TechNation - August 2016 by MD Publishing

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VOL. 7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

AUGUST 2016

women OF HTM THE

Company Showcase Technical Prospects

News and Notes Industry Updates

Roundtable Sterilizers

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

ROUNDTABLE: STERILIZERS Innovations and new ideas continue to impact the often life-saving techniques of surgery. However, even the most advanced surgery techniques will fail when using unsterile instruments. TechNation contacted professionals familiar with sterilizers to find out the latest regarding these important pieces of health care equipment, including purchasing and servicing options.

THE WOMEN OF HTM There are no "men only" signs outside the doors of technical schools and college electronics programs, but the interest level for these jobs proved more appealing to men in previous decades. Now, more and more women are entering the world of HTM and excelling in a rewarding profession that offers room for growth and success. Next monthâ&#x20AC;&#x2122;s Feature article: HTM and IT: A Dynamic Duo

Next monthâ&#x20AC;&#x2122;s Roundtable article: IV Pumps

TechNation (Vol. 7, Issue #8) August 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.

AUGUST 2016

1TECHNATION.COM

INSIDE

Departments 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

P.12 SPOTLIGHT

p.12 Department of the Month: Alaska Clinical Engineering Services Department p.14 Company Showcase: Technical Prospects p.18 Professional of the Month: Bart Onoday p.20 Biomed Adventures: Go Jump off a Bridge

P.25 INDUSTRY UPDATES

p.25 News and Notes: Updates from the HTM Industry p.28 ECRI Institute Update p.30 AAMI Update

P.32 THE BENCH

p.32 Shop Talk p.35 Tools of the Trade p.36 Biomed 101

P.52 EXPERT ADVICE

p.52 Career Center p.55 Ultrasound Tech Expert Sponsored by Conquest Imaging p.56 Karen Waninger p.58 Thought Leader p.60 Tech Savvy p.62 The Future p.64 Roman Review

P.66 BREAKROOM p.66 p.68 p.70 p.78

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

p.73 Index

Inhel Rekik, Biomedical Engineer, MS, Clinical Engineer

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AUGUST 2016

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DEPARTMENT PROFILE Alaska Clinical Engineering Services By K. Richard Douglas

ast month, we told the story of outdoorsman Caleb Campbell in our Biomed Adventures feature. Who is a biomed who regularly traverses large distances in Alaska to do his job as a member of the Alaska Clinical Engineering Services (ACES) department.

The HTM professionals who make up the ACES team have a unique mission as they serve facilities scattered around the state of Alaska. Trips to clinics are often on dogsleds or ATVs instead of in a service van. A long day on the job can literally mean a long day; often 17 to even 24 hours of daylight. “[The] Alaska Clinical Engineering Services Department is small for the large scope of service we offer,” says ACES Director Robert Axtell. “ACES has a total of seven personnel; of these personnel ACES has only five biomedical personnel.” In addition to Axtell, there is Senior Office Specialist Kathleen Hillstrand, Lead Biomed Specialist Bill Noel, Biomed Specialist Jack Yerxa, Biomed Specialist Karen Ruth, Biomed Specialist Caleb Campbell and Biomed Technician Cody Mingo. ACES is in a unique situation that calls for a different approach when compared to its counterparts in the lower 48. “ACES is not your typical biomed; we act more like an independent service organization,” Axtell says about the Anchorage-based department.

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AUGUST 2016

Cody Mingo travels to the Napakiak Clinic.

The group supports a total of six sub-regional hospitals in Alaska, 20 sub-regional clinics and over 100 village clinics throughout Alaska. “We provide biomed services to our Tribal Health Organizations/Indian Health Service (THO/IHS) clients all over the state of Alaska. ACES has contracts with 20 THO/IHS Alaska organizations. We provide preventative maintenance, corrective maintenance, equipment install, and equipment removal/destruction on everything that touches a patient,” he adds. The group covers basic biomed, dental and dental X-ray, X-ray/imaging and even biomedical safety cabinets. At one time, the department operated differently. “ACES has been around for about 18 years, they were a federal program originally with all federal employees,” Axtell says. “Just prior to 1997, all the tribes came together and decided that all of the tribes, whether they were very small tribes or larger tribal health organizations, wanted the ability to have the same health care,” Axtell says. Today, the group is a contract-based organization. Because of the remoteness of their work environment, each team member is well

trained to address the repair and maintenance needs of a variety of equipment. “ACES biomeds complete ADEC dental training,” Axtell says. “Biomed specialists complete RSTI, Planmeca, safety cabinet training and various other vendor-specific training.” “In order for us to work on some equipment, we require vendor-specific training, such as ventilators [and] X-ray,” Axtell says. Also, there are times when the vendors themselves get involved and must sent an engineer to a site.

PROJECTS AND PROBLEM SOLVING For a biomed department, which is challenged to cover the largest state in the country the project list is bigger than life also. “We have completed several projects all over the state of Alaska. Some of the big projects have been the opening of Samuel Simmonds Memorial Hospital in Barrow Alaska [and] Norton Sound Health Corporation Hospital in Nome Alaska,” Axtell says. “ACES is a project orientated group of technicians; [and] have installed a six-room dental clinic in Kodiak, Alaska, and X-ray systems, both dental and medical in various places throughout Alaska. Truly there are way too many projects to list them all.” Not only is Alaska the largest state, but it is also the most sparsely populated. The sheer expanses the team at ACES has to cover, along with the modes of travel, make any workday challenging and unique. “Every day is a challenge for ACES personnel, we travel all over the state of Alaska. ACES personnel travel three weeks each month and are in the office one week,” Axtell says. “An easy week for our technician looks kind of like this: 5 a.m., arrive at Anchorage International Airport – the weather may be 50 degrees.”

The team members of ACES love Alaska and everything the state has to offer – that is their reward for the occasional dogsled commute or a tsunami warning. “Depart Anchorage to Barrow Alaska (723 air miles away). This flight has to stop in Fairbanks, Dead Horse Alaska, then to Barrow. Arrive in Barrow at 12-1 p.m.,” Axtell adds. He points out that when the biomed arrives in Barrow, it could be 20 degrees below zero. He says that all the travel on Monday would be followed up with four 10-hour days. Then, the biomed would depart Barrow at 11:30 a.m. and arrive in Anchorage around 3:30 p.m. A crazy week for a technician would take this scenario a step further. The biomed might depart Anchorage at 6 a.m. on Monday on a small plane to Bethel, Alaska. They would arrive in Bethel at 10 a.m.

The department member would then get on a bush plane and head to four to five small village clinics throughout the week. “Technicians may travel on boats, float planes, snow machines, four-wheelers; we have even had technicians travel by dog sled to the clinic,” Axtell says.

EXTREME HTM If that overview of a typical day doesn’t sound over-the-top enough, consider this one. “One of the craziest trips our technicians have ever had was a two-day trip to St. Paul Island, Alaska,” Axtell recalls. “We chartered a flight to St. Paul to fix some medical equipment. After arriving at St. Paul, the fog, wind, and rain came in and the technician and the pilot were stuck for a total of 21 days. So, a two-day trip was now a 21-day trip,” he says. Another time, one of the biomeds was visiting Adak Island and while there a tsunami warning was issued. The biomed had to make his way to the highest point of the island and wait it out.

When the team members are back in Anchorage for that one week each month, they are busy closing out all of their work orders and setting up all their trips for the next three weeks. They are at home on the weekends. The four biomed technicians in the department were all hired from the lower 48. The lead tech is from Alaska. Axtell has lived there most of his life and the department’s office specialist is from Alaska as well. For the biomeds, it’s a testament to the tradeoff of living in one the most beautiful places on earth, and facing the additional challenges of a biomed job that’s like no other. Axtell points out that for those living in Alaska, you go from your heated house to your heated car to heated stores and heated work places when the weather is extremely cold. He says that the summers are for fishing. The team members of ACES love Alaska and everything the state has to offer – that is their reward for the occasional dogsled commute or a tsunami warning.

SPOTLIGHT

COMPANY SHOWCASE Technical Prospects

echnical Prospects was founded by Bob Probst in 1997. The 18-year Siemens CT service engineer decided to branch out and use his knowledge to start a company that would provide a viable alternative to OEM sales and service. When he first established the company, Probst’s sole mission was to service facilities’ medical equipment. However, after recognizing the need for a medical imaging parts supplier, he ventured to provide a dual service: equipment engineering and quality pre-owned tested parts. By providing replacement parts at a cost up to 90 percent lower than original equipment manufacturers, Probst served a unique purpose.

For the first five years of business, he focused exclusively on Siemens CT parts. He soon realized that if he wanted to break into new imaging modalities, he would need some help. Robert brought in his son, Jeremy Probst, who had the necessary education to help his father take Technical Prospects to the next level.

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AUGUST 2016

What are some advantages that your company has over the competition? PROBST: Technical Prospects is the only parts company in the industry that focuses solely on Siemens. We have over 32,000 parts in our warehouse and are able to fill 70 percent of requests immediately from our stock. Our DOA rate is also lower than industry standards. These attributes combine to make us the only reasonable choice for Siemens Medical Imaging replacement parts.

Can you explain your company’s core competencies and unique selling points?

How has the company grown over the years?

PROBST: The company started in a 10-foot-by-10-foot bedroom in Greenville, Wisconsin. In August of 2009, the company moved into its current 60,000-square-foot state-of-the-art facility on 15 acres. The headquarters were designed around the Technical Prospects business model with growth in mind. We did just that in 2013 when we added 12,000 square feet of training and Quality Assurance (QA) bay space to our existing building. Today, Technical Prospects has positioned itself as the expert in Siemens Medical Imaging equipment replacement parts, engineer training and technical support. The company provides its customers a select few number of OEM replacement parts and several refurbished parts at 30

and shipping to sales process and accounting,” Jeremy Probst says. “As a result, the company can tell you what parts they have available almost immediately, at all times. All parts and orders are traceable and accountable. Having this backbone infrastructure allows us to grow and is going to allow us to grow indefinitely.”

Jeremy Probst Chief Operating Oﬃcer, Technical Prospects percent less than the manufacturer’s price. Field-tested parts are available at an even more significant savings. The company installed an enterprise resource planning (ERP) software system to help streamline processes and better manage all aspects of the company. “We put in a full enterprise management system to control our business from all different aspects, from quality, inventory

PROBST: At Technical Prospects we have three pillars that make up the business; Parts, Training, and Technical Support. Siemens Medical Imaging parts are the backbone of the business, making up almost 90 percent of our gross revenue. We offer new OEM, used and refurbished parts for Siemens X-ray, CT, fluoroscopy, cardiac, vascular and mobile systems. Our team of technical engineers ensures each part is in working order before it leaves the facility by testing it in one of our 26 QA bays. We also take it one step further, cosmetically refurbishing housings, handles and other visible parts. We make sure that we achieve 180 degrees of quality on each part that leaves our facility. Our technical training offers engineers the opportunity to expand their knowledge of Siemens Medical Imaging equipment, in turn expanding their careers. The majority of the classes

TECHNICAL

PROSPECTS

Experts in Siemens Medical Imaging

are Siemens specific focusing on the whole system be it X-ray, CT, portables, fluoroscopy or cardiac. The 10-day courses introduce students to the inner workings of the system with a mix of lectures and hands-on lab time. Students explore the system interface, learn the parts, troubleshoot common issues, and learn how to access and interpret error codes. The technical support team assists customers with their Siemens Medical Imaging equipment issues. From troubleshooting questions to installation help, our team will work with you to diagnose the problem and purchase the right part to fix your equipment.

What product or service that your company offers are you most excited about right now? PROBST: The beginning of 2016 brought about continuous course development to

round out the offerings at our training center. We have added three new Siemens Medical Imaging equipment training courses, as well as opened up a new online offering, “Introduction to X-ray.” These additions are helping us assist customers. Having trained engineers means less reliance on OEM contracts and service providers, equaling significant savings for the hospital.

What is on the horizon for your company?

PROBST: This year Technical Prospects introduced our first online training course, “Introduction to X-ray.” By the end of 2018 we hope to have rounded out our online offerings with “Introduction to Computed Tomography,” as well as blended courses. With the demands placed upon service engineers, being out of the field for a two-week course is becoming more and more difficult.

Online and blended classes allow these individuals to work on their education while performing their work duties.

What is most important to you about the way you do business?

PROBST: Technical Prospects will provide the global medical imaging community pre-owned OEM quality standard imaging parts at less than OEM pricing with an honest and consistent reputation due to quality shipping, friendly service and knowledgeable staff. Technical Prospects is committed to meet or exceed our customer requirements and to provide continuous improvement to our processes. At Technical Prospects, quality is paramount in all we do. FOR MORE INFORMATION, visit www.technicalprospects.com

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SPOTLIGHT

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PROFESSIONAL OF THE MONTH Bart Onoday, CBET By K. Richard Douglas

or many people; you never know where life will lead. That truism has application among many biomeds as well. One day you start your own business and another, you get recognized by your peers with a statewide award. Some things are carefully planned and others are a complete surprise.

Bart Onoday, CBET, started his own business, Cascade Medical Services LLC, in late 2015. It was the result of careful planning and implementation. In sharp contrast, Onoday’s recognition as winner of the Oregon Biomedical Association’s 2015 Biomed of the Year award – was a surprise. Happenstance brought Onoday to the HTM field. “I really didn’t know the career field existed until I was in the U.S. Air Force. While working in the hospital, I was curious about the role of some of the Airmen working on broken medical equipment,” he remembers. “I talked to one of them and he mentioned I could get out of the Air Force and be successful doing this type of work. It interested me much more than the career I anticipated developing from my medic role,” Onoday says. He enrolled in a biomedical service technician program at Spokane Community College and completed the two-year program. He had found the program while doing research before he left the Air Force. “There was a program conveniently located in my hometown. The program was challenging, but there were thorough and motivating instructors. I graduated from the program in 1998,” he says.

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AUGUST 2016

He went to work for a large HMO hospital in Seattle and worked there for two years. He then moved to Oregon and took a position with a small community hospital as a general and surgical biomed. He stayed there for the next five years. At this point, he took a slight departure from what he had been doing and took a position in sales and service for an anesthesia-specific equipment and supply house for the next couple of years. “I then began my career at a university hospital in Oregon, specializing as a biomed in surgery, anesthesia, lasers and special projects, leaving to begin my own business after eight years in the setting,” Onoday says. Being self-employed had been a dream of Onoday’s for many years and it was very familiar since his father was a business owner. When a vendor of the hospital retired, Onoday eventually bought out his company. The business did not do a lot of biomed work, more mechanical, but it provided a customer base to build from.

LEAP OF FAITH Starting a business is no easy feat. Onoday characterizes it as his “greatest challenge.” “It has also been the most gratifying,” he adds.

“I encourage all biomeds to consider volunteering to help advance our profession, whether with this organization or others that support our goals.” “It was a huge undertaking to simply take the fi rst step. There was tremendous research, planning, legal preparation, courses, and consultation. As for special projects, one of the more interesting was a project for building out surgical suites, which included an addition of a hybrid room,

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FAVORITE PART OF BEING A BIOMED: Bart Onoday is congratulated on being named the 2015 OBA Biomed of the Year.

Helping people

WHAT’S ON MY BENCH HD integration upgrades, and an interdisciplinary approach with teams, including cath lab, cardiac surgery [and] interventional radiology,” Onoday says. The desire to become a business owner grew from watching his father. “My father was a huge influence in my aspirations to become a business owner. He will soon be retiring from his own low-voltage business that has had great success since he started it in 1985,” Onoday says.

WHILE NOT ON THE JOB In his non-working hours, Onoday seeks adventure and fi nds satisfaction through do-it-yourself projects. “I have a passion for motorcycles and the outdoors. I have recently enjoyed adventure riding including backcountry routes to Canada with my best mate, Sean McKeown,” he says. “I visit Mexico often and am planning an adventure ride through Baja. I enjoy working with my hands on projects at home and recently undertook a full remodel of our family’s home and enjoyed the accomplishments of doing much of the work with my wife.” Time with family is a priority in Onoday’s life.

“I have been married to my wife for almost four years and have a step-daughter who is a sophomore at University of Oregon studying business. My parents, sister, brother-in-law, and children live in Washington. They are very important to me and are a big part of who I am,” he adds. He says that the family connects as often as possible, which he says, is never enough. The biomed of the year award caught Onoday by surprise. His wife knew he was going to get the honor ahead of time, but Onoday had no idea. He had been working outside the conference’s main room, checking in members. His wife came to get him and tell him to come into the room. He was really surprised to hear the president say his name, when announcing the award. “It was an honor and a surprise to be the recipient of the second-ever Biomed of the Year Award,” he says. “I only became aware of the award at the Oregon Biomed Association annual conference last fall. I appreciated that the award came from the nomination of peers, and I did not expect to be so positively recognized by my colleagues. The fact that those that I

• • • • •

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so greatly respect would recognize my accomplishments means a tremendous amount to me,” Onoday adds. He is a proponent of association membership and is an officer with the Oregon Biomedical Association. “I am currently the treasurer for the group and am glad that I took the leap to be involved. I was unsure I could devote the time and effort needed, but I am very thankful now for the opportunity to work with the board of the association and learn about the value that the OBA brings to its members,” Onoday says. “I encourage all biomeds to consider volunteering to help advance our profession, whether with this organization or others that support our goals.” If the recognition by his peers is any indication, the future of Onoday’s small business should be on the right course for success.

SPOTLIGHT

BIOMED ADVENTURES Go Jump off a Bridge K. Richard Douglas

ho hasn’t heard the sarcastic quip; “If someone told you to jump off a bridge, would you do it?” It accuses the listener of being somebody prone to any suggestion or peer pressure. Incredibly, stepping off that bridge is a badge of honor in one sport. There are people who jump off bridges, and cliffs and towering antennas and buildings, and are proud to do so. And, they are not exclaiming “good-bye cruel world” in the process. They know exactly what they are doing and enjoy the challenge. At least, the devotees of BASE jumping do.

BASE jumping is an acronym for Building, Antenna, Span, and Earth, denoting some of the most common fixed structures that jumpers leap from. The jumpers employ a rapid-deployment parachute to shift things into controlled descent mode as early as needed. Michael Chuma, a biomed manager with JANNX Medical Systems, working at Mercy Medical Center, has taken the plunge and had expert guidance in the process. Chuma’s son, Sean, is one of the most experienced BASE jumpers in the world and has a track record in the sport that puts him in the record books. It was with the confidence of having his son’s expertise that put Chuma into enough of a comfort zone to have his toes dangling over the edge of a platform on the 486foot high Perrine Bridge in Twin Falls, Idaho. The first time he went off the platform, attached to the side of the bridge, he made a tandem jump with Sean. It was in June of 2012 and Chuma says that the Perrine Bridge was the only bridge that BASE jumpers could use year around legally.

NOT FOR THE FAINT HEARTED Jumping off of a bridge from nearly 500 feet up could be terrifying, but Chuma knew that his son had loads of experience doing just what he was going to do and took a methodical approach in preparation.

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AUGUST 2016

Michael Chuma (center) pictured with his son, Sean (left), before their tandem jump.

“The morning started very early watching the other BASE jumpers packing their rigs and talking about the day ahead,” Chuma recalls. “Sean usually goes around greeting everyone insuring everyone knows what they are doing. He is kind of the ambassador of BASE in Twin Falls. After several hours of watching the jumpers do their jumps, to include my son, it came my time to prepare,” Chuma says. He says that Sean explained to him what was about to happen. He says that his son wanted to make sure he was ready and didn’t panic during the jump. Sean then placed the tandem harness on him, making certain it was very snug so he wouldn’t slip out. “I actually felt fairly calm,” he says. The calm did not last.

“He put on his gear, and us and other jumpers, walked out to the bridge. At that time the nerves started. We got to the exit point, which was a platform he and a friend built,” Chuma says. “Once again, he checked to see that my harness was all intact and on properly. He then checked his gear. Now, came the time to climb over the rail of the bridge. That was the hardest part because I became tense, and at the age of 60, I am not as flexible as in my younger years,” Chuma adds. Once the two got on the small platform, Chuma remained strapped to the rail for safety. His son ensured they were hooked together. At this point, Chuma had to turn around so that he was facing looking out over the platform at the expansive drop below. “Now, that was nuts,” he remembers. “As we turn, he is telling me where to put my feet. At one point, he kept telling me to put my feet on the edge with my toes hanging over the edge. You can imagine what I was thinking and saying. He had another person on the bridge holding the pilot chute as we prepared to jump,” Chuma adds. “This is called a PCA. All I know is this person holds it until we jerk it out of his hand when we fall,” Chuma says “It opens our chute.” When everything was in order, Chuma’s son had him count to three and they made the leap.

“The whole experience doesn’t take long, but is something I will never forget. It was more exciting than a tandem skydive. Coming in for landing is a whole other experience, seeing the ground come at you.”

“I think we fell about 50 to 75 feet before the chute fully opened. It was the most awesome experience I have ever experienced; what a rush,” he says. “The whole experience doesn’t take long, but is something I will never forget. It was more exciting than a tandem skydive. Coming in for landing is a whole other experience, seeing the ground come at you,” Chuma says. He says that in most cases, people land standing up, but he ended up sliding in a sitting position.

FIXED WING OR RIVER BRIDGE Jumping off a bridge isn’t the only experience Chuma has with free falling. He has tandem jumped from airplanes a few times also. He once jumped with his son, who is also a very experienced skydiver. “A tandem off of an object is like night and day compared to an airplane,” Chuma says. “There’s no comparison.”

He points out that there can be obstacles to negotiate when jumping off of a cliff, but it is open air when skydiving. Since his fi rst tandem jump off the bridge, he has also made two solo jumps; all in 2012. Chuma landed in the Snake River on his solo jumps and boats picked him up. His son’s business has someone in a boat for this reason. Chuma has been an HTM professional for a long time, having spent a total of 29 years with Aramark, including time with Masterplan. He worked for CREST Services also. He has spent more than two years as a manager with JANNX Medical Systems. Don’t try to play a practical joke on this biomed; he only falls for what he wants to. SEAN CHUMA’S BUSINESS, TandemBASE, can be found at www.tandemBASE.com.

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NEWS & NOTES

Updates from the HTM Industry

TRIMEDX ANNOUNCES RICHARD SCHNEIDER AS CHIEF OPERATING OFFICER CABMET PLANS ANNUAL SYMPOSIUM CABMET’s annual symposium will be held August 5-6. The Symposium will be at Children’s Hospital Colorado (13123 East 16th Avenue, Aurora, CO 80045). Happy Hour and Poker Tournament will be held Friday at the, Tin Cup (50 S. Peoria Street, Aurora, CO 80012) Golf Tournament will be held Saturday, August 6 at Kennedy Golf Course (10500 E Hampden Ave, Denver, CO 80014), this is a shotgun start. Rooms reservations are available at a discounted rate at the Spring Hill Suites (13400 East Colfax Avenue, Aurora, CO 80011) which is directly across the street from Children’s Hospital Colorado. Use the code “CABMET” when booking hotel reservations.

TriMedx has named Richard Schneider as Chief Operating Officer. In this role, Schneider will focus on overall operations in addition to customer and employee relationships. Schneider is an accomplished executive leader with more than 20 years of broad-based experience in operations, strategy, account management, business development and finance/ risk management. Prior to joining TriMedx, he served in several executive roles with Asurion, a global leader in support, protection and technology solutions for consumer-connected devices. At Asurion, Schneider led the warranty operations team that generated more than $70 million in value through cost improvements across all business segments while improving service turn times and increasing customer Net Promoter Scores. “Rich has developed a diverse range of leadership skills that will greatly benefit our organization, our employees and our customers,” James Willett, President of TriMedx, said. “He will not only be instrumental to the operations of TriMedx, but will also help drive new service and product offerings moving forward.” Schneider earned an MBA from the University of Michigan’s Ross School of Business and a Bachelor of Arts degree from Dartmouth College. FOR MORE INFORMATION about TriMedx, visit www.trimedx.com.

CAR CRASH CLAIMS LIFE OF FDA DEVICE STERILIZATION EXPERT Friends and colleagues are mourning the sudden death of Vicki Hitchins, Ph.D., a research microbiologist in the Center for Devices and Radiological Health at the Food and Drug Administration (FDA). Hitchins was killed after her car struck a tree early on a June morning in Silver Springs, Maryland. She was 71. “This is heartbreaking,” said Joe Lewelling, vice president of emerging technologies and health IT at AAMI. “I have known Vicki for about 25 years, and she was much more than a colleague – she was a good friend.” Hitchins, an expert in cytotoxicity

INDUSTRY UPDATES

testing, co-chaired the AAMI Sterilization Standards Committee for almost 20 years and was a member of numerous other standards working groups and committees, including ISO/TC 194, biological and clinical evaluation of medical devices. She led the U.S. delegation to ISO/TC 198, which focuses on the sterilization of health care products, for 17 years and spoke at the 2011 AAMI/FDA Medical Devices Reprocessing Summit. Hitchins also played a significant role in AAMI publications, participating as an expert on roundtable discussions, serving as an

Editorial Board member for sterilization editions of Horizons, and co-authoring numerous articles that appeared in B&IT and other AAMI publications. AAMI Board Chair Phil Cogdill, who worked with Hitchins on a number of committees, said: “Vicki was a pleasure to work with. She was a down-to-earth scientist and loved her microbiology research at the FDA. She will be missed by all but especially by those around the world who know her for her steadfast work in standards. Our thoughts and prayers are with her family at this difficult time.”

AUGUST 2016

1TECHNATION.COM

MILLS PROMISES STREAMLINED TJC SURVEY PROCESS George Mills, director of engineering at The Joint Commission (TJC), delivered a two-part message at AAMI 2016. First, the nation’s largest accreditation organization for hospitals is taking steps to streamline its survey process with a new emphasis on qualifying the risk associated with deficiencies. At the same time, the pressure is on hospital-based healthcare technology management (HTM) professionals to think critically and document their practices and procedures. “You know how to do your jobs, and you do your jobs well,” Mills said at the AAMI 2016 Conference & Expo. While Mills was quick to praise the work of HTM professionals, he also made it clear that TJC was expecting these departments to rise to the challenges within the fast-changing and complex world of modern health care. For example, effective Jan. 1, 2017, HTM departments must have documentation on hand for specific devices at the time of a survey. Current practice allows for follow-up documentation. “If we ask for it, and you don’t have it – you don’t have it,” Mills said. “I’m going to write you a finding.” However, Mills emphasized that TJC was offering a solution, namely a checklist – which was expected to be available on TJC’s website on July 1 – that would help HTM departments keep track of this documentation. The change, which is part of a broader initiative called Project REFRESH, took effect June 6 for psychiatric hospitals that use TJC accreditation. It kicks in at the start of next year for all other accreditation and certification programs. For Mills, meeting TJC standards is not so much about ticking boxes 26

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AUGUST 2016

as it is consistently applying critical thinking skills and tools, such as risk assessments, to meet the specific challenges faced within individual health care delivery organizations – and keeping detailed records of these processes. Mills also “strongly encouraged” the group to start dashboarding, as it helps keep compliance “front and center” and can be leveraged to “get a seat at the table” for important discussions about things such as technology acquisitions. Additionally, Mills explained the details of Project REFRESH. The acronym summarizes the changes as the following: • Real-time information gathering between surveyors and the Standards Interpretation Group during surveys • Enhanced survey accuracy • Fewer standards • Revised criticality models for standards • Easier and less complex decision process • Streamlined post-survey process • Higher consistency in interpretation of standards The move toward simplification includes a paring down of TJC’s code. According to Mills, 131 elements of performance (EP) have been deleted as a result of REFRESH projects, with additional deletions pending. These edits will help streamline the manual but won’t diminish any elements of performance linked to Centers for Medicare & Medicaid Services’ requirements or reimbursement, Mills assured the audience. Starting Jan. 1, 2017, surveyors at most health care delivery organizations will classify their findings based on the new “SAFER matrix.” This model takes into consideration the context and environment of the finding, and maps it based on the likelihood of

harm to a patient, visitor, or staff and how widespread the issue is (limited, pattern, or widespread). The SAFER matrix will replace the current scoring methodology, which means: • The elimination of direct and indirect EP designations. • Consolidation of all Evidence of Standards Compliance submissions into one timeframe: 60 days. • No more “measures of success.” • No more “opportunities for improvement.” • No more A or C categories. “We really want to focus on patient safety rather than risk to patients,” Mills explained. It also will help health care delivery organization leaders prioritize corrective actions. Mills’s presentation was recorded and will be available to attendees through AAMI University. Those unable to attend the AAMI 2016 Conference & Expo will have the opportunity to purchase the recording through the AAMI Store later in the year.

RECALL MANAGEMENT TOOL MATCHES ALERTS DIRECTLY TO HOSPITALS’ EQUIPMENT INVENTORY DATA The faster a hospital responds to a product safety alert or recall, the safer its patients are. But how can busy hospital staff quickly see which ones have the potential to affect their patients? The ECRI Institute has announced the release of Automatch for Equipment, the newest enhancement to its Alerts Tracker automated recall management solution used by hospitals and health systems worldwide. Alerts Tracker with Automatch automatically identifies equipment models and supplies within a health care facility’s inventory that are impacted by an alert or recall, and notifies designated department staff. “We were the first to automatically match alerts automatically to a hospital’s supply inventory data,” states Eric Sacks, ECRI Institute’s director of health care product alerts. “We are excited to announce that with the release of Automatch for Equipment, we can now match each alert to our

member hospitals’ inventory of affected equipment models as well, providing a more complete patient safety solution.” Automatch promotes efficiency, reliability, and enhanced patient safety for hospitals, health systems, integrated delivery networks (IDNs), physician practices, and other health care providers who are challenged with managing, distributing, and addressing thousands of alerts and recalls that may or may not affect them. It dramatically reduces the need for manual inventory database searches. “We have a very strong and loyal community of Alerts Tracker member hospitals who share their problems and challenges around recall management with us every day,” continues Sacks. “By developing innovative solutions like Automatch for Equipment, we are helping them to address those challenges head on.” Alerts Tracker Automatch for Equipment cleans the data in a

hospital or health system’s inventory by matching it to ECRI Institute’s standardized database of medical devices. This eliminates duplications and disparities upfront. The experienced Alerts Tracker team offers ongoing support to its members with personalized implementation, expert reporting tools, and guidance on developing sound policies and practices. Alerts Tracker Automatch for Equipment officially debuted at the Association for the Advancement of Medical Instrumentation AAMI 2016 Conference and Expo. For more information or a demonstration of the Alerts Tracker Automatch for Equipment, visit www. ecri.org/alertstracker, contact ECRI Institute by telephone at 610-825-6000, ext. 5891 or by email at clientservices@ ecri.org.

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ECRI UPDATE

Applauding Greatness in Exceptional Health Technology Management

ach year, ECRI Institute presents its annual Health Devices Achievement Award to the member facility that has carried out the most exceptional initiative to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. In the May issue of TechNation, we spotlighted Texas Children’s Hospital upon its receipt of the 10th Annual Health Devices Achievement Award for its alarm management initiative. In this article, ECRI Institute recognizes the four additional organizations that were selected as Achievement Award finalists. The technology management initiatives described by these organizations (listed below in alphabetical order) earned honorable praise from the award selection committee.

Assessing the Cost-Effectiveness of Approaches for Reducing Retained Surgical Items – Banner Health’s Success Story Banner Health (Phoenix, Arizona) was selected as a finalist for its efforts to: 1. Reduce all serious reportable events (SREs) related to surgery, including the number of retained surgical items (RSIs), such as surgical sponges inadvertently left inside the patient during a procedure. 2. Determine the conditions under which radio-frequency identification (RFID) sponge-detection technology would, and would not, be a cost-effective adjunct to the organization’s program for reducing the number of RSIs. Banner Health had instituted a Safe Surgery Program in its many hospitals and ambulatory surgery centers with the goal of reducing all SREs related to surgery. These include wrong-site,

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AUGUST 2016

wrong-patient, and wrong-procedure events, as well as RSIs. Concern existed, however, about whether the program by itself would be sufficient to reduce the rate of RSIs. The organization was considering investing in a technological solution – an RFID sponge-detection system – to help reduce those risks. To plot the best path forward, the Banner Health team designed methods to assess the effectiveness of the Safe Surgery Program and to calculate the cost-effectiveness of an RFID system. The researchers assessed several scenarios, determining the conditions under which it would, and would not, make financial sense to purchase an RFID system. Overall, the team found that its Safe Surgery Program reduced the rate of retained sponges to a point where the addition of RFID technology would not have been cost-effective. Learn more about Banner Health at www.bannerhealth.com.

Implementing Alarm Default Changes to Improve Patient Care and Patient and Staff Satisfaction – Boston Medical Center’s Ongoing Initiative Boston Medical Center (Boston, Massachusetts) was selected for its low-cost, high-impact processes for improving the management of telemetry monitoring alarms. With significant improvements already achieved in how the hospital

manages cardiac telemetry patients, Boston Medical Center needed to establish a method for evaluating, testing, and implementing additional alarm management improvements in a consistent manner. The organization’s Clinical Alarm Task Force instituted a procedure that involves rigorous process management, data analysis, clinical trials, education, and governance. Boston Medical Center’s ongoing efforts to improve the management of telemetry patients have resulted in fewer alarms, better information contained within the system (e.g., alarm histories), and improved communication between the nurses and the medical staff, as they work together to manage the patient in a more comprehensive manner. The experience also has helped the organization compile a list of essential components for managing telemetry alarm default changes, which it shared in its award submission. Learn more about Boston Medical Center at www.bmc.org.

A Cooperative Approach to Reducing Supply Costs – Cooper University Health Care’s Program to Engage End Users in the Purchasing Process Cooper University Health Care (Camden, New Jersey) was selected as a finalist for demonstrating how forging a partnership between the Supply Chain and Process Improvement functions could help reduce supply costs and lay the groundwork for future cost management initiatives. Faced with the challenge of reducing costs in the cardiac catheterization and electrophysiology laboratories by $1 million for the upcoming year – without eliminating any of the existing device vendors from the current technology mix – the organization used Lean and

Six Sigma methodologies and tools to meet its goals. The organization brought together all stakeholders for a wellplanned, one-day event to review the current landscape, to identify solutions, and to agree on the path forward. With full commitment obtained from all involved parties, the organization was able to negotiate savings that exceeded its goal. Furthermore, the partnership established between the Supply Chain and Process Improvement departments helped increase end-user engagement in the purchasing process, which the organization believes will help it maintain the safety, quality, and appropriateness of the products it purchases. Learn more about Cooper University Health Care at www.cooperhealth.org.

Harnessing Data for Medical Equipment Replacement Planning – University of Pittsburgh Medical Center’s “Fleet” Program The University of Pittsburgh Medical Center (Pittsburgh, Pennsylvania) was selected for its data-driven approach to planning for medical equipment replacement. UPMC instituted its “Fleet” program, as the initiative is called, to identify outdated, unsupported, or technologically deficient equipment in need of replacement across the enterprise. Central to the Fleet process is the calculation of a Replacement Priority Value (RPV) for the equipment in UPMC’s inventory. The RPV allows comparisons to be made and priorities to be set based on a quantitative analysis. The organization calculates the RPV through a weighted formula using data extracted from an in-house-developed computerized maintenance management system. Factors considered in the analysis include the age of the equipment, its expected useful life, and its lifetime maintenance cost. UPMC calculates that the capital and expense savings realized directly through the Fleet initiative have totaled over $10.2 million in the five years since the program was initiated. Additional benefits that UPMC ascribes to the Fleet program are that it has: • Allowed the organization to consolidate equipment demands and clinical requirements across the enterprise to facilitate the standardization of both equipment and operations • Helped the organization identify, purchase, and deploy equipment that interfaces directly to the electronic medical record system, increasing user throughput and efficiency • Facilitated quick responses to regulatory “recall” equipment and platform upgrades across the enterprise • Created opportunities for reallocating existing resources Learn more about University of Pittsburgh Medical Center at www.upmc.com. THIS ARTICLE IS EXCERPTED FROM ECRI INSTITUTE’S MEMBERSHIP WEBSITE.The full article features additional information on the award winners. For details about the annual award, visit www.ecri.org/Pages/Health-Devices-Award_Winners.aspx; call 610-825-6000; or email communications@ecri.org.

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AAMI UPDATE AAMI 2016 Roundup

he AAMI 2016 Conference & Expo had a banner year with 2,349 people attending the event in Tampa, Florida – a new record. The conference offered a wealth of education sessions and speakers, covering virtually every major issue facing the healthcare technology field. Here are just a few of the highlights.

MILLS PROMISES STREAMLINED SURVEY PROCESS George Mills, director of engineering at The Joint Commission (TJC), said the nation’s largest accreditation organization for hospitals is taking steps to streamline its survey process with a new emphasis on qualifying the risk associated with deficiencies. This initiative, called Project REFRESH, took effect June 6 for psychiatric hospitals that use TJC accreditation. It kicks in at the start of next year for all other accreditation and certification programs. The move toward simplification includes a paring down of TJC’s code. According to Mills, 131 elements of performance have been deleted as a result of REFRESH projects, with additional deletions pending. These edits will help streamline the manual but won’t diminish any elements of performance linked to Centers for Medicare & Medicaid Services’ requirements or reimbursement, Mills assured the audience. Starting Jan. 1, 2017, surveyors at most healthcare delivery organizations will classify their findings based on the new “SAFER matrix.” This model takes into consideration the context and environment of the finding, and maps it based on the likelihood of harm to a patient, visitor, or staff and how widespread the issue is (limited, pattern, or widespread).

1TECHNATION.COM

AUGUST 2016

The SAFER matrix will replace the current scoring methodology, which means: • The elimination of direct and indirect EP designations. • Consolidation of all Evidence of Standards Compliance submissions into one time frame: 60 days. • No more “measures of success.” • No more “opportunities for improvement.” • No more A or C categories. “We really want to focus on patient safety rather than risk to patients,” Mills explained. It also will help healthcare delivery organization leaders prioritize corrective actions.

STAKEHOLDERS ANTICIPATE FDA ACTION ON THIRD-PARTY REPAIRS Members of the healthcare technology community said they expect the Food and Drug Administration (FDA) to take some kind of regulatory action regarding the third-party repair and refurbishment of medical devices, but they don’t know what specifically to expect or when. Speaking during a panel discussion at the conference, Binseng Wang, vice president of quality and regulatory compliance at Greenwood Marketing LLC, said he was worried about what might be in store from the FDA. “I’m not as optimistic as when we fought

this same battle back in 1997,” he said, noting that 20 years ago, reprocessors of “single-use devices” (SUDs) were subject to additional regulations. Ultimately, he foresees “segments of devices coming under greater scrutiny and being controlled more rigorously this time,” similar to what occurred for reprocessors. AAMI President Mary Logan, who also sat on the panel, noted that the FDA’s call for information suggests that the agency does not have a predetermined path. Logan added that she is “neither optimistic nor pessimistic” about what may be in store. “Do I think they are going to do nothing? No. But I think it’s so complex that it’s going to take them a long time to figure out what they are going to do,” Logan said.

CLINICAL ENGINEERING LEADER SAYS EQUIPMENT MANAGEMENT MUST FOCUS ON IMPACT Historically, the effectiveness of a medical equipment management program (MEMP) has been measured by focusing on the ability to answer the questions asked by regulatory agency inspectors. According to David M. Dickey, corporate director of McLaren Clinical Engineering Services (MCES) with McLaren Health Care in Flint, Michigan, although questions such as “What are your preventive maintenance (PM) completion rates?” and “How do you find missing equipment?” are important, they are not by themselves measures of MEMP effectiveness. “HTM has yet to define and agree upon standard measures for quantifying and reporting the quality and effectiveness of an MEMP,” said Dickey during a presentation given at the 32nd Annual Conference on Clinical Engineering Productivity and Cost Effectiveness,

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held in coordination with the AAMI annual conference. Simply reporting the number of PM inspections done on time, according to Dickey, does not measure the quality of the inspections. In Dickey’s opinion, MEMP effectiveness would be more appropriately measured by metrics such as how a device repair program minimized patient injury or death or how a staff education program prevented increases in patient length of stay. “The best answer to the question on the effectiveness of an MEMP may lie in one key fact: At least for our program, we have not APPROVED had a patient injury that was caused by, or had a PROOF CHANGES NEEDED contribution from, any component of our MEMP,” Dickey said.

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SHOP TALK

Conversations from the TechNation ListServ Q:

What are your thoughts on this technique? A Velcro type material is used to hold the power strip off the floor and attached to the wall in a patient care room. Is this safe?

Remove the power strip and plug both cords into outlet. If more outlets are needed, have an electrical tech replace the outlet with a four-outlet plug.

A very simple solution can resolve this. Call the local code officer or the fire department. This is a safety problem.

In a word, no. If you need more outlets you add them. In this case, having a four-way put in to replace the two-way wouldn’t have been hard and much safer.

It doesn’t look like it’s HG rated. Those molded plugs eventually tend to leave the ground prong behind when used in a tight HG outlet found in most patient care areas. If it has surge protection, leakage current might be on the high side with many low-cost strips. It might not pass electrical safety when acceptance tested. It has an over exposed power switch and those can get bumped and switched off and IV pump batteries discharge). It should help to keep the painter employed when it gets snatched by “cord-method-unpluggers.” It looks like something IT would devise. Apart from just looking tacky, I am curious what the fire marshal’s thoughts will be. Surface mounted, hardwired, HG multi-outlets can be purchased to permanently replace the duplex receptacles in patient rooms (like your photo seems to indicate). These

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AUGUST 2016

outlets screw directly onto the existing outlet box after removing the original receptacle. They are more aesthetic, and they can take a pretty good hit. The face is large enough to accommodate a full complement of HG powercord plugs – your outlet strip won’t let you put two side by side without skipping an outlet. They come with 4 (or 6) 15-amp rated outlets; and can be ordered in white, ivory, red and orange to satisfy most designations and decors. You might even find them in GFCI. They are UL approved also. It has been a while, but I think Leviton brand was what we went with. There should be others. Individually they are a little pricey, but if you are buying in bulk they really begin to make since. They are no more expensive than a good quality hospitalgrade multi-strip which may get you into trouble, anyway. The downside is that an electrician must install them which is an additional cost. But once installed, they will not require asset tagging and you will never need to hunt them down to re-inspect them. It’s the kind of upgrade that a smaller local electrical contractor would love to bid on. You can coordinate with plant ops to have it done in conjunction with room re-painting. In older facilities, those old outlets probably are due for replacement anyway. Many will fail a tension test, which makes cheap outlet strips even more hazardous in your hospital (or your home). The Joint Comission inspectors, by the way, love these kind of projects so document it thoroughly. And, it’s just safer.

I agree regarding the code and safety issue. But, relating to the actual Velcro mounting solution, a good industrial Velcro will hold such a device just fine. However, the adhesive will not set up and hold to the vertical paint surface for very long. If by chance the adhesive does hold, the paint will pull off the wall.

How do you keep people from plugging their smartphones into USB ports at your facility?

Disable the USB ports.

This is a great topic. How many of you in the HTM world are not paying attention to this vulnerability of USB ports on the medical devices? You have a large volume of medical devices that are in your inventory right now that touch the hospital network. An unsuspecting visitor or perhaps a health

care provider who has a cellphone that is low on battery can see a USB port on their loved-ones patient bedside monitor. They take their USB charging cable and insert it into the USB port. The cellphone has a virus or an “Internet bot” on the phone. They have just unleashed havoc into your hospital network. Network security is everyone’s responsibility!

Glad you asked this. I am curious what others are doing. I was about to research buying USB port covers to help minimize this activity.

If the device has an administrator account you can disable the USB ports that are being used except for the keyboard and mouse.

These posts are from TechNation’s ListServ go to www.1TechNation.com/ Listserv to find out how you can join and be part of the discussion.

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BIOMED 101

Machine Learning for HTM Professionals By Benjamin Larson

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? In computer programming, you learn how to turn common tasks into logic based steps. You take a simple task and boil it down into a series of binary commands. You have to program every step and you have to have a rule in place to handle every possible exception. Computers can’t think for themselves. Or can they? With machine learning, computers make the rules. Instead of having a human program each step, machine learning is accomplished by feeding data through an algorithm. The algorithm then develops the programmatic logic and rules from data it is fed. Machine learning comes in two flavors: Supervised and Unsupervised. 1. Supervised Machine Learning Example: Field Service Analysis Supervised learning creates a function from a data set containing both input variables and a result. Consider a list of inputs for housing prices (square footage, garage, number of bathrooms). If you know the result (price the house sold for), you can easily develop a formula that can predict the selling price of a house. Let’s say you manage a field service operation where you employ two levels of field engineers: Tier 1 and Tier 2. Tier 1 engineers are junior, lower cost employees. Tier 2 are your senior engineers. As a manager, you are constantly trying to strike a balance between customer satisfaction and the company’s bottom

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line. You are concerned that every time a Tier 1 engineer cannot complete a repair and has to call in a Tier 2 engineer, the customer experiences extended downtime. However, you don’t want to send Tier 2 engineer out to perform a job a less costly Tier 1 engineer could perform. The answer: Logistic Regression You put together a spreadsheet of all your repairs for the past two years, including information such as equipment type, age, model, location, repair history score. In the last column of your spreadsheet is your result (0 or 1), where 0 = Tier 1 completed the job, and 1 = Tier 2 had to be called in. You run this data through a logistic regression algorithm and it builds a model (an equation). Once this model is built, you can then feed your next repair call into your model, entering the input variables above. The output is a number between 0 and 1 representing the probability a Tier 2 technician will need to be called out to complete the job. (A 0.75 output means there is a 75 percent chance Tier 2 will need to be called out). Using this information, you can determine when to just send out a Tier 2 engineer in the first place. The beauty of this model is that it continues to learn and improve. If you retrain the model with new data, it will adjust to changes and improve its accuracy. Maybe your Tier 1 engineers are getting better? Maybe some of the newer equipment is more complex and provides greater challenges? The real world is not a static target. We rely on outdated information, be-

BENJAMIN LARSON Informatics Specialist of the Department of Clinical Engineering, Atlantic Health Systems

cause we lack the bandwidth needed to re-evaluate a metric. However, updating a machine learning model can be as simple as retraining the model with fresh data. 1. Unsupervised Machine Learning: Repair History Clustering Unsupervised learning doesn’t look for an answer. Instead it groups information into like sets forbanalysis. It is a bit more of an art. Since the result is a grouping of like data, it is up to the analyst to make sense of the groupings and to draw inferences about the data from the groupings. Let us take three years of ultrasound repair history. We compile this data into a spreadsheet and pass this spreadsheet through an unsupervised machine learning algorithm known as K-Means Clustering. K-Means Clustering takes each row from your spreadsheet and converts them to a vector. It then maps the vectors out in space and uses something known as a geometric mean to see which ones

Chart 2

Chart 1

seem to cluster together (see chart 1). Each dot represents an Ultrasound machine. The dots are assigned a color based on their proximity to each other. The yellow stars represent the geometric mean for each cluster. Using my data set of 300+ ultrasounds, the algorithm returned four clusters. Looking closely at the clusters, patterns quickly emerged. To help illustrate, I have a snippet from my fourth cluster (see chart2). A quick glimpse into this cluster shows something interesting. A single department with four Philips IE33 ultrasounds managed to rack up 318 work orders in

three years (that is a little over two a week). Checking the other clusters, I see that I have plenty of IE33 (66 to be exact) that do not appear to be problematic. I also note that this department has other ultrasounds that do not have nearly as many repair tickets. Using the information provided and my experience in the field, I concluded the techs in this department do not know how to use the IE33. With a repair rate of twice a week, the cost of bringing in the vendor to retrain the department is easily justified. Other clusters show information like high parts expenditures, above average labor minutes for repairs, and a high

number of vendor repairs. Each cluster can provide you with actionable information. While both of these examples are intentionally simplistic, they show the possibilities machine learning opens for the HTM profession. Data found in your computerized maintenance management system (CMMS) can provide insight and help your department improve its efficiency and cost effectiveness.

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ROUNDTABLE Sterilizers

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edical equipment has advanced tremendously since the very first surgery was performed. Innovations and new ideas continue to impact the often life-saving techniques of surgery, including minimally invasive procedures and robotic surgery options. However, even the best surgeon in the world will fail when using unsterile instruments.

TechNation contacted professionals familiar with sterilizers to find out the latest regarding these important pieces of health care equipment, including purchasing and servicing options. The panel of experts includes D. Wayne Ambroult, BMET III, Sterilizer Specialist with Banner Health; Neil Blagman, Product Engineer at Replacement Parts Industries Inc. (RPI); Marie LaFrance, Senior Product Manager, High Temperature Sterilization, STERIS Corp.; and Paul Strachan, Director at Novant Health.

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN STERILIZERS IN THE PAST TWO YEARS? Ambroult: I would say the Steris V-Pro H2O2 sterilizer has impacted the sterilization process because of its ability to process both lumen and non-lumen products in the same chamber and it is less expensive than its competitor. Blagman: The most recent changes to tabletop sterilizers involve the ability to download run and cycle data to an external computer through the use of a built in USB port. This increase in on-board computer power also gives the manufacturer the ability to remotely diagnose cycle failures and error conditions through the same USB port. The addition of closed-door drying, vacuum pumps and pulsed steam to tabletop sterilizers brings their abilities much closer to the most advanced bulk sterilizers. LaFrance: In the past, inspectors often checked if health care facilities had written sterilization policies and procedures in place, and if proper load content, cycle parameter and indicator records were kept on file. This is typically done manu-

ally and/or with an electronic instrument tracking system. Today, facilities are increasingly being asked to also show documentation of staff training and maintenance on their sterilization equipment. Strachan: For service issues, being able to interact via a laptop (whether it is a sterilizer or washer) is a noted change in the past several years. We are seeing more of this. Also, there is an OEM that has standardized the user interface controls on all their latest models of sterilizers and washers.

HOW HAVE THOSE CHANGES IMPACTED THE STERILIZER MARKET? Ambroult: It provides faster product turnaround time and reduced equipment processing costs in a more affordable and safer sterilizer. Blagman: The tabletop sterilizers currently available today have been available unchanged for many years and are quite sufficient for almost all applications. However, as specialized medical instruments have become more complex, the techniques and equipment used to sterilize these devices must also be developed. The addition of vacuum systems and pulsed steam allow tabletop sterilizers to process the most complex instruments and packs. LaFrance: These changes have made connectivity more important than ever. It created a need for a convenient way to remotely monitor equipment performance and maintenance. STERISâ&#x20AC;&#x2122; CS-iQ Sterile Processing Workflow Management Software offers scalable instrument-tracking

D. WAYEN AMBROULT Sterilizer Specialist with Banner Health

and equipment-monitoring solutions, while ProConnect Response Center remotely monitors equipment performance and helps reduce downtime. Strachan: Being able to troubleshoot the system with a laptop and creating a standardized user-friendly control panel are great features to have for the biomed and SPD staff. Anytime you provide features that truly improve the interaction with the system is a plus to be noted when purchasing time comes around.

HOW WILL NEW ADVANCES AND FEATURES IMPACT STERILIZER MAINTENANCE? Ambroult: Sterilizers have become more efficient because of obvious design improvements and better designed electro-mechanical components as well as built-in self-diagnostics and monitoring capabilities. Blagman: As tabletop sterilizers become more and more complex the tools and diagnostics become more specialized and more complex. The addition of specialized extender cards, test fixtures and data

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HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE STERILIZER NEEDS OF TODAY? Ambroult: One way a facility might be able to better afford their sterilizer needs would be to research if there are upgrades that can be done to their existing sterilizer through the manufacturer. Upgrades to displays, controls, etc., can help extend the life of an older sterilizer by providing updated options offered on newer units. This isn’t always an option, but is definitely worth looking into when considering replacement versus equipment upgrades.

NEIL BLAGMAN Product Engineer at Replacement Parts Industries Inc. (RPI)

boxes give the service technician a much more detailed view of the run conditions. Unfortunately, these advanced service tools are not always available to the average technician in the field and when they are available from the manufacturer they can be relatively expensive. LaFrance: With remote monitoring, sterilizer malfunctions can be proactively detected and diagnosed. It can decrease the time it takes to dispatch a technician, as well as reduce equipment downtime. Remote diagnosis also helps ensure the correct parts needed for a successful repair are brought on the first visit. When it is time for formal inspections, maintenance records can be electronically produced, eliminating the need to keep paper records. Strachan: Like other devices that interface with a service laptop, this will definitely be a troubleshooting asset. Being able to retrieve error logs, histories and activate all valves and sensors is a much appreciated improvement. I am willing to bet at some point you may see sterilizers/washers being remotely diagnosed. Currently, we have scope washers that have this capability. Standardization of user functions across all models should be beneficial in minimizing user error associated service calls.

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Blagman: As tabletop sterilizers have grown in size and sophistication they have become a major cost savings for smaller facilities and clinics. Using standard AC line voltages and power cords allows the facility to position the sterilizer anywhere they find most convenient. The fact that tabletop sterilizers use self-contained steam generation removes the need for external steam generators or boilers along with the costs of installing steam supply lines within the building. The use of self-contained reservoirs and collection bottles reduce the need for floor drains and feed water plumbing. LaFrance: It’s important for CSSD managers to compare the current productivity of the department with existing equipment and the possible increase in productivity if new equipment is purchased. Today’s sterilizers are designed to process larger loads and are equipped with cost-saving features that can more than justify the investment. STERIS can provide site-specific life-cycle cost and productivity analyses to help determine customer needs. Strachan: Sterilizers have a very long life span compared to other devices or modalities. Planning for the future cannot be stressed enough, especially if you have a limited budget. As previously mentioned, keeping up with the small issues will often prevent more costly repairs and downtimes. Sometimes it may make sense to retire a problematic

NOVEMBER AUGUST 2016 2014

MARIE LaFRANCE Senior Product Manager, High Temperature Sterilization, STERIS Corp.

system ahead of its life span. Check with the OEM and see if they can provide a replacement solution within your budget. Also, third parties can be a great source for refurbished options that may be a good fit for your budget.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR WHEN DECIDING WHETHER TO GO WITH AN ORIGINAL EQUIPMENT MANUFACTURER OR A THIRDPARTY STERILIZER PROVIDER? Ambroult: I would have to say one should not just consider equipment cost but also manufacturer technical support, parts availability, service availability, equipment warranty, equipment longevity, and ease of operation by department personnel. In terms of maintenance and support, response time and quality of parts would be important. Are they using OEM or third-party parts? Blagman: For many smaller clinics and medical facilities the sterilizer is an indispensable device. Even if the facility has a spare sterilizer or an opportunity to have their sterilization needs temporarily met off-site the delays in getting sterile instruments processed can lead to case backlogs. When considering service op-

tions the local third-party service company may be able to be on site quicker than the original equipment manufacturer which could save the facility down time. Also, since the original equipment manufacturer may not have local representation the third-party service may save the facility an expensive travel charge. LaFrance: At first, it may seem prudent to go with the lowest-cost alternative when purchasing a steam sterilizer. However, third-party products and quality may not compare to an OEM offering, and safety is a key consideration. STERIS pre-owned products must meet stringent quality and performance guidelines during the remanufacturing process. For instance, the AMSCO C Steam Sterilizer is STERIS’ certified and preowned steam sterilizer offering. It is equipped with updated controls and software that meet the current AAMI standard and has been thoroughly tested and cleared for use by the FDA. Strachan: We typically use a combination of OEM and third-party providers for service when the situation calls for this. I would suggest knowing what kind of training the third party has had. What qualifies them to do the work? If they cannot provide any documentation around this that would be a deal breaker. Response time is also a consideration. Who can get there the fastest will play an important role in who you call. A good way to determine whether to go with OEM or third party, particularly with service, is how they treat you without a service contract in place. For purchases, whether OEM or third party, it is important to ask what kind of support you can expect to receive after the sale.

HOW CAN HTM DEPARTMENTS ENSURE THEY RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS WHEN PURCHASING STERILIZERS? Ambroult: I would have to say that when purchasing equipment, it is important to include in the purchase contract not just operator manuals but also service manuals with parts breakdown,

and literature. The ordering departments may not think about training/literature for the in-house biomed. Better yet, it is very important to have and keep a good working relationship with the SPD manager as well as maintaining relationships with the OEM sales team.

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING STERILIZERS?

PAUL STRACHAN Director at Novant Health

schematics, etc. and, if desired, factory training for biomedical personnel. Most importantly, the purchase contract must include “in service” for department personnel to ensure they know how to safely operate the equipment. Blagman: Sterilizers are capital equipment and like any other piece of capital equipment when the purchase order is issued it should include, in writing, the purchase of any necessary service documentation, tools and training needed for the HTM department to develop the skills to troubleshoot and service the sterilizer. LaFrance: Operator manuals should be supplied at no charge with every sterilizer purchase. As a full-service supplier, STERIS also includes equipment in-service training both on-site and in electronic format. Clinical education for staff is also delivered on an ongoing basis. STERIS Service also offers extensive training programs for biomedical technicians, should a facility opt to service their own equipment. Strachan: I highly recommend that CE is involved in the ordering process for new equipment. It is much easier at this time to ask questions regarding training

Ambroult: Things to consider when purchasing and servicing sterilizers should include equipment reliability, equipment cost, parts availability, manufacturer service and support. Do they need a full-service contract or scheduled maintenance only with time and materials as needed? What is the response time? Is there 24/7 support? How far will the service technician travel? All of these factors should be considered. Blagman: Tabletop sterilizers come in many different sizes and different manufacturers’ products have different capabilities and cycles. Before purchasing any sterilizers the facility should review the needs of their users and should size the sterilizer based on their anticipated needs and the types of instruments they are planning to sterilize. LaFrance: Steam sterilizers are a longterm investment. If not on a regular maintenance contract, sterilizers should be inspected at least twice a year to maintain peak performance and avoid costly future repairs. Periodic calibration of equipment is also necessary to ensure cycle efficacy and patient safety. Be aware that special tools may be required to effectively perform this procedure and seek appropriate advice from the OEM. Strachan: Whether the service is provided by the OEM, third-party or in-house, it is important to stay on top of maintenance. Addressing even the smallest of problems and leaks will go a long way in decreasing failures and downtime.

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We Can Do It!

women OF HTM THE

By K. Richard Douglas

cultural revolution occurred from the 1950s to the 1970s that changed the nation’s employment and household-income landscape dramatically. It could be surmised that the change really began in 1920 when the 19th Amendment was passed and women won the right to vote. It is hard to imagine that the women’s suffrage movement did not win approval until 144 years after America won its independence; but it did.

While many women worked as part of the war effort during World War II, in defense plants and missile factories, others served in the military. Rosie the Riveter represented an increase of women in the workforce during the 1940s. When many men returned from military service after WWII and the Korean War, they settled down with their wives and the baby boom generation was born. The baby boom generation, and their parents, witnessed a seismic change in the participation rate of women in the American workforce. It began during the war and continued into the new millennium. By 1972, when Helen Reddy sang “I am woman, hear me roar, in numbers too big to ignore,” the woman’s liberation movement was in full swing and would

grow during the remainder of the decade. Women entered the workplace in large numbers in the following decades. Their participation rate peaked in 1999 at 60 percent and currently sits at about 47 percent. Today, in America, there are more women in management, professional and related positions than men. Earnings disparities remain in many employment segments, but it is an issue that has gained more attention. While many traditionally male dominated occupations have seen an evolution in recent years, the HTM field is still a largely male occupation. There are no “men only” signs outside the doors of technical schools and college electronics programs, but the interest level for these

women THE

OF HTM

jobs proved more appealing to men in previous decades. That has changed. It’s not a monumental change, but more people are entering the field from both sexes. AAMI points out that, according to the Office of Science and Technology Policy, “almost 41 percent of the bachelor’s degrees in biomedical engineering were awarded to women in 2013-2014.” In addition, just over a third of AAMI members are female.

NO BIG DEAL

JORDAN KEEBAUGH, ASSISTANT CHIEF AND BIOMEDICAL ENGINEER

“ Every day new challenges are thrust upon us; it is how a person deals with those challenges and learns from them that truly defines an individual.”

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Ironically, when we asked women in the HTM field what it was like to enter a field dominated by males, most said they didn’t give it much thought. There was no sense of apprehension, despite the fact that men have historically dominated the HTM profession. “I have never thought about it as I was introduced into the field through electrical engineering, which is even more male dominated than HTM,” says Izabella Gieras, MS, MBA, CCE, director of Clinical Technology at Huntington Memorial Hospital in Pasadena, California. “More and more women are entering the field, which is great to see and (there are) wonderful opportunities for mentorship,” she adds. Andrea Brainard, CBET, group manager of Healthcare Technology Management for Children’s Health in Dallas Management for Children’s Health in Dallas not only ignored the statistics, but saw it as a challenge. “Actually, that is one of the main reasons why I wanted to get into HTM –— to change the stereotype, the mold, and to prove women can be successful in a male-dominated profession,” she says. For others, they gain extra motivation as they fight old stereotypes. “Whenever I was considering the HTM profession, the prospect of entering a male-dominated field never really

crossed my mind,” says Jordan Keebaugh, assistant chief and biomedical engineer at the Richard L. Roudebush VA Veterans Affairs Medical Center. Keebaugh had already become accustomed to the strong presence of men while studying for her degree in biomedical engineering. It was a part of the culture. “I think gender bias still exists in the HTM field, which I myself have experienced firsthand, however it just pushes me to not only be a stronger individual but a more knowledgeable clinical engineer,” she says. “Every day new challenges are thrust upon us; it is how a person deals with those challenges and learns from them that truly defines an individual,” Keebaugh says. “Gender bias is one of those challenges, but it can be overcome with confidence and knowledge.” Keebaugh also deals with a gender-neutral first name, which has become a running joke in the her department, as staff co-workers have to explain to vendors that “Mr. Keebaugh” doesn’t work at the facility. Inhel Rekik, MS, clinical engineer at the University of Maryland Medical Center in Baltimore, also saw no problem with the fact that HTM was largely male. It just seemed like the right fit for her. “While doing my bachelor’s degree, there were only a few women, but it wasn’t something I gave much thought to,” she says. “Growing up, I always liked science and math, so I never questioned where I should be. I knew it’s either medicine or engineering. I wasn’t interested in what we might consider women dominated careers.,”she remembers. Rekik says that she knew that being a woman in HTM, at the time, wouldn’t be the norm. Yet, it didn’t bother her. She just wanted to achieve her full potential and be challenged and passionate about the work she was doing.

“That is one of the main reasons why I wanted to get into HTM – to change the stereotype, the mold, and to prove women can be successful in a male-dominated profession.”

ANDREA BRAINARD, CBET GROUP MANAGER OF HEALTHCARE TECHNOLOGY MANAGEMENT

“I wanted to work for a good cause and make a difference and HTM seems to be the field I should be in,” she says. Alyssa Merkle, who is a biomed at UMass Memorial Medical Center, responded “not at all,” to the question of having any apprehensions about entering a male-dominated profession.Merkle was featured in a TechNation Biomed Adventures feature as an HTM professional who was a member of the New England Patriots cheer squad.She is now in a masters program at the University of Connecticut(UCONN). “I had already been through four years of college in a male-dominated major. To me, starting to work in the HTM profession really was no different. I never felt that being a woman hindered my work or worked against me,” she says. “Man, woman, we all learned the same things throughout the course of our college work and I was just excited to keep learning. It really never even crossed my mind that I was going into a field where I would most

likely be the minority gender,” she adds. She points out that regardless of gender, “your effort and dedication to the job is going to either hold you back or move you along in your career.” Merkle works full time as an HTM professional while also taking night classes as part of UCONN’s masters in science in biomedical engineering program. The program she is in has a focus on clinical engineering. She says that the program has been more than she could ask for. “I am at a stage in my profession where I am expected to still be fully learning. I have had great mentors between my professor at UCONN and my managers at UMass Memorial Medical Center who have inspired me to keep learning new things and seeing new things in my hospital through this experience,” Merkle says. “At the same time, I have been given full responsibility as a Clinical Engineer at UMass Medical and don’t feel like I am just an intern for two years,” she adds. “I really have the best of both worlds right now to transition me from college to the full work force. I feel valued as a full-time employee and also nurtured to keep learning about the field.” Carol Wyatt, MPA, CHTM, CBET, north regional director for Healthcare Technology Management with Baylor Scott & White Health, says that her experience as a woman in the HTM profes-

sion has been “outstanding.” “I have learned and grown from every situation,” she says. Wyatt got her HTM traiing in the military. “Many years ago, I worked for a state hospital working with patients with multiple disabilities,” she says. “I wanted to help the patients have better lives. I looked around for training and found it with the U.S. Army in the form of medical equipment maintenance. I traded six years of military service for medical equipment repair training,”she adds. Jennifer DeFrancesco, MS, CCE, CHTM, chief of Biomedical Engineering at the Indianapolis VA Veterans Affairs Medical Center and the Veterans Integrated Service Network (VISN) 10, agrees with her counterparts that “as a female engineer, you know what you are getting yourself into in terms of the gender equity within the field. It almost becomes something you don’t think about,” she says. DeFrancesco points out that health care is traditionally “female friendly” and “so that pulls the HTM industry a little more in that direction in comparison to traditional tech paradigms.”

ADVICE TO THE NEW GENERATION There are myriad courses of study to consider when college bound. For women considering the pursuit of a HTM career,

THE WOMEN OF HTM

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any hesitation should be laid aside and put to rest in the opinions of women who have garnered experience working in the HTM professionfield. “I’d say do it!,” Brainard says emphatically. “We need more women in the field to change the stigma of this still male-dominated field. I don’t say that only because we need more women in the field, but also because it’s a great career choice with plenty of opportunity to grow – and at a rapid pace,” she says. “In my opinion, women typically have very strong customer service skills, which is a huge bonus as a technician. If you keep your customers happy, you’re happier, and your boss is happier. I think of it as the ‘trickle-up effect,’ ” she adds. Brainard says that for those who are interested in the HTM profession, but hesitant to enter, she would strongly recommend talking to someone who is out there and has done it. “I’m sure there are other women who have had to struggle harder than some, but my belief is that, as long as your heart is in it and you enjoy the profession, view it as a new challenge each and every day to do your best and prove yourself,” she says. Brainard knew that she wanted to pursue HTM when she first discovered the profession. “I didn’t have a plan for after high school, but my boyfriend – now my husband – was going to college, so I looked at the course catalog and found Biomedical Technology,” she says. “At first, I didn’t even know that I had an interest in the profession – it was one of those ‘a-ha’ moments for me, where I thought, ‘Ooh yeah, I need to do this,’ ” she adds. As someone who had always been mechanically inclined, and who had worked on cars, it seemed interesting to her. She spoke with the program’s department

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ALYSSA MERKLE BIOMED AT UMASS MEMORIAL MEDICAL CENTER

“ I never felt that being a woman hindered my work or worked against me.”

chair, and he shared with her the ins and outs of the field and mentioned that there were not a lot of women in the field. “At that moment, I literally said ‘Sign me up,’ ” she recalls. Wyatt says that her advice would apply to both women and men considering the field.

“Nowadays, there are many paths you can take within the HTM field. Determine what your goal is, map out a plan and then execute it. If your goal changes, map out a new plan and execute the new plan,” she suggests. “I encourage women to constantly challenge themselves during their careers in HTM, to take on different assignments and to constantly exceed expectations,” Rekik says. “Women need to keep themselves engaged in their job, and if they feel that they are getting too comfortable, it means it’s time to take on new role/assignments or ask for a promotion.” She also points out that women, who enter HTM, don’t have to feel like they must choose between having a family and being successful. She says they can have both. “Don’t slow down your career path because you want to have kids one day. Give it all you’ve got, so when it’s time to stop for a few weeks, you will go back to a job that’s fulfilling,” she adds.

WHAT THE FUTURE MAY HOLD A career in HTM is worth pursuing regardless of gender. “I believe the HTM field offers a great future for women and men. It’s a different HTM world from just a few years ago,” Wyatt says. “There are so many options from bench techs to project management to hybrid biomed/IT techs. It’s a great field for anyone who is dedicated to serving others and has the skills to service equipment.” “The future is bright for all HTMers, but I see the proliferation of women in HTM as being especially noteworthy in the tech community,” DeFrancesco says. “HTM is trailblazing in gender equity in comparison to many of our technical counterparts (IT, other engineering disciplines, etcetera.). The tremendous growth of our profession over the last de-

cade and projected growth over the next decade have challenged the ‘sacred cows’ of our industry, including the collaborative service delivery models, as well as the diversity of skills needed by HTM departments and professionals.” DeFrancesco says that this has opened the doors up to a lot more diversity in the field – both in traditional and acquired paradigms. She points out that the bottom line is that employers will seek out the candidates who are the best fit for “their program and for working with their clinical and administrative staff, and that genuine need is driving much of the gender equity we are seeing in our field.” While women are becoming biomeds, they are also choosing to become clinical engineers. This has been a popular option and even includes more women than men in some programs. “Our graduates are all engineers with a BS and MS degree in engineering. They end up in the health care environment as clinical engineers or clinical engineering managers,” says Frank Painter, professor and clinical engineering program director in the biomedical engineering graduate program at the University of Connecticut. “The attitude in the workplace has been nothing but encouraging. The majority of the health care workers in the rest of the hospital are women, so the women in clinical engineering are very well accepted by the rest of the health care community,” Painter says. “Having an MS BME degree puts them in a very good position to work side by side with nursing, finance and administrative managers who mostly have degrees at the masters level as well. In fact, I would say that women in general have an easier time integrating into the health care team than many men do,” he adds. There will be a new generation of biomeds who will fill the shoes of those long-term baby boomers who retire every

“I encourage women to constantly challenge themselves during their careers in HTM, to take on different assignments and to constantly exceed expectations.” INHEL REKIK, MS CLINICAL ENGINEER, UNIVERSITY OF MARYLAND MEDICAL CENTER

day from HTM. The new generation will not necessarily be as largely male as in the past. The field of HTM promises to be a rewarding choice for both men and women. “The number of women entering the field is increasing and I anticipate this to continue,” Gieras says. “More and more women are assuming leadership positions or already hold those positions and I am sure this will not end as more women continue to enter this field.” Brainard agrees that the future looks bright for women entering HTM and that a change in the profession has already been occurring in the ranks. “Woman are making great strides in all areas of technology. Thirteen years ago, when I started at Children’s Health, there were two female technicians; myself included. We now have six, including myself. While that doesn’t seem like a huge jump in physical numbers, it is a 300 percent increase for our organization. And I’d call that a success,” Brainard says.

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CAREER CENTER Time to Get Serious By Cindy Stephens

ost of us have not had time for spring cleaning in our personal or professional lives. Now, summer is here and we are enjoying time with family and vacations.

CINDY STEPHENS Stephens International Recruiting, Inc.

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AUGUST 2016

With summer almost behind us, it is time to get serious and evaluate your job performance and your career. Instead of floating through the upcoming months, take this time to look closely at yourself, your job accomplishments and put new life into your career. The competition is tough today. Job security no longer exists! This is not the time to be taking it easy or relaxing. You need to be sure you are meeting the challenges to survive and prevail in today’s environment. Have you seriously considered the difference between the top performers and those who are middle-of-the-road performers? In most cases, top performers bring a portfolio of experience, skills, and characteristics utilized in the performance of their jobs. How you are perceived by your bosses as well as your peers is often the single greatest factor in career advancement. The good news is that you are in charge of your career and your behavior. You have the opportunity to impact perception to your professional advantage. Take time to review your skills, job performance, your relationships with your employer and peers, and consider how you are viewed as an individual and as an employee. You need to do what it takes to be valuable to your employer and set yourself apart from others!

This brief list may provide an opportunity for self-analysis and, potentially, a useful tool to see how your boss and others perceive you.

RELIABLE AND DEPENDABLE Do you arrive on time every day and complete your work on or before deadlines? Following instructions, policies, and procedures should be normal for most employees, but you would be surprised to find how many employees have been let go during staff cutbacks due to their lack of respect for following expected work hours and/or lunch breaks!

EXCEEDS EXPECTATIONS This quality is one of the highest measurements of achievement. Often, a manager’s perception of success or failure is determined by setting and exceeding your boss’s expectations. Do you do what it takes to get the job done (even when it isn’t “your job”), and do you go above and beyond what is expected? You should be known as a problem solver, one who takes the initiative. Procrastination adds to inefficiency and highlights poor performance, putting your career at serious risk.

EXCELLENT COMMUNICATION SKILLS Verbal as well as written communications are in great demand today, and many employees have not accomplished the basic written and verbal grammatical skills that are needed for most business communications today. Excellent documentation, reports, and

basic communication skills can make a difference in how you are perceived. If you have poor grammar, whether speaking or in writing, it gives the impression that you are lacking a basic education. Excellent listening skills fall in this category as well. Pay attention when someone speaks to you directly. Consider enrolling in a community college to polish up communication skills if you feel you are lacking in this area.

EXCELLENT MANAGER AND LEADER The ability to manage your time as well as manage and motivate a team is an important characteristic of a successful leader. Organizational skills and tidiness are important in setting an example for others and in getting the job done well. How well you plan and manage your daily activities provides you needed focus to complete job requirements on time. You should be seen as flexible, accepting change easily, especially when your plan changes and other requirements take over your day. You should be open-minded to others’ ideas and techniques and should not be opposed to criticism. Learn from your mistakes.

ENTHUSIASM AND COMMITMENT TO THE ORGANIZATION Taking the initiative inspires confidence in your ability to assume additional responsibility. Managers want people on their team who eagerly take on challenges and exhibit the kind of energy that inspires others to follow. There is no

room for negative attitudes in any organization. Leave your personal problems at home and remain focused on meeting your company’s goals. Your ability to concentrate on your job responsibilities, no matter what is going on, indicates you are able to take on more responsibility and more importantly, are ready for the next level in your career.

PROFESSIONAL APPEARANCE AND MANNER You are not judged by your performance alone. Carelessness towards your appearance and daily grooming isolates you, regardless of your abilities. People shy away from associating with people who have sloppy appearance such as unkempt hair, wrinkled or stained clothing, or dirty, raggedy nails despite their expertise. It may not seem fair and it may seem unimportant, but you need to pay attention to this as perception is very important in this area! Just as important is your ability to remain professional at all times in your mannerisms. Avoid gossip and getting involved in office politics at all times. Treat others with respect regardless of your personal opinion of an individual. Always be seen as the ultimate professional in appearance and manners!

LOYALTY Employers want employees who will have a strong devotion to the company – even at times when the company is not necessarily loyal to its employees.

INTEGRITY, HONESTY AND CONFIDENTIALITY You should be seen as the person who is always trusted to do the right thing, always. I cannot express this enough. You cannot be the person to go behind a person’s back and speak about another person, your boss, the company, or even a competitor. Maintaining strict confidentiality is a part of this and a person should not have to be told to keep information confidential, regardless of the individual involved or the situation. Everyone has a different portfolio of education, experience, skills and characteristics. Each person brings different levels of each of these traits to their respective positions. Excellent performance is expected, but if you have exceeded in every aspect listed above, it will separate you from coworkers. The ability to view yourself and your performance through the eyes of your boss is a critical part of career development. In one’s career, perception is reality – and it should be actively and thoughtfully managed. No matter where you are in your career, there’s always room to improve your skills and position yourself for the next opportunity. Now is the time to get serious. If you feel you need to adopt a new work philosophy after you have reviewed your skills, job performance, and your relationships with your employer and peers, then start now! Get your career in shape now and be ready when the opportunity presents itself. Ensure your skills and personal characteristics set you apart from the rest. Take the steps needed to keep your career on track. Here’s to your success!

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Are Your Ducks in a Row? By Matt Tomory

he FDA recently requested comments from the public on Refurbishing, Reconditioning, Rebuilding, Remarketing, Remanufacturing, and Servicing of Medical Devices Performed by Third-Party Entities and Original Equipment Manufacturers. The period for comment closed on June 3 and I have had an opportunity to read and contemplate all 73 submissions.

MATT TOMORY VP of Marketing & Sales, Conquest Imaging

The stated reason for the request was that “various stakeholders have expressed concerns about the quality, safety, and continued effectiveness of medical devices that have been subject to one or more of these activities that are performed by both original equipment manufacturers (OEM) and third parties, including health care establishments.” The request targets either users or providers of this equipment and/or related services. Where this is going is not predictable, but one of the secondary effects is that health care providers are beginning to question the quality and qualifications of parts and service providers like never before. Up until recently, the focus of many providers has been centered on initial price rather than long-term cost, quality and safety. Now, we are getting questions about repair processes and methodologies, quality assurance, safety testing, quality manuals, test equipment calibrations, ISO certifications, warranty/DOA statistics and repair personnel credentials. This is information all health care providers should be asking

any vendors they use. These questions are also imperative for any secondary vendors. Many organizations within our industry will source parts, probes, assembly components and subcontract services. As an ISO-certified organization, we not only are held to high standards but are also bound to ensure any providers we use for products and/ or services are properly vetted as well. A couple of years ago, we began placing ducks in the boxes of every ultrasound part and probe we sell as a symbol of a genuine Conquest Imaging part and the fact that our ducks are in a row. As the industry continues to evolve, please make certain the vendors you use have their ducks in a row as well. As someone who has been in the industry for over 30 years (16 with OEMs and 14 with Conquest Imaging), I welcome these questions and applaud the FDA for trying to ensure the care someone’s loved one receives retains OEM equivalent specifications for performance and safety. After all, at the end of the day, it is patient care and safety we are all focused on.

EXPERT ADVICE

KAREN WANINGER What Are You Doing With That? By Karen Waninger

few weeks ago, the entire HTM team at one of our sites was displaced due to construction (destruction?) activities in preparation for a new hospital which will open on that site in 2018. My team was challenged to condense everyone and everything into an area less than half the size of our original space.

KAREN WANINGER MBA, CBET

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AUGUST 2016

The team did a great job of separating the potentially useful items from the scrap in their efforts to consolidate and relocate within the required time frame. There were entire shelving racks filled with items that had been “saved” for decades, much of which had been salvaged originally by technicians who have been gone for years. That was somewhat understandable, I rationalized to myself, since the facility still has that old equipment stashed away in random locations throughout the hospital buildings. I was not as successful in my own efforts to manage the contents of my office. I do remember a fleeting moment of dismay when I walked in and looked at the stacks of boxes that had been moved to the area I now affectionately call my “cage.” Actually, with block walls on three sides and the fourth side open, it is more representative of a jail cell minus the bars, but that’s all irrelevant. It was a typical crazy morning, so I found my essential piles and files for that day and headed out to my meetings, thinking I would start unpacking everything later that day — that was almost two months ago. As I was looking last week to make room for a new summer intern, I realized the boxes were still piled basically where the moving crew stacked them. The emotional needle moved from dismay to depression, which was quickly overshadowed by whatever the crisis of the day happened to be. The underlying

issue, however, had triggered a deeper thought process: How often do we keep things that really will never be useful? It seems to be a common characteristic among the people I know in this profession, to analyze and assign some real or perceived value to everything around us. Think about the way we hold on to our service delivery strategies, data collection processes, inventories of equipment and parts, and perhaps even personnel. Many of the things we do, and the way we do them, may really not be necessary in the current environment, but we keep doing them because it would require more effort to make changes than to just continue as is. At the recent AAMI conference, there were some really good discussions around reliability centered maintenance and why it would be beneficial if there were standardized, defined sets of problem and corrective action descriptions. At the same time, there were hints that we may see new expectations regarding regulatory requirements. These related topics led to a discussion of developing some consistent methodology for demonstrating the safety and effectiveness of our medical equipment management strategies. Imagine the possibility of turning decades of collected data into meaningful information. With that thought, you can probably also envision the uproar that would result from any expectation of

TRIM 2.25”

I read TechNation because... I can get all of the information on latest test equipment and information on what’s happening in the biomedical world. Stephen Taul, BMET II Novant Health by every HTM organization? Would we be willing to give up our known, comfortable processes for the long-term benefit of our profession overall? As you ponder that, please also evaluate how many things you have collected, stored, set aside, filed, saved, or otherwise accumulated over the last several years. How many of those things are you really using? Those 12 boxes the movers stacked along the wall of my cage are still there, with the exception of two that I found time to empty. Almost everything from the first box went into the waste disposal or recycle bins. The contents of the other box were put back in or on my desk, and are used frequently. Regarding the other 10 boxes, maybe I will go through them eventually, or maybe I will decide after another two months that I am not going to do anything with whatever is inside them. It would certainly have been easier to go through the department move if someone had asked “What are you doing with that?” every time we put something on a shelf or in a drawer during the past decade or so. Perhaps we should start utilizing that same concept now with our data collection process. It would make sense to start looking for ways to store information that we really will want to use on a regular basis in the future, before some external decision maker sets a timeline that forces us to make changes before we are prepared to handle the disruption.

TRIM 9.75”

abandoning our numerous individual processes in favor of implementing some yet-to-be-defined, widely accepted, standard data collection methodology. How much information have we gathered over our years of activities directed at making sure we were hitting those targets for completion of scheduled maintenance inspections? Or how about all those work orders that have been carefully coded with the different specific repair actions? Have you reviewed them and made changes to your program based on that information or have you diligently collected it and filed it away, never to be looked at again? Coping with disruptions and interruptions has actually highlighted the key service delivery activities that have continued to be absolutely necessary because they are vital to our efforts to support the clinical care areas. As my team has come to realize, there are a few key resources we use on a regular basis. Once identified, significant efforts were made to assure those items were readily accessible and that everyone on the team was familiar with where to find them within our new space. Could the HTM profession decide to go through a similar type of disruption voluntarily, without it being mandated by any regulatory agency? What would happen if we simultaneously adopted a few new service codes and activity descriptions, and if the same ones just happened to be used

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“EYES 360” By Alan Moretti

hroughout my career working within hospitals, a very important skill that I acquired early and have honed during my HTM tenure is what can I call “Eyes 360.” It is a highly reliant skill and in many ways it is a tool of instinct.

ALAN MORETTI VP, Advanced Imaging & Radiation Oncology, Renovo Solutions

1TECHNATION.COM

AUGUST 2016

As an HTM professional who works in the health care environment where medical equipment responsibilities are assigned and performed, Eyes 360 can be more far reaching that any theory taught in a technical school. On a recent visit to a valued client site my Eyes 360 skill came into play. As I entered the CT clinical area for the primary purpose of my visit – the CT scanner – my Eyes 360 picked up several other items within the area. What were those, one may ask. Well, directly behind the CT’s gantry were two very large unsecured medical gas tanks that stood about five feet tall. Anyone who is even somewhat familiar with rocket propulsion theory can visualize what might happen when a five-foot tall medical gas tank is tipped over violently and the inlet tip either becomes cracked or broken. The result is a missile effect that makes the medical gas tank a projectile of destruction to anyone or anything in its path. My immediate reaction was to call over the clinical manager responsible for the area and share the serious safety situation I had discovered in this CT suite using my Eyes 360. The hospital’s medical gas tank farm folks were summoned by the clinical manager and they removed both unsecured tanks in less than half an hour. Another instance that comes to mind was while rounding at a val-

ued client’s site. This time, I was in a hybrid operating room that housed a bi-plane interventional imaging system, patient hemodynamics monitoring equipment, anesthesia, ultrasound and other very expensive pieces of medical equipment. We all gathered in the room and were discussing the clinical setting and its technology attributes. During our conversation my eye caught what appeared to be a discreet discoloration in a ceiling panel. My Eyes 360 told me to find a step ladder and touch the discolored ceiling tile to satisfy my curiosity. Well, it was moist to the touch and lifting the panel exposed a leaking pipe that needed immediate attention. The message of this month’s column is that vision is an inherit skill that all HTM professionals can develop and nurture. The concept of Eyes 360 is not rocket science, but one of common sense. Observe your surroundings constantly, look for the obvious and search out hidden traps and land mines that exists in the health care environment. Be on the lookout for things that can affect patient/staff safety, create equipment service event challenges and promote the value of service excellence. We all have a vested responsibility when it comes to the delivery of quality patient care.

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011

TECH SAVVY

Move Over MU, MACRA is Moving In By Jeff Kabachinski

he Centers for Medicare and Medicaid Services (CMS) are about to add to the Meaningful Use (MU) incentive program with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, CHIP = Children’s Health Insurance Program). The idea is to simplify the way health care is paid for and create an infrastructure to move from a fee-for-service to a value-based reimbursement or a pay-for-value system.

JEFF KABACHINSKI Senior Director of Technical Development, ITD

This installment of Tech Savvy takes a look at the new program and attempts to understand what this might mean to the Hospital Information System (HIS) network. Another aspect of this installment of Tech Savvy is to get familiarized with the new language and terminology – yippee another new language to learn. In the new rule the Department of Health and Human Services (HHS) and CMS indicate three central main concerns of MACRA: • Better system interoperability for physicians and patients to access information from other health care systems • More flexibility in the Meaningful Use portion of the program • Technology designed around physician workflow and interactions with patients Overall, this a fundamental change in the incentives and penalties of the MU program. The MU program had a list of quality measures that must be met to show you’ve moved to a certified EHR (Electronic Health Record) system and are simply getting a meaningful use out of it. Within MACRA we must now instead show that it has a positive effect on patient health care outcomes, clinical workflow and reimbursement methods. This can be a big deal if the health care organization depends on the CMS reimbursements which can

1TECHNATION.COM

AUGUST 2016

be as much as two-thirds of the overall revenue. The MU program will now be called the Advancing Care Information program (ACI) and becomes a pointbased ACI performance category score. There are two major portions of MACRA – the MACRA-Related Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM). ACI now falls under the MIPS portion.

MIPS MIPS consolidates components of three current programs: the Physician Quality Reporting System (PQRS); Physician Value-Based Payment Modifier (VM); and the Medicare Electronic Health Record (EHR) Incentive Program (ACI). Some of the current requirements within ACI no longer need reporting such as the Computerized Provider Order Entry (CPOE) measure. This includes orders for scans, tests, medications and treatments and is core to system operation. Since it’s such a core piece of system operation not much would happen without it. So, why measure it? Interestingly the MIPS portion of the program is intended to be budget neutral meaning that the amount of awarded incentives would match the amount of assessed penalties. They’ve estimated that to be around $800 million the first assessment period – pocket change in government monetary terms. The MIPS assessment period will be

TRIM 2.25”

I love TechNation because... “Within MACRA we must now instead show that it has a positive effect on patient health care outcomes, clinical workﬂow and reimbursement methods.”

FOUR PERFORMANCE CATEGORIES The MACRA rule recommends measures, reporting, and data standards in four performance categories: quality, use of resources, clinical practice improvement activities (CPIAs), and ACI. MACRA also has incentives for participation in particular APMs.

APMS MACRA has incentives for participation in particular APMs that support the goals of turning from fee-for-service payments into APMs that center on improved health care, intelligent spending and healthier patients. MACRA also has proposed measures for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in sending comments and recommendations on physician-focused payment models (PFPMs). Health care providers must also show their commitment to interoperability and

data exchange routines. The three-part attestation contains answers to this main question: the provider did not knowingly disable functionality to restrict interoperability of certified EHR technology from patients, and health care providers, despite the requestor’s technology vendor. TRIM 9.75”

the calendar year two years prior to the year in which MIPS is used. As the initial MIPS payment year is scheduled to begin in 2019 that means it has a January 1, 2017 start date. The new quality measures would be assessed, established and can change every year with input from the health care community. The next year’s measures will be published in the Federal Register on November first of every year.

READY OR NOT It’s difficult at this point to exactly determine what the resulting healthcare IT requirements will be without knowing the quality and performance measures involved. We know that interoperability and cybersecurity will be a major part of the quality measures. The new rule also emphasizes information exchange and that patients have access to their health information through use of APIs. A recent survey by the Healthcare Information and Management Systems Society (HIMSS) showed that while health care providers were not opposed to the big change, most didn’t think that they were ready to make the move into the next phase of participation for the Quality Payment Programs. They’re looking to the rest of the health care industry to help define a consistent approach to MACRA with tools to build infrastructure support mechanisms. The HIMSS site (www. himmss.org) has a wealth of information, some informative recorded webinars and fact sheets about MACRA. Stay alert regarding this one – don’t get caught flatfooted!

I love that the articles are easy to read and are full of useful information. Mark Peavey, BMET I

Phoebe Putney Health System

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THE FUTURE A Degree is the Goal By Roger A. Bowles, MS, EdD, CBET

just read the June 2016 issue of TechNation and two things really stuck out to me. First, the need for entrylevel biomedical equipment technicians will continue to increase at an exponential pace. And second, the supply of entry-level BMETs seems to be decreasing. As a follow up to my esteemed colleague, John Noblitt’s comments in his column... our enrollment too has been taking a steady dive.

ROGER A. BOWLES MS, EdD, CBET Department Chair/Professor Biomedical Equipment Technology Department Texas State Technical College

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AUGUST 2016

Several years ago we were busting at the seams with 250 students. This fall, I’m hoping we are over 100. I’m not sure of the cause of this steady decrease. In the past year, we have recruited more than we ever have in the past, visiting well over 40 high schools and taking part in multiple career expos and other events. Just in the past six months, our department received a much needed shot in the arm when the school allowed us to replace aging equipment with more modern devices. Global Medical Imaging has helped us tremendously by allowing us to buy modern ultrasound equipment at a deeply discounted price … and then providing training at our facility to local BMETs, our students, and of course, me. When I was an active BMET and working on ultrasound equipment (20 years ago), ultrasound systems were hardware based. Our school still has a few of the old Acuson 128 and ATL Ultramark 9 systems. Yes, the systems still work but they are antiquated for training purposes … big ugly CRTs, dozens and dozens of huge circuit boards, and are not networkable. Now, thanks to GMI, and our administration, we have Philips IU22, GE Logic E9 and Acuson S2000 ultrasounds.

Thanks to the generosity of Fresenius, we have two brand new dialysis machines, donated free of charge. We also have newer ventilators, centrifuges, defibrillators and other items. The equipment is more modern and is still found in hospitals. We have an increasing number of internship partners and employers asking about students. In fact, there are more jobs available than there are graduates. This is good for the students to have and it should make the program very enticing to someone trying to choose a career path. We plan on using the June 2016 issue of TechNation in our recruiting efforts. But how do we get the students in the door and keep them until graduation? Retention seems to be another problem. Some students understandably change their mind and their major if they simply decide it isn’t for them or have extreme academic difficulties. Some have work/life issues, financial issues, etc. And some, unfortunately, cannot bridge the gap between high school and college. They have difficulty making it to class, completing assignments, or taking the time to get everything they can out of each lab (choosing instead to leave as soon as possible and then wondering why their grades suffer). Our administration has recently floated the idea of “badges.” Basically, students would earn badges at several steps along the way to graduation. This, they believe, will hold their attention through the rough parts and give them mini milestone accomplishments. I’m open to the idea but it makes me think about people’s ability to focus on the goal, and keep their “eyes on the prize.”

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I teach motorcycle safety on the weekends. The novice class is 5 hours in the classroom and 10 hours on the range over the course of a weekend. The students complete 17 range exercises consisting of basic skills like braking, throttle control, shifting, turning, etc. The exercises build on each other and at the end of the day; the students take a skill evaluation on the motorcycle. If they pass the on-cycle evaluation, and the written test, they are given a EMPOWERING THE BIOMEDICAL/ certificate that they can take to the Department of Public CE PROFESSIONAL Safety and get the “M” endorsement on their license. Are they expert riders at the conclusion of riding two days in the parking lot? No way. And I tell them that they are OVER 30 beginners and should continue receiving training and pracHOURS OF ticing to build their skill levels before they blast out onto the EDUCATION! interstate. Competency-based education at its best, right? The students do not receive a badge for turning, a badge PLUS: for braking, a badge for clutch control, etc. The goal is the • Networking certificate that they earn at the end of the second day if they • Keynote are successful in the class. Badges would mean nothing. I feel the same way about awarding badges in an associate • Roundtable PROOF APPROVED CHANGES NEEDED SUPP ORTED BY: degree program. The goal is the degree that will gain them • Exhibit Hall NEW ENGLAND SOCIET Y entry to the field. Breadcrumbs along the way don’t make OF CLINICAL ENGINEERING CLIENT SIGN–OFF: sense to me. Just like in the motorcycle class, I encourage BMET studentsCONFIRM to “look up”THAT and seeTHE the whole picture. PLEASE FOLLOWING ARE CORRECT WWW.MDEXPOSHOW.COM Know that not everything is simple and it takes motivation, LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR determination, skill and perseverance to earn the “trophy.”

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THE ROMAN REVIEW Happiness is a Ritual By Manny Roman

was conducting “Internet research” and ran across a very interesting article regarding what makes people happy. It appears that neuroscience has conducted research and found that you can make yourself happy by implementing four rituals. Studies conducted at UCLA found that these four simple rituals will place you in an upward spiral of happiness.

MANNY ROMAN, CRES Founding Member of I.C.E. imagingigloo.com

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AUGUST 2016

Since it is in my nature, I researched the word ritual to ensure that I understood exactly what that is. I found that, per Wikipedia, a ritual is a sequence of activities involving gestures, words, and objects performed in a sequestered place and performed according to a set sequence. Rituals are repetitive behaviors. They may be triggered by tradition, religion or even an emotional event. It is the emotional event that we are interested in here. The emotion we are pursuing is unhappiness. It seems that even though they are different pride, shame, and guilt all activate similar circuits in our brains. It can be appealing to feel guilt and shame because they activate the brain’s reward center. Worry also makes the brain feel better since you are at least doing something about your problems. Worry even helps to calm the limbic system by increasing the activity in the thinking brain. So when we are unhappy, what can we do to make sure that we extricate ourselves from the downward spiral and begin an upward spiral toward happiness? Ask yourself, “What am I grateful for?”

HAPPINESS RITUAL 1 - GRATITUDE Gratitude works on the brain at the biological level. Gratitude boosts dopamine as does the antidepressant Wellbutrin. Gratitude also boosts the neurotransmitter serotonin as does Prozac. Even if you can’t find something to be grateful for, don’t worry. It is the process of searching for something that provides the benefits. If you can’t find something, be grateful for this article and me.

HAPPINESS RITUAL 2 - LABELING OK, so what do you do when you are really down and the bad feelings overtake you? It seems that trying not to feel something doesn’t work, it may even backfire and cause worse feelings. Research indicates that labeling the negative feeling will get your thinking brain involved and reduce the amygdala involvement thereby reducing the impact of the emotion. The amygdala is the center of emotion and will quiet down once the thinking brain begins to get involved.

HAPPINESS RITUAL 3 - DECISION Brain science shows that making decisions reduces worry and anxiety and may actually help you solve problems. Making decisions involves the thinking brain and again calms the limbic system where the amygdala resides. “But decisions are hard work,” you say. Then, don’t make the absolute best decision. Make a “good enough” decision. Trying to make perfect decisions overwhelm the brain with emotions that will make you feel out of

Realize that “Good enough is almost always good enough.”

control. Realize that “Good enough is HAPPINESS RITUAL 4 almost always good enough.” TOUCH PEOPLE Studies indicate that you get a shot Yep, touch other people, not indiscrimiof dopamine, the feel-good stuff, when nately, of course. Handshakes and pats on you make a decision on a goal and the NEEDED back will do, although a long hug will PROOF APPROVED CHANGES then achieve it. You will feel better go much further. Relationships are than ifSIGN–OFF: something good happened by important for the brain’s feeling of CLIENT chance. We don’t just choose the things happiness. I have always said that we are we like, we likeCONFIRM the things we choose. in a relationships business. PLEASE THAT THE FOLLOWING ARE CORRECT

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The Happiness Ritual comprises finding something to be grateful for, labeling the negative emotions, deciding on good enough and touching others. So … I am grateful for the opportunity to write this column. The label for the emotion while writing it is: stressful. I will accept it as is which is good enough. And, I am going to go hug Ruth right now. I like Ritual 4 the best.

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DID YOU KNOW Science Matters

Thin, powerful new microchip-like lens Engineering researchers have built a paper-thin high-resolution lens that could replace the glass lenses in smart phones, cameras and telescopes. Base of lens is ordinary glass

Fins cover ‘meta-lens’ Fins are 600 nanometers (0.0006 mm) tall Fins are titanium dioxide, a white Set at precise material used in angles, they act paint, toothpaste as “waveguides” Can be made inexpensively using the factories that mass-produce microchips

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Entire lens is a disc 1/4 mm (0.01 in.) wide Microscopic fins focus light as it passes through lens

Image quality: As good as best commercial glass lenses Precision: Can focus an object smaller than a wavelength of light (about 400 nanometers, or 0.0004 mm)

Magnification: As high as 170 x Color correction: Accurately focuses red, blue and green light without absorbing or scattering it

Source: Federico Capasso of Harvard John A. Paulson School of Engineering and Applied Sciences; Science magazine Graphic: Helen Lee McComas, Tribune News Service

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AUGUST 2016

Aperture (light collecting power): Equivalent to an f/0.8 lens

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THE VAULT

o you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your chance to prove it! Check out “The Vault” photo. Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will be entered to win a $25 Amazon gift card. To submit your answer, visit 1TechNation.com/vault-august-2016. Good luck!

SUBMIT A PHOTO Send a photo of an old medical device to editor@mdpublishing.com and you could win a $25 Amazon gift card courtesy of TechNation!

LAST MONTH’S PHOTO Invasive milliamp meter for a 1939 general electric x-ray machineThis photo was submitted by Daniel Anderson. To find out who won a $25 gift card for correctly identifying the medical device, visit www.1TechNation.com.

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