am a University of Florida fan, and their patch has a huge bulldog on it,” she jokes. “I also incorporated their motto ‘Whatever it takes’ in our design.” Sheaks says that while there is no commitment to the military once cadets

age out, many cadets do decide to join one of the branches — not just the Air Force. “I have prior cadets in West Point, the Air Force Academy, Marine OTS and the Citadel,” she says. “Many commit to one branch and join ROTC so when they graduate they are an officer and will transfer right into the service. Some cadets join just to get their service hours to graduate,” she adds. As a biomed electronics specialist, Sheaks helps bridge the gap with IT. “As for my job, I am the IT Liaison for my department and I also specialize in vents and EEG,” she says. “I also do all of the drug library pushes for our infusion pumps.” Many of the next generation of well-trained military members can thank this HTM professional for getting off to a good start. The continuing mission of CAP is to “save lives and preserve liberty,” according to the group’s national commander. With the help of HTM professionals, who give of their time, many organizations are able to meet their goals. FIND MORE INFORMATION about the Civil Air Patrol at www.gocivilairpatrol.com.

SPOTLIGHT

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Tri-Imaging Solutions: Two Companies In One

BUILDING FOR THE

HUMBLE BEGINNINGS Tri-Imaging Solutions is a fresh, innovative, and ambitious company. Tri-Imaging just celebrated its third year with a new state-of-the-art facility to accommodate the company’s exponential growth.

TWO COMPANIES Tri-Imaging Solutions is a training institution and a parts company. It is not a parts company that offers training – it is much more. “Tri-Imaging Solutions is a diagnostic imaging support company providing replacement parts, equipment, service support, and technical training”, explains President Eric Wright. “It is no surprise that statistically a large percentage of the current service engineers are close to retirement and will be leaving a large gap in the seasoned skills available to help guide those entering the profession. Our strategic approach grew from this and John Drew has been diligently working on rolling out a completely new way to train.” Wright adds.

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“We stress the importance of continuing education and top-notch training,” says Vice President of Operations John Drew. “It goes back to our focus of ‘Empowering the Engineer!’ Providing quality imaging parts is just a portion of the value we want to offer, especially with all of the health care changes and uncertainty. We understand the best way to cut cost is to run efficiently. How better to do that than with your own team? Whether it is an in-house hospital group or service company – we are able to provide support in areas to strengthen, grow and, most importantly, save them time and money!” Adding Kim Presley, another notable industry expert, made perfect sense to drive development, enrollment and awareness of Tri-Imaging Solution’s new programs. “I didn’t think twice about jumping at the opportunity to join this exceptional team that has repeatedly proven their integrity and focus on not just quality products but also an emphasis on quality people,” Presley says.

CUSTOMER CARE Satisfaction is the goal. Each and every order is unique. “It’s more than a parts sale to us,” Director of Customer Care Kim Cole says. “It’s about making our Customers independent of the OEM. We treat each and every shipment as if our loved one’s life depended on it. We understand there are other choices in the market. We want to prove we are the better choice by the level of Customer care provided. Our commitment and genuine focus is on our Customers.” “Taking care of Customers is my passion and why I joined the Tri-Imaging family,” she adds.

EXPERIENCE Tri-Imaging Solutions’ strength comes from over 200 years combined experience equating to a true average of over 12 years per person on its efficient team! This experience is evident at every level of the company from leadership to sales to Customer care to logistics and throughout the entire team.

FUTURE GET TO KNOW JOHN DREW The new expansion gives us the ability to add depth and breadth to support our customers. We are very excited with the new training facility and training program which enhances our mission of “Empowering the Engineer” says Josh Raines.

INDEPENDENTLY OWNED Tri-Imaging Solutions is an independently owned company serving the diagnostic imaging market. “Why does it matter that we are independently owned?” says Vice President of Sales and Marketing Wanda Legate “As an independent provider, we support our Customers by being flexible and reacting quickly to their ever-changing needs. We think ‘outside the box’ as we look for opportunities to assist our Customers. When our Customers have a problem, we want to be the solution.”

TRAINING OPTIONS Hi-Intensity Tri-Imaging Training (HITT): HITT reduces the gap between training and real world service. This is the latest addition to our unique and intuitive training program. Blended Learning: Similar to today’s college courses, we combine an online learning platform with extensive laboratory time at its Nashville, Tennessee facility. This approach reduces time away from your facility without compromising the quality

and effectiveness of the training. “Having spent more than a dozen years in training, plus the last two years in support services, I better understand the gap between training and what the real world engineer needs,” John Drew says. “As we listened to our Clients wants we knew we had to take a unique and different approach to training. It is always good for the industry to have a choice.”

OUR MISSION Tri-Imaging Solutions strives to live up to its name and be a Solution for its Customers while at the same time Empowering the Engineer. The company’s mission statement reads as follows: “Impacting lives by creating individual, Customer-centric experiences based on a shared core belief in bettering patient care through personal accountability, integrity, and admiration.” FOR MORE INFORMATION, about Tri-Imaging Solutions visit www.triimaging.com

John Drew is a 13-year veteran of the diagnostic imaging industry. Most of his time has been spent as an instructor, teaching multivendor and mulit-modality for diagnostic imaging equipment. In addition, he continues to provide tech and field service support. He has also presented at countless biomedical events over the years, including MD Expo and the annual AAMI Conference & Expo. Drew has had the opportunity to attend, design, develop, improve and/or teach courses in the following areas: Rad, R&F, mammography, ultrasound, C-arm, CT, PACS and networking. His experience in these modalities spans across all major manufacturers including, but not limited to, GE, Siemens, Philips, Hologic and Toshiba. Prior to entering the industry, Drew spent more than eight years in the U.S. Navy where he achieved a rank of E-6. Two and a half of those years were spent teaching advanced electronics courses. The rest of his time in the Navy was spent sailing the seven seas!

SPECIAL ADVERTISING SECTION

SPOTLIGHT

NEWS & NOTES

Updates from the HTM Industry CMIA EDUCATIONAL CONFERENCE SUCCESSFUL

ANTHONY CORONADO

More than 100 people attended classes in Fresno at the California Medical Instrumentation Association (CMIA) Educational Conference held on January 29. Speakers presented five daylong training sessions on a range of topics, including HL-7, ESU testing, the Philips iU22 ultrasound, fundamentals of medical laser use and safety, and basics of networking. “CMIA is extremely grateful to the companies and instructors who provided these eight-hour classes,” according to the CMIA website. The companies and instructors included Conquest Imaging’ Jim Rickner, QRS Calibrations’ Dave Heiselt, GE Healthcare’s Kevin Jackson, William Avery and Gregory Absten. Several honors were also announced, including the CMIA Professional of the Year, awarded to Anthony Coronado. The Frank Yip Memorial Scholarship, which is given to those pursuing further education in biomedical or clinical engineering, was awarded this year to three

DATREND SYSTEMS LAUNCHES VPAD-RF Datrend Systems Inc. is pleased to announce the launch of their latest product, vPad-RF. vPad-RF, the smallest full-featured Electrosurgical Unit (ESU) Analyzer on the market, is designed to test all makes and models of ESUs including continuous and pulsed-wave systems. One of the unique features of vPad-RF is that it includes a built-in High Frequency Digital Oscilloscope and Spectrum Analyzer, allowing users to investigate complex waveforms using only one piece of test equipment. Ron Evans, President of Datrend Systems stated, “By utilizing state-of-the-art Digital Signal Processing techniques along with the computing power available on the Vision Pad Platform, we are able to offer functionality that is unique in our marketplace. Building the product on the vPad platform has also allowed us to provide the user with enhanced data recording, reporting and most importantly, integrated maintenance checklists which provide users step-by-step instructions for carrying out complex preventative maintenance procedures. As with our other products built on this platform, transferring test records to external data repositories can be done via Bluetooth, Wi-Fi or USB.” For more information on this and Datrend’s other products visit the company’s website www.datrend.com or contact them directly at 604-291-7747.

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recipients: Todd Robinson, Roman Matal and Daniel Bit-heydari. San Diego earned the CMIA Chapter of the Year Award. Lifetime memberships were bestowed on Kenneth Jackson, Mike Speer and Gus Sakis. The association also recognized a number of corporate members that have provided ongoing support to CMIA through sponsorships of chapter, regional and statewide gatherings. Companies receiving a recognition award included Conquest Imaging, Tenacore, Pronk Technologies, Replacement Parts Industries, USOC Bio-Medical, QRS Solutions, Pacific Medical, Welch Allyn and OMED. CMIA’s newly elected 2016 officers were also announced. They include Chairperson Jenn Nichols, Chairperson Pro Tem Beth Morrison, Secretary Rene Steinkellner and Treasurer Fred Yoffe. For additional information or to join CMIA, visit www.CMIA.org.

MERIDIAN BIOMEDICAL INC. ACQUIRES QUALITY MEDICAL RENTAL

RIGEL INTRODUCES VENTILATOR TESTER Rigel has extended its range of test instrumentation for biomedical equipment with the introduction of a ventilator tester. The Rigel VenTest 800 gas flow analyzer is ideal for bench top and field service testing of all commonly available ventilators to verify that the ongoing accuracy and reliability of the equipment remains within the required performance standards. Precise sensor technology enables the VenTest 800 to accurately measure flow, pressure, temperature, and O2 concentrations bidirectional and is compatible with 13 gas standards and 7 gas types. The three model range includes a standard VenTest 800 analyzer for use with all standard ventilators, including adult, neonatal, pediatric and high frequency equipment, as well as anesthesia machines and spirometers. In addition, specially adapted models for the testing of vacuum measurements (VenTest 810) and low flow pressures (VenTest 820) are also available. The VenTest 800 incorporates a simple, intuitive user interface and graphics display for ease of operation during testing and calibration settings. As well as an internal memory, at the push of a button, all measured values can be transferred to PC records by USB, RS-232 and optional Ethernet interfaces. Once saved, optional software is available that provides a wide range of graphical analysis capabilities, including real time flow/ pressure curves, functional zoom and certification documentation. The Rigel VenTest 800 is the latest addition to the company’s comprehensive range of dedicated biomedical test equipment that also includes electrical safety analyzers, vital signs simulators and performance analyzers. More details at www.seaward-groupusa.com.

Meridian Biomedical Inc. recently announced the acquisition of Quality Medical Rental (dba Quality Medical South). Meridian will continue to do business as Quality Medical. The founders of QMR, John McMahon and Don Perfetto, had built one of the largest biomedical service companies in the Southeast specializing in respiratory and infusion equipment. With an emphasis on speed, responsiveness and quality QMS became synonymous with best-in-class performance. “We wanted to find the right buyer who would not only do right by our employees but continue to invest and continue our long tradition of quality service,” the founders said in a press release. “After a long search for a suitable acquisition target, we were very impressed with the level of QMS’s customer satisfaction,” Meridian Biomedical CEO PK Bala. “Further due diligence revealed an impressive customer base and a team of managers, clinical and biomedical engineers and technicians with capabilities that were second to none in the industry.” With its roots in the high tech after-market industry, Meridian intends to develop QMS into a best-in-class service provider. “We want to be the most advanced biomedical service facility in the U.S.,” said Jim Worrell, SVP. Meridian will adopt 5S and Lean, as key pillars of the operations strategy with a state-of-the-art service floor management system that will enable ISO-9001 certification within 18 months. The company will also launch supply chain solutions to facilitate in-house pick up of medical equipment within a 1,000 mile radius of its service center in Largo, Florida. Customer interactions will be enhanced with the introduction of dedicated customer portals and e-commerce capabilities. While the company will keep its roots in respiratory and infusion, service capabilities will be expanded to include other major biomedical categories. The company also has a new website: www. QualityMedicalsouth.com.

INDUSTRY UPDATES

THE INNOVATION INSTITUTE ADDS TO PORTFOLIO TEXAS HOSPITAL WINS AWARD FOR ALARM MANAGEMENT INITIATIVE ECRI Institute recently announced Texas Children’s Hospital in Houston as the winner of its 10th annual Health Devices Achievement Award. The award recognizes an outstanding initiative undertaken by an ECRI Institute member health care institution that improves patient safety, reduces costs, or otherwise facilitates better strategic management of health technology. The winning submission, “Alarm Management Reboot,” describes Texas Children’s successful effort to improve patient safety by incorporating enterprise-wide alarm management practices to make alarms more meaningful and actionable. Spearheading the project, Texas Children’s alarm management steering team started with a baseline analysis of the current alarm management program. The team also laid out the Joint Commission’s National Patient Safety Goal into an action plan, which designated specific operations necessary to meet the phases of the patient safety goal. Ultimately, Texas Children’s partnered with an outside organization to develop an alarm dashboard – a system that allowed the team to collect and analyze alarm data by care area, by nurse, and by patient. Simple changes soon progressed into patient-specific alarm dashboards that helped the care team make decisions around alarm settings. “We realized that substantive changes were needed to shift focus from the number of alarms, to actionable information based on an analytic dashboard,” said John Weimert, director of biomedical engineering at Texas Children’s. “This project aligned people, technology, and governance to meet the common goal of improving patient safety.” “ECRI congratulates Texas Children’s for their winning submission. With the Joint Commission’s 2016 patient safety goal on the minds of hospital leaders, this project came at the perfect time. The team did an admirable job of revamping their alarm management program with an in-depth assessment of the environment at the patient’s bedside,” says ECRI Institute’s David Jamison, executive director, health technology evaluation and safety. “The actionable approach Texas Children’s took to stop alarm fatigue provides a good example for hospitals nationwide,” added Jamison. A formal award presentation will be made at Texas Children’s in spring 2016. Texas Children’s award-winning strategy will be featured in an upcoming article on ECRI Institute’s website. ECRI Institute also recognizes four additional organizations that were selected as finalists for the 10th annual Health Devices Achievement Award. The technology management initiatives described by these organizations (listed below in alphabetical order) likewise earned praise from the award selection committee: • Banner Health (Phoenix, Arizona): “How a Safe Surgery Program Can Reduce Serious Reportable Events and Assist Supply Chain Decision Making for RFID Technology” • Boston Medical Center (Boston): “Clinical Alarm Task Force” • Cooper University Health Care (Camden, New Jersey): “Partnership Between Supply Chain and Process Improvement: An Optimal Structure” • University of Pittsburgh Medical Center (Pittsburgh): “Medical Equipment Fleet Analysis: An Objective and Centralized Approach to Equipment Replacement”

For more information about ECRI Institute’s Health Devices Achievement Award or about becoming a member of ECRI Institute’s medical technology procurement and management programs, contact ECRI Institute at 610-825-6000, ext. 5891; visit www.ecri.org; email clientservices@ecri.org; or write to ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462.

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MultiMedical Systems (MMS), a California-based clinical engineering service company, was introduced recently as the Innovation Institute’s newest addition to its portfolio of health care service companies. “Choosing to join the The Innovation Institute was an easy decision for us,” said MMS President Daren Kneeland. “The wealth of knowledge and resources that come with being a part of the Innovation Institute portfolio will allow MMS to expand our service offerings more quickly and to a wider customer base nationally.” “We are looking forward to working with our new Innovation sister company TKA to provide specialty services which we are confident will complement the excellent service TKA is currently providing their customers,” Kneeland added. “We will continue our unwavering mission of providing the highest quality clinical engineering services available, and we are excited to see what the future will bring with this new union,” said Jeff Lagrutta, MMS Chief Operating Officer and Founder. “We welcome MultiMedical Systems to our family of health care service companies,” said Joe Randolph, President and CEO of the Innovation Institute. “Their expertise in health care technology resource management adds quality and value to our organization as a provider of the finest and most trusted health care services in the country. This is the 10th company for The Innovation Institute’s Enterprise Development Group. Other portfolio companies include Tech Knowledge Associates, Petra Integrated Construction Strategies, Healthcare Design & Construction, Far West Staffing Services, Healthcare Coding & Consulting Services, Healthcare Property Advisors, Total Health Environment, 360 Dynamic Technology Innovations Inc. and FutureSense.

FLUKE BIOMEDICAL ANNOUNCES THE QA-ES III ELECTROSURGICAL ANALYZER An electrosurgical unit (ESU) that does not function correctly can be hazardous, leading to ineffective cutting, cauterizing, or vessel sealing, burning a patient or physician, or even starting a fire. It is, therefore, important to verify the performance of electrosurgical units, and ensure they are operating as specified. The Fluke Biomedical QA-ES III Electrosurgical Analyzer tests all critical electrosurgical unit (ESU) functions, including precision power, current, frequency, crest factor, and load resistance. “For over a decade, the QA-ES II Electrosurgical Analyzer has been a trusted tool for biomedical technicians,” explains Eric Conley, General Manager for Fluke Biomedical. “Our new QA-ES III provides improved performance, wireless functionality, and is ready out-of-the-box with no need for additional cables, leads or

hardware. In addition, it is 5.5 pounds lighter than its predecessor, making it easier to carry from location to location.” The multi-purpose ports of the QA-ES III, coupled with its color-coded stacking leads, minimize the number of connections necessary to test and verify the performance and safety of ESUs. The QA-ES III also provides increased accuracy and range for measuring vessel sealing, contact quality monitor (CQM), high frequency (HF) leakage, and output power distribution in single or continuous mode. “The QA-ES III has industry leading performance and specifications for power, current, peak-to-peak voltage, and crest factor, making it an ideal electrosurgical analyzer for today’s modern high-power ESUs,” explains Shirin Khanna, QA-ES III Senior Marketing Manager. “It can

store up to 5,000 test records on-board that can be quickly and easily transferred to a PC via Bluetooth or USB.” The QA-ES III complies with the latest global industry standards for testing electrosurgical devices including ANSI/AAMI and IEC. It is easy to set-up and use with a large LCD screen and on-screen guides. It also features built-in automation for quick power distribution testing. An optional Ansur test

automation plug-in standardizes work, shortens overall test time and reduces error by automating preventative maintenance procedures with customized test templates and reports. The QA-ES III will be offered worldwide. Wireless capabilities will initially be available in the U.S., Canada, and Europe (except Russia), and roll-out to other countries, starting in early March 2016.

ALPHA SOURCE PUBLISHES ULTRASOUND SERVICE DATA ANALYSIS Alpha Source has announced the publication of a retroactive data study on the total cost of ownership of ultrasound imaging equipment. This study is based on the real-time experience of 673 ultrasound units in clinical use in U.S. hospitals and clinics. The report “Economic Value Analysis (EVA) on the Total Cost of Ownership of GE Healthcare LOGIQ 9 Ultrasound Imaging Equipment” is an evidencebased approach to considering the economic benefits and risks of comprehensive service contracts compared to billable hourly service and in-house biomed resources. The study tracks the service history of a large,

nationwide installed base of this specific type of ultrasound equipment over the three-year time period of 2010-2014. The equipment was serviced either by the OEM or Alpha Source, a service provider for certain types of ultrasound equipment. “We think it’s important for the HTM community to make informed decisions on the best methods of service and support for medical equipment, whether that involves the OEM, a qualified ISO, or in-house biomed resources.” states Don Smith, VP of Service for Alpha Source and a co-author of the study. The study shows that the range of service and parts expenditures from unit

to unit is wide. Although the average total annual spend across all units was $9,800 per year, the high end of the range is over five times the average. Furthermore, a significant number of hospitals (23 percent) will spend 50 percent more than the average cost of a contract and 10 percent will spend twice the average annual price of a service contract by purchasing hourly billable service (T&M) and parts. To receive a complimentary copy of this report, visit www.alphasource. com/EVA.

INDUSTRY UPDATES

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011

ECRI UPDATE

ECRI Institute Release C-Suite Watch List

hat does 2016 herald, given that 2015 was another big year in medical technology? A Hospira Symbiq™ infusion pump was hacked. Drug costs soared, not only for novel new drugs, but also for some generics, as meetings convened about high costs and value pricing. Google transformed into Alphabet and extended its reach into various healthcare technology initiatives, including new robotic surgery platforms with real-time imaging and other data, which may soon give the company that has cornered the market for almost 20 years some stiff competition. And hospitals were on the hook again for serious adverse events such as contaminated duodendoscopes and healthcare-acquired infections. New technology offers the promise of reducing organ transplant wait lists by improving the condition of lungs and hearts that are donated for transplantation and keeping them viable longer so they are acceptable for transplanting. New payment models put hospitals in the driver’s seat for the entire continuum of care for joint replacements starting in 2016. Hospital C-suite leaders must focus more than ever on creating higher value and excellent outcomes for lower costs. ECRI Institute’s annual Top 10 Hospital C-suite Watch List includes both technologies and critical technology use issues that should be on your radar. It covers topics that will affect workflow, clinical processes, patient outcomes, staffing models, and capital funding needs. The 2016 list examines 10 topics poised to affect care delivery, including: Mobile Stroke Units: Are They More Than a Concierge Ambulance Ride?

3. 32

Medical Device Cybersecurity: When Will Your Pacemaker Be Hacked? Wireless Wearable Sensors: Data Sense or Data Chaos? 1TECHNATION.COM

APRIL 2016

4. 5. 6. 7. 8. 9.

Miniature Leadless Pacemakers: Will Potential Benefits Make a Difference? Blue-violet LED Light Fixtures: Can the Flip of a Switch Help Prevent Healthcare-acquired Infections? New High-cost Cardiovascular Drugs: Will They Help Your Readmission Rates? Changing Landscape of Robotic Surgery: Is a Mainframe to Tablet-type Paradigm Change Coming? Spectral Computed Tomography: What’s the New Hype About? Injected Bioabsorbable Hydrogel (SpaceOAR): An End to Some Radiation Therapy Complications?

10.

Warm Donor Organ Perfusion Systems: Will They Ease the Organ Supply Shortage?

LET’S EXPLORE THE NO. 1 ISSUE ON THE WATCH LIST: MOBILE STROKE UNITS. A mobile stroke unit (MSU) is a new concept that uses specially outfitted ambulances and a special staff model, telemedicine, and equipment to enable

stroke diagnosis and prompt treatment at the patient’s location before transport to the hospital. The specially trained onboard team, in teleconsultation with a stroke neurologist, performs blood tests, takes computed tomography (CT) scans, and administers tissue plasminogen activator (tPA), if indicated, before a patient with stroke reaches the hospital. This could be an important change in care delivery because about 87 percent of strokes are ischemic and stroke is a leading cause of death. Patients with stroke have long been treated with tPA to protect the brain if they meet criteria for tPA’s narrow therapeutic window (3.0 to 4.5 hours after symptom onset). But most stroke victims do not present in time for tPA treatment in the emergency department (ED), and fewer than 7 percent of affected patients receive tPA.

THE FIRST STEP Four MSU programs are operating in the United States in urban areas, branching out to suburban areas. The first program started in May 2014 led by University of Texas Health Science Center in collaboration with Memorial Hermann-Texas Medical Center, CHI

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telemedicine communication. The Houston MSU program uses Google Glass worn by onboard personnel to transmit images while MSU staff keep their hands free to tend to the patient. Using telemedicine, remote stroke specialists can see and hear the patient, consult with fi rst responders, and view test results. If appropriate, tPA is initiated before transport, and infusion continues during the drive. Patients with confi rmed strokes are transported to a stroke center, while others may be transported to the closest ED. The receiving hospital then has the opportunity to activate its stroke response team.

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Stay tuned! In future issues of TechNation, we’ll take a deeper dive into more of the topics featured on ECRI Institute’s 2016 Top 10 Hospital C-Suite Watch List. This article is excerpted from ECRI Institute’s 2016 Top 10 Hospital C-Suite Watch List. The full report contains more guidance on mobile stroke units and other novel, new, or emerging technologies. To download the full report, visit www.ecri. org/2016watchlist. For more information on ECRI Institute’s evidence-based health technology assessment or consulting services, contact communications@ecri. org, or call (610) 825-6000, ext. 5889.

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INDUSTRY UPDATES

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St. Lukes’ Health, Houston Methodist, and Ben Taub hospitals. The UTHealth Mobile Stroke Unit operates in the greater Houston area seven days a week, 10 hours a day, every other week. Another program started in July 2014 at the Cleveland Clinic in partnership with MetroHealth Hospital and Cleveland Emergency Medical Services (Cleveland MSU program). It operates from 8 a.m. to 8 p.m. each day every other week within a limited area of Cleveland. The Cleveland Clinic may expand its program to Palm Beach County, where it has a comprehensive stroke center. In midOctober 2015, Mercy Health System launched its Mercy Life Flight Network MSU, which it staffs 24/7. The University of Colorado Health debuted its fi rst MSU mid-January 2016, integrating it with its Epic electronic health record. During the initial 10-week pilot period, the MSU will operate Monday through Friday, 8 a.m. to 8 p.m. in Aurora, Colorado, then split its time between Aurora and UCHealth Colorado Springs. These programs were modeled after programs in Germany at Charite University and the University Hospital of Saarland. An MSU program starts with an emergency response vehicle outfitted with appropriate staff, equipment, medicine, and on-scene and remote clinical personnel who communicate through telemedicine technology. The care team must have appropriate knowledge to recognize, distinguish, and treat different types of stroke where the mobile unit picks up the patient. Although MSUs focus primarily on ischemic stroke, they are also equipped to treat other types of stroke. MSU equipment includes a portable CT scanner, tPA with infusion lines, mobile blood lab, telemedicine equipment with broadband access, and other medical equipment commonly found in an ambulance. MSU staff models include a paramedic, EMS driver, critical care nurse, CT technologist, and vascular neurologist onboard or available through

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AAMI UPDATE

AAMI Promotes Proactive Approach to Healthcare Cybersecurity in Wake of Hospital Ransomware Attack

he stunning news that a California hospital paid ransom to regain control of its computer systems after a malware attack serves as a stark reminder that healthcare facilities need to take a focused and strategic approach to cybersecurity – and AAMI has the resources to help. In February, Hollywood Presbyterian Medical Center paid nearly $17,000 in ransom to take back access to its electronic records, including sensitive patient data, after a hacking attack that is now under investigation by the FBI. The network had been shut down for about a week, affecting everything from electronic health records to networked medical devices. “The malware locks systems by encrypting files and demanding ransom to obtain the decryption key,” the hospital’s chief executive, Allen Stefanek, said in a statement. “The quickest and most efficient way to restore our systems and administrative functions was to pay the ransom and obtain the decryption key. In the best interest of restoring normal operations, we did this.” Based on federal records, hundreds of cybersecurity breaches have been reported by healthcare institutions, including medical providers, insurers, and hospitals. This includes a Texas facility that went down for a week in early 2016 due to ransomware, and a Florida hospital that was the victim of a similar attack in September 2015. “The best approach to cybersecurity, for both healthcare delivery organizations and device manufacturers,

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APRIL 2016

is a proactive one,” said Mary Logan, president of AAMI. “What we’ve heard from security experts time and time again is that you can’t add on cybersecurity after the fact, you have to build it in – to devices, systems, and the culture of an organization. If you don’t invest in protecting your network up front, you will pay for it later.” AAMI has developed a number of resources to assist healthcare manufacturers and healthcare delivery organizations with identifying and mitigating cybersecurity issues: • Horizons – Cybersecurity in Healthcare: What You Need to Know. This issue of Horizons addresses issues fundamental to cybersecurity, reports on key trends, and offers insights on protecting medical devices and technology from cyberthreats. • ANSI/AAMI/IEC 80001-1.This national standard focuses on risk management for IT networks that incorporate medical devices. It defines responsibilities for medical device manufacturers, IT developers, and those engaged in installing, using, reconfiguring, maintaining, and decommissioning IT networks. • BI&T cover story – “Is Your Patient Data Secure?” This article addresses

cybersecurity threats hospitals face and highlights the role healthcare technology management professionals play in assessing risk and securing network architecture. • FAQs for the Wireless Challenge in Healthcare. This complimentary resource is intended to help healthcare technology, information technology, and facilities management professionals understand how to best use, manage, and secure wireless technologies in healthcare settings. All of the resources are available from the AAMI website, www.aami.org.

AAMI REPORT TAKES HARD LOOK AT MEDICAL DEVICE SUSTAINABILITY Suppliers, manufacturers, distributors, and other healthcare technology professionals all have a responsibility to reduce potential negative impacts on the environment when making decisions involving the development and use of medical devices, according to a technical information report (TIR) released by AAMI. The report does not try to define what sustainable practices look like for each group of stakeholders, but instead provides general guidance for how organizations can reduce their environmental footprint and be better global citizens when it comes to medical technology. The document, AAMI TIR65:2015, Sustainability of Medical Devices – Elements of a Responsible Product Life Cycle, is a first for AAMI in viewing healthcare technology through the prism of responsible environmental and social stewardship across the entire life cycle of a device.

“What we’ve heard from security experts time and time again is that you can’t add on cybersecurity after the fact, you have to build it in – to devices, systems, and the culture of an organization. If you don’t invest in protecting your network up front, you will pay for it later.” Environmental considerations relate to reducing waste and embracing “green” practices. Social considerations refer to fair labor and business practices. “TIR65 describes how the product life cycle can be designed so as to ensure medical devices ‘do no harm,” said Ramé Hemstreet, vice president of operations and chief sustainable resources officer for National Facilities Services of Kaiser Permanente and co-chair of AAMI’s Sustainability Committee, which authored the report. “It’s important to know that the device that may save your life isn’t unintentionally and unnecessarily contributing to the environmental and social factors that can be detrimental to human health.” The majority of the report focuses on environmental sustainability. According to the committee, although medical device manufacturers play the largest role in determining the environmental impact of their products, organizations that purchase and/or use those devices make choices that also can affect how they impact the environment. For manufacturers, environmental factors that should be taken into consideration include: • Product and packaging design • Raw material selection • Use of recycled materials • Manufacturing practices • Resource management, such as decisions related to energy use, air quality, and water • Distribution practices For users and purchasers, decisions that affect a device’s environmental impact include those relating to:

• The original selection and acquisition • Routine maintenance and repair • Medical gas usage • The question of single use versus reprocessing • Recycling, refurbishment, or donation “TIR65 should begin a dialogue as to how to best reduce the impact of manufacturing, packaging, shipping, utilizing, and disposing of medical devices,” Hemstreet said. “I hope the TIR helps raise the visibility of these considerations, and in some cases, even causes tangible actions to occur.” The report builds on the AAMI Sustainability Committee’s 2013 white paper, Elements of a Responsible Product Life Cycle, and reflects a collaborative effort involving device manufacturers, healthcare providers, professional organizations, and sustainability advocates. TIR65 can be ordered from the AAMI Store, www.aami.org/store.

HIGH SCHOOL STUDENTS SHINE IN AAMI ESSAY CONTEST ON HEALTHCARE TECHNOLOGY This past fall, AAMI challenged high school students from across the country to describe a healthcare technology of the future and how it would improve patient care. More than 250 essays were submitted, and three were selected as winners by members of AAMI’s Technology Management Council (TMC). When evaluating the ideas submitted by students, members of the TMC were not considering whether they might be products in development at leading manufacturers. Rather, TMC members

were assessing the creativity of the students. The TMC awarded top honors to Stanley Rozentsvit, a junior at Leon M. Goldstein High School for the Sciences in Brooklyn, New York. Rozentsvit’s prize-winning essay focused on a device that would help doctors diagnose illnesses such as cancer or coronary artery disease earlier by detecting biomarkers in the blood. “The key to detecting biomarkers at the beginning of a disease is a device that senses and distinguishes between blood protein levels transcutaneously, or through the skin. A system like this would eliminate the need for a patient to visit a doctor for a biomarker blood test because the device could be worn at all times, sensing protein elevations in vivo,” Rozentsvit wrote. Katie Karmin, a junior at North Shore Country Day School in Winnetka, Illinois, was selected as the second-place winner, and third place was awarded to Alicia M. McMahon, a junior at Tamalpais High School in Mill Valley, California. AAMI President Mary Logan commended all of those who participated. “Thank you to all of the students who submitted an essay for this contest, and congratulations to Stanley, Katie, and Alicia,” she said. “It is by encouraging young people to think about new ways to solve the problems we are facing in healthcare today that the future of medical technology will be built.” FOR MORE INFORMATION, please visit www.aami.org.

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BIOMED 101

What to know about Anesthesia machines By James Swandol, CBET

got my start in the biomedical field maintaining and repairing anesthesia machines right after graduating from college. With eight years of experience, I have worked on just about every make and model of anesthesia machine currently on the market throughout the United States. I have received training from all of the major anesthesia machine manufacturers. Over the past eight years, I have seen just about every type of malfunction. I know anesthesia machines inside and out and they are, still to this day, my favorite equipment to work on because they are what started my career in the biomedical field. FUNDAMENTALS OF ANESTHESIA To be successful with an anesthesia machine you must learn the fundamentals. The easiest way to begin is to start with the gas supplies. Today’s anesthesia machines use Oxygen (O2), Air, and Nitrogen Oxide (N2O). These gases are color coded for identification purposes. Understanding the color code for these three gases is extremely important. First thing you must learn are these three colors: Green for O2, Yellow for Air, and Blue for N20. These gases enter the anesthesia machine from pipeline supply or cylinder supply. Pipeline is the facility supplied gases and connect to the back of the anesthesia machine using a safety system called Diameter Index Safety System (DISS). DISS prevents the connection of the wrong type of gases making it impossible to connect N2O where the O2 is supposed to connect and likewise. Cylinders use a safety system called Pin Index Safety System (PISS). PISS works just like DISS in the manner that it prevents the operator from connecting the cylinders incorrectly on the anesthesia machine. Once the gases enter the anesthesia machine they go through a pressure regulator. Pipeline pressure from the facility is set at 50psi. The cylinder

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APRIL 2016

Hypoxia prevention device. Every manufacturer uses a different approach here so it is important to learn the terminology each manufacturer uses. For example, GE Healthcare uses the Link25 system where as Draeger uses a system called the SORC. Regardless of how the manufacturer goes about insuring this safety measure they all prevent O2 levels from dropping below 21 percent oxygen which can be fatal for the patient

JAMES SWANDOL, CBET

Baylor Scott & White McKinney

pressure varies based on the size of the cylinder and the type of gas. The regulator steps the pressure down to 25psi to prevent damage to the anesthesia unit. Gases are controlled on the front of the anesthesia machine with knobs that are labeled not only with gas name but also by the color code mentioned earlier. This part of the anesthesia machine is known as the gas blender. An important thing to know about the blender is the

ABSORBER The absorber of an anesthesia machine works like a circle, the fresh gas supply comes from the mixer and enters the absorber where it is routed to the patient through a disposable patient circuit with a wye connection. When the patient inspires the gas mixture is delivered to the patient’s lungs, then the patient’s exhaled gases enter the wye connection and go to the expiratory side of the absorber where it is routed to the soda lime. Soda lime is a material that scrubs the CO2 from the exhaled gases of the patient. Once the CO2 has been scrubbed the gases are routed to the Bellows or the breathing bag depending on which mode of operation is being used. Once the gases have reached this point they can be used again on the patient completing the circle. The soda

“There are too many steps during preventive maintenance to go off of memory. Keep in mind this machine is keeping the patient alive during surgery, cutting corners with anesthesia maintenance should never be done.” lime plays a very important role in this operation, the soda lime crystals will turn purple when they have absorbed all the CO2 they can hold. Once this happens, it is time to replace the soda lime. KEY TO SUCCESSFULLY COMPLETING PREVENTIVE MAINTENANCE The best advice I can give when completing preventive maintenance is to have your service manual with you. It doesn’t matter if it is a hard copy or a digital copy on a tablet just make sure to use it. There are too many steps during preventive maintenance to go off of memory. Keep in mind this machine is keeping the patient alive during surgery, cutting corners with anesthesia maintenance should never be done. One tip I have used for every anesthesia machine I’ve worked on is that; before I sign off that it is ready for cases I asked myself if I would want my kids or wife to use this anesthesia machine during a surgery. Use proper test equipment. Every service manual explains what test equipment is necessary to complete maintenance for a particular anesthesia unit. Let’s face it, test equipment is expensive and management will frown upon another expense, but using the proper test equipment is the only way to ensure that the unit is performing the way the manufacturer designed the unit to work. Last piece of advice, not all anesthesia machines are created equal. Different manufacturers have different approaches to how to ventilate a patient. Just because you have been trained on one model does not mean you can work on any anesthesia machine. Request to be manufacturer trained on your anesthesia machines. Take the time and study the manuals, learn your anesthesia machines. CONCLUSION I’ve spent the majority of my biomedical career working on anesthesia machines. I’ve learned that without the fundamentals it is difficult to completely understand how anesthesia machines are supposed to perform. Proper training is key. Do not attempt to work on an anesthesia machine without proper training; the patient’s life depends on it. Take your time, complete the maintenance properly and always in accordance with the manufacturer’s recommendations. Never skip steps and never sign off on a unit unless you feel comfortable with your loved ones using it during a surgery.

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SHOP TALK

Conversations from the TechNation ListServ Q

I work for a small critical access hospital. I am not able to justify buying expensive test equipment for one or two pieces of equipment. Does anyone know of a restriction that bars the creation of a co-op of sorts, providing a pool of test equipment that can be scheduled like a timeshare? The equipment would be cleaned and tested after returning from a member. A portion of the purchase, calibration, cleaning, and shipping of the equipment would be paid by members when they schedule use. An example would be a $4,000 piece of equipment would only need 20 uses ($200) to be paid off. Small hospitals would have access to great test equipment. The manufacturers would still sell the same amount of equipment because right now small hospitals are either testing using other methods or contracting with a third party to come in and test their equipment.

While it might work well financially, operationally it would be a nightmare to track the following: 1. Is test equipment available when you need it for a PM? 2. Is test equipment available when you actually need it for a STAT repair? 3. Shipping time to send test equipment from account to account. 4. Calibration costs? 5. Missing accessories, broken test equipment. The way I was able to justify purchasing test equipment was to compare what a PM would cost under agreement or T&M and calculate ROI if the test equipment is purchased. There have been times when it does not make sense to purchase test equipment for one or two devices. 42

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APRIL 2016

I think that it is an interesting idea. Finding out what can go wrong and setting up steps to prevent or minimize the problems would be important.

Renting certified test equipment is also an option for small jobs. I know we do some of this.

respiratory and they will track it down.

Service manuals usually recommend an inspection cycle of 12 months. Our policy also states that an O2 monitor be used with every blender, so if there are any issues Respiratory would know right away and pull it out of service. And again, overhaul every 24 months.

How are you maintaining O2 blenders and who (respiratory or biomed/CE) is responsible for coordination/completion of the maintenance? The blenders in our facility are tested every six months by biomed. Routine checks and calibrations such as the weekly user calibration to ambient and 100 percent O2 are performed by the users. Three of our blenders have a two-year factory calibration that the manufacturer does not offer training for, so those are returned for service every two years. The scheduling and coordination for all but the user tests and calibrations is handled by biomed.

I (Biomed) do annual preventive maintenance to make sure they perform and blend accurately. Every two years I send them off to be overhauled (right now, to Tenacore).

A A A

$350 from USOC, Biomed is responsible. In house, CE does maintenance.

Blenders are tested annualy and overhauled every two years (in-house). If we cannot locate a blender we notify

Wouldn’t it be nice if blenders had hour meters, like ventilators? Some blenders that get little or no use are still required to be sent out for overhaul every two years. My HP Sonos 5500 power cord caught on fire and now it won’t power up. I changed out the power supply but it is not powering up. Is there a fuse that I need to change? And, where can I locate it? Or, do I need to change the power cord and how do I do it?

I am fairly sure you need to change the power cord, and figure out what caused it to catch on fire. The on-off switch acts as the circuit breaker, so that may have shorted out. From there, the AC goes to the isolation transformer. Then, it goes to a Power Factor Corrector on the inside left rear corner of the system, which converts the AC input to 215V for the DC-DC converter. Once you get AC input, you should see the 215V LED is lit, on the bottom right of the DC-DC converter. These posts are from TechNation’s ListServ and MedWrench.com. Go to www.1TechNation.com/Listserv or www. MedWrench.com/?community.threads to find out how you can join and be part of the discussion.

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APRIL 2016

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Webinar

Wednesday

WEBINAR WEDNESDAY Experts Address Infant Incubator Testing, Cost of Contracts

Staff Reports

ebruary was a big month for free education via the Technation Webinar Wednesday series. In one TechNation Webinar Wednesday session, Fluke Biomedical’s Ashton Solecki provided an in-depth look at how to ensure proper performance of modern infant incubators and radiant warmers. It was a popular topic with more than 300 people attending the webinar. TechNation gave out prizes during the presentation. Greg Johnson of Southeastern Biomedical Inc. won a TechNation pullover given away during the live webinar. Al Hardy of Burton, Michigan, won lunch for his department via a social media post. Solecki, product marketing manager of the neonatal test product line at Fluke Biomedical, gave an excellent presentation. The interactive webinar included poll questions for attendees to help customize the session. She touched on the basics of incubators, including how incubators work and common terms, before diving deeper into the subject matter with a discussion outlining the importance of a uniform environment, testing standards, the reasons for standards and best practices. Solecki continued the webinar with an informative Q&A session to provide insights for attendees. Her vast knowledge was obvious as she was able to provide thoughtful solutions. The Q&A session was limited by time constraints, but Solecki said she would answer the questions she did not get to during the webinar via email. Her presentation was a hit with attendees. The webinar received positive reviews in a post-webinar survey.

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APRIL 2016

“I really enjoyed the speaker. She did a great job presenting. I like to tune into TechNation webinars as often as I can to learn more about the industry,” Brett S. wrote. “These webinars are an excellent way to stay connected to the current standards of testing. The webinars are always professional and relevant,” Matt H. wrote. “I enjoy the webinars. They help keep me and my staff current and actively thinking about our field and how our testing is important/relevant,” Robert B. wrote. Fluke Biomedical, a global provider of test and measurement equipment and services to the health care industry, sponsored the webinar. It serves biomedical engineers, quality-assurance technicians, medical physicists, oncologists, radiation safety professionals and is continually expanding its range of solutions to a broader range of health and safety professionals. Additional information is available at flukebiomedical.com. TechNation’s Webinar Wednesday series continued in February with industry veteran Pat Lynch’s presentation “Can Contracts Help Lower Total Cost

of Ownership?” The webinar was sponsored by Alpha Source. Lynch blended new information from the Alpha Source white paper “Economic Value Analysis (EVA) on the Total Cost of Ownership of GE Healthcare Logiq 9 Ultrasound Imaging Equipment” with data he has collected over his more than 40 years of work in the health care industry to address the cost of ownership. He covered a wide range of issues including service contracts, time and management agreements and in-house service plans. Lynch also discussed the financial risk associated with any purchase. The webinar concluded after an informative Q&A session. The webinar was popular with HTM professionals with 228 attendees who rated the presentation as a 4 on a 5-point scale with 5 being the best possible score. Attendees also left positive comments in their post-webinar surveys. “The information presented is current, relevant and provides technicians with an excellent source for meeting their continuing education requirements for a variety of training needs,” Luis M. wrote. “TechNation’s Webinar Wednesday is a great way to have my questions answered from leading experts in the field,” Jonathan T. wrote. “TechNation provides excellent webinars geared toward my job functions. I always get to learn new things, and discover different perspectives I had not considered before,” Chad J. wrote.

“TechNation provides excellent webinars geared toward my job functions. I always get to learn new things, and discover different perspectives I had not considered before.” - Chad J.

Two lucky attendees earned prizes. Barry Skelly of Greene Memorial Hospital in Ohio won a TechNation pullover for correctly identifying Chicago as the site for ICE 2016. Ruthie Matthews II of OSF St. Anthony’s Health Center in Illinois won lunch for the department by nominating an imaging service director for ICE18.

FOR ADDITIONAL INFORMATION about the TechNation Webinar Wednesday series, including recordings of previous presentations and a calendar of upcoming webinars, visit 1TechNation.com/webinars. TECHNATION WEBINAR WEDNESDAY would like to thank our February sponsors, Fluke Biomedical and Alpha Source.

join & connect with

Earn valuable CE Credits Recorded webinar and workbook available Learn from industry leading professionals Keep up with the industry’s latest technology All for FREE! Visit www.1TechNation.com/webinars to view the calendar for upcomming webinars!!

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APRIL 2016

ROUNDTABLE

Test Equipment for Imaging Devices

ealthcare technology management is the unsung hero of health care in the United States and around the world. These men and women keep medical devices in working order to a standard that ensures patient safety. Test equipment is a huge part of their job whether it be a repair or preventative maintenance. Test equipment for diagnostic imaging devices is just one category of important tools HTM professionals use to safeguard patients. TechNation reached out to a panel of experts to find out what to look for in imaging test equipment. Harkless: Since your test equipment represents a major investment that is critical to your business for a long time to come, one should look for a partner who is proven, stable, reliable and established. Consider the life cycle of the relationship including service, repair and calibration considerations that are critical to operating and maintaining test equipment over the long run. As diagnostic imaging continues to grow and evolve, the requirements of your test equipment may grow and will likely evolve as well. One should select test equipment from a line that is modular, interchangeable and extensible to meet changing needs.

The panel of experts includes Fluke Biomedical/RaySafe Product Sales Specialist Ed Brand, Tri-Imaging Solutions Vice President of Operations John Drew, Lynda Hammond from ATS Laboratories, Radcal Corp. President and CEO Curt Harkless and RTI Inc. Northeast Account Manager and Product Specialist John Larrier.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR WHEN PURCHASING TEST EQUIPMENT FOR DIAGNOSTIC IMAGING EQUIPMENT? Brand: When purchasing test equipment, ease-of-use is most important. It’s tempting to get distracted by a test device’s bells and whistles, but it’s difficult to obtain accurate results and increase productivity if you have to constantly re-learn how to use the device every time you need to test a piece of medical equipment. Drew: Most important is to determine what your need is. Then, look at equipment that will meet that need. Second, future expansion. There are many bells and whistles that can be added to the basic setup. You may not need them now, but you may want to add them later as you take on more modalities, etc.

ED BRAND

Product Sales Specialist, Fluke Biomedical/RaySafe

Hammond: Have a clear understanding of the ultrasound imaging system parameters you intend to evaluate. In particular, a key selection factor is the frequency range of the transducers to be tested and the type (linear, convex, endocavity and TEE).

Larrier: The most important things to look for are that the equipment meets the needs of the user, it’s ease of use, and the level of support and service provided. The user needs to consider what they need to accomplish with the equipment and will the purchase allow them to do so. Once they have considered that, they should consider how will using the equipment fit into their workflow and are they willing or able to adjust their workflow to use new equipment. The smartest physicist or biomed needs questions answered and quick access to support and service is key in deciding what equipment to purchase.

THE ROUNDTABLE

WHAT ARE SOME OF THE FUNDAMENTAL TEST EQUIPMENT CAPABILITIES HTM PROFESSIONALS NEED TO BE ABLE TO TEST AND MAINTAIN IMAGING EQUIPMENT?

information in one shot so that a test engineer can work efficiently. The equipment also needs to be paired with a robust software system to provide useful and accurate analysis of the information.

WHAT ARE SOME OF THE LATEST FEATURES OR CAPABILITIES DEPARTMENTS SHOULD LOOK FOR WHEN PURCHASING TEST EQUIPMENT FOR MEDICAL IMAGING DEVICES?

Brand: Test equipment needs to be able to accurately measure all pertinent parameters on each modality. PC connectivity is important, especially when used to generate reports. But in situations when time is of the essence, it is extremely useful to be able to view all measured parameters as well as waveforms without needing to connect the test equipment to a laptop or tablet. Drew: Generally speaking for maintenance just basic capabilities such as measuring kV, mA, dose, dose rate and using a multi-meter are sufficient. If performing more complex troubleshooting then using an Oâ&#x20AC;&#x2122;scope may be necessary. Hammond: Phantoms provide a means to monitor the performance of an ultrasound imaging system on a routine basis. The phantom provides test structures that evaluate an imaging systemâ&#x20AC;&#x2122;s dead zone, vertical and horizontal measurement calibrations, focal zone, sensitivity, functional resolution, axial-lateral resolution, gray scale, displayed dynamic range and image uniformity. In addition, Doppler flow phantoms used in combination with digital pumping and controller system provide a means to evaluate the velocity, sensitivity, penetration and direction of flow. Harkless: In X-ray imaging, the name of the game is getting good imagery with

1TECHNATION.COM

APRIL 2016

JOHN DREW

Vice President of Operations, Tri-Imaging Solutions

minimal dose which is why ensuring that the system is operating correctly is so important. In assessing the behavior of the system, the following are standard measurement quantities: dose, dose rate, kV, mA, filtration, pulse number and pulse duration. The ability to view and analyze waveforms of these quantities provides a much deeper understanding of the operation of the X-ray system, especially for the new dynamic mode switching systems. Specialized measurements such as beam width in CT systems can also be important and streamlined accessories and techniques exist to perform these measurements. Larrier: A critical capability for test equipment is that it can measure low doses accurately and do so in a reproducible manner. Equipment needs to be able to produce multi-parameter

Brand: Departments should look for test equipment that is designed to be adaptable to ever-changing measurement needs. For example, manufacturers of mammography machines are constantly introducing new target/filter combinations. New test equipment should be able to measure all commercially available machines as well as be adaptable to new ones that will soon become commercially available. Hammond: The ATS Model 570 Endoscopic-Multipurpose phantom has the ability to accommodate linear, convex, endocavity and TEE probes without exposing the transducer to potential damage from bending of the cables. Harkless: With the advent of low-cost computer tablets, measurement systems providing two-line text displays are being displaced by those that integrate large, easy to read displays. These displays run sophisticated applications that automatically record and display all measurement details including time and date stamp, detailed measurement data, waveforms, serial numbers of equipment used and calibration date. All of this information can be immediately saved in

standard formats for later review or archiving. Since these displays are essentially tablet computers, all of the connectivity features such as Internet communication, e-mailing of reports, and remote printing of results are now accessible to the user. Larrier: New test equipment should be able to provide data in a wireless communication mode. Low-dose sensitivity is essential in testing today’s mammography and dental equipment effectively and accurately every time. Additionally, detector design and layout as well as the ability to upgrade hardware and expand calibrations and beam qualities so the equipment can be used in the ever-changing landscape of medical imaging devices is a must.

HOW CAN HEALTH CARE FACILITIES MAKE SURE THEY ARE PURCHASING QUALITY TESTING EQUIPMENT FOR THEIR MEDICAL IMAGING DEVICES? Brand: Pay attention to what the OEMs’ service engineers are using. Ask them what they like and dislike about their test equipment. If you’re able, also ask your medical physicist the same questions. Most importantly, get a demonstration, or, better yet, ask for an extended evaluation. Drew: There are a few common manufacturers out there that most of us use. Their equipment is all good and pretty much does the same measurements with some variation (they may argue this point). I recommend asking around to find out what your colleagues are using. Demo it for some

communications, and analysis software is also critical. Larrier: Health care facilities should actively engage the vendor in proving the quality of their equipment. An onsite demo of the equipment should be arranged and, if necessary, further independent testing by a qualified staff person should be conducted to verify the quality of the equipment. A facility should also inquire about quality with other users of the equipment. A check with OEMs might also be helpful to find out what their field service personnel use. Finally, facilities should make sure that the equipment is certified by an approved standards organization.

JOHN LARRIER

Northeast Account Manager and Product Specialist, RTI Inc.

IS IT IMPORTANT TO HAVE A TESTING DEVICE WITH A WAVEFORM DISPLAY? WHY OR WHY NOT?

time to get familiar with it before making your choice. Hammond: Seek opinions from colleagues in the field. Review the warranty policy. Call the manufacturer – Are they able to answer your questions and concerns? Harkless: Experience, stability and commitment to the X-ray system quality assurance mission result in quality instruments. For instance, Radcal has been committed to the industry, designing and manufacturing instruments in the U.S. for over 40 years. Many of the company’s original products, the 1015, remain in productive use to this day. That said, the industry continues to grow and evolve so innovation in the area of sensors, touchscreen displays, wireless

Brand: Yes! Absolutely! Waveforms give context to the numbers and they can help you diagnose tube or generator issues. Drew: Yes, waveforms can be very helpful for troubleshooting. When performing PMs I recommend saving all the test data to a laptop. It will allow you to compare to other PMs, make reporting easier and use as a tool for troubleshooting now or in the future. Harkless: The ability to view the waveform provides a depth of understanding with regard to the operating state of the imaging system unmatched by point measurements. New innovations provide ever improving imaging capabilities with reduced effective radiation dose. These

THE ROUNDTABLE

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING TEST EQUIPMENT? Brand: As with most anything, you get what you pay for. If you do your homework and consider the payback you’ll realize in the form of increased productivity, you’ll be happy with your investment. Also, purchase test equipment that is “future proof.” This will help you prolong your equipment’s useable life as technology advances.

LYNDA HAMMOND

ATS Laboratories

improvements come with added complexity that requires waveform display and analysis to effectively assess. Waveform analysis can seem daunting, but with the right equipment and software this analysis can be achieved with ease (and without the need for special equipment or scopes as in the past). Larrier: Yes. A numeric read-out provides the quick results of a test or measurement. However, the waveform can show the “how” and perhaps “why” that result (the digital read-out) was given. The waveform provides the user an extra layer of information, especially if there is a question about the outcome of the test, by giving the user the option to inspect the measurement in greater detail.

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APRIL 2016

Drew: You will find many pieces of test equipment will fit your need. I feel that finding one that has ease of use, expandability, meets your size requirements, etc. takes a little time. Don’t be afraid to ask for a demo and then work with it in your operating space for some time to determine if it really works for you. It is an expensive decision and will be with you for years to come. Hammond: If you don’t understand anything about the equipment you are purchasing continue to ask questions and seek information until you are comfortable. Harkless: Time is money when performing quality assurance on high usage systems. It is worth thinking through the QA process in its entirety including setup, measurement, analysis, reporting and archiving of the results. Look for systems that provide hands-off automatic ranging, direct data readout, and avoid the need for applying manual corrections. Systems that provide the

CURT HARKLESS

President and CEO, Radcal Corporation

ability to generate forms tailored for a user’s individual needs that are completed automatically in the course of a measurement can dramatically reduce the timeline and effort associated with the measurement process. Forms in standard applications such as Excel facilitate archiving and subsequent retrieval in the future. Larrier: Price, of course, is a major consideration. However, all of the considerations noted above – accuracy, dependability, dataflow – should be considered first. If the equipment meets the needs of the facility’s staff, then price should be the final consideration. The work being done is important enough that the facility should ensure that it is getting the best equipment.

THE ROUNDTABLE

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ECRI’S LIST OF TECH HAZARDS

BY K. RICHARD DOUGLAS

1TECHNATION.COM

APRIL 2016

GOING STAYMOBILE ALERT

C MARK WAKEFIELD CBET, director/account manager, Physical Asset Services-Clinical Engineering at Littleton, Parker, and Castle Rock Adventist Hospitals

1TECHNATION.COM

APRIL 2016

onventional cleaning of these endoscopes proved to be insufficient to remove all bacteria. This problem leads ECRI Institute’s list of the “Top 10 Health Technology Hazards for 2016.” ECRI points out that ﬂexible endoscopes, and duodenoscopes in particular, are constructed in such a way that makes thorough cleaning difficult. The proper reprocessing of these scopes is critical to the well-being of patients. Biologic debris must be removed prior to sterilization or disinfection. The need for this precleaning step is just one area of concern identified by ECRI Institute in this year’s list. ECRI Institute’s Health Devices Groups says that the list “identifies the potential sources of danger that we believe warrant the greatest attention for the coming year.” ECRI points out that the list does not necessarily reflect the most frequently reported problems, or those with the most severe consequences, but instead those issues demanding the most immediate attention. Besides the concerns about flexible endoscopes, the list also includes: • Missed Alarms Can Have Fatal Consequences • Failure to Effectively Monitor Postoperative Patients for Opioid-Induced Respiratory Depression Can Lead to Brain Injury or Death • Inadequate Surveillance of Monitored Patients in a Telemetry Setting, May Put Patients at Risk • Insufficient Training of Clinicians on Operating Room Technologies Puts Patients at Increased Risk of Harm • Errors Arise When HIT Configurations and Facility Workflow Do Not Support Each Other • Unsafe Injection Practices Expose Patients to Infectious Agents • Gamma Camera Mechanical Failures Can Lead to Serious Injury or Death • Failure to Appropriately Operate

Intensive Care Ventilators Can Result in Preventable Ventilator-Induced Lung Injuries • Misuse of USB Ports Can Cause Medical Devices to Malfunction The ECRI Institute considers several criteria when forming its list. Those criteria include severity, frequency, breadth, insidiousness, profile (is it publicly known) and preventability. Nominations for the list come from ECRI Institute’s own engineers, scientists, clinicians and other patient safety analysts. These experts base part of their nominations from investigating incidents, testing medical devices, speaking with other health care professionals, observing operations, assessing hospital practices and reviewing the literature, according to ECRI. There should be a preventable element to any item that makes it on the list. ECRI also says that the absence of a topic from a previous year should not be perceived as any indication that it is a hazard that no longer deserves attention. Of the 10 issues identified by ECRI, there are several which directly require some intervention from the HTM department. Addressing some problems may require outside help.

ECRI’S LIST OF TECH HAZARDS

It may require a joint effort between HTM professionals and their IT colleagues, according to Mark Wakefield, CBET, director/account manager, Physical Asset Services-Clinical Engineering at Littleton, Parker, and Castle Rock Adventist Hospitals in the Denver, Colorado area for Catholic Health Initiatives/ Centura Health. “Some of the most obvious resources for addressing these concerns are the hospital IT and biomed/clinical engineering departments. If the concerns and steps listed previously are going to be addressed and utilized, these two departments are going to need a good working relationship,” he says. “Unfortunately, it is not uncommon to find an inherent divide between these two groups of highly trained and intelligent individuals. If this is the case, a possible solution is to create a team of dedicated individuals that work as a liaison between these groups, i.e. an independent CE/IT department that does not retain 100 percent responsibility for either career field,” Wakefield explains. “This group endeavors to translate IT’s and CE’s actions and responsibilities in terms that can be better understood for both parties, while maintaining a workflow of mutual benefit. In my current hospital system, this has been done successfully and has helped bridge the gap in communication,” he adds. Other sources that should be considered are OEMs and third-party vendors as well as staff from other hospitals. Vendors are a good resource for reviewing not only their hardware and software, but in providing application and workflow reviews and equipment utilization. Third-party vendors can often provide a non-biased review of the same information. In larger hospital systems, utilizing the work and successes of each other’s hospitals, can help reduce the “silo” effect of working alone and/or re-creating the wheel. Working together also helps create standardiza-

tion which so often appears to be lacking in health care. ECRI Institute’s Health Devices Group says that the purpose of the annual list encompasses several concerns and recommendations. They say that the list is intended to help HTM professionals in several ways “The list is intended to help HTM professionals’ patient safety priorities. The list highlights the healthcare technology safety topics that we believe warrant attention for the coming year (since we publish the list at the end of the preceding year),” according to the ECRI Institute’s Health Devices Group. “While not all hazards on the list will apply at all health care facilities, the list can provide a starting point for patient safety discussions.” In order to address these risks, ECRI suggests that HTM professionals develop action plans to help reduce the risks. “The complete report describes the problem, provides practical recommendations for action, and lists sources of additional information or guidance,” according to the ECRI Institute. ECRI Institute’s Health Devices Group says the list draws widespread attention to these important safety issues, which can help HTM professionals obtain the resources needed to address the hazards for the betterment of patient care.

FLEXIBLE SCOPES From dirty endoscopes to the misuse of USB ports and HIT configuration concerns, there are several hazards for patients and staff that can be remedied through the efforts of the HTM professional. The worst problem areas on flexible scopes tends to be the scope’s channels and the elevator mechanism. “Most types of endoscopes can be reprocessed effectively provided that staff carefully adhere to the vendor recommended reprocessing protocol,” the ECRI Institute says.

Some of the most obvious resources for addressing these concerns are the hospital IT and biomed/ clinical engineering departments. If the concerns and steps listed previously are going to be addressed and utilized, these two departments are going to need a good working relationship.”

“Often, reprocessing failures can be traced to some breach of that process – for example, if staff skip or do not adequately perform a manual step in the reprocessing protocol or fail to account for the impact of changes made in the supplies used,” the ECRI Institute adds. ECRI points out that under current recommendations, some scopes are still not being effectively disinfected. “However, for some types of endoscopes – duodenoscopes in particular – concerns exist that the devices cannot be reliably cleaned even when the recommended protocol has been followed,” according to the ECRI Institute. “Industry, regulatory bodies, and the research community have been grappling with this

GOING STAYMOBILE ALERT

issue since it was discovered that disinfection was sometimes failing even when manufacturer instructions were being diligently followed.” The ECRI Institute recommends periodic culturing of duodenoscopes as a way to monitor for colonization with infectious agents. Its recommendations and associated resources are available on the “CRE and Duodenoscope Resource Center” webpage at www.ecri.org/cre.”

HTM’S RESPONSE Wakefield says that of the items on the 2016 list, USB ports and HIT configuration are the two areas where his CE group is leading the way. “We are working with IT/IS, but have been independently developing data security scripts for updating and managing the data security settings for medical devices,” he says. “The automatic script makes it easier and more time efficient to upload data security patches from the Operating System (OS) providers as well as from the equipment manufacturers. This has created a more systematic and standardized approach across my current hospital system.” There’s no doubt that more than a few HTM professionals have lamented their concerns about user errors and the ability of clinicians to understand the operation of a device. ECRI Institute includes insufficient training of clinicians on operating room technologies on its list of hazards. They say that approximately 70 percent of “accidents involving medical devices can be attributed to user error or the technique of use.” “HTM professionals are being challenged by leaders in their field to become more involved and play a larger role in educating and training users on new technologies used in the operating room and elsewhere in the hospital,” according to the ECRI Institute. George Mills, Director of the Department of Engineering at the Joint Commis-

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sion, reinforced this point while referring to topic No. 5 on ECRI Institute’s 2016 list in a February 11 webinar broadcast to the clinical engineering community. “HTM professionals should not accept ‘Sure, I know how to use that’ from a clinician when they are first using new equipment. Rather, they should be proactive about demonstrating to clinicians the tricks they picked up during training, demonstrating newer features or aspects of use as a way to communicate the value of training and to assess whether additional training is needed,” according to the ECRI Institute. This extends to acquisition. If the HTM professional is involved in the process from the start, they can “inform purchasers and clinicians of the potential roadblocks that they see and provide input about the training requirements that would be needed to avoid those roadblocks,” according to the ECRI Institute. HTM professionals are often the ones directly receiving the complaints from OR clinicians. The HTM staff know which features are being used, which ones are causing difficulty and the ones that may require additional training. “It wouldn’t be an unusual circumstance for a facility to purchase a technology because it offers an advanced feature, only to find that the device or feature is not being used because clinicians have not been properly trained on its use and are uncomfortable with it. One consequence in that scenario is that HTM professionals would need to service both old and new technologies,” according to the ECRI Institute. HTM professionals also can provide input about factors that would make their own support efforts easier for instance, purchasing an anesthesia machine that requires two to three hours of annual maintenance as opposed to a device with similar performance that requires eight hours of downtime twice a year, according to the ECRI Institute.

ECRI’S LIST OF TECH HAZARDS

Wakefield agrees, the HTM department can influence these issues at the point of purchase. “One way that HTM departments can be proactive in regards to these issues is to be plugged into the capital equipment purchasing process,” Wakefield explains. “For example, in the aforementioned CE/IT group, all medical equipment must be reviewed and vetted out before final approval for purchase can be obtained. The process includes reviewing manufacturer literature, MDS2 sheets, and DICOM conformance statements to see if the equipment is compatible with the IT network.” “If the equipment fails to meet any of the established criteria, it will not be approved for purchase or use. This review process, along with CE’s review, has helped our hospital system standardize on equipment, which in turn has helped obtain bulk purchase pricing on equipment, due to standardization, as well as minimize capital expenditures on equipment that cannot be used,” Wakefield says. HIT configurations were identified in this year’s list. Conflicts with facility workflows are the issue. Wakefield says there are steps that can be taken to help mitigate this problem. “There are several steps that may be taken to help move down the path of minimizing, if not resolving, possible configuration versus user workflow errors,” he says. “These steps may include, but not be limited to: Review any past incidents where errors have been made due to the incompatibility between HIT configurations and facility workflow. This may be completed by reviewing your local incident reporting system. Were there lessons learned that need to be followed up on and or implemented?” Wakefield also says to identify equipment and interfaces where the greatest risk of error may occur. Patient monitoring, radiology modalities, PACS systems, and drug or prescription processing systems

are all examples of a good place to start. “Work one-on-one with clinical users of equipment to ensure that proper workflows are identified and are compatible with the equipment and their interfaces with HIT. What departments have the highest risk of error? Intensive care units and the chaotic workflow of emergency rooms, operating rooms or imaging departments with the potential of overdosing patients are also good examples,” he explains. “All are important areas but which area takes the priority?” “Work with HIT departments to evaluate clinical workflows and data requirements to identify how systems may or may not be tailored to work cohesively with each other,” he adds. “Are the technologies or software being utilized by IT and the hospital compatible with, and configurable to, the clinical workflow?” He suggests involving key stakeholders from all areas so that complete buy-in to the processes and resolutions may be obtained. This does not imply there will always be 100 percent agreement, but instead, can a consensus be reached so that everyone can move forward together with a plan of action. ECRI Institute agrees that the need for cooperation between HTM and IT is important. “For instance, HIT systems are highly configurable and must be tailored to meet a facility’s individual care practices at a care area or unit level,” according to the ECRI Institute. “More than just familiarity with the care practices and workflow, this requires knowledge of the capabilities of the HIT system itself, the available infrastructure to support the system, the other devices and systems in use, and a host of other considerations,” according to the ECRI Institute. “Thus, optimal configuration of an HIT system will require collaboration among clinicians, the facility’s IT department, HTM professionals, and the HIT vendor.”

They say that approximately 70 percent of accidents involving medical devices can be attributed to user error or the technique of use.”

MISSED ALARMSAlarm fatigue from false alarms plays into another hazard on the list. Missed alarms can end in a fatality. The over-activation of alarms has been a central focus within health care in recent years. But, as ECRI points out, alarm fatigue is only part of the current concern. “Alarm fatigue is a key aspect of the problem – and one that gets a lot of attention – but it is not the only factor that needs to be considered. Efforts to address alarm fatigue typically help prevent missed alarms by stripping away the noise – literally and figuratively,” ECRI points out. “They reduce the number of alarms that sound for clinically insignificant conditions so that care providers are

GOING STAYMOBILE ALERT

ECRI’S LIST OF TECH HAZARDS

more likely to notice, and be available to respond to, the conditions that truly require attention. Such efforts are a necessary step toward improving how clinical alarms are managed, but on their own are not sufficient to prevent all missed alarms,” according to ECRI Institute’s Health Devices Group. ECRI says that health care facilities also need to consider “will an alarm activate when warranted (e.g., can the medical device reliably detect a particular patient condition, and has the device been set up properly)? Will the alarm signal be reliably communicated to a person who can respond? Does that person know how to respond appropriately?” What is the role of the HTM professional as it relates to this issue? ECRI points out that at many hospitals, HTM professionals have played very active roles in alarm improvement programs. Activities where the HTM department has been instrumental in finding a solution to this issue include obtaining and analyzing alarm data, assessing alarm notification technologies and processes and training staff on the proper use of medical devices and communications technologies.

GAMMA CAMERAS Mechanical failures in gamma cameras can lead to injury or death, as the list of hazards points out. ECRI Institute adds that a technician should never leave a patient unattended in a scan room. Staff should always be present to respond to a potential emergency. The ECRI Institute also highlights the importance of having an effective program in place to manage and promptly respond to safety-related recalls. For complex technologies like gamma camera systems, even seemingly minor notices could have significant safety implications.

1TECHNATION.COM

APRIL 2016

Recall notifications do not always fully describe all the problems that are addressed by the prescribed corrective actions. Also, because gamma cameras include very complex electromechanical systems, users may not recognize that actions specified in the recall are intended to prevent a mechanical failure.

USB PORTS Rounding out some of the areas where HTM professionals can have a direct impact on the ECRI list of hazards is with the inappropriate use of USB ports. ECRI Institute has this advice: “Make sure hospital staff understand the intended purpose of USB ports on medical devices. And as a corollary, make sure they know what uses are inappropriate. For particularly sensitive equipment, consider the use of USB locks,” according to the ECRI Institute. ECRI also suggests the widespread use of mobile technology can be a factor. “Since we know that hospital staff, visitors, and sometimes patients have personal devices they want to keep charged – and that phones have been known to cause problems with medical devices – provide safe charging options, where possible,” according to the ECRI Institute. Practical steps to address these concerns, based on solid information and insights, can place the HTM department in a position to safeguard patients and staff. The thought that goes into ECRI Institute’s list, along with actionable steps to address these concerns, will create a safer health care environment and make the best use of the expertise available from every biomed.

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Questions to Consider for Your Job Interview By Cindy Stephens

ou made it to the face-to-face interview and everything seems to be going great. Then, the hiring manager asks, “Do you have any questions for me?” All of sudden your mind goes blank. Most of us have been in that situation and how you respond can make a difference in the hiring decision.

Cindy Stephens Stephens International Recruiting, Inc.

1TECHNATION.COM

APRIL 2016

First, it’s important to remember that interviews are an exchange of information. The job interview is not only for the hiring official to determine if you are the perfect person for the job. It is also a critical time for you to gather the right information to make an intelligent decision. You should be prepared with questions that show your sincere interest in the company and the position. This will help determine if the job is a good fit for you. Prior to the interview, you should research the company and the job requirements. It is important to think ahead. Asking the hiring official questions shows your interest in the job and the company as a whole. Here are some questions you may want to consider: • Prepare questions about the specific job duties and responsibilities to clarify the job description you reviewed prior to your interview. Also, ask who will be your direct supervisor (Director of Healthcare Technology Management, Shop Supervisor, Regional Manager). • After researching the company, develop well-crafted, probing questions. If you have an opportunity to interview with a peer, ask them “What did you do yesterday?” This may tell you more about that person, the job and the company culture than what you will get from the person describing the job to you.

• During the interview, consider asking your interviewer to describe the company philosophy and values to determine whether you are a good fit with the company’s culture. This is when you show your interviewer how much you truly know about the company. Whether the interview is in-person or Skype, you should seek to determine if the company culture will be a good fit for you. Remember, you should enjoy your job, which means fitting into the company culture as well as being able to perform job functions. • Inquire about the history of the position. It’s important to understand why the position is now available. You may want to ask the reason the position is open and how long it has been vacant. You might inquire as to why the previous person left the position. If they want to share the answer to your question, you can very quickly tell from their answer if this is a company that advances its people (person was promoted) or if there is an issue with expectations or internal differences. Either way it opens the door for further discussion. • Ask about the biomedical or service department’s strengths and weaknesses. Interviewees’ rarely ask this question, however, it will allow you to better understand the current dynamics of your potential colleagues, as well as

give you the opportunity to elaborate on how you can complement their strengths. For example, if one of the BMETs is known for seeing the big-picture, you can complement this with your attention to detail. • Ask about the accomplishments of the previous employee; this may provide you with some insight as to expectations. Ask about the goals of the position and the department. • Determine what the hiring manager wants you to accomplish. If you are really interested in the position, and you want the job, then be sure and ask, “What is it you want me to get accomplished in the first six months – first year – in the position?” That will get their attention very quickly and shows the interviewer that you are an individual that plans for the long term. • Also, ask the interviewer about their professional background. Some interviewers love the opportunity to talk about their career. These questions show you’re interested in the job, as well as the company and the interviewer. • Before the close of the interview, ask the hiring manager to explain the selection process and ask when you can expect to hear back from the company. Also be prepared to respond to specific questions about your resume including gaps in employment, reasons for leaving, etc. However, be sure to never speak negatively about any prior employer, supervisor or company. Never stretch the truth, either, about possible discrepancies or vagueness in your responsibilities or salary. • Make sure to have a good reason for any short-term position listed on your resume. Good reasons typically include things like “offered a better position,” “no room for advancement,” “company/facility closing,” or “company layoff.” • Indicate involuntary job changes. Not all job changes are viewed negatively. If your position changed as a result of a merger or acquisition or you are a contract worker, explain it on your resume. • Ensure you explain all periods of unemployment and describe what you were doing during your unemployment (i.e., volunteer at a community school, hospital, etc. or taking classes or continuing education to improve your skills.) • Responsibilities and duties should be expanded on. Highlight your experience and expertise that fits the position you are considering. Remember that it is up to you to convey enthusiasm, confidence, energy, motivation and technical skills during your interview. The interview is also your opportunity to exhibit excellent communication skills. Don’t get caught with a blank stare when you are asked if you have any questions during an interview. Be prepared with questions for the hiring manager that shows your sincere interest in the company and the position. Remember to gather a lot of information so you can discover if this is a good fit for you as well as the company!

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