TechNation - September 2016 by MD Publishing

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Vol. 7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

SEPTEMBER 2016

MAPPING YOUR HTM NETWORK Adding IT To Your Toolbox

14 Professional of the Month

Jennifer Jackson

33 News and Notes

Industry Updates

42 Shop Talk

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to the need for better collaboration between HTM and IT services.”

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

ROUNDTABLE: IV PUMPS TechNation interviewed industry experts regarding infusion pumps to find out important features to consider when purchasing new devices. The panel of experts also shares tips and insights regarding I.V. pumps. Next month’s Roundtable article: Anesthesia

ADDING IT TO YOUR TOOLBOX New technology has found its way into hospitals and other medical facilities as much as anywhere else in the modern world. The steady creep of technology has altered the dynamics of the HTM professional’s role, moving into networking, cybersecurity, databases, informatics and data analysis. The roles of many HTM professionals are evolving and now often benefit from a solid relationship with IT. Next month’s Feature article: Medical Device Security

TechNation (Vol. 7, Issue #9) September 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.

SEPTEMBER 2016

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INSIDE PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Chandin Kinkade

ART DEPARTMENT

Jonathan Riley Jessica Laurain Kara Pelley

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas John Noblitt Todd Rogers Manny Roman David Scott Cindy Stephens Karen Waninger Steven Yelton Alan Moretti Jeff Kabachinski

WEB DEPARTMENT

Adam Pickney Taylor Martin Cindy Galindo

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

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Proud supporters of

SEPTEMBER 2016

Departments P.12 SPOTLIGHT p.12 p.14 p.18 p.21 p.22 p.24 p.28

Company Showcase: ProbeHunters Professional of the Month: Jennifer Jackson ICE 2016 Conference Review Letter to the Editor Department of the Month: Eskenazi Health Biomedical Engineering Department Biomed Adventures: An HTM Pro Gives Back Company Showcase: Tenacore Holdings Inc.

P.33 INDUSTRY UPDATES p.33 p.36 p.38

News and Notes: Updates from the HTM Industry ECRI Institute Update AAMI Update

P.42 THE BENCH p.42 p.44 p.47 p.48

Shop Talk Biomed 101 Tools of the Trade Webinar Wednesday

P.66 EXPERT ADVICE p.66 p.68 p.70 p.72 p.74

Career Center Ultrasound Tech Expert Sponsored by Conquest Imaging Thought Leader Roman Review Tech Savvy

P.76 BREAKROOM p.75 p.76 p.78 p.79 p.82

Did You Know? Medwrench Bulletin Board The Vault Index Parting Shot

Like us on Facebook, www.facebook.com/TechNationMag

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COMPANY SHOWCASE PROBEHUNTER

ogether, Ann-Christiné and Björn Segall run the Swedish company BBS Medical AB. They have a worldwide market for their ultrasound probe test system – ProbeHunter.

“I have been in the ultrasound business for more than 30 years, I started as a service technician in the early 1980s. My background at that time was as a TV repair service man, and I did my military service in the Marines where I learned how to use radar. There are a lot of similarities between radar and ultrasound,” says Björn. “I started at Kontron with service on ultrasound and quickly ended up in sales. At this point in time, ultrasound was a new diagnostic method and you had to convince the users to use it. I had the opportunity to work with the best scientific people in Norway. Together with a friend I developed an interface and a solution for CW Doppler and that was my way to the position as European Manager at

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Vingmed (now GE). In 1986, I started the company BBS Medical AB. The business was sold to GE in 1999.” Björn and Ann-Christine met in 1983, when Ann-Christine was working in public relations at one of Sweden’s leading newspapers. OEM ULTRASOUND PROBE CHALLENGES In 2002, BBS Medical AB was offered the opportunity to take on an ultrasound test system: First Call. From that point in time, Ann-Christiné and Björn decided to work together. In the beginning, the biomedical engineers were very reluctant. “You can’t see the problem, that’s the problem, you need a tester – we told them,” Björn says. “We had all the OEMs against us.” “Finally, we got a region in Sweden to test through their inventory of probes. They had 100 systems and approximately 400 probes on service contracts. We found that 40 percent of the probes where defective,” Björn explains. “And the hospitals cancelled all service contracts and the OEMs lost substantial revenue.”

SEPTEMBER 2016

The company BBS Medical AB came away with a proven solution and more hospitals in Scandinavia wanted to test probes and buy their own testing systems. From 2008 to 2010, The Royal Institute of Technology in Stockholm (KTH) wanted to use the company’s database for study purposes. The studies confirmed the results that BBS Medical had after its initial testings: 35-40 percent of nontested hospital probes had defects and there were confirmed incidents on patients due to faulty probes. In Scandinavia, BBS Medical continued the dialog with the biomedical engineers and today there are demands when buying new ultrasound systems. The OEMs have to provide quality protocols with the probes and provide proof of how they monitor the probes over time. “This is still unique, it took BBS Medical 14 years to implement this on the Scandinavian market, but we foresee that this will spread across Europe and then to the rest of the world,” says Ann-Christiné. In 2013, GE decided to get into the probe repair business, they real-

Together, Ann-Christiné and Björn Segall run the Swedish company BBS Medical AB.

“ The driving force is, of course, patient safety and Quality Assurance, because we will all end up under a probe, and you want to know that it is fully functional.” – Ann-Christiné ized that aftermarket sales did not belong to them and that it is a fruitful business. They acquired Unisyn probe repair business in Denver, Colorado and the IP to First Call. “We at BBS, knew that it wasn’t any development on the First Call since 2009. We knew since we had developed our own probe adapters to our customers,” Björn explains. GE decided to keep the First Call for internal use and left a gap on the market. “It took us three months to recover and to decide what to do,” says Björn. “We discussed with our customers, asked them what they wanted and everyone wanted to know more about the probes, to test in real time and wanted new features.” “Ann-Christiné and I made a decision, let’s challenge First Call with improved features. The new project started,” Björn continues. “We found what we were

looking for, and decided to invest the financial recourses ourselves. After a year we had it! ProbeHunter was born. And we made First Call Adapters to fit on ProbeHunter so that everyone with a First Call could benefit from the ProbeHunter features as well.” “It was a great day when we introduced ProbeHunter, a real-time tester, at Medica in a closed VIP demo room in November 2014. The ProbeHunter was released in December the same year at a seminar arranged by BBS and it was sponsored by Toshiba, Siemens and Philips. Everyone in the business was curious about what we had developed. And many were impressed about the fast development, that such a small company like ours from Scandinavia had introduced such an advanced test system for the ultrasound industry,” Ann-Christine says.

Since then sales are taking off, adapters for all probe types are being developed. The system is now accepted and installed by all market segments: array manufacturers, hospitals, probe repair companies, distributors of ultrasound and OEMs. “The driving force is, of course, patient safety and Quality Assurance, because we will all end up under a probe, and you want to know that it is fully functional,” she continues. “As we see it, every probe that is traded or in use should be frequently tested and have a test protocol.” Until the entire industry understands the importance of testing ultrasound probes, we will continue on our mission, Björn concludes. FOR MORE INFORMATION, about ProbHunter, visit www.probehunter.com

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SPOTLIGHT

PROFESSIONAL OF THE MONTH

Jennifer Jackson, MBA, CCE By K. Richard Douglas

he Professional of the Month for September is an awardwinning biomed. Her work spans the IT and clinical engineering departments. Jennifer Jackson, MBA, CCE, is the director of Clinical Engineering and Device Integration within the department of Enterprise Information Services (EIS) at Cedars-Sinai Health System in Los Angeles. Jackson was recognized with both the ACCE-HIMSS Excellence in Clinical Engineering and Information Technology Synergies Award for 2015 and the ACCE 2015 Professional Achievement in Technology Award. “The recognition received from both awards, mostly for achievements in device integration, makes me incredibly proud of my team because they are awesome, smart, creative, and just great people to have in one’s life,” Jackson says. “It was also a great ‘win’ for Cedars-Sinai and our CIO, Darren Dworkin, who took a chance in not only bringing Clinical Engineering into the IT organization, but also adding the Device Integration component to it.” “That combination has made us extremely efficient and led to the successful integration of several medical devices. It has also given the Clinical Engineering staff a unique professional growth path now that we do more IT-like application management and development, which few departments have yet,” Jackson says. Before heading off to school, Jackson thought her course of study would lead to a medical degree. As she puts it; “I wanted to heal the sick, cure diseases, and otherwise make that positive contribution to society.” A letter from Boston University

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redirected her path a bit by suggesting that, with her high scores in math and science on college entrance exams, combined with her interest in pursuing a career in medicine, she would be well served to choose biomedical engineering as a course of study. “Most importantly, for a premed student looking to distinguish myself from the others, it noted how my medical school application would be that much more competitive because biomedical engineering was one of the hardest degrees to complete with high marks; so, do well in biomedical engineering and my medical school application process would be a breeze,” Jackson says. Although the degree wasn’t yet very well known, Jackson liked the line of reasoning, and she liked the academic scholarship that made it all the more intriguing. She ended up liking the engineering aspects of the program and abandoned the medical school dreams to move toward her new career aspirations. “After graduation, I took a job as a research engineer for the sleep lab at Brigham and Women’s hospital in Boston,” Jackson says. Because of limitations on funding in the program, the team “built ad hoc physiological monitoring, environmental control, and lab information systems; the

SEPTEMBER 2016

Jennifer Jackson, MBA, CCE Director of Clinical Engineering and Device Integration

commercially available products were far beyond our fi nancial reach,” Jackson remembers. Because of the ad hoc nature of the equipment, Jackson’s technical expertise meant that support fell on her and one other colleague. “I was always running around fi xing something or replacing something, regardless of the time of day, day of the week, or if it was a holiday,” she says. After a couple of years, she left the position. “I went off to work in the medical device industry for a few years, doing field service at the beginning, but then transitioned to software development. I enjoyed software development but missed working in a hospital. An opportunity came up to join the biomedical engineering department at Brigham and Women’s and I took it. It was like I was being invited to come back home,” Jackson says.

FAVORITE BOOKS: “The Night You Were Born” because I’m a mom and this book has such a tender sweetness to it. Also, earlier books by David Sedaris because I like to think my dark humor and wit are like his. “Pride and Prejudice” because I am a hopeless romantic. “The Iliad” and Greek tragedies; but hubris will kick your booty in the end … and several others. I love to read and each story has something amazing to share about the human condition. Brian Nhem talks with Jennifer Jackson while working on a medical device.

CAREER PROGRESSION Jackson started out as a clinical engineer before taking on the role of assistant director for the Brigham’s biomedical engineering department. A move out of the country resulted in a short hiatus. “When I took a small pause in my life to move to Rome, Italy with my now-husband, I stepped down from that role, but agreed to stay on as a project manager,” Jackson says. “Thankfully, Skype and other web-based tools made communication and collaboration possible across the world.” “At the same time, I was also president-elect of ACCE. I did bring it to the board of directors and we discussed if I should continue on and put myself up as a candidate for president. With Skype, email, and Google docs, we thought I could continue to serve, even though I was across an ocean. So, I ran and was elected as president of ACCE,” Jackson adds. When she returned stateside, Jackson interviewed and was offered her current position as the director of clinical engineering and device integration at Cedars Sinai. Getting back to those awards, the efforts she has made, along with her team, are leading the way in the

developing relation between IT and clinical engineering. “That I am still trying to figure out this integration between clinical engineering and IT and what it might mean for the future of the department. We’ve done some awesome projects and continue to grow as a team, tweaking job descriptions and duties when necessary, but I can’t say that we completely understand now where that line between traditional IT application management and clinical engineering is anymore,” Jackson says. “There are some great talks about this, and at the 35,000 feet level, and from that view, it all makes sense. But we are into the details now,” she adds. Even after the work Jackson and her team have accomplished in the IT/ biomed equation, she asks the question that will become more commonplace. “Is it OK to say that I’m IT now or do I continue to separate myself as Clinical Engineering? I report to the CIO, and work as a member of the IT leadership in my institution, though I still have to further defi ne my role because few of my IT or CE colleagues, outside of Cedars, seem to quite get it yet,” she says. Away from work, Jackson enjoys spending time with her 5-year-old daughter. She and her husband, Sergio, have been married for nine years.

FAVORITE MOVIE: I’m a huge “Star Wars” fan and always will be. “A New Hope” and “Empire Strikes Back” are my favorites of the series. Regarding those three movies released in the late 1990s/early 2000s – I demand a do over.

FAVORITE FOOD: Unprocessed

HIDDEN TALENT: Don’t think I have one. If so, it is well-hidden, even from me.

FAVORITE PART OF BEING A A CLINICAL ENGINEERING DIRECTOR: “The chance to work with so many great leaders across the world, in both the traditional clinical engineering and IT realms. Healthcare technology is rather ubiquitous, though how and how much we use may differ so the conversation is easy to translate across borders.”

WHAT’S ON MY DESK • My mobile phone because I use that more than the landline device that sits on my desk • My Bluetooth speaker because I love listening to music while working. • Picture of my daughter • Picture of my team • A replica of the IV pump made by the start-up company I worked for. It is a great innovation that I am proud of but also a reminder to me that great innovation needs to be balanced with great leadership because one cannot exist without the other.

SPOTLIGHT

CONFERENCE REVIEW ICE 2016 Exceeds Expectations

he Imaging Conference and Expo (ICE) in Chicago included new features in 2016. The ICE 18 Leadership Summit and Reverse Expo brought imaging equipment sales and service vendors together with radiology and imaging directors from some of the nation’s top hospitals. It provided a unique opportunity for decision makers to meet, network and share ideas. ICE 2016 continued over the next two days with an exhibit hall filled with leading vendors, top-tier educational opportunities, networking events and entertainment in the same intimate setting seen at all of MD Publishing’s conferences and expos. Some highlights of the conference included the Industry Roundtable where a valuable discussion forged bridges as service providers and C-suite hospital professionals engaged in meaningful dialogue about pertinent issues. Steven Jung, director of diagnostic imaging at Alexian Brothers Medical Center, gave the conference high marks, especially the educational sessions. “I can’t say enough about it because they are so applicable to our day-to-day work and what is happening with our environments,” Jung said about the classes. “You should check it out if you get a chance,” he added when asked if he would recommend ICE 2017 to a colleague. John Garrett, BS, Imaging Specialist, BMET, said attendance at just one educational session proved the value of conference attendance. “I’m going to be able to go back and next week I’ll be able to take an idea I was

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“This is a great show to come to because of the audience – how specific it is and the depth of knowledge that most working on and actually package it in a way that I can sell it,” Garrett said. He said his interactions with vendors may also pay dividends. “We may have a vendor that we can help by getting them into our company and that will allow them to actually show what they can do and help us in the process,” Garrett said. “So, it’s a win-win and there’s nothing better than a win-win in business.” Kyle Grozelle, manager of global education and training at Summit Imaging, is a fan of ICE. “We were able to participate in the Reverse Expo at this show which has got to be by far one of the best ways to meet and greet some new people,” Grozelle said. “And, then, we were able to back it up with a great trade show experience where we got to meet those people and have longer conversations.”

SEPTEMBER 2016

customers have already you can really get great feedback as well as identify new customers that way.” “This is a great show to come to because of the audience – how specific it is and the depth of knowledge that most customers have already. You can really get great feedback as well as identify new customers that way,” Grozelle added. ICE 2017 will be held in Washington, D.C. on July 24-25. For additional information, visit AttendICE.com.

ICE SCRAPBOOK 1. Vendors and attendees enjoyed networking during the Exhibit Hall Welcome Reception sponsored by technical Prospects. 2. Nicole Serwetnyk is presented with a door prize by Wendy Kroeker from Exclusive Medical Solutions.

7. An informative expert panel discussion provided helpful insights from different perspectives. 8. Angie McDonald’s class on using data to drive innovation in imaging management drew a crowd.

3. Exhibitors reported great exhibit hall traffic and high-quality attendees at ICE 2016. 4. The Reverse Expo offered a unique opportunity for imaging equipment sales and service vendors to meet with radiology and imaging directors from some of the nation’s elite health care facilities.

5. The Chi-Town Summer Cookout, spronored by RSTI, provided a relaxed atmosphere ideal for networking. It was the perfect way to wrap up the conference. 6. Tri-Imaging Solutions Vice President of Operations John Drew’s presentation “Reducing Service Costs by Brining Imaging Service In-house” was one of the most popular sessions at ICE 2016.

SPOTLIGHT

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LETTER TO THE EDITOR Response to ICE

aving attended the Imaging Conference and Expo (ICE) the last two years, I feel compelled to review this year’s conference. The 2015 conference was well worth the trip and the reason for my attendance and participation in the 2016 conference. However, the 2016 ICE was on a completely different level. It struck me that ICE has hit its stride. What really made this year different was the addition of a few key events. Having a keynote speaker, ICE18 Leadership Summit,* and the industry panel discussion made a good event into a great event. I was given the opportunity to present this year. That was a great experience. Participating in ICE18 Leadership Summit, however, had a much bigger impact. The ICE18 was a group of industry professionals that included a radiologist, imaging directors, biomedical imaging specialists, and a mix of various others. Everyone in the room was an imaging department stakeholder. There were four presentations that were more guided discussions that allowed everyone to participate. These allowed interaction from various viewpoints on the subjects presented. The discussions were lively and fairly intense as each individual contributed concerns, questions, and ideas for improvement. It was by far one of the most productive and interesting events I have taken part of as an imaging professional. The industry panel discussion, which focused on moving from OEM contracts to third party service, was eye opening. The panelists were wonderful, and I cannot thank them enough for their participation. They gave a look at service from the viewpoint of the users and department management. There was a great deal of audience participation. Again it allowed for a dialog that involved a wide variety of people from the across the industry. The kind of dialog so many in the industry desire and could benefit from. With 20 years of experience in the imaging field, I have to say that this year the ICE conference was the refreshing experience that the industry needs. The two days are intense and focused. There is a lot of information to absorb, great idea exchange, and a chance to run into old industry friends you haven’t seen in a while. The only way I can really explain how great the experience was is to say that I know where I will be July 24-25, 2017. I will be in Washington, D.C. at the Imaging Conference and Expo.

John Garrett * The ICE 18 Leadership Summit is an elite group of 18+ thought leaders from the Imaging Community (Radiology Directors, Imaging Service Directors, Imaging Technologists, etc.) from the country’s most prestigious hospitals, imaging centers and health systems. These 18 plus will gather for the “ICE Talks” where you can learn and share innovative and creative ideas to help you personally and professionally. If you are interested in participating in the ICE 18 for 2017, email info@attendice.com EDITOR’S NOTE: We received this letter shortly after returning from ICE 2016. The Imaging Conference and Expo (ICE) is dedicated to Imaging Directors & Imaging Service Professionals, including Technologists and Directors of Imaging Services. ICE offers continuing education, networking opportunities and an exhibit hall filled with the industry’s leading companies.

SPOTLIGHT

DEPARTMENT PROFILE Eskenazi Health Biomedical Engineering Department By K. Richard Douglas

isted number eight on Forbes magazine’s “Best Places for Business and Careers,” and with a population approaching two million, Indianapolis, Indiana, is a popular city. Education, finance and health care are all major employers in the area. Sporting events and conventions all bring tourists to the area, especially the past few years. The state of Indiana has more than 300 FDA-registered medical device manufacturers, who employ 20,000 workers. Some of those medical devices remain in the state and are maintained by the Eskenazi Health Biomedical Engineering Department, which provides medical equipment services to the entire Eskenazi Health system. “Eskenazi Health is one of the leading providers of health care in Central Indiana, with physicians of the Indiana University School of Medicine providing a comprehensive range of primary and specialty care services within our 315-bed hospital and inpatient facilities as well as 11 community health centers located throughout Indianapolis,” according to the system’s website.

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Eskenazi Health’s mission has been to serve the vulnerable populations of Marion County. “The department is independent of IT and reports through the associate vice president of facilities and the hospital COO, however we support many networked systems and have responsibility for medical device integration systems such as middleware products that allow connection to the EMR system,” Royal says. There is a relationship built between IT and CE via the Lunch and Learn program and regular meetings with the biomed director and IT leadership team.

PROJECTS AND LEARNING The department has had its fair share of challenges. “The hospital opened in December of 2013, the team had to undertake a significant effort to commission new equipment and systems as well as decommission the old hospital equipment and systems,” Royal says. Having the challenges of a new hospital has meant lots of new systems and a corresponding ramping up of the learning curve for the team. There was a lot of brand new equipment in the new facility. The team handled much of this transition before Royal came on board, he says. “Computer-based training presentations, along with onsite instruction, has not only helped current team members but will be in place for future team members to ensure knowledge is not lost,” Royal says. “There was a large number of retirements after the hospital opened that caused a knowledge drain. The new education system implemented

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ensures succession planning and raises the knowledge of the department as a whole.” Royal said moving the hospital’s database was also a big part of the move. Currently, the team is involved in the planning and implementation of a new electronic medical record system. “As part of this project, the team will be providing middleware support of the medical device integration which will include all medical devices that have EMR capabilities,” Royal says. On the training side, the department is hosting CABMET study sessions in association with the Indiana Biomedical Society. In addition to preparing for professional certifications, the team also

“Eskenazi Health is one of the leading providers of health care in Central Indiana” integrates an educational component into their training. “Eskenazi Biomedical Engineering holds education as one of its key assets. The department continues to develop education with a relationship with Indiana University-Purdue University Indianapolis (IUPUI),” Royal says. “Matt Dimino, radiology service technician and IUPUI instructor, teaches HTM courses at the hospital. He also has created a basic radiology service course in the computer-based training system and is now developing an IT training course series focused on the HTM field. Other technicians have developed computer-

based training based on their specific training and modality,” Royal adds.

BROADENED EXPERIENCE Besides an emphasis on continual education, the group has made time for camaraderie and leisure activities. “The Biomedical Engineering team also partners with Roudebush VA Hospital, next door, for an annual outing to the ballpark as part of HTM week,” Royal says. Exposing technicians to a wide variety of repairs offers the opportunity to expand that technician’s skills and experience. “A process of ‘house-call’ assigns a technician daily that addresses urgent repairs,” Royal explains. “This gives a technician experience in all areas of the hospital and builds new skill sets that normally would be under a specialist. We still utilize a specialist, when needed, but this method fosters a culture of teamwork and teaching.” “Another daily assignment is the ‘room PM tech.’ The hospital opens up three rooms a day that allows facilities, biomed, and environmental services to make needed repairs. This process also ensures every room is inspected each year,” Royal adds. “The department also has begun engaging with the IT department on regular educational presentations called ‘Lunch and Learn.’ This interaction builds relationships and knowledge among the two support teams,” he says. In addition to its more routine duties and special projects, the department is responsible for biomedical device integration and offers other services. “Other service support provided is to video monitoring of patients with fall risks, infant abduction system and a RFID tracking system for medical devices,” Royal says. “The department also assists leadership with a capital plan for medical devices that includes replacement and upgrades.” The group remains dedicated to the HTM profession off the job as well. The department has a strong relationship with the Indiana

The 18-member biomedical engineering department is led by Director Matthew Royal, CBET, CHFM, CHC, CHTM, CLSO-M and Manager/Clinical Engineer Ben Esslinger, CBET. Team members include Biomedical Engineering Administrative Assistant Joan Katona-Gary, BMET III Rod Pollard, BMET III Kendall Wood, BMET III Elias Ekoubazgie, BMET II Paul Swigart, BMET II Karl Day, BMET II Victor Burroughs, BMET II Tracy Ylovchan, BMET II Aaron Wilson, CBET; BMET I Michael Shannon, CBET-C; BMET I Cameron Harney, CBET-C; BMET I Pierre Romulus, BMET I Dong Kim, Radiology Service Technician-IT Matthew Dimino, Radiology Service Technician Anthony Phoenix and Imaging-Biomedical Service Technician Greg DeJong, CBET.

Biomedical Society. Ben Esslinger serves as the current president and Matt Royal serves as treasurer. Royal is also president of the Indiana Society of Healthcare Engineering. Eskenazi Health has hosted IBS and ISHE meetings and is currently hosting CABMET study sessions on behalf of

IBS, according to the group. Four of the Eskenazi Health biomed department members recently received their certifi cation. This innovative biomed team is well positioned to be a model of what the HTM department of the 21st Century should look like.

SPOTLIGHT

BIOMED ADVENTURES AN HTM PRO GIVES BACK

K. Richard Douglas

n past issues of TechNation, we have highlighted the efforts of HTM professionals who volunteer, or work in positions, where they bring their knowledge and skills to developing countries for charitable organizations. The need is great and the benefits, to the local populations, are enormous.

The quality of health care in many developing countries is often nowhere near the levels that we take for granted in the U.S. Ismael Cordero, biomedical service manager with Gradian Health Systems is a prime example of a biomed giving back. Cordero started his biomed career in the more traditional sense nearly 30 years ago, but has spent the last 20 years in very non-traditional roles. His non-traditional work has seen him pay it forward working for charitable and not-for-profit organizations. In addition to his current work with Gradian Health Systems, he spent 17 years at ORBIS International, where he managed the medical technology for the Orbis Flying Eye Hospital. “Initially, I worked in hospitals and for medical equipment rental companies inspecting and repairing medical equipment, specializing in respiratory equipment,” Cordero says. “And while I enjoyed my daily work and felt a sense of contributing to society by maintaining life-support equipment I was also growing increasingly antsy to do something more exotic and had an itch to travel around the world.”

FLYING FOR EYE HEALTH One day, while reading a technical magazine, he spotted what looked to be a strange, but intriguing ad for a biomedical engineer position onboard an airplane. He took a train to New York for an interview and ended up getting the job. For the next few years, he

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Ismael Cordero Biomedical Service Manager

worked as a biomedical engineer, maintaining and managing equipment onboard Orbis’s Flying Eye Hospital. The Orbis Flying Eye Hospital is a unique organization that includes a fully equipped mobile teaching hospital aboard an MD-10 aircraft. In 2015, Orbis “enhanced the skills of more than 30,326 eye care professionals, and conducted over 2.13 million screenings/examinations on adults and children around the world,” according to the organization’s website. When Cordero first took to the skies in the Orbis Flying Eye Hospital, it was aboard a DC-8. “This fully functional ophthalmic hospital was housed inside of a Boeing DC-8 aircraft, which would fly to about 10 different countries per year and set up as a training hospital in the host-city airports,”

SEPTEMBER 2016

Cordero says. “Ophthalmologists, anesthetists, nurses and biomedical technicians would be trained on all aspects of eye care.” In addition to maintaining the equipment on the Flying Eye Hospital, Cordero would go to local hospitals and repair broken equipment while teaching local biomeds. “After my work onboard the plane, I took on a more office-like position for Orbis at its New York headquarters and managed biomedical engineering for the entire organization, but I still travelled frequently,” Cordero says. During his 17 years with Orbis, he says that he “repeatedly saw the poor state of many health care facilities in more than 50 countries. I also saw how biomeds in many places were not sufficiently trained or given the recognition and support that they deserve. This, combined with many inappropriate donations and purchases, results in many inoperable medical devices which undermine the quality of patient care.”

FLYING ENABLING ANESTHESIA EVERYWHERE Cordero knows a lot about helping those who need professional medical intervention in areas of the world where they might go without otherwise. He continued his interest in using his HTM skills in a non-traditional manner, by also working with Gradian. “I’ve been with Gradian for almost three years as the biomedical services manager. My job is to train and provide technical

Left: Ismael performing factory training. Below: Ismael in an operating room in Bangladesh.

Ismael helps during an installation in Malawi.

support to our customers, as well as to our network of in-country biomeds, that either work for distributors that we partner with or as independent contractors. I also produce technical materials such as manuals, technical bulletins, maintenance instructions and videos which we make easily available for download,” he says. According to Gradian’s website, the company “equips hospitals to deliver anesthesia safely and economically. Our mission is to improve access to safe surgery and perioperative care by providing technology, service and training to strengthen anesthesia capabilities. We design and build equipment used worldwide in hospitals ranging from worldrenowned academic centers to resourceconstrained district facilities.” “One big difference between all of my previous jobs and Gradian is that now I represent the manufacturing side of things, whereas before I was representing the health care provider side,” Cordero explains. “But my intentions and focus are the same: to ensure the best patient care possible,” he says. “I am also involved in the research and development of new products meant for low-income settings, where infrastructure problems, such as lack of trained medical equipment maintenance personnel, poor electrical supply and an absence of compressed medical gases are daily issues,” he adds. Cordero says that this part of his work is new to him, but equally exciting as training and supporting biomeds. He offers that

most people, himself included, several years back, thought of manufacturers as only being interested in making a profit, not only by selling their equipment but also by selling the service required to maintain the equipment they make and sell. “Gradian is different, in that it is non-profit, and at its core is a desire to train and elevate the role and importance of biomeds worldwide,” Cordero says. With his experience working with biomeds worldwide, Cordero points out that in developing countries, biomeds have the additional challenge of “spare parts, tools, manuals, budgets for maintenance, basic formation and continuing [that are] non-existent.” If the lack of these necessary resources didn’t make those biomeds jobs difficult enough, Cordero offers this insight. “Biomeds in low-income countries are generally not seen as an integral part of the health care team. They are mostly seen as a luxury. And on top of that they are expected to perform miracles without the requisite tools, resources and support,” he says. “Most biomeds have two or more jobs. Generally, most of the day they work at a public hospital and then in the evenings they provide their services to private hospitals and clinics. The salary from one employer is usually not enough to live on, which is very different than the U.S., where biomeds make a pretty good living with just one job.” Cordero’s personal objective, after 30 years of working in the field, is to “encourage, support and promote biomeds.”

“But my intentions and focus are the same: to ensure the best patient care possible.” He also has some advice for those biomeds who might want to lend their expertise and help those in developing countries or poorer health care environments. “There are many companies and NGOs in the U.S. that deploy volunteer and paid biomeds to install and repair equipment and train other biomeds. These trips can range from several days to several months,” he says. “Even those who can’t travel abroad to train or service equipment can contribute by providing tools or test equipment that they no longer have a need for, or they can participate as long distance mentors to biomeds in other countries,” he adds. He says that for those looking to contribute their skills or knowledge to the global cause, they should contact the following societies and organizations, among many others: The American Association for the Advancement of Medical Instrumentation (AAMI) www.aami.org/ The American College of Clinical Engineering (ACCE) www.accenet.org/ The Clinical Engineering Division of the CED of the IFMBE cedglobal.org/.

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COMPANY SHOWCASE TENACORE HOLDINGS INC

he Tenacore approach to biomed depot repair is a comprehensive platform that includes manufacturing, distribution and extensive repair capabilities. Tenacore now has multiple repair centers in order to provide cutting-edge services in respiratory, patient monitoring, infusion pumps, as well as ultrasound and endoscope labs. To be effective as a full-service depot repair center, vertical integration and expansion of the Tenacore portfolio was mandatory. By comparison, a traditional “repair depot” may only service a fraction of the portfolio that Tenacore offers.

The expansion into the repair depot business opened another window of opportunity for Tenacore. “There was a need for manufacturing high-quality components for device repair, reliable delivery of components, and reasonable pricing,” Vice President Albert Negron explains. Tenacore purchased Newport Plastics in April of 2008, and started making its own FDA-regulated parts and repair kits for many of the products they were fixing. The increased quality, shorter lead times, and lower cost to the end user spurred even more growth. Due to the vertical integration and manufacturing capabilities being on-site, Tenacore is able to utilize its service depot as a research and development platform. This allows us to work with hospital biomeds to identify needs and streamline the R&D process to help lower costs with in-house manufacturing. This also creates a more cost-effective alternative to traditional OEM or third-party distributorships.

QUESTION 1 What competitive advantage does Tenacore have with on-site manufacturing capabilities? A. Ability to identify real world needs of biomedical engineering departments B. Streamline the R&D process C. Create more cost effective alternatives D. All the above ADVANCING THE REPAIR DEPOT EXPERIENCE The company’s numerous products and manufacturing capabilities are complemented by on-site Biomed education training programs. Tenacore provides introductory and advanced courses based on the needs of the engineer or hospital biomed department. The mission of Tenacore is to advance repair depot techniques through research, peer-to-peer education, and membership initiatives with IDNs. To accomplish this feat, we have built a platform that is

28 | JULY 2015 SEPTEMBER 2016 28 MEDICALDEALER 1TECHNATION.COM

brand centric and customized to the needs of our partnerships. Positive customer experiences, quality credentials, and a dedicated focus, are what Tenacore prides itself with. Exceptional customer service is coupled with emphasis on quality to guarantee the best patient outcomes. “We’ve built a new online portal (tenacore.com/portal) where our customers can follow their order throughout the service process. Customers are also able to create shipping labels, look up service reports, approve estimates and find old invoices,” Negron says, when describing some of the perks customers receive. “The portal will also be able to pull up data and analytics for corporate directors and supervisors. An email is also sent out to notify the customer of status changes, i.e. order received, estimated and shipped.” QUESTION 2 What kind of educational offerings does Tenacore have? A. Individual biomed training B. Group/modality based programs C. IDN focused programs D. All the above A PERFORMANCE CULTURE As a manufacturing facility, located at the company’s headquarters in Santa Ana, California, we have a competitive advantage to operate around the clock. Pair that with the quality credentials, OEM trained and certified technicians,

MEDICAL EQUIPMENT, PARTS & SERVICE

Tenacore offers a quality repair depot modeled after a hospital environment that has paired biomedical engineers with subspecialties such as patient monitoring, module repairs, telemetry, fetal transducers, and more.

you have a fully functioning machine that’s parallel to none. “Jennifer Page, in our business development department, has done an excellent job building relationships and aligning Tenacore’s objectives with IDN, asset management groups and corporate customer objectives,” Negron says. “Oswaldo Chavez, our service manager, has built a top-notch team of trained technicians who service equipment to OEM specifications and customers’ expectations.” Competition can be fierce in the medical device market for both repairs and manufactured products; however, our strong and proven reputation for quality work sets Tenacore apart. QUALITY CREDENTIALS: ISO 13485:2003 ISO is the International Organization for Standardization and is the world’s largest developer and publisher of international standards. They provide solutions that meet the requirements of business and the broader needs of society. ISO 13485:2003 provides requirements for quality management systems which aid in the design, development, manufacturing, installation, and servicing of medical devices. Tenacore ensures a superior quality system over other service and manufacturing depots by:

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• Conducting 100% quality control inspection on all finished devices and repairs • Complying with ISO 13485:2003 • Periodically calibrating all equipment used for testing, measurements and calibration to the NIST Standards • Complying with most international standards and other industry standards for quality inspection procedures. • Having complete traceability for all devices that are manufactured or serviced. QUESTION 3 What quality credentials does Tenacore adhere to? A. ISO 13485:2003 B. CE Mark C. FDA regulated D. All the above CUSTOMER SUPPORT Tenacore is not only focused on developing innovative technology, but also on providing superior repair capabilities and biomed support. The Business Development Team is dedicated to building a productive relationship that provides IDNs with all the resources necessary to create their own brand of repair depot. This team is committed to customizing and building teams around the specific goals of each group.

Tenacore has a distinct performance culture where its “A Players” are the critical drivers of the company’s success. This culture creates a unique edge that not only influences how Tenacore conducts business, but also drives how employees make decisions and surpass their goals. Employees are driven to embrace the culture of teamwork, innovation, and sustained superior performance. Tenacore’s team approach is designed to ensure happy customers. “It takes a strong internal team in order to create a positive customer experience. Our entire staff, from the customer experience specialists to the account managers, genuinely care about each and every transaction and customer,” Negron says. QUESTION 4 How does Tenacore continue to drive innovative approaches with IDNs? A. Offer training programs for IDNs B. IDN repair depot branding C. Strong internal team to create positive experience D. All the above FIND ADDITIONAL INFORMATION about Tenacore online at www.tenacore.com ANSWER KEY D, D, D, D

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NEWS & NOTES

Updates from the HTM Industry

TRISONICS RECEIVES ACCREDITATION FOR QUALITY MANAGEMENT SYSTEM MCKESSON EXPLORES ALTERNATIVES FOR ENTERPRISE INFORMATION SOLUTIONS McKesson Corp. is exploring strategic alternatives for its Enterprise Information Solutions (EIS) business, a division of McKesson that provides core hospital information systems. EIS serves hospitals and health systems with software solutions, managed services, and infrastructure and hosting services to enable them to succeed through health care reform and beyond. The portfolio includes core solutions such as: Paragon hospital information system; STAR and HealthQuest solutions for revenue cycle management, financial and supply chain management; OneContent document and content management; and coding and other professional services to help maximize the total value of information technology. In a separate announcement, McKesson announced the formation of a new healthcare information technology company with Change Healthcare Holdings Inc. that will include the majority of the McKesson Technology Solutions businesses.

Trisonics has received accreditation for demonstrating its ongoing commitment to quality by satisfying customer requirements and industry specifications. “We are very proud to have received certification to the ISO 9001:2008 standard. Trisonics is committed to setting the gold standard in ultrasound solutions through meeting and/or exceeding our customers’ requirements and expectations. We will accomplish this through our commitment to continually improve our quality management system, service and processes,” Trisonics COO Jennifer Riner said. “Trisonics has demonstrated its commitment to world-class quality management by implementing and becoming certified to the ISO 9001 standard. They have joined an elite number of organizations worldwide who have achieved certification to this globally recognized quality standard,” said Randy Daugharthy, director of the registrar program at the Performance Review Institute Registrar. “PRI Registrar is proud to partner with Trisonics in this accomplishment and look forward to continued support of their objective of quality excellence.”

EQ2 LLC MOVES HEADQUARTERS TO NORTH CAROLINA EQ2 LLC, a hospital computerized maintenance management system (CMMS) provider, is moving its headquarters from Burlington, Vermont, to Charlotte, North Carolina. The move co-locates EQ2 with parent company AMT Datasouth’s operations center. “By moving to Charlotte, EQ2 and AMT Datasouth will be able to share certain facilities and overhead operations that will benefit both companies. Additionally, Charlotte will provide EQ2 a broader base from which the

company will more easily be able to find people to help it continue to grow,” EQ2 CEO Joe Eichberger said. The company is also anticipating opportunities for growth by gaining a presence in the South, where it can partner with numerous hospital systems there that can benefit from the HEMS CMMS. EQ2 has many CMMS modules and dashboards designed specifically for biomed departments. The HEMS CMMS is designed for both the everyday user (for example a

“technician” who performs maintenance activities and addresses compliance needs) and leadership (such as members of the C-suite who need advanced reporting and dashboards) to be able to make running their hospital operations more efficient and cost-efective.

INDUSTRY UPDATES

RENOVO SOLUTIONS LAUNCHES DIGITAL DETECTOR SOLUTIONS FUTURE OF INTERIM CONTRACTORS SPARKS FORMATION OF FIRM Next Level Interim Search-Healthcare IT has announced the formation of a firm in association with The Tolan Group. NLIS-Healthcare IT is dedicated to helping clients find short-term interim IT talent when a key member of a team suddenly departs or an organization needs additional resources for specific projects. NLIS-Healthcare IT is committed to providing healthcare IT organizations, hospitals and integrated delivery networks with high-quality HCIT talent for various interim roles. NLIS-Healthcare IT has an extensive database of talented healthcare IT professionals. “Our firm understands every facet of the healthcare IT marketplace extremely well,” said Tim Tolan, Managing Partner of NLIS-Healthcare IT. “We plan to use our domain knowledge to serve our clients by offering interim HCIT contractors to meet the ever growing demand for talent in this tight technology labor market. As a leading national Top 10 search firm, we have the resources and scalability to hire a single HCIT contractor or an entire team across the United States.” For more information visit http://nlinterim.com

1TECHNATION.COM

DECEMBER 2015 SEPTEMBER 2016

Renovo Solutions has announced the launch of Digital Detector Solutions to provide a cost-effective alternative to traditional full-service agreements for digital detector replacement coverage. Digital detectors are wired or wireless portable imaging devices which allow hospitals, clinics, and outpatient facilities to bring convenient radiology services to patients in the hospital or exam room, rather than moving the patient to the radiology department. While digital detectors allow for higher quality patient care, their portability puts these devices at greater risk of being dropped or damaged in transit with a replacement cost between $85,000 and $120,000. “In this era of value-based care, every hospital radiology department is required to stay within budget,” says Sandy Morford, CEO of Renovo Solutions. “They have to fully insure for the risk of breakage or failure of digital detectors, as they do with their other specialized imaging equipment. With no comparable alternative, these service agreements are expensive and provide little flexibility in coverage options.” Digital Detector Solutions creatively manages risk to provide the equivalent service and coverage of a traditional full-service plan at a fraction of the cost. The program is unique because it provides separate replacement coverage for digital detectors, which typically have a greater risk of damage and financial loss. By covering the digital detectors separately from other imaging equipment, the program more appropriately calculates and manages the risk, and by extension, the cost. The cost savings realized through Digital Detector Solutions are substantial, with average cost reductions of 20 to 50 percent for digital detector coverage. Digital Detector Solutions provides manufacturer equivalency in terms of coverage, protection and warranty. Mike Bohl is a Renovo Solutions client using Digital Detector Solutions. “This enables my ability to contain budgets and continually deliver, which was the primary decision factor in choosing the Digital Detector Solutions program over a traditional OEM full-service agreement,” says Bohl, a board-certified radiology technologist and CEO and Director of GenRad Imaging Group. “The creation of this Digital Detector Solutions product will now empower the clinical equipment owner both financially and operationally from being tied to expensive service agreements or catastrophic replacement expenses,” says Alan Moretti, Vice President of Advanced Imaging and Radiation Oncology for Renovo Solutions. Renovo Solutions has partnered with ProTek to create Digital Detector Solutions.

INDUSTRY UPDATES

SIEMENS HEALTHINEERS INTRODUCES ENTERPRISE SERVICES IN THE U.S. At the 24th annual Health Forum/ American Hospital Association (AHA) Leadership Summit, Siemens Healthineers introduced an expanded services portfolio to help customers in the United States enhance the patient care experience, improve population health, and reduce the per-capita cost of health care. This new business line, known as Enterprise Services (ES) and previously offered to international customers of

Siemens Healthineers, includes expanded transformation and advisory services, asset management services, managed department services, and other capabilities. The ES business line will allow hospitals and clinics to share risk with Siemens Healthineers by providing them with optimal technology, equipment management services and clinical workflow solutions. “With Enterprise Services, Siemens

Healthineers ushers in an exciting new era of collaboration with our customers, enabling them to more effectively address budgetary issues and other pressures, and helping them create a first-class clinical environment,” said August Calhoun, Ph.D., Senior Vice President of Siemens Healthineers Services. “Now, hospitals and clinics are able to focus squarely on their core mission of delivering the highest-quality patient care.”

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ECRI UPDATE

Evaluating Automated Whole-Breast Ultrasound Scanners

CRI Institute’s Health Devices engineering team recently completed an evaluation of three automated whole-breast ultrasound scanners. This excerpt from the published study describes some of the purchasing considerations that the group identified during its testing.

TECHNOLOGY OVERVIEW Automated whole-breast ultrasound (AWBUS) scanners were developed primarily to address two concerns: (1) the limitation of screening mammography to detect breast cancers in women who have dense breast tissue and (2) the userdependent and time-consuming nature of conventional handheld ultrasound of the breast. The limitation of screening mammography has prompted more than 25 U.S. states to enact what are called “breast density laws.” (Similar laws are being considered in several additional states.) Although the requirements vary from state to state, breast density laws typically require that women who have dense breast tissue, as identified with mammography, be notified by their physicians about the limitations of mammography to detect breast cancer in dense breasts. The laws further specify that these patients be offered options in their care, including receiving additional imaging exams. (For more details, see: http://www. diagnosticimaging.com/breastimaging/breast-density-notificationlaws-state-interactive-map.) Ultrasound is one of several imaging modalities that may be used as a supplement to mammography to improve the overall efficacy of breast imaging for patients who have dense breasts. Tomosynthesis and magnetic

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handheld ultrasound. •D ata acquisition is more time-efficient and is separate from diagnostic interpretation, thereby enhancing workflow. •A WBUS scanners provide a large field of view that enhances the ability to localize pathology in relation to anatomical landmarks, such as the nipple.

FORM AND FUNCTION resonance imaging are other modalities that may be used. The breast density laws, along with the commercial availability of AWBUS models from several vendors, have fueled interest in AWBUS as a supplement to mammography. AWBUS examinations are typically performed after a screening mammogram; the two modalities provide complementary data. AWBUS scanners represent a technological advancement over conventional handheld breast ultrasound in that they automate the acquisition of ultrasound images of the breast and facilitate review of images for formal interpretation by a physician. Specific advantages compared with handheld ultrasound include the following: • AWBUS scanners improve reproducibility and reduce interobserver variation. • Exam performance and results are less operator-dependent than with

SEPTEMBER 2016

Ultrasound imaging systems transmit high-frequency sound waves into the patient and receive echoes that result from the interaction of the sound waves with body tissues. These systems use a transducer to transmit and receive the ultrasound signals; these signals are then used to create images on a video display. AWBUS systems automate the acquisition of “B-mode” ultrasound images of the breast – these images depict anatomical structures in grayscale. Some AWBUS scanners have additional imaging capabilities, such as Doppler modes that are used to assess blood flow and improve characterization of breast disease. AWBUS systems are currently available in two forms: •A rticulated-arm-style scanners use a transducer attached to an articulated arm that can be positioned over the patient. The patient lies on her back on a table, and the transducer is placed in contact with the patient’s breast. Once activated, the transducer mechanically sweeps across a region to acquire a

series of 2-D ultrasound images of the breast. • Table-style scanners use a dedicated table that houses a transducer within a recessed portion of the table. The patient lies face-down on the table with one breast positioned over the transducer. Once activated, the transducer rotates 360° to acquire a series of radial 2-D images. With both designs, the acquired 2-D images are sent in standard format to a workstation, where they are compiled to form a volume data set that is used for review. AWBUS systems use specialized software on the workstation to improve diagnostic interpretation and facilitate time-efficient workflow.

COMPARING SYSTEMS ECRI Institute recommends that healthcare organizations consider factors such as the following when selecting an AWBUS system.

INTENDED APPLICATIONS Some AWBUS devices are indicated for screening and diagnostic imaging applications, while others are indicated only for diagnostic imaging applications. Configuration: Dedicated Device versus Add-on to a Conventional Scanner Some AWBUS systems are dedicated devices that can be used only for automated acquisition of B-mode breast ultrasound images. An additional ultrasound scanner is required if the clinician wants to, for example, use ultrasound to evaluate the patient’s axilla for lymph node disease, acquire Doppler data, or perform an ultrasound-guided biopsy. Alternatively, some AWBUS devices connect to a conventional ultrasound scanner. When not being used for AWBUS exams, the conventional ultrasound scanner equipped with handheld transducers can be used: • For non-breast applications (e.g., obstetrical ultrasound exams) • To better characterize breast masses detected with AWBUS by using color Doppler imaging (CDI) to assess the vascularity of the mass or by using elastography to assess the relative stiffness of the mass • For ultrasound-guided breast biopsies If a facility already owns a conventional scanner that is compatible with an AWBUS component, this could represent a cost saving. Note, however, that if the conventional scanner is used to acquire additional data – such as CDI to assess blood flow in a mass, or elastography to assess tissue stiffness – operators must possess the skills needed to effectively use these additional modes. Form: Articulated-Arm-Style versus Table-Style Scanners Articulated-arm-style systems are easier to move and may require less physical space than table-style scanners. With this type of scanner, however, operators must have the skills to determine whether additional data acquisitions are required to ensure a

thorough exam of the patient, and if so, how many. Some patients may feel more comfortable being examined on a table-style AWBUS scanner because their breasts are not exposed as much and require less manual manipulation compared to an articulated-arm-style scanner.

PERFORMANCE: WHAT ECRI INSTITUTE LOOKS FOR When testing the performance of AWBUS systems, ECRI Institute uses industry-standard quality assurance tests and a custom-designed breast-tissue-mimicking phantom to objectively determine: • Spatial and contrast resolution • Image uniformity and tissue penetration • Accuracy of distance measurements and calculations The organization also looks at safety concerns, answering questions such as: What ergonomic features are present, and does the system have any components that could cause injury to users or patients? To examine the impact of each system on workflow, the group considers, for example: • Is the user interface easy to operate? • How many data acquisitions are required on an averagesize patient? • How much time is required to perform a bilateral examination, including patient preparation, positioning, data acquisition, and data transfer? • A re there any patient-related limitations (e.g., breast size, the patient’s physique) that could affect use of the device? • What are the hardware and software requirements? • W hat image interpretation software features and tools are available? The organization also assesses: • Breast compression features for how they affect patient comfort • The ability to integrate the device into a facility’s existing health IT infrastructure • Inspection and preventive maintenance requirements • The total cost of ownership In its recent evaluation, ECRI Institute found that all three of the tested models offer acceptable performance. Differentiating factors include the intended applications, configuration, and form, as described above, as well as some features affecting workflow, the user experience, and total cost of ownership. THIS ARTICLE IS EXCERPTED from ECRI Institute’s “Evaluation Background: Automated Whole-Breast Ultrasound Scanners,” Health Devices 2016 March 23. The complete article – including model-specific test results and product ratings, along with additional guidance for purchasing and using this technology – is available to members of ECRI Institute’s Health Devices System and associated programs; learn more at www.ecri.org/components/HDS.

INDUSTRY UPDATES

AAMI UPDATE

First Round of Candidates Interview for CEO Position

he first round of interviews for AAMI’s new president and CEO took place in early August. Asecond round with the finalists is expected this month. The search is being led by Korn Ferry, with the assistance from members of AAMI’s Executive Search Committee..

Mary Logan, only the second AAMI president and CEO in AAMI’s 48-year history, will be retiring at the end of 2016. Her departure will come almost eight years after she took the helm of the association. “Mary has done a remarkable job of leading AAMI since 2009. She brought new life and energy into AAMI and has helped position the association for a strong future. Now it’s up to all of us to find that perfect person who embodies the spirit, energy and skills needed to lead AAMI through this next phase into the future,” Phil Cogdill, who chairs both the AAMI Board of Directors and the search committee, wrote in AAMI News. The search for AAMI’s next president has generated considerable interest in trade publications that cover the healthcare technology and association industries. Reporters and other interested parties are making calls, trying to determine who is in the running. With input from AAMI staff, the Board of Directors, and other volunteers, Korn Ferry and the search committee developed a leadership profile that outlined the qualifications and qualities the next CEO of AAMI needs to help the association grow and thrive at a time of incredible

1TECHNATION.COM

change for healthcare technology and healthcare in general. Cogdill described this person in his essay as “someone who is a proven strategic thinker, capable of anticipating challenges and trends, a credible executive with stature and presence, and a ‘servant leader’ who will gracefully navigate the unique dynamics of working with a diverse membership, volunteer board, and staff.” This person will also have proven business and financial acumen, strong negotiation skills, a sense of diplomacy, and a track record of recruiting, developing, motivating and retaining staff. Fitting this profile is more important than having experience in any specific field or industry, according to Cogdill. “AAMI’s new president could come from any number of career paths with experience as a hospital senior executive, industry senior executive, seasoned association executive, or someone from a unique sector that aligns well with AAMI’s core businesses,” he added. The committee plans to have a new CEO firmly on board before the end of the year. Ideally, search committee members would like to have some overlap between the start of the new president’s tenure and the end of Logan’s.

DECEMBER 2015 SEPTEMBER 2016

New Video Takes Charge of Device Battery Management The batteries used to power medical devices are increasing in variety and complexity. AAMI surveys of healthcare technology management (HTM) professionals consistently show that the management of batteries is a top medical device challenge. A failure in battery management can result in a loss of power, leakage, overheating, fires or explosions. To help HTM professionals better understand and manage batteries, AAMI has released an instructional video, Battery Management and Medical Devices. The video, released in June, covers the most commonly used battery technologies, the benefits and drawbacks of different battery types, how to develop a battery management plan, as well as procurement, testing, and safety. “Each hospital should have at least one person who really knows what’s going on and can be used as an in-house resource,” said David Marlow, CBET, a senior biomedical technician for the University of Michigan Health System in Ann Arbor and a consultant for the video. “People need to realize that all batteries are perishable items. They’re going to die. How you treat them determines how long they’ll live.” According to a small survey by the Food and Drug Administration (FDA), up to half of service calls in hospitals are related to battery issues, as detailed in the March/April 2014 cover story of BI&T. In an interview with AAMI, Alan Lipschultz, president of HealthCare

Technology Consulting, said that keeping batteries working requires a defined plan and staff education. “There is a much greater variety of batteries available than in the past, and their chemistries and characteristics vary widely. Your staff needs to understand the differences between the battery types and how each type should be stored, charged, and disposed of,” he said. Battery managers can use the video to select the right batteries for their devices and keep them working properly. That’s especially important when these devices are used outside of a clinical environment, such as in a patient’s home. Jake Kyprianou, senior science health advisor for the FDA, who contributed to the script, said, “We’re excited that AAMI has taken the initiative to provide what we see as a service to the health care community, and we want to thank AAMI for raising awareness of this issue.” Battery Management and Medical Devices can be purchased from www.aami. org/store or by calling 877-249-8226. Guide Shows HTM Departments How to Move ‘Beyond the Basics’ Healthcare Technology Management (HTM) departments should strive to provide added value to health care delivery organizations – moving beyond compliance with regulatory requirements to help blaze new trails for the effective and safe stewardship of medical devices and enhancing patient care in the process, according to the authors of an updated version of AAMI’s HTM Levels Guide. “Just doing the regulatory basics is one thing. That’s important. But we’ve also

found examples of HTM programs doing very innovative things that provide a lot more support to clinicians,” said Matt Baretich, CPPS, president of Baretich Engineering and co-author of the updated guide. “We wanted to emphasize that the target for every agency or program is level two – established. You’re not just meeting basic requirements – you’re

“AAMI’s new president could come from any number of career paths with experience as a hospital senior executive, industry senior executive, seasoned association executive, or someone from a unique sector that aligns well with AAMI’s core businesses” providing a lot more value to the organization.” The guide – which was developed based on feedback from clinical engineers, consultants, AAMI staff, AAMI’s Technology Management Council and others – provides guidance to help HTM departments progress through three levels, defined as: • Fundamental: Programs that provide a basic level of technology services and

compliance with applicable standards and regulations. The authors describe the minimum level as suitable for new HTM programs and those in very small health care organizations. • Established: Programs that have moved beyond the basics to provide additional services, with a focus on cost effectiveness. This is the level that all HTM programs should work to achieve, according to the authors. •A dvanced: Programs that are on the leading edge, demonstrating the full range of potential for HTM contributions to patient care. While very few programs achieve this level of performance across the board, the authors believe that every HTM program can find opportunities for improvement at this level. The guide also includes a pull-out HTM program checklist poster to help departments visualize what they have accomplished and where they are headed. “The HTM Levels Guide is easy to use, read, and makes it easy to make decisions on what to implement,” said Patrick Bernat, director of HTM at AAMI. “Certainly, a manager or director of a department would use the guide for planning. But anybody in the field could read and understand it, to learn where the field is headed.” The second edition of the HTM Levels Guide is available to download for free. Printed copies can be ordered from the AAMI Store using product code HTMLEVEL. Printed copies cost $50 or $30 for AAMI members.

INDUSTRY UPDATES

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The Imaging Conference and Expo (ICE) is the only conference dedicated to Imaging Directors & Imaging Service Professionals. ICE offers valuable CE credits from the ASRT via world-class presentations and instructors.

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SHOP TALK

Conversations from the TechNation ListServ Q:

What are the benefits of the newer CMMS technologies? What do you use your CMMS for? Is it just for PMs?

The CMMS is our primary tool in our tool kit. The CMMS is much more than a PM tracker. Of course, it does generate our regularly scheduled preventive maintenance but it is much more. It is used to inventory every single medical device that comes into the facilities whether or not we touch the device with our own hands. It is used to capture the purchase order that the device is ordered on and the acquisition cost. We capture the MAC address, the IP address, software revision levels, any other pertinent network connectivity information (VPN), does it contain and/or transmit protected information, encryption strategies for any stored data ... all of this information is contained in the device history file for each inventory item in our CMMS. The CMMS builds and displays the dashboard data. All facilities in our health system have a video dashboard in our healthcare technology management department office. The video display has all of the monthly and annual pertinent data for the performance of the HTM team at that facility – PM completion, CM completion, average repair time, and many other data points that are graphically displayed. This way all technical team members can look up and see a snapshot of how the team is performing. The CMMS manages recalls and field corrections for medical

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devices. The CMMS tracks our expenses through connectivity with our financial system where purchase orders are generated. It tracks our labor time so that we can understand how the team is performing, who and when team members are on duty so calls are distributed automatically. The CMMS is our source for the financial audit team. The audit team can track the installed devices of the facility and match it against the depreciation schedule. The HTM team builds the cost-ofservice ratio by using the data of the CMMS. The CMMS is used to track all purchased service, including service contracts. The CMMS has the full “inventory” of all purchased service contracts and each contract’s terms and conditions are matched with individual pieces of equipment so that technicians can just pull up relevant data on their tablet devices as to how a contracted device is covered, i.e. hours of coverage, parts coverage, etc., including the service entity’s contact phone number. This allows tremendous efficiency so that technicians can respond quickly while mobile and actually make the appropriate arrangements on covered devices for service without too much delay or complexity. The CMMS allows our caregiver customers to place service requests. The CMMS, due to its web-enabled enterprise structure, allows access for any credentialed user, not only HTM technicians but also the CEO, COO, CFO, nursing director, nurse, etc., this way the HTM program has full transparency. PM schedules and CM status are available to all users. No need for ugly, gooey PM

SEPTEMBER 2016

stickers to cover our devices. As you can see from the above narrative, the CMMS plays a major role to complete the “tool belt” of our healthcare technology management program and technicians. It is much more than a PM tracker.

All that sounds just wonderful, as long as the people end of it gets done. Do you actually believe that all equipment that comes in to your facilities that you don’t touch get entered? Do you actually think nurses go and check on a computer to see if the PM has been done on the equipment they use? We can’t even get them to notice the different colored stickers on the equipment. We’d have no idea what rental beds come into the hospital if it wasn’t for the company sending their records to us. Heck, we can’t even get the nurses to plug in battery-powered devices to keep them charged! I doubt our nurses are any worse or better than anywhere else. It does sound like you get a bunch of good info. Sadly, we seldom get notice of what equipment is purchased, since it’s all done by corporate, it just shows up. Trying to get the info from corporate as to price and such is very difficult since we can’t look at the purchase orders they produce. As for IP address, and such, again corporate IT sees no reason why we, the people who maintain it, should have any need for such. With any equipment that gets connected to the network the request for that connection goes through, you guessed it, corporate IT. Must be sweet to have the power to do what it sounds like you’re able to do.

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HTM cannot let ventilators sit “in the shop” without getting repaired in a timely manner that could cause a need to rent. If HTM is tardy with repairs, someone in leadership will see an escalation in rental costs and start asking questions. Of course, there are times when rentals are appropriate since we budget capital for our typical census load. There are times when the census will balloon, such as flu season, this can cause the need to rent. Those anomalies are planned and budgeted for in our program. It is HTM’s responsibility to ensure that rented devices are promptly returned when not needed so that rental fees can stop in a timely manner. HTM is really the technology manager ... at least you should be. Of course I want nurses and clinicians to do patient care, not equipment care. I never depend on those folks to be the “lookouts” for devices due for PM. I expect my HTM team to get after the devices due for PM and not have the clinical care team worry if their devices are compliant or not. I expect my HTM teams to ensure we are compliant with our responsibilities. I hope the HTM leadership is monitoring your PM compliance efforts and asking questions if there are difficulties with compliance.

TRIM 9.75”

Your experience sounds very disappointing. At our health corporation, the corporate HTM department, reports to the corporate chief information officer (CIO). The CIO is also the senior vice president and has oversight of the supply chain. Yes, our HTM program actually is an integral part of the entire enterprise. Nothing capital gets purchased without the HTM team knowing. Every single purchase must be signed off by the corporate director of HTM (that’s me). Every one of my director’s at the local level facility is engaged in the capital acquisition process. They counsel our patient care and diagnostic departments on the equipment that should be “on-the-radar” for replacement. That capital plan also gets communicated to senior leaders. The HTM directors request the quotations for the local facility leaders. Yup, we’re connected. Of course, since we report directly to the corporate CIO, we get full cooperation from our IT peers. Our team members are the medical device integration implementers, so working hand-in-hand with our IT brethren and getting the required IP addresses from IT for medical devices that connect to the network is part of our process. Medical device cybersecurity is everyone’s responsibility hence the need to document the IT strategies for medical devices in the CMMS. The HTM team also controls/ monitors everything that gets rented. It can’t get rented unless the HTM department rents it. HTM manages all of the costs associated with rentals. Those rental costs are communicated to senior leaders throughout the organization. There is “skin-in-the-game” for all levels.

TO READ THE REST OF THIS TechNation ListServ string, visit 1technation.com/ shop-talk-september-2016/. THE SHOP TALK ARTICLE is compiled 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.

THE BENCH

BIOMED 101

Managing Component Obsolescence in Medical Devices By Rob Phillips, Sales and Marketing Director of Accutronics

achine learning is an important tool in the “Data Analytics Toolkit.” What is it exactly and why is it so powerful? More importantly, how can I leverage it as an HTM professional?

The consumer market seems to have accepted that planned obsolescence, or planned failure, is simply a fact of modern life. In the field of medical technology, however, the idea of having to replace a costly device because the battery, for example, is suddenly obsolete after less than two years would cause uproar. Of course, obsolescence is inevitable to some degree, especially as technology is constantly changing and adapting to consumer expectations and medical innovations. Battery technology in particular is constantly in the headlines as cell manufacturers attempt to keep pace with the needs of consumer devices leaving medical device OEMs with limited options. The development of health care devices is becoming increasingly holistic and system-led, no longer operating in silos. This means that component obsolescence has a much deeper impact, as the entire system has to be taken into consideration when replacing a part to ensure stringent requirements and regulations continue to be met. The demand for these smarter devices, that still need to provide a return on investment (ROI) with a long product development lifecycle (PDLC), is forcing medical device original equipment manufacturers (OEMs) to take a long hard look at component 44

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obsolescence management. This raises a quandary, where do OEMs invest their time and expertise? Should they take engineers away from research and development of revolutionary devices to focus on obsolescence solutions? It’s not an easy choice to make. Medical technology (medtech) OEMs are having to focus on maintaining devices rather than replacing them, and so being aware of when and where issues may arise during a device’s lifespan is vital unlike, for example, a smartphone. Reliance on a supply chain that was primarily developed for an industry that changes more rapidly than the relatively slow-paced medical sector will cause problems. Battery cell manufacturers can often fall into this category. International, commercial cell manufacturers often design battery cells with their own consumer device divisions in mind. When these devices evolve and place different demands on batteries, the cells will be discontinued and replaced with different models. Medical devices need to be able to rely on a continuous supply of the same battery type for an average lifespan of around 10 years, so they need to be able to count on their supplier. That’s why, as a battery integrator, Accutronics prefers to be involved in

SEPTEMBER 2016

ROB PHILLIPS

Sales and Marketing Director of Accutronics

the early stages of a device’s design. This then allows the battery to be tailored to meet the device’s specific requirements and ensures that the battery includes cells which are available from multiple vendors, have longevity and meet all regulatory safety requirements. Good cell selection means the battery will be available for the life of the device whilst a poor choice can mean successive redesigns throughout the product lifecycle. Planned obsolescence management doesn’t have to mean you plan to fail. Working with component providers that are committed to helping manage future obsolescence will allow medical device OEMs to focus on developing new technology rather than investing valuable resources on extensive obsolescence programs.

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echNation’s free Webinar Wednesday series continues to provide valuable information to HTM professionals on a variety of pertinent topics – including RTLS. The recent webinar “Driving Operational Efficiencies by Implementing RTLS (Real-Time Location Systems),” presented by Sonitor Technologies Director of Business Development and Sales Alan Tangen, explored the role RTLS can play in driving operational efficiency and cost avoidance in the health care environment. As part of his technological overview of how RTLS systems work in a health care environment, Tangen underscored the importance of RTLS accuracy and reliability, and why ultrasound-based systems provide the highest level of performance. Specifically, Tangen discussed how RTLS, in addition to tracking assets, can provide contextual data related to assets and temperature monitoring that can help improve workflow, eliminate waste, reduce costs associated with excess inventory and avoid excess risk and cost associated

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with loss of temperature sensitive materials. The in-depth presentation, zeroed in on a few key points that included: • RTLS for asset tracking; • RTLS for optimizing inventory utilization; • RTLS for temperature monitoring; • RTLS for waste management; and • RTLS for workflow optimization. The webinar is available online along with several resources including the webinar workbook, Sonitor Technologies company profile and three facts sheets provided by the company. For additional information about Sonitor Technologies, visit Sonitor.com. The webinar was popular among HTM professionals with 200 attendees who applauded the series and the benefits it provides. “I like the exposure to new products and information in the HTM field and these webinars provide great access to that,” Josh R. wrote in his post-webinar survey following the Sonitor Technologies presentation. “I find TechNation Webinars highly educating and informative; I simply love it. It makes me a smarter biomed,” Alero O. wrote. “TechNation webinars are an excellent recourse for continuing education credits. We have found them to answer some of the questions we have had for specific equipment

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NOVEMBER 2014 SEPTEMBER 2016

ew technology is having an impact on the infusion pump market. The global infusion pumps and accessories market is expected to reach $10.2 billion by 2020, according to a news release from market research firm MarketsandMarkets.

“Growth in this market is mainly attributed to the increasing prevalence of chronic diseases owing to the rising geriatric population; increasing use of infusion products in home care with favorable reimbursement coverage; and technological improvements in infusion products,” according to MarketsandMarkets. TechNation interviewed industry experts regarding I.V. pumps to find out important features to consider when purchasing devices. The panel of experts also shared tips and insights regarding I.V. pumps. The members of the panel for this roundtable article are Pacific Medical Manager of Technical Solutions Brian Barton, Iatric System Senior Vice President Jeff McGeath, Elite Biomedical Solutions Co-Owner/Vice President Nate Smith, J2S Medical Director Sales and Marketing Sarah Stem and AIV Director of Sales Jeff Taltavull.

WHAT ARE THE MOST IMPORTANT FEATURES TO LOOK FOR WHEN PURCHASING I.V. PUMPS? Barton: Depending on the type of pump being purchased, at minimums it needs to have “smart” technology. I would also look for wireless connectivity, ease of programming, a drug library that is customizable to the given care area, hard alerts, barcode scanning, and maybe the capability of generating alarm evidence based reports with error trending. When purchasing PCA pumps you may also want to look into the ability of connecting and operating in tandem with a respiratory monitoring module that would allow deactivation or to pause the dose and deactivate the patient

dose button in the event the patient falls below a defined respiratory rate. McGeath: Necessary and important I.V. pump features include ability to minimize medication errors, as well as wireless and EHR integration capabilities. As for purchasing the pumps, while many may be sold through distribution in the outpatient and homecare markets, most, if not all, shipments are made directly by the manufacturer. Most third-party pump providers ship used or reconditioned pumps. Because of this, third-party biomedical service companies as well as third-party integration companies are more common. Manufacturers’ certification training should be a minimum requirement for service organizations. Integration companies should also have extensive knowledge of the pump vendor’s capabilities and should have a developed relationship, not proprietary, whereby common integration standards, such as IHE-PCE protocols, have been tested and validated for functionality. Smith: A device that takes care of the entire hospital’s needs. Be sure to review all recalls that the device has had and that the OEM has properly resolved each issue. Also, what type of service plan do they have? What’s the turn around time? Are there third parties that can help suffice needs if the OEM isn’t addressing their needs in a timely manner? Stem: Important features to look for would include safety software to reduce patient incident risk as well as total cost of ownership, warranty, and RN/BMET training. Reliable partners will address and

BRIAN BARTON

Pacific Medical Manager of Technical Solutions

consult with buyers on long-term costs associated with software implementation, repair and deployment. Last, continuous field support with global reach is a sign that you are working with a value-focused provider which can be a most valuable feature with software driven equipment. Taltavull: I think, first and foremost, a facility should look for a safe and reliable pump with ease of use. Secondly, the facility needs a clear understanding of servicing options on the equipment, both OEM and secondary market. Thirdly, requirements for all necessary tubing sets should be considered to best coordinate long-term financial planning.

WHAT ARE THE BENEFITS OF THE NEW SMART PUMPS?

Barton: The main purpose of “smart” technology is the reduction or prevention of medication errors. Drug libraries that can be updated, adjusted or maintained wirelessly. Reporting of trends capability. Other benefits include connectivity to other monitoring devices, barcoding

THE ROUNDTABLE

Taltavull: Smart pumps make it easier to store patient data as well as ease and safety of dosage calculation. Many of the pumps cross multiple delivery platforms using different modules or stacking features that allow a more all-in-one option where historically, multiple pumps were needed.

HOW CAN FACILITIES WITH BUDGET CONSTRAINTS ACQUIRE THE LATEST I.V. PUMP TECHNOLOGY?

Barton: The facility needs to understand that although it may cost capital up front it will provide a return on investment (ROI) in the future. Negating just one medication error would most likely pay for the entire cost for the upgrade. Also, having the smart technology will help nursing work flow

JEFF MCGEATH

Iatric System Senior Vice President

capabilities for confirmation of proper medication and the reduction of nursing workload. McGeath: The key advancement of new smart pumps is integration to EHR systems, which often includes auto-programming, charting, alarm management and device tracking capabilities. For pharmacy, key benefits include having a centralized drug library management and being able to enforce dosing guidelines. Smith: Eliminates user error along data collection that helps monitor and improve patient safety. Stem: The premier benefit to new smart pumps would be reductions in the number of patient incidents. Nurses love the ease of use and time savings while biomed can manage alarms to quickly troubleshoot repairs. Legal can access software as well which drives accountability with regards to risk control, potentially preserving hospital funds during serious inquiries. Smart pumps focus attention on patient monitoring, promoting the “five rights,” which helps nurses deliver high-quality care.

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NATE SMITH

Elite Biomedical Solutions Co-Owner/ Vice President

McGeath: From a pump standpoint, an “upgrade-able” platform should be considered. For example, adding a wireless card or a wirelessly enabled battery pack to an existing infusion pump can enable more advanced communication and external software applications when a facility has developed the wireless infrastructure to support these advances. This eliminates the expense of purchasing new devices, as well as reduces the time required to configure and train clinical staff on their use. Essentially, a wireless card/battery is plugged in, and devices are configured to communicate on the hospital’s network.

certified with a no-hassle, OEM-matched warranty allowing customers to extend their buying power. Another option during a capital freeze is to lease or rent equipment.

Smith: There are plenty of third parties in the marketplace that can sell refurbished I.V. devices for half the cost that the OEM sells them for. You can get the same software levels and quality that the OEM sells. Also, third parties help by offering a trade-in for your older devices.

Stem: Facilities can acquire the latest I.V. pump technology easily by purchasing from a quality aftermarket supplier. Some companies provide I.V. pumps re-

NOVEMBER 2014 SEPTEMBER 2016

Taltavull: Financially challenged facilities do face an uphill battle with newer equipment. This issue can potentially be overcome as the secondary market continues to be a strong option for the purchase and servicing of pre-owned equipment. In all cases, each facility needs to do its research to determine their needs including the latest software revisions, delivery capabilities, and all options for equipment maintenance.

HOW CAN A BIOMED EXTEND THE LIFE OF AN I.V. PUMP? Barton: Regular maintenance. Upgrades when needed. Sometimes staff training for not only the nursing staff, but also the transporters, and central services or whoever is in charge of the cleaning and distribution. Sometimes it also may be necessary to perform preventative maintenance more often than the OEM

Ensuring that pumps always require a human confirmation step and physical interaction to initiate or stop medication delivery are examples of pump requirements you can establish with your vendor to greatly reduce risk.

recommended intervals, depending on the service area and the history of repairs. McGeath: It is highly recommended that hospitals and biomed departments seriously consider purchasing some of the value added warranty and training options pump vendors provide. Ensuring you have good technical and parts support from your vendor will allow the biomed engineer to leverage existing best practices inside the department to maximize the life of the pump equipment. Smith: Replacement parts can help extend the life of all infusion pumps. Third parties offer biomed-tested recertified parts also companies like Elite sell new replacement parts, which last much longer that re-certified parts. These parts also come with a one-year warranty and can extend the life of a pump for up to 5 years. Stem: Biomed can extend the life of an I.V. pump by partnering with a provider that supports both current and endof-life technology. Maintaining annual preventative maintenance also ensures equipment is operating in accordance with a manufacturer’s set specifications. Addressing correct operation and offering training with RN staff is another way to reduce repair and extend the life of infusion equipment. Taltavull: The biggest thing we see, as a third-party repair company, is a tendency in letting OEM recommended preventive maintenance slide. Keeping up on your PMs and regular safety checks, calibration checks and general structural integrity of the units is the best way to keep your pumps alive. I think it is important to make sure staff is aware of the small things that can lead to big repairs and increased cost.

IS CYBERSECURITY A CONCERN REGARDING I.V. PUMPS? HOW CAN

Smith: I’m not familiar with the cybersecurity side of I.V. therapy. That would be up to the IT department working with the OEM to ensure this doesn’t happen.

SARAH STEM

J2S Medical Director Sales and Marketing

HEALTH CARE FACILITIES PROTECT PATIENTS AND PATIENT INFORMATION FROM HACKERS? Barton: As all medical devices become more connected they will obviously become more vulnerable to hackers. The Department of Homeland Security is or has already investigated more the two dozen suspected cybersecurity flaws in medical devices. This is something that will be an ongoing and moving target to maintain and/or overcome not only on the design side but in the way the device connects wirelessly to each facility. This subject is an entire article in itself. McGeath: Cybersecurity is important for all medical devices. In October 2014, the FDA issued guidance for all medical device manufacturers, stating: “Manufacturers should address cybersecurity during the design and development of the medical device, as this can result in more robust and efficient mitigation of patient risk.” Smart pumps should never allow an attacker to remotely start, stop or change infusion details of any medication delivery.

Stem: Software driven equipment does pose a cybersecurity concern and facilities can address this by implementing strong security protocols. Incorporating firewalls on closed networks where outside access is not possible is common when trying to prevent hackers and protect patient safety. Safety software will engage and prompt the device to alarm if the delivery rate is outside the range for a particular drug – this is a powerful reason for hospitals to consider smart pump technology. Taltavull: Cybersecurity has to be a concern in today’s society as these pumps become smarter and contain more patient data. While there are huge benefits to this it also opens the door to risk. Manufacturers are constantly updating software, so make sure to stay current with all service and upgrade recommendations.

WHY IS BI-DIRECTIONAL INTEGRATION BETWEEN SMART PUMPS AND EHRS IMPORTANT? Barton: The ability of an infusion pump to be auto-programed from EMR will reduce pump programming errors. The ability of communicating with the pharmacy of activity by notifying them the dose is almost complete will enable the next I.V. to be started in a more timely matter. It would also allow any updates to the drug library to be “pushed out” in a timely manner. The accuracy of documentation is another important ability of bi-directional communication.

THE ROUNDTABLE

them take care of each of their patients much more effectively. Stem: Integration between smart pumps and EHR technology allows for comprehensive patient care; utilizing the barcode system also aids in efficiency. Physician orders go direct to pharmacy which programs the device allowing nursing to again verify with automatic documentation complete; time saved which equals better bedside care. A closed loop system aids in asset tracking and alarm management. It is great tool for biomed during annual preventative maintenance.

JEFF TALTAVULL

AIV Director of Sales

McGeath: By implementing an autoprogramming workflow between the pump and the EHR, hospitals can greatly reduce the risk associated with human error of pump setup. Facilities with different equipment in different locations, or facilities with traveling nurses, can have greater risk of human error. For example, one pump may increase a value by hitting a “plus” sign on the keypad but another pump may do that via a “right arrow” sign on the keypad. Further, one pump may increment the value by 10 with each key press, while another pump may only increment the value by one with each key press. A lack of consistency can create risk, but auto-programming integration with the EHR reduces this risk. Once a pump is running, getting start time, stop time, and medication delivery data into the EHR can also have positive revenue impact. An outbound (from the pump) documentation interface into your EHR may allow for better billing data and reimbursements. Smith: The ease of transporting patient information so both the nurses and doctors have real-time patient information. This will clinically help

1TECHNATION.COM

Taltavull: As smart pumps become more integrated and wireless, they will be depended on to capture all of the data between multiple functioning units to maintain accurate health records for the patient. The more compatible they are, the more data that will be captured, leaving less risk of oversight from clinical staff.

WHAT ELSE DO YOU THINK IS IMPORTANT FOR TECHNATION READERS TO KNOW ABOUT I.V. PUMPS?

Barton: Make sure you’re properly educated to manage all infusion pumps used at your facility. I think that anytime a new device is being implemented in your facility it’s just as important for the CE staff to be trained on the device at least as well, if not more, than the staff using it. McGeath: Current and future trends will continue to emphasize system integration via the hospital’s wireless network. Along with initial and ongoing device certification training, it is beneficial for biomeds to become familiar with the wireless hardware contained within a device to understand not only how to troubleshoot but how to configure these components. Wireless and encryption/authentication protocols are constantly being updated and a basic knowledge of wireless networks is advantageous. Computer literacy will also

NOVEMBER 2014 SEPTEMBER 2016

be a “must have” as new applications are developed and released to help biomedical personnel configure, troubleshoot and even locate devices for service. Smith: There’s really only four big OEMs in the marketplace (Hospira, Carefusion, B.Braun and Baxter). Customers really need to ensure they are getting the device that truly meets their needs from cost, implementation, maintenance/recalls to end of life. You definitely need to ensure that you have a back-up plan for maintenance and service if the OEM runs on back order or has unreasonable service rates or turn around time. This is the largest installed base in the marketplace and it get’s real expensive if you have to start renting devices because the OEM take care of your needs. Stem: It’s important for facilities considering new or additional infusion equipment to partner with providers that deliver efficient, reliable and cost-effective solutions. Considering aftermarket and non-OEM parts is a great way to extend the life of a device while preserving capital. I.V. pumps that are software driven pose connectivity issues, buyers should be sure to match revisions when buying capital or parts to avoid interruption. Taltavull: The I.V. pump world is ever evolving. OEMs are making it harder for end users to have flexible options to controlling their costs. I can’t emphasize enough how pertinent it is for a facility to do it’s full due diligence when making a buying decision. A facility must understand the long-term costs, the long-term servicing options and, more importantly, if there are options. They also need to be responsible when using third-party services on these ever changing pumps. They need to find reliable, educated and ISO-certified repair partners to help control their costs. That can be in depot repair, service parts or calibration. Knowledge is the best buying power a hospital can have.

THE ROUNDTABLE

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“The increasing convergence of medical and information technologies leaves little question as to the need for better collaboration between HTM and IT services.”

1TECHNATION.COM

DECEMBER 2015

MAPPING YOUR HTM NETWORK adding IT to your toolbox By K. Richard Douglas

rogress in medical technology has advanced at a mindnumbing pace over the past decade. Advances include imaging diagnosis enhanced by software and spectral computed tomography, wearable diagnostics, blueviolet LED light fixtures for disinfection, more advanced robotic surgery and electronic medical records and supporting systems. New technology has found its way into hospitals and other medical facilities as much as anywhere else in the modern world. It was inescapable then, that the steady creep of technology would change the dynamics of the HTM professionalâ&#x20AC;&#x2122;s role, moving beyond the high-tech characteristics that many medical devices already possessed, and into networking, cybersecurity, databases, informatics and data analysis. Several years ago, the evolution of technology in health care began to require a collaboration between the IT and clinical engineering departments, like never before. It is a trend that will only deepen as the explosive pace of technology marches forward.

GOING MOBILE

MAPPING YOUR HTM NETWORK adding IT to your toolbox

Although the two groups have differing cultures, and that may never change, the roles of many HTM professionals are evolving. This changing dynamic has even been the stimulus for several “hybrid” roles within the evolving framework that includes clinical engineers, BMETs and IT professionals. Some of these new roles include clinical systems support specialists, radio frequency spectrum managers and clinical systems engineers. In order to tackle these hybrid roles, along with keeping current on evolving technologies, the need for additional credentials falls upon the HTM professional. Network+ or A+ certifications can help move a biomed a step towards the IT culture. They may also help bridge the language gap, where the biomed is finding that speaking in IT’s esoteric language is becoming a necessity. Because of these differences, biomed may find itself extending an olive branch, while IT may not find as many compelling reasons to do the same. There are some job description changes that accompany those certifications as the role of the biomed evolves. Reporting relationships may change also, and many have changed already to reflect the evolving nature of networked medical devices. Today, the biomed department may report to facilities or IT or supply chain. Regardless, the biomed must be able to speak everybody’s language. “The increasing convergence of medical and information technologies leaves little question as to the need for better collaboration between HTM and IT services,” says Steve Grimes, FACCE FHIMSS FAIMBE, managing partner and principal consultant at Strategic Healthcare Technology Associates LLC in Swampscott, Massachusetts. “General recognition of that fact has led many organizations to move their HTM programs within their IT service umbrella

1TECHNATION.COM

STEVE GRIMES, FACCE FHIMSS FAIMBE Managing Partner and Principal Consultant at Strategic Healthcare Technology Associates LLC

Information Technology at Henry Ford Health System in Michigan. “The reality is that the skill sets are very different, but are beginning to have more intersections. From an organizational structure, it is logical to have both teams reporting up through the same structure. In order to promote manageable risk, the two organizations must work very closely together,” he says. Grimes points out that another change, along with the reporting alignment, has been the alignment of organizations and education opportunities that have come together. “On one positive note, we have developed much closer relation between HIMSS, AAMI and ACCE in the past 15 years and we have increased the number of HTM/IT tracks in our conferences and publications,” he says.

TWO CAMPS; TWO CHOICES (from a few percent a decade or two ago to an estimated 30 to 40 percent today),” he says. “Unfortunately, many of these organizations overlook that simply changing lines in an org chart does not necessarily guarantee better collaboration between service support models that traditionally have been very different.” Grimes won AAMI’s 2016 HTM Leadership Award, partly because of his pioneering work in “advancing the understanding of safety and risk management in the interface between medical devices and IT systems.” He has not only provided leadership to AAMI, but to ACCE and HIMSS as well. “In order to establish a good working relationship, there must be an underlying trust as well as mutual respect and reciprocity. Historically, there has been distrust and the feeling that IT is after biomedical jobs or vice versa,” says Ali Youssef, PMP, CPHIMS, CWNE #133, principal mobile solutions architect in

DECEMBER 2015 SEPTEMBER 2016

For many biomeds, who enjoy electronics or mechanics and found their way to the HTM profession, the profession remains rewarding on its own. Being on the patient care side, along with the diversity of daily experiences, are what many HTM professionals cite as rewards for their work. For others, whose motivation is financial, the IT world offers the lure of potentially more income. Will HTM professionals, with new IT credentials, jump ship? Will there even be enough new HTM professionals entering the field? There are issues that biomed leadership must address. According to the 2015 HealthITJobs.com Healthcare IT Salary Survey, the average health IT salary was $87,443 and the average bonus was $7,990. HTM managers are concerned that when new students enter college, and consider HTM or IT, they may focus on income potential. “I do believe there is a risk that reluctance or hesitancy on the part of the existing HTM community to embrace the

integrated concept of medical and information technologies will lead to a new professional taking over the support for the new breed of medical devices and systems,” Grimes says. “That new professional might very well drain significant potential talent from the ranks of the HTM community and may find its way to the typically better funded — and often better organized — IT service,” he says. The previously mentioned hybrid roles, and IT-oriented credentials, may have to become more widespread and accelerated. Grimes believes this type of progress can’t occur too quickly. “So, I believe the question remains whether today’s HTM professional can proactively adapt with sufficient speed to adopt the new methodologies and skills necessary to support the new converged technologies,” he says. “If the existing HTM community does not evolve, they risk increasing marginalization, eventual obsolescence and replacement,” Grimes adds. To stay relevant in this HIT leaning environment, HTM professionals must maintain and update their knowledgebase and competencies. “The best way is to remain active in organizations such as AAMI and HIMSS to stay abreast of the latest technologies as well as network and learn from like-minded peers,” Youssef suggests. “Usually the certifications are valid for three years and require either ongoing educational credits, or a retest. One of the tracks that I have personally leaned heavily on is the CWNP organization, which teaches the fundamentals of Wi-Fi administration, design, security and analysis,” Youssef says. “The other key mobility track is the IEEE WCET certification, which is focused on mobility, including cellular and other technologies, that may be in a hospital or clinic.” Beyond the additional training that

“In order to establish a good working relationship, there must be an underlying trust as well as mutual respect and reciprocity.” ALI YOUSSEF, PMP, CPHIMS, CWNE Principal Mobile Solutions Architect Henry Ford Health System

HTM professionals will seek for career growth, there are changes in HTM education programs and the recruiting standards that managers employ that are another dynamic of the HTM/IT synergy. “In terms of recruitment, we recognize that there is a fine line between hiring HTM positions with strong IT skills and creating IT jobs in HTM. For some organizations, that might not be an issue, while for others, defining that fine line is a directive that must be addressed,” says Jennifer Jackson, MBA, CCE, director of Clinical Engineering and Device Integration within the department of Enterprise Information Services (EIS) at Cedars-Sinai Health System in Los Angeles. “Initially, we struggled to identify candidates that were strong and experienced in HTM with the extra IT skill sets, so we started training internally with great success. We are fortunate to have CE, Device Integration and IT staff who are willing to take the time to teach and explain things to their colleagues,” Jackson says.

Jackson’s department has been fortunate to hire new technical staff with the right skill set. She says these were BMETs that left the field in pursuit of a more IT-focused career. When the opportunity came up to return to HTM, and still use the newer IT skills, they accepted the challenge. “Since our medical device systems are more complex and more integrated, that knowledge is always put to good use,” she says. “We implement the systems and we get the calls to address problems when they occur at the point of care. If we can’t fix it, then we turn to another colleague, perhaps on the DBA team or the desktop support team. Those new IT skills come in handy to identify what we can fix and when it is time to consult other experts,” she adds. Jackson’s role reflects the changing dynamic with her title including “device integration.” This is a growing trend. There are now job titles that represent the changing responsibilities, expanded

GOING HTMMOBILE AND IT

MAPPING YOUR HTM NETWORK adding IT to your toolbox

MATTHEW DU VALL Biomedical Technician with Treasure Valley Hospital

skills and the realities of networked medical devices that are part of every biomed’s world. Reporting structure, and its continued evolution, plays a role in the two groups’ relationship. “There are certain barriers which are eliminated when HTM reports into IT, but the vision, mission and goals all still have to align. In our experience, here at Cedars Sinai, we’ve actually discovered that the result of building trust and teamwork has led to more robust technology management solutions,” Jackson says. “I have learned so much about the care and feeding of other HIT technologies that I actually feel more empowered to work with my IT colleagues and we interact with the vendors together. It is helpful to design and architect the new systems together so that we can have the important conversations early on; security, maintenance, back-ups, etcetera,” she adds. This topic is playing such an important role in the two departments’ responsibilities

1TECHNATION.COM

that HIMSS and ACCE introduced an award that recognizes efforts at developing a synergy between the two in 2006. Jackson won that award in 2015. Responsibility for many tasks remains very clearly delineated. IT still handles servers and network infrastructure and biomeds still handle medical device repair and PMs. The specialization of both groups is fixed to a degree, with the exception of certain overlapping areas. One difference is that if a biomed is working in a hospital, they always remember that they are in a hospital. There still exists some level of suspicion or a lack of understanding between the two groups as well. “There is a self-induced ego to both groups. Which is more important; patient care and safety or patient, facility IP,” asks Matthew Du Vall, biomedical technician with Treasure Valley Hospital in Boise, Idaho. “The IT thinks the HTM does not maintain the same level of security as the IT do. This, of course is wrong. The HTM is all about security and safety, especially at the patient’s level. The IT are not told this in training. It is very hard to convince them of this.” There are other contrasts as well. Biomeds are better prepared, and more comfortable, in the clinical environment. A person trained in IT has not had this eventuality as a part of any traditional training in the computer sciences. The Eskenazi Health Biomedical Engineering Department has achieved bridging the gap between the two disciplines. It engages in an interdepartment activity that brings the IT and biomed groups together periodically. They call it “Lunch and Learn,” where the departments get together on a regular basis for educational presentations. According to Matthew Royal, the clinical engineering department’s director, this “interaction builds relationships and knowledge among the two support teams.”

DECEMBER 2015 SEPTEMBER 2016

Royal says that the Lunch and Learn allows the biomed department to “give IT an overview of what that system is. And when we have an issue, it might be on their network, that they manage; say it’s a server or network infrastructure, that we’re scheduling downtimes together,” Royal says. “Sometimes changes that they don’t think affect our medical equipment, actually do, and so having that communication, when you schedule certain maintenance on an IT system; we need to have that communication from them.” Royal says that if an anesthesiologist in the OR is looking to see the vitals and patient information coming over to the medical record, and has an issue, it could be an issue between the machine and the middleware or the EMR system. If you’re familiar with all of those modalities, he reasons, then you are going to be able to fix the problem a little bit easier and you’re introducing one less person into the troubleshooting process. “I think that is our intent. We are the one-stop shop. We’re helping our IT department out by fixing it for them, without them coming into an environment that they’re not used to coming into, like a surgery room or clinical procedure,” Royal says. “That’s where we’re more comfortable. Just from a safety, an infection control, standpoint, you don’t want to introduce a whole lot of extra people into that clinical environment that could compromise it, particularly if they don’t have that kind of experience.”

WORKING COLLABORATIVELY Cooperation and coordination is still the name of the game between the two departments. Tedd Koh, CRES, CBET, CCNA, A+, NET+, Security+, a medical electronics technician at Olive View UCLA Medical Center, says that when his department upgraded a patient

“I think that is our intent. We are the one-stop shop. We’re helping our IT department out by ﬁxing it for them, without them coming into an environment that they’re not used to coming into.”

MATTHEW ROYAL Clinical Engineering Department Director at Eskenazi Health

monitoring system, because of the connectivity to bedside monitors, central monitors and servers, there had to be cooperation with IT. When a customer uses their Enterprise Service Desk to report an issue, IT and biomed come to the site to determine which group will take care of the issue, Koh points out. Koh says that the relationship between the two departments has become better in recent years because projects like implementing an EHR or patient monitoring system could not be completed without that cooperation. Grimes agrees and points out that HTM services that have best succeeded have been those that have recognized the convergence of medical and information technologies necessitates a strong collaborative approach between HTM and IT toward the support of these new integrated systems. He says that both groups need to understand and appreciate how each

has traditionally had different approaches to service support and that both can best succeed in supporting new technologies when they can adapt and adopt the best service support elements from each other. Grimes says that initially there will be support gaps when HTM and IT begin collaborating and that success will only be achieved if the gaps are quickly identified and filled by an integrated team willing to step out of comfort zones and accept new responsibilities. He adds that the need for medical and information technology support continues to change and that successful support requires a continuing evolution in HTM and IT services through education and the adoption of new management and technical skills. He also says that HTM services that have best succeeded have recognized “that stakeholders, requiring technology support, have a single point of contact (e.g., a common service desk and integrated support system) so that the stakeholder is not being forced to manage who is taking responsibility between biomed, IT, a vendor, etcetera.”

LOOKING AHEAD The future of health care will continue to include more innovations and technologies that require cooperation between the two groups. “There’s no question in my mind that the future is headed towards further embracing mobility and finding creative ways to leverage IoT and wearable’s for actionable clinical data,” Youssef says. “The end result is a stronger focus on wellness. Both biomed and IT will need to be educated and prepared for this inevitable evolution.” Grimes says that while sophisticated health care technologies will continue to be developed and deployed, it remains to be seen which ones will translate to real benefits regarding patient care. “Particularly, as the technology becomes more complex, care must be taken to judiciously select the right technology, systematically deploy that technology, consider necessary workflow changes, and ensure there is adequate life cycle support,” he says. “Organizations that consider only promised benefits and focus on only the hurdle of initial capital costs likely will see

GOING HTMMOBILE AND IT

MAPPING YOUR HTM NETWORK adding IT to your toolbox

some of their hoped for benefits, if any, only after making significant additional investments,” Grimes says. Determining the usefulness and efficacy of any given technology falls upon both groups to guide their employer’s decision making process. “HTM and IT can greatly improve future prospects of realizing the benefits of new technologies by educating their organizations’ leaders and users on the nature of resources needed to support those technologies after acquisition and the costs associated with that support,” Grimes adds. “To accomplish this, HTM and IT need to be able to effectively and convincingly communicate with those

leaders and users. HTM and IT also need to acquire and develop the requisite resources, including management, technical and collaborative skills to ensure availability of the needed support.” Grimes points out a third element. “In the future, successful health care organizations will likely have – or contract with –an integrated technology support service that includes various HTM, IT, telecommunications, and other technologyrelated professionals, operating in a matrix, to provide those organizations with comprehensive support in such areas as acquisition, deployment, integration, workflow design, training, lifecycle management, and systems analysis,” he

says. “The support model is likely to be built around the ITIL, COBIT, or ISO 20000 standards and systems engineering principals.” Despite the different cultures and differing jargon, the current relationship between these important departments requires cooperation and synergy as illustrated by industry leaders. “At the end of the day, we are still expected to be able to speak for the performance of our systems,” Jackson says. “In other big areas, like IT security, we collaborate closely with the bigger department team instead of trying to tackle medical device security by ourselves on a separate, isolated track.”

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CAREER CENTER Avoid These Pitfalls By Todd Rogers

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

I have an article for TechNation due and I’d like input on what I should write about; I’m thinking about etiquette and pet peeves exhibited by candidates,” is what I said to my teammates in our weekly meeting.

To professional recruiters, this is a humorous challenge that always brings to light strange oddities and anecdotes of our workforce. To be sure, if you asked people to describe some of the most ridiculous things that a recruiter has ever said or done, you’d get an equally interesting list of stories and gripes. The reality of the interview process is that candidates are basically shoved out on stage and told to perform with little to no coaching. Interviewing for a job is inherently awkward and stressful. And, it demands that you do something that is genuinely discouraged in our society: sell yourself in a competitive situation where you’re not going to be given very much feedback as to how you did. The cards are almost always stacked against you. As a result, recruiters gain exposure to some really odd behaviors that only come out when someone is really stressed out. THE EARLY ARRIVER When I was in the Marines, my company first sergeant once told me, “If you’re not five minutes early then you’ve arrived late.” I’ve found this to suit me quite well over the years. Don’t be the guy who’s more than 10 minutes early. You can wait in your car or anywhere else. But once you tell the receptionist

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who you are, he or she calls the interviewer to announce your arrival. Don’t wait in the lobby. Last week we had a guy arrive 45 minutes early. That’s not good. THE BLISSFULLY IGNORANT Some people don’t realize or are simply too lazy to learn about the company prior to arriving for an interview. If you show up for an interview and can’t make a reasonable showing that you know at least how a company generates money, you should postpone the interview until you do know. When asked, make an attempt to show that you care. THE TOO COMFY CANDIDATE One colleague interviewed a candidate who put her feet on the table during the interview. That kind of thing doesn’t happen very often and if I was in the room, I’d be fighting the temptation to knock those feet back to the floor. But, formalize yourself for an interview. Even if you believe the job is a little beneath your skill level, you should act slightly humbled at all times. HOLD PLEASE If you’re being interviewed by phone, don’t put the interviewer on hold to take another call. It’s also a good idea to seclude yourself from interruptions and

Leader –Healthcare Technology Management & Medical Systems Engineering Technologist Universal Health Services, Inc. Founded in 1978, Universal Health Services, Inc. (UHS*) is one of the nation’s largest and most respected healthcare management companies. UHS subsidiaries own and operate 235 acute care and behavioral health facilities and surgery centers in 37 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the United Kingdom, and employ more than 74,000 people. The Leader - Healthcare Technology Management provides leadership and is responsible for the implementation of the UHS corporate HTM program and services. The Medical Systems Engineering Technologist performs evaluations, repairs, inspections, and preventive maintenance on devices used in the care and treatment of patients at UHS facilities, affiliates, and other institutions that have UHS relationships either owned or contractual. We are currently hiring for Leader - Healthcare Technology Management positions in 14 of our locations. These openings are located at our facilities in: Texas, South Carolina, Nevada, California, Texas, Florida, Oklahoma, and Washington, D.C.

background noise. If you are expecting an urgent and important call, you should inform the interviewer that if that call should come, you’re going to have to take the call. The better play is to reschedule the interview and to do so apologetically.

We are also hiring Medical Systems Engineering Technologists in 19 of our locations. These openings will available at our facilities in: Texas, South Carolina, Nevada, California, Florida, Oklahoma, and Washington, DC. For more information and to apply online, please visit: jobs.uhsinc.com

PROOF S

We are an equal opportunity employer.

PROOF APPROVED CHANGES NEEDED THE HOUDINI If you’re diligent, you’re probably interviewing for more than Committed to CLIENT SIGN–OFF: one job. If you get an offer that you accept, contact the other emService Excellence PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT ployers and let them know that you’re no longer available. You LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR never know what the future may hold and if you don’t bow-out with grace, the future will certainly not be kind to you and your future interviews. TRIM 3.25”

FONTS ON COVER LETTERS There’s nothing wrong with working from a template on your cover letters. The key is to properly customize your cover letters to each employer which includes making sure that your fonts match. It’s a poor showing when you provide a nice cover letter but then fail to properly match the lettering with your customizations. THE EYE WANDERER Eye contact is essential. Too little eye contact and you appear disinterested. Too much eye contact is creepy. Eye contact at parts of the body that are below the nose is bad. Seek balance.

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EXPERT ADVICE

TRIM 4.5”

EMPTY-HANDER Now and then I interview someone who shows up empty-handed: no notebook, no pen, no resume, no anything. Bring all of the things I just mentioned. Bring several resumes, two pens, a decent looking notepad, and if you really want to go the extra mile, bring copies of performance reviews, letters of recommendation, and a list of references which include names, titles, contact information, and how you know the people on the list. Just be sure to bring stuff with you. This list is not exhaustive. I invite readers to email comments to Editor@MDPublishing.com and share other list-worthy items that you believe should be included. The ones I mentioned are just a few tips of who not to be and how to go about being who you should be during an interview.

your partner to

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