TechNation - October 2016 by MD Publishing

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Vol. 7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

OCTOBER 2016

12 Company Showcase

Pacific Medical

24 News and Notes

Industry Updates

42 Roundtable

Anesthesia

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

ROUNDTABLE: ANESTHESIA New technology and updated features can make maintaining medical devices difficult and that is true when it comes to anesthesia devices. TechNation contacted industry experts to find out how biomeds can extend the life if anesthesia devices, what to look for when purchasing equipment and more. Next month’s Roundtable article: CT

MEDICAL DEVICE SECURITY: NEUTRALIZING THE THREAT The threat of cyber attacks on health care facilities has become such a concern that the Healthcare Information and Management Systems Society (HIMSS) Foundation’s Institute for e-Health Policy and the College of Healthcare Information Management Executives (CHIME) recently held a briefing on Capitol Hill titled “Hacking Healthcare: The Cybersecurity Threat Landscape.” We look at how biomeds keep devices safe, prevent cyber attacks and dispose of old equipment. Next month’s Feature article: Tips for Acquiring Parts

TechNation (Vol. 7, Issue #10) OCTOBER 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.

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Departments P.12 SPOTLIGHT p.12 Company Showcase: Pacific Medical p.14 Department of the Month: British Virgin Islands Health Services Authority p.18 Professional of the Month: Alberto Perez p.20 Biomed Adventures: Forty Coup Love Affair

P.24 INDUSTRY UPDATES p.24 p.28 p.30

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

P.32 THE BENCH p.32 p.35 p.36 p.38

Shop Talk Biomed 101 Tools of the Trade Webinar Wednesday

P.66 EXPERT ADVICE p.56 Career Center p.58 Ultrasound Tech Expert Sponsored by Conquest Imaging p.60 The Future: HTM Educational Programs p.62 Karen Waninger: Make it Personal p.64 Thought Leader: Never Be Afraid To Hire People Smarter than Yourself p.66 Tech Savvy: NSM vs. CM p.68 Roman Review: Success is Being Prepared

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ndy Bonin’s search continues. It is another perfect 75-degree day in Southern California and the president of Pacific Medical is scouting for another new building. Just having added another 10,000-square-foot building, Bonin knows that they’re going to need more space to keep up with not only demand, but the new partnership Pacific Medical announced with Jordan Health Products (JHP). In addition to Pacific Medical’s accelerated revenue growth, JHP will provide resources, networking and cross-selling opportunities. “We are really excited about the partnership with Jordan Health Products,” says Bonin. “I anticipate JHP will help us expand into the rapidly growing, highly fragmented global equipment market.” Pacific Medical, headquartered in San Juan Capistrano, California, is already recognized worldwide as the the best solution for the repair and refurbishment of patient monitoring equipment – including OEM-compatible accessories and parts from all major manufacturers (GE, Philips, Masimo, Nellcor and Welch Allyn to name just a few). Pacific Medical specializes in patient monitors, modules, telemetry, infusion pumps, suction regulators, fetal transducers, SpO2/ECG/TEMP/ NIBP cables, O2 blenders, endoscopes and gas analyzers. The company prides itself on a very large inventory, reducing slow turn times and backorders.

SERVICE. SERVICE. SERVICE. How does a company grow at such a substantial clip year after year and still satisfy the needs of their customers? “Service. Service. Service,” Eric Hatteberg, Director of Sales, answers in a quick authoritative tone. “Of course it is our goal to be a profitable company, but it doesn’t dictate how we relate to the customer.”

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without quality as a driving force, you’re not going to have any customers to service. “Service and quality really do make up what our brand is,” says Hatteberg. Pacific Medical believes that their “Brand” is not just a logo and color scheme. It is how a customer experiences the interaction with the company, and its services and products

FAMILY

Pacific Medical doesn’t shy away from bringing more sales and customer service people on board. “If it takes more than a few minutes for us to get back to a client and answer their questions, we are not doing our job,” Hatteberg says.

QUALITY IS IN THEIR DNA While service is a priority, the entire Pacific Medical team understands that

OCTOBER 2016

As you walk through the building and into the repair depots that house the certified technicians that work on patient monitors, modules, telemetry, infusion pumps, gas analyzers, O2 blenders, etc., you feel a little quieter, more serious vibe. “These folks know the importance of the work they do,” states Damon Kelley, Vice President. “They know someone’s life depends on the quality of their work. That is a massive responsibility, one that we all take very seriously.” Again, the earlier theme of family comes into play. Speaking with an engi-

“ Of course it is our goal to be a profitable company, but it doesn’t dictate how we relate to the customer. If it takes more than a few minutes for us to get back to a client and answer their questions, we are not doing our job.”

neer, he mentions how strange, and at the same time eye-opening, it was last summer to see the same equipment that he works on monitoring his Mom’s vital signs in her ICU room. “The realization that someone is really depending on me is challenging, but I’m trained so well that I feel very confident that I’m up to the task,” he says.

NEW MARKETS While not willing to divulge what new markets Pacific Medical is exploring, Bonin and his management team are very excited about the new partnership with Jordan Health Products. The partnership reflects JHP’s optimistic outlook for Pacific Medical and the success of Pacific Medical’s business. “JHP is the perfect partner to help us go after new customers in new markets, as well as introducing us to the untapped market segments that JHP has already penetrated,” Bonin adds. “JHP is successfully deploying a strategy of acquiring, partnering and growing with medical, surgical, and diagnostic imaging equipment companies to become a major industry player in North America and internationally.

That fits our plan perfectly.” Bonin takes a quick look back at the last building. “Not big enough.” PACIFIC MEDICAL PROVIDES hospitals and surgery centers worldwide a reliable source for the repair and refurbishment of patient monitoring equipment. Their full service repair depot houses numerous certified engineers working with the latest equipment to ensure each piece of equipment is ready for patient use. Pacific Medical carries an enormous inventory of recertified monitoring equipment for sale along with OEM compatible accessories and parts from all major manufacturers. As part of their new partnership with Jordan Health Products, Pacific Medical joins the following companies as part of the JHP portfolio: Global Medical Imaging LLC; DRE Medical Group Inc.; Oncology Services International Inc.; and Integrated Rental Services Inc. Through these companies, JHP and their partners are able to offer a wide variety of new and refurbished medical, surgical, diagnostic imaging, and oncology equipment, as well as the rental, service, repair, and installation of this equipment.

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SPOTLIGHT

DEPARTMENT PROFILE

British Virgin Islands Health Services Authority Biomedical Engineering Department By Conor King Devitt

ny tourist ferrying between ports or taxiing through the hills of the British Virgin Islands (BVI) will witness a montage of imagery that may seem like the very substance of a 9-5 commuter’s daydream: anchored catamarans, beachside cocktail shacks, turquoise-colored bays, and many tanned hands holding tumblers filled to the brim with Caribbean rum.

What that quick series of images will not capture, however, is the flip side of island life, the required resilience of a population living in geographic and communicative isolation. Things simply take longer in the Caribbean, and because of that, professionals across different fields here have had to develop a certain level of wiliness. In the BVI, scrappy problem-solving ability is not some-

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AUGUST 2014 OCTOBER 2016

thing just written about in a cover letter; rather, it is the necessary skill of a day-to-day existence beset with endless inconveniences and delays. Nowhere is that creativity exercised more than in the four-person biomedical engineering department at BVI Health Services Authority, the medical body that manages Tortola’s Peebles Hospital and 13 other clinics throughout the British Overseas Territory. “We have a good team here. In our department, as in facilities and biomed, we have a high staff retention,” said Kaream Pickering, biomedical engineer and manager of the department. “The guys that are with us are with us for a lengthy period of time.” Originally opened in the capital city of Road Town as a two-room facility in 1922 and referred to as the Cottage Hospital, the territory’s main medical facility was eventually renamed after its founder, Major Peebles, according to BVIHSA documents. In December 2014, a new seven-floor, 151,000 square feet expansion officially opened. The 120-bed facility cost more than $100 million and features three operating theaters, one procedure room, and three labor and delivery rooms. With that expansion came a gigantic increase in the number of medical machines and the need for a capable biomedical engineering department to maintain them.

The new Peebles Hospital officially opened its doors in December 2014.

BVIHSA’s team is broken up into two units; Pickering and Candia Thompson, a biomedical engineer, form the general department. Delton Turnbull and Jared Penn are the authority’s dialysis technicians. Most of their work is done at Peebles Hospital and the Iris O’Neil Clinic on the sister island of Virgin Gorda. In addition, the BVI’s government brought a national health insurance program on-stream in January of this year, increasing the number of patients and the amount of the hospital’s equipment that is used, according to Franka Potter, marketing and communications director at BVIHSA.

UNIQUE CHALLENGES When asked what the greatest challenge is working in the island environment, Pickering said, “Parts. The delay in

The British Virgin Islands Health Services Authority Biomedical Team consist of: (from left) Manager and Biomedical Engineer Kaream Pickering, Dialysis Technician Jared Penn, Biomedical Engineer Candia Thompson, and Dialysis Technician Delton Turnbull

“ We always try to cross-train everyone so we’re not always dependent on one person.” parts. Especially depending on the company you’re dealing with and the kind of contract you have.” With FedEx, parts typically take twice as long to arrive as they would in the continental U.S., Pickering explained. Shipping through general freight often causes delays of a week or two. Both Pickering and Thompson mentioned technical support as another major challenge. Because the BVI is outside of the United States, some companies cannot legally provide them with technical support, Thompson said. They are often rerouted to Puerto Rico for support, which can cause difficulties due to the language barrier, according to Pickering. As a well-experienced team, however, they have developed strategies over the years to combat their geographic challenges, he explained. They stockpile broken equipment to part-out still-functioning elements, recycling broken dialysis machines, infusion pumps, monitors, defibrillators, ECG machines, ventilators, and much more. They also bulk-order

equipment they know breaks down often and takes a while to reach the territory. This does not mean, though, that they take any chances with machines. “I don’t guess when it comes to medical equipment,” said Pickering, who trained at Memorial Hospital West and Prestige Biomedical, both in South Florida. “[Where] I trained, the guy told me, ‘Always deal with a piece of equipment as if you or any of your family members were getting care from it.’ So I don’t guess.” The frequent lack of technical support has forced them to become more familiar with the service manuals for different pieces of equipment, increasing their depth of knowledge on the machines, Pickering said. “Sometimes it makes you a better engineer, because now you have to figure it out yourself,” Pickering explained. “You have your manual and your book, and now you have to sit and go through every step, by yourself, versus calling [for technical support] and they’ve seen this problem probably 200 times.” Pickering and Thompson work on everything that does not require a

separate certification, including devices like vital signs monitors, sterilizers, centrifuges and laparoscopic equipment. BVIHSA contracts maintenance for diagnostic imaging equipment, lab equipment (besides the centrifuges), and anesthesia machines, largely on an annual basis through the Miami-based Biomedical International Corporation. Turnbull and Penn maintain the hospital’s 11 dialysis machines, which are notoriously temperamental. “You have 11 different machines, you could have 11 different problems,” Penn said. They keep detailed notes on each individual machine to prepare for any future issues, Penn explained.

GROUP EFFORT Both Pickering and Turnbull stressed how important it is for their team to develop a variety of skills, especially in the context of their isolated location. “We always try to cross-train everyone so we’re not always dependent on one person,” Pickering said. Turnbull mentioned how they work with and learn from the BVIHSA’s electricians, plumbers, air-conditioning technicians and other maintenance department employees, just in case someone is on vacation or sick and anyone needs a helping hand.

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PROFESSIONAL OF THE MONTH Alberto Perez, BMET III By K. Richard Douglas

usiness machines to biomed; the story of a career detour into the HTM profession often reads like that. Alberto Perez, BMET III, first got a diploma in Business Machines Technology from a vocational school and worked repairing mechanical and electronic circuits.

“In the 1980s and early 1990s, I worked as a warehouse coordinator and maintenance technician for SmithKline Beecham,” Perez remembers. “While working there, I met Wayne Cumbie, who was SmithKline’s Laboratory Biomed Engineer. He was the first biomed I met and he became my mentor in the biomed field. I got hooked immediately and went back to school to complete another associate degree in biomed so I could enter the field,” Perez completed that degree in 1996. “After finishing my degree, Mr. Bill Hart helped me find my first job,” he says. Hart had been his biomed course instructor at Hillsborough Community College (HCC). The job was with Benjamin Biomedical as a biomedical technician. He handled repairs across Florida, from Tallahassee to Miami. “I learned a lot about patient monitoring, sterilizers, and many other types of medical devices,” Perez says. “It wasn’t easy at that time, as there were no cellphones or easy Internet access to research for parts, manuals or service. I remember carrying a ‘phone card’ and using pay phones to call for tech support,” he says. Contacting tech support back then was a necessity because Perez was

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OCTOBER 2016

doing a lot of learning on the job. There was a lot of equipment he had never seen before. Perez says that when you have to learn by yourself, you are more likely to retain that information. He went to work for National MD afterwards, before it was acquired by GE Medical Systems (now GE Healthcare). He spent almost 10 years

“ I enjoy working with people and mentoring new hires. I like to motivate students during our monthly BAAMI meetings.” with GE Healthcare and progressed from a Biomed II to a BMET III, and then to a Site Leader. “I joined Baycare Health Systems in 2007, where I still work as a BMET

Alberto Perez, BMET III 2008 Florida Biomedical Society’s “Biomed of the Year”

III. I am in charge of the surgical departments at St. Joseph’s Hospital in Tampa,” Perez says. His specialization in the surgical department evolved out of specific training. “I’m specially trained in heart/lung machines and heater/coolers, ESUs, surgical tables, booms and lights, anesthetic gas monitors and all kinds of equipment used in the surgical environment,” Perez says. He says that when something happens “in the middle of a case,” you have to act and think fast. A loose wire can make a monitor display go out. Perez considers operator error as a first step before assuming equipment failure.

RECOGNITION Perez’s work ethic caught the attention of employers and associations.

FAVORITE BOOK: Books about travel FAVORITE MOVIE: James Bond movies FAVORITE FOOD: Puerco Asado (Cuban Roasted Pork) HIDDEN TALENT: Car Mechanic. I love to disassemble stuff. FAVORITE PART OF BEING A BIOMED: Being there for the customer. WHAT’S ON MY BENCH • I have four tool carts that I use depending on the area of the hospital I need to service. • Family pictures • Symposium Brochures (AAMI, FBS, MD Expo, etc) • Business cards from vendors • Buckets with spare parts

Alberto Perez, BMET III, uses his 20-plus years of experience to maintain medical equipment at Baycare Health Systems.

“While working for GE Healthcare, they used to offer an award called the Triple Crown Award to a CE shop that completed three requirements; 100 percent PM completion on time, correct inventory of equipment and excellent customer support. I won the award in 2007,” he says. The following year, he was awarded the Florida Biomedical Society’s (FBS) “Biomed of the Year” award at the group’s annual symposium. Each region around Florida submits their nominee for the biomed of the year honor. Perez had no idea he was chosen as the winner until the FBS annual symposium. It was a complete surprise.

as out of state. This summer alone, her team played in Auburn, Alabama; Marietta, Georgia; Spartanburg, South Carolina; Atlanta, Georgia; and Myrtle Beach, South Carolina. We enjoyed it very much and we were able to enjoy some vacation time hiking and whitewater rafting. We also enjoyed sightseeing in Nashville, Chattanooga and the Smoky Mountains,” Perez says. “Also, since we live so close to Orlando, we enjoy going to Disney World every chance we get,” he adds. Perez has a second daughter named Christina and his wife’s name is Rita. They have a toy poodle named Molly.

SOFTBALL DAD

STAYING CONNECTED

Bowling used to be a big interest, but today Perez is more of a softball dad. “My daughter, Stephanie, plays fast-pitch softball at her high school and with her travel ball team,” Perez says. “I spend my weekends watching her play softball all over Florida, as well

Perez has been active outside of work as a member of BAAMI (Bay Area Association of Medical Instrumentation) in Tampa since 2005. “I was elected as the BAAMI State Representative to FBS (Florida Biomedical Society) in 2009. I’m still

active as the representative and feel very proud of being involved with the FBS Board,” he says. “Alberto is actively involved with various biomed associations. He works tirelessly with the Bay Area Association of Medical Instrumentation in Tampa, finding sponsors and helping with every monthly meeting,” says Carlos Villafane, CBET, CET, who works at St. Joseph’s Hospital and serves as BAAMI’s president. “He is our local representative for the Florida Biomedical Society and helps by contacting vendors and sponsors for the yearly FBS Symposium,” Villafane adds. One of the things that Perez enjoys most about working in the field is encouraging the next generation of biomeds. “I enjoy working with people and mentoring new hires. I like to motivate students during our monthly BAAMI meetings,” he says.

SPOTLIGHT

BIOMED ADVENTURES

Forty Coupe Love Affair By K. Richard Douglas

t started as a love affair on a farm, long ago and far away; he was 10, she was 26. But, five years later, she disappeared. Then, two years later, she found her way back to him. Paul Sherman’s wife claims that his 1940 Chevy Special Deluxe Coupe was his first love. Sherman doesn’t disagree. Sherman, CCE, FACCE, owns his own business, Sherman Engineering, and is the technical project manager for the Integrating the Healthcare Enterprise’s Patient Care Devices domain (IHE-PCD). “This is an industry effort to get the systems to actually talk to each other. My role is to help a lot of really smart design people, from different manufacturers, work together to make connectivity actually happen,” Sherman explains. IHE is a not-for-profit organization. When that old Chevy, that had caught Sherman’s eye and attention, at age 10, went away and finally reappeared, he knew he had to make it his. “When I rediscovered the car in a neighbor’s field (in 1973), I approached her to buy it,” he says. “She ended up giving it to me (kind of like a free kitten). We took it to my father’s house, where it sat until 1988.”

SMOOTH MODIFICATIONS Before Sherman took possession of the old coupe, it had been converted from a stock

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AUGUST 2014 OCTOBER 2016

Paul Sherman with his 1940 Chevy Special Deluxe Coupe during a a long trip to Pikes Peak.

Chevy to a drag car. “The neighbor’s son and his best friend modified the car to set an engine closer to the rear wheels (more traction). They cut out most of the firewall and part of the floor, then welded in motor mounts a foot back from the stock position. They also removed the front seats and replaced the rear axle (though it was gone when I got the car). The motor mounts were badly welded, leaving holes in the frame and the firewall/floor cut was quite primitive,” Sherman explains. With the modifications that were made to the car, Sherman knew that he would not be attempting to completely restore it to stock condition, but live with some things and change others. He was going for a certain look, and was also guided by the availability of parts. “When we repaired the firewall, there was no way to make it look stock, so I

went for a ‘smooth’ look,” Sherman says. “With the holes in the frame, and the state of the front suspension, I decided to replace the frame ahead of the firewall with one from a 1970 Nova/Camaro (Mustang II suspensions were not common then). That also let me decide to lower the car overall,” he adds. The front bumper and the trunk handle were also missing, so Sherman decided the smooth look would be extended to the whole car as a workable option. He says that this led to the removal of the rear bumper and door handles. Power comes from a 350 V8 that was custom built from the bare block out. “At first, I bought a used 350 to get the car rolling. Eventually I built the engine that’s in it now. I have a friend who is a professional engine builder; rather than buy a crate motor, we built one from a bare block four-bolt 350,” Sherman says. “He supervised the machine work and told me what parts to buy. I assembled the engine under his supervision. It is normally aspirated, with a moderate sized carb (650 cfm) on it. For what it is, the mileage isn’t bad — I normally run about 16 mpg,” he says. That covers the exterior and engine compartment, but the modifications didn’t end there. “The prior owners had removed the gauges. Being an old electronics guy, I wanted digital gauges. I worked with Dakota Digital on fitting their gauges to the stock dash panel,” Sherman says. “I like my music while driving, so I assembled a pretty good sound system. I also modified the dash to take a new style radio and make it fit well,” he says.

The 1940 Chevy Special Deluxe Coupe all polished up.

TAKING TO THE ROAD Building a cool hot rod and leaving it in a garage isn’t the objective for most people who build a project car. Unless it is intended only for car shows, most people like to take to the open road in their creation. Sherman fits into that group. “We have taken several long trips in the car. The first was to Mt. Rushmore; we went to meet one of my uncles — he drove from Washington state in his 1936 Dodge pickup street rod. This was before the interior was done — the seats weren’t all that comfy and the inside was hot and noisy. Since then, we’ve taken it to the AAMI meetings in Charlotte, Philadelphia and Denver, never driving back the same way we drove there,” Sherman says. After the 2015 AAMI conference, Sherman took his custom hot rod to fabled Pike’s Peak. When you build a custom street rod, many adjustments only become evident after putting some miles on the vehicle. Sherman learned that a few things would require a return to the drawing board. Those challenges found solutions though. “I’ve never put air conditioning in the car. During the trip to Mt. Rushmore, it became quite hot inside.

We had icy wet cloths to cool us down, so it was OK,” Sherman says. “The only other challenge is long drives on hot days — sometimes the fuel system goes into vapor lock. That’s when heat vaporizes the fuel in the line and the car stops running. It’s pretty rare, and I may have solved the problem. During the Denver trip, the valve cover gaskets worked loose a little, letting oil leak; messy and smelly, but easily solved,” he says.

“ People of all ages and genders love seeing the car” One of the benefits of driving a vehicle that is out of the ordinary is the attention it receives. People generally appreciate something that comes out of handcrafting and imagination. “The reaction continues to surprise us. People of all ages and genders love seeing the car,” Sherman says. “ When we

stop, I usually get somebody coming over to ask about it. During the Mt. Rushmore drive, we stopped in for lunch just before a tour bus left. After lunch, we stopped at the South Dakota Welcome Center – the bus was there. All of a sudden, all the passenger came over to see and ask about the car. I really love that other people enjoy it.” “As for the ride – it is great. The seats provide great support and the suspension has enough give to keep it pretty smooth,” he adds. Although Sherman’s experience with electronics goes back to 1974, he has been a biomed since 1989. Before working with Integrating the Healthcare Enterprise, he worked for the VA from 1990 through 2012. “I worked at the Portland and St. Louis hospitals, then moved over to a national engineering support office, where I managed the benchmarking and recall/hazard programs and helped the medical centers when they came across really challenging situations,” he says. If you happen to see a guy pull up to the 2017 AAMI conference in Austin, Texas, in a cool street rod, don’t wonder who it is. Just try to imagine that the shiny street rod was once sitting in a farm field; the apple of a 10-year-old’s eye.

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1TECHNATION.COM

OCTOBER 2016

NEWS & NOTES

Updates from the HTM Industry

RICHARDSON HEALTHCARE ANNOUNCES DISTRIBUTION AGREEMENT, XR-29 COMPLIANCE SOLUTION Richardson Healthcare, a Division of Richardson Electronics Ltd., has an exclusive distribution agreement with Cool Pair Plus, an independent equipment sales and service company. Under the terms of the agreement, Richardson Healthcare will be responsible for the sale of cryogenic replacement components including MRI coldheads, compressors, flexlines and adsorbers to its customers within the United States. Cool Pair Plus (CPP) was founded in 1995 and provides MRI cryogenic equipment and parts to the health care industry. CPP offers technical support, exchange and repair services for MRI coldheads and compressors across many brands. With its International Medical Equipment and Service (IMES) division based in South Carolina, Richardson Healthcare provides reliable, cost-saving solutions worldwide for major brands of CT and MRI equipment. This agreement complements Richardson Healthcare’s product portfolio and supports the expansion of its offerings

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MARCH 2016 OCTOBER 2016

of diagnostic imaging replacement parts and high-value components. Richardson Healthcare and Cool Pair Plus share a commitment to OEM-quality through on-site testing and repairs, which serves as the foundation for this relationship. Richardson Healthcare also has announced the addition of Medic Vision Imaging Solutions’ SafeCT-29 that helps achieve XR-29 compliance to its diagnostic imaging product portfolio. This solution allows hospitals and imaging facilities to avoid facing reimbursement penalties or investing in new equipment, ultimately saving significant costs. Medic Vision specializes in image enhancement and CT radiation management solutions. The SafeCT-29 solution offers Richardson Healthcare customers the only non-OEM solution to comply with XR-29 that is cleared by the FDA. SafeCT-29 meets the guidelines required by CMS in the NEMA XR-29 “Smart Dose” standard for CT imaging equipment. SafeCT-29 is vendor-neutral and

integrates with the CT scanner’s existing configuration. The product creatively uses the system’s own software to prevent scanning when assigned dosage exceeds per-patient targets. Installation is completed within hours, requires minimal workflow interruption, and is cost-effective compared to other solutions on the market. “XR-29 compliance represents a crucial challenge for our customers,” Richardson Healthcare Executive Vice President and General Manager Pat Fitzgerald said. “It was important for us to help find a reliable, FDA-cleared product that lets providers keep their current technology in place without losing valuable reimbursement revenues. We believe SafeCT-29 is a great, affordable answer to this challenge, and we are proud to help bring it to our market.” To learn more about this new solution and other diagnostic imaging solutions, contact Richardson Healthcare at healthcare@rell.com or 888-735-7373.

ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

PACIFIC MEDICAL JOINS JORDAN HEALTH PRODUCTS Pacific Medical has partnered with Jordan Health Products (“JHP”). Founded in 2005 by Andy Bonin, Pacific Medical repairs, services and sells new and refurbished medical equipment, specializing in patient monitoring devices and corresponding accessories. Since its inception, Pacific Medical has expanded to cover many different facets of patient monitoring equipment by repairing devices and accessories, selling equipment/parts, and providing technical support. “We are really excited about the partnership with Jordan Health Products,” says Bonin. “I anticipate JHP will help us expand into the rapidly growing, highly fragmented global equipment market.” The partnership reflects JHP’s optimistic outlook for Pacific Medical and the success of Pacific Medical’s business. “JHP is the perfect partner to help us go after new customers in new markets, as well as introducing us to the untapped market segments that JHP has already penetrated,” Bonin concludes.

JHP’s health care equipment and service business is focused on the complete life cycle of medical, surgical, diagnostic imaging and oncology equipment, including sales, install, service, repair, sourcing and refurbishing. Pacific Medical will be part of the JHP group of health care companies, providing incremental resources, networking and cross-selling opportunities. JHP is focused on a strategic expansion into the rapidly growing, highly fragmented global equipment market. Pacific Medical joins the following companies as part of the JHP portfolio: • Global Medical Imaging LLC, Charlotte, North Carolina; • DRE Medical Group Inc., Louisville, Kentucky; • Integrated Rental Services Inc., Louisville, Kentucky; and • Oncology Services International Inc., Montebello, New York. JHP expects additional acquisitions to further augment service expansion and growth across these platforms.

FIRST CALL PARTS EARNS ISO CERTIFICATION First Call Parts Inc. recently announced its certification to ISO 9001:2015 for the breakdown of diagnostic imaging systems and repair, refurbishment, and testing of imaging systems parts. TUV Rheinland of North America granted the certification as of August 15, 2016. Certification to ISO 9001:2015 signifies that First Call Parts has a quality management system that has been audited by a third party and deemed to be effective and able to consistently provide a product that meets all requirements of interested parties. This certification should provide customers with confidence that First Call Parts can

provide repaired, refurbished, and tested imaging system parts that will meet their needs and expectations. Certification symbolizes commitment not only to continual improvement but to customer satisfaction. First Call Parts’ quality policy reads, “To consistently provide superior customer service that provides value and satisfaction and deliver top quality products that rival OEM replacement parts. We are committed to refining our quality, expanding our capabilities, developing our employees, and being socially responsible. We are dedicated to meeting customer, regulatory,

internal, and ISO requirements and ensuring the continual improvement of our quality management system.” First Call Parts has been in the imaging replacement parts business for over a decade. For additional information about First Call Parts, visit the company’s website at www.firstcallparts.com.

INDUSTRY UPDATES

HTM EDUCATORS FACE PROGRAM CLOSURES, AAMI REPORTS Those looking to enter the biomedical technology field now have fewer options when selecting an educational program. The 11 Brown Mackie College campuses that offered degrees in biomedical technology are no longer enrolling new students in this program. DeVry University is discontinuing its bachelor’s in biomedical engineering at seven of the 13 campuses where it was offered. One of the reasons cited for these changes is low enrollment. Barbara Christie, the healthcare engineering technology management program director at Indiana University-Purdue University Indianapolis, said she has difficulty attracting students. “Truly one of the greatest challenges I face is recruiting students into my program,” she said. “However, the lack of academic programs is a catch-22 – the discipline cannot attract large numbers of high school students if there are no academic programs for the student to attend.” William Phillips, associate national dean for program development at DeVry University, correlates low enrollment in biomedical technology and clinical engineering technology programs to students’ fears that they will be pigeon-holed for the rest of their careers. For Phillips, the solution is not to prepare students to work in a specific industry, but to give them the tools that they will need to succeed in a wider career field. For example, he said, the steps involved in tasks such as troubleshooting or fixing a circuit are the same whether a person is working in transportation, manufacturing, or health care, so it is important to focus on teaching students these core competencies of engineering technology and then letting them learn about industry specifics as part of a specialization in their program of study, internships or co-ops, certificates, or “boot camps.” Steven Yelton, a professor of HTM for Cincinnati State Technical and Community College, disagrees with the idea that young professionals will not commit themselves to one career or field. “I’ve heard this said about millennials, but honestly I have not found that within the biomedical profession. I find that most tend to stay in the biomedical field,” he said. “My students pick biomedical engineering technology [BMET] because it gives them more opportunities, not less. They feel like with a BMET major, they could work in hospitals or for biomedical companies, as well as for electronics companies. I find that electronics employers will hire BMET graduates, but hospitals will not hire electronics graduates unless there are no BMETs available.”

1TECHNATION.COM

OCTOBER 2016

FDA RELEASES DRAFT GUIDANCE ON USE OF REALWORLD EVIDENCE The Food and Drug Administration (FDA) has released a draft guidance document and is seeking comments on how real-world data (RWD) collected from outside the clinical trial process should be used when making preand postmarket decisions for medical devices. The draft guidance, “Use of Real-World Evidence to Support Regulatory Decision-Making for Medical Devices,” is a “cornerstone of our strategic priority of creating a national evaluation system for medical devices,” the FDA wrote in an email. “That system would build on and leverage the vast amount of data and information collected during the treatment and management of patients.” The use of RWD, and the real-world evidence (RWE) derived from aggregating it, can help improve the understanding of medical device risks and benefits, the guidance said, and is part of the FDA’s efforts to balance safety with the availability of new device technology. However, data collected from clinical environments may not have the same data quality controls as clinical trials. To that end, the FDA said it will assess the “relevance and reliability” of the data source to determine whether it is “reliable, complete, consistent, accurate, and contains all critical data elements necessary for evaluating the performance of a device in the applied regulatory context.” The FDA said the new guidance will not change its standards for making regulatory decisions. However, the FDA said it will “consider the use of RWE to support regulatory decision-making for medical devices when it concludes that the clinical data contained within RWD sources(s) used to generate the RWE are of sufficient quality to provide confidence in the analyses necessary to inform or support the regulatory decision throughout the total product life cycle. The threshold for sufficient quality will depend on the specific regulatory use of the evidence.” Marilyn Neder Flack, vice president of patient safety initiatives and executive director of the AAMI Foundation, said she’s pleased that the draft guidance includes the flexibility to determine when real-world data should be used, given the benefits and risks for a particular device. Comments can be submitted online at www.regulations.gov until Oct. 25.

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ECRI UPDATE

Evaluating Wearable and Noncontact Continuous Vital Signs Monitoring Systems

CRI Institute’s Health Devices engineering team recently completed an evaluation of wearable and noncontact continuous vital signs monitoring systems – devices that can facilitate the continuous monitoring of low-acuity patients, a practice that has been attracting interest. Low-Acuity Continuous Monitoring Spot checks of the patient’s vital signs are routine practice in med/surg units and other low-acuity care areas. Every few hours, a staff member will assess parameters that might include the patient’s pulse rate, noninvasive blood pressure (NIBP), temperature, arterial blood oxygen saturation (SpO2), and respiration rate.

discussion. But for facilities interested in this technology, we describe some of the options and offer guidance for comparing alternatives.

Beyond the Bedside Monitor Low-acuity continuous monitors are a class of device that fills a niche between two other monitoring technologies:

connected via cables/leads to a display unit situated near the patient’s bed (see the figure). Other available designs, which are relatively new to the market, provide greater patient mobility or comfort. For instance: •W earable monitors consist of small, lightweight display units that are attached to or worn by the patient. Sensors attached to the patient are connected directly to this wearable unit, allowing the patient to move more freely. •N oncontact (or “unconnected”) monitors can measure certain vital signs (e.g., heart rate, respiratory rate) without any physical connection to the patient. These systems typically use a sensor placed beneath the mattress.

Purchasing Considerations The ECRI Institute recently tested three wearable and noncontact continuous vital signs monitoring systems. Following are a few of the tips and test findings from the organization’s studies.

Define Your Clinical Needs

For low-acuity patients, this level of observation typically is sufficient. On rare occasions, however, a patient’s condition will begin to deteriorate during the gap between measurements. The potential to catch such deteriorations before they lead to critical events, such as cardiopulmonary and respiratory arrests, has some hospitals considering continuous measurement of vital signs in low-acuity care areas. An analysis of the pros and cons of implementing low-acuity continuous monitoring is beyond the scope of this

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MARCH 2016 OCTOBER 2016

spot-check monitors and higher-acuity, ECG-equipped physiologic monitors. They offer continuous monitoring, which spot-check monitors lack, and they are less expensive than ECG-equipped physiologic monitors. Some low-acuity continuous monitors are similar in design to traditional physiologic monitors, though smaller and with fewer capabilities. With this “bedside monitor” design, sensors attached to the patient (e.g., noninvasive blood pressure cuff) are physically

Because low-acuity continuous monitoring is not yet considered a standard of care, key actions before deciding whether to invest in the technology are to define your care area’s clinical needs and to identify the monitoring capabilities and performance characteristics that are required to meet those needs. Consultations with clinical staff can be particularly helpful in this regard.

Understand the Impact Give careful thought to whether obtaining a new monitoring system will require changes to the current clinical workflow and care area infrastructure. For example: •F or a care area that previously used

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the care area?” The organization discovered differences in how the systems managed these situations. Other performance factors that ECRI Institute considers include whether the Advanced lmage Diagnostics systems’ patient trend displays or earLight Measurement Internal optics ly-warning scoring algorithms, if available, Wireless Documentation & More! are backed by clinical evidence. That is, can claims like “the systems can detect early patient deterioration or ailments like sepsis” be supported? Key safety factors that ECRI Institute 614-657-7780 examines relate to alarm fatigue and data info@capitalmedicalresources.com security. The organization also assesses workflow considerations, examining activities such as patient association and TRIM 2.25” disassociation, system setup and configuration, and the setting and adjusting of alarm limits based on individual patient needs. AD SIZE PUBLICATION ECRI Institute found that all three of the 1/6 Page Vertical DEALER TECHNATION ORTODAY systems itMEDICAL tested offer acceptable performance, though forGUIDE different applications BUYERS OTHER – THE BIOMEDICAL/HTM PROFESSIONAL NOTES and not without some drawbacks. The MONTH systems’ battery life, for example, was not at the level the organization prefers. Replace images with hi re Differentiating J F factors M A that M ECRI J Institute J A S O N Irvine, D CA • April 9-11, 2017 identified include the ease (or difficulty) of JL (or inability) to patientDESIGNER: setup, the ability detect emergent events and/or predict SAVE THE DATE patient deterioration, and the total cost of Hotel Irvine • California ownership.

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During its evaluations, ECRI Institute examines performance, safety, workflow, and other factors to differentiate the models under consideration. One interesting aspect of the testing for these systems is “the level of physical activity involved,” notes Priyanka Shah, the project lead for ECRI Institute’s study. “Walking, running, climbing stairs, rolling – we did it all,” reports Shah. “Because these systems can be used on patients who are moving in their beds or who might be ambulatory, we needed to simulate a wide range of movements to see how the systems would respond.” Patient movement can affect a monitor’s ability to accurately measure patient parameters. A facility will want to avoid systems that display erroneous values during such periods or that sound frequent alarms for nonactionable conditions. ECRI Institute was largely satisfied with how the three systems it tested fared under such circumstances, according to Shah. Another factor to consider is how the system will react when a patient equipped with a wearable monitor transitions out of, and then back into, the care area. “Will monitoring continue while the patient is outside the care area? And will that data be saved – or lost – when the patient returns to

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periodic spot checks, a new workflow will be needed to manage patient alarms. Combatting alarm fatigue is a very real patient safety consideration. • For a facility that intends to integrate its monitoring systems with an existing EMR system, the systems’ compatibility and additional costs for interface development will have to be considered. In addition, the projected cost of consumables (e.g., disposable sensors) will be an important financial consideration.

April 9-11, 2017

THIS ARTICLE IS ADAPTED FROM ECRI INSTITUTE’S “EVALUATION BACKGROUND: Wearable and Noncontact Continuous Vital Signs Monitoring Systems,” Health Devices 2016 Jun 29, and related guidance materials. The source articles – which feature model-specific test results and product ratings, along with additional guidance for purchasing and using this technology – are available online to members of ECRI Institute’s Health Devices System and associated programs; learn more at www.ecri. org/components/HDS.

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INDUSTRY UPDATES IRVINE_SPV.indd 1

9/9/16 3:01 PM

AAMI UPDATE Committee Looks to Standardize Technology Acquisition

AMI’s Medical Equipment Management Committee is developing a new standard on the acquisition of healthcare technology, with the goal of creating a consistent process for healthcare delivery organizations (HDOs) and a uniform set of topics that should be covered during the requisition process.

Capital equipment planning is becoming a bigger issue, and many hospitals are finding they are not making optimum decisions about medical equipment, facts that are detailed in the July/August cover story of AAMI’s peer-reviewed journal, BI&T. Patrick Bernat, AAMI’s director of HTM, said there is a need to establish clear protocols and policies. “Without a formal process in place for acquiring healthcare technology, and without involving the necessary players in the process, healthcare technology acquisition can become disorganized and disjointed,” he said. A formalized, streamlined approach to technology acquisition could help HDOs make more appropriate decisions, save time and money, and reduce end-user error. “The industry would greatly benefit from a referenceable standard on healthcare technology acquisition that identifies the benefits/need for an effective acquisition process to HDO leadership, lays out an effective process with appropriate stakeholders engaged, and provides examples of tools that can help facilitate the acquisition process,” said Stephen Grimes, managing partner of Strategic Health Care Technology Associates and a member of the Medical Equipment Management Committee. The new standard is expected to cover service documentation, risk management files, processes for making purchasing

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MARCH 2016 OCTOBER 2016

decisions (including who should be involved in those decisions), depreciation schedules, monitoring of hazard alerts and product recalls, and identifying technical specifications. The committee is also aiming to develop a standardized request for proposals.

A CALL FOR PAPERS AAMI will devote the spring 2017 edition of its award-winning supplement Horizons to clinical alarm management. Proposals are being accepted until November 2. Those interested in submitting a research article, systematic review, case study, commentary, or other type of paper should email Senior Editor Gavin Stern at gstern@ aami.org. Authors should specify in 200 words or less the topic of the proposed manuscript and describe how it will advance the literature on the subject. Once submitted, manuscripts will undergo peer review. The content of Horizons is indexed and searchable on various healthcare and scientific databases, including PubMed.

LIKE THOSE IT SERVES, HUMAN FACTORS COURSE EVOLVES WITH TIMES Over the course of seven years and 1,200 students, AAMI’s Human Factors for Medical Devices course has continued to evolve. This year, the three-day program, which offers an introduction to regulatory

requirements as they relate to the discipline of understanding how humans interact with devices, is undergoing another refresh. The most recent evolution of the course – which is aimed at quality and design engineers, research and development managers, and risk managers – includes an increased focus on combination products and ties in with changes stemming from the Food and Drug Administration’s (FDA) February 2016 guidance document, Applying Human Factors and Usability Engineering to Medical Devices, as well as revisions to ANSI/AAMI/IEC 62366-1, Medical Devices—Part 1: Application of usability engineering to medical devices. “Many participants were coming to our course with the new guidance in their hands, and we know they want us to be up to date with the FDA’s published position on human factors,” said Bob North, chief scientist at Human Centered Strategies in Colorado Springs, Colorado, who directs the course. “We also present material from the newly updated international guidance, IEC 62366, which has undergone an upgrade to make it harmonize more with the FDA’s guidance. The course now has an integrated agenda that includes both of the FDA’s devices and drug centers. We now have officials from both of those FDA centers giving co-presentations.” Since 2009, AAMI’s human factors course has seen an increasing number of participants from the pharmaceutical industry – thanks to greater integration of drugs and devices – which North described as “game changing.” As a result, the course has gradually incorporated the unique human factors requirements for participants seeking clearance on combination products. Today, it includes instructors from the pharmaceutical industry as well. The completely revised program will launch in November and will incorporate

additional investigation techniques, including class exercises where participants use data to identify device design flaws. To register for an upcoming session, please visit the AAMI Store at www.aami.org/store.

PACK A ‘BROWN BAG’ FOR FREE YOUNG PROFESSIONAL WEBINAR SERIES AAMI’s Next Gen Task Force has launched a free “brown bag” style webinar series for students and young professionals. These sessions are intended to spark conversations around the issues facing those who are just starting out in the field. “AAMI’s Next Gen Brown Bag webinars are the big kickoff for our initiative to get more young professionals involved in

healthcare technology. Our goal is to help launch our members’ early careers by providing resources and networking opportunities,” said Allison Rafti, director of membership marketing at AAMI and the staff manager for the Next Gen Advisory Task Force. “This supports AAMI’s strategic priority to help young professionals develop in their careers, climb the ladder, and hopefully stay and find success in the healthcare technology field.” This month, the webinars will focus on the armed forces. Jonathan Richardson, a federal government service sales manager at Siemens Healthcare, will provide advice on transitioning from military healthcare technology management to the private

sector. On October 31, Danielle McGeary, director of clinical engineering for the VA Boston Healthcare System, will talk about working for the VA. In November, Inhel Rekik, a clinical engineer at the University of Maryland Medical Center, will focus on how women in engineering can overcome challenges. Angela Spillane, a consultant with Mainspring Healthcare Solutions, an Accruent Company in Boston, Massachusetts, will discuss taking on projects to advance your career. FOR A COMPLETE LISTING OF WEBINARS and resources to help career advancement, visit www.aami.org/nextgen.

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INDUSTRY UPDATES

SHOP TALK

Conversations from the TechNation ListServ Q:

A: A:

It is never too early to start Christmas shopping. What is a good gift to give a biomed? What is one tool, book, or resource that every biomed needs to have in the toolbox?

I need to perform preventive maintenance on a Sterrad 100S and I need a code to do it. Can anybody help me with this? You need a service access key to be able to perform a PM on this. The key is only available to trained techs. You can change all the parts yourself but will be unable to calibrate the temps and vacuum settings if they are needed.

I would give him one year free AAMI membership subscription. I personally benefited from the resources that come as a part of membership benefit. A Swiss Army Deluxe Tinker knife. It has both pliers and scissors on it, along with a fairly decent #2 Philips blade or a Leatherman equivalent, if he would wear one.

There’s a PM1 for ~1000 and PM2 for ~4000. I’ve never used a PIN though. I’ve just completed the PM and reset the PM date in the service menu. The service access key allows the tech to go into the deep menu in order to calibrate the temperature and vacuum settings. It also allows you to test all the other functions to ensure proper operation or assist in troubleshooting. For example, testing the door, printer, injector, etc.

A subscription to TechNation magazine!

For a tool, I agree totally with the answer that said to give a Swiss Army Deluxe Tinker knife. For a book, give them “Who Moved My Cheese?” and as a resource, a subscription to TechNation.

I’ve tried the tool route. I’ve tried the personal practical route (roadside emergency kit). But after talking with my team, they want gift cards. Amazon and Wal-mart cards were the favorites.

I would appreciate an AAMI membership! As for tools, I am too picky to let someone else make those decisions for me!

1TECHNATION.COM

RPI may be able to help.

A: Q:

OCTOBER 2016

For the 100S you do not need a code

Our end user’s ultrasound machine purchased under a year ago from a supplier in the United States now displays the following: “The instrument has detected an internal error and is collecting information to help diagnose the

problem. Please contact your Philips Representative. The Restart control will be enabled when information has been collected.” Any experience as to what the cause of this might be?

I had this error on a unit from one of my customers and it was an intermittent power supply issue. Check the leads on it when the error pops up and see what voltages, if any, are missing. If there are any leads out, check the service manual to see what is powered by that voltage supply and either disconnect or remove it and reboot the unit. If the issue was the load, and not the supply, your lead should be back on the power supply if not it’s the supply.

I had the same problem. In my case the cable between the signal processing unit and the PC had problems with contact. After disconnecting and reconnecting it, it worked again.

Internal Error – as stated above it is almost always the power supply; however, there have been a few issues with the token ring cable and/or the signal processer board.

Your issue is likely software.

THESE POSTS are from TechNation’s ListServ and MedWrench.com. Go to www.1TechNation. com/Listserv or www.MedWrench. com/?community.threads to find out how you can join and be part of the discussion.

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1TECHNATION.COM

OCTOBER 2016

BIOMED 101

A Secret to Success: The Power of Your Word By Benjamin Lewis, MBA, CHTM

hether you are a HTM professional who is a technician on the floor, a manager of an in-house program, or a vendor providing OEM or third-party services, the power of your word will have boundless influence on the success of your career and your program. Your word, and the influence that comes with it, is all about meaning and doing what you say. It sounds like a simple concept, but it can be more difficult when put into practice. “If it were easy, everybody would do it.” Most of us have heard this saying before from a parent, a teacher or a coach. The same applies with people’s trust in your word, if it were easy; everyone would be trustworthy professionals that follow up and follow through without incident. While we all know people that we can depend on like that, they seem to be the exception and not the rule, making our dependable colleagues stand out in the crowd. Being one of these trustworthy colleagues does have its advantages. People tend to want to do business with people that they can depend on. So, how can you build stock in your word and become (or remain) a pillar of your HTM community?

• SET REALISTIC GOALS BASED ON WHAT YOU KNOW: Most people try to be trustworthy and most are generally good people. We don’t wake up in the morning actively seeking to disappoint. A big mistake that causes people to break their word comes from making a promise or openly setting a goal to a customer when it is based on incomplete information. Telling the

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OR that you’ll have their OR table up and running by tomorrow at 11 a.m.? You will need to have already ordered the part to make sure it is in stock, have a tracking number, know it has shipped, know when it is supposed to hit the dock, and know you have time to install it. If not, temper their expectations or wait until you have more information.

• DON’T BE AFRAID OF NO NEWS OR BAD NEWS: Being a technician, engineer, or manager, people will come to you for answers, and often, the truth at the time may be that you don’t have any answers yet. The best thing to tell your customer at that time is the reality of the situation. You will be respected for your honesty. Troubleshooting a difficult problem can take time and people get stuck, which is bad news. As both a service provider and a customer, I would always rather give and get honest bad news than a hopeful but inaccurate assessment about how the repair is almost complete.

• FOLLOW THROUGH, EVEN IF IT IS PAINFUL: Have you ever received or given a flat rate repair quote that turned

BEN LEWIS, MBA, CHTM

Director of Clinical Engineering GA/FL with Novant Health Inc.

into a nightmare? The parts and time have gotten out of control and you are losing money on this one. I hope you are working on an empty stomach, because you are eating this one. Did you tell Nurse Jane you would have her fetal monitor completed by tomorrow and the parts are still sitting on your desk at 4:30 on a Friday afternoon? Time to suck it up and delay your dinner plans. Even when it is painful, and more importantly, especially when it is painful, put your best foot forward and honor your original commitment. These are just a few examples of how you can take simple steps to set yourself apart from others of whose, innocently or not, word is not their bond. Service on medical devices is a relatively small field. Customers and vendors knowing that they can trust you will carry long term weight in our profession. Your reputation will follow you throughout your career and being the person that meets his or her commitments and over delivers is the type of reputation that you won’t mind having.

OCTOBER 2016

1TECHNATION.COM

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1TECHNATION.COM

OCTOBER 2016

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Innovating Together Part of

Webinar

Wednesday

WEBINAR WEDNESDAY

TechNation Webinars Continue to Deliver Staff Reports

he TechNation Webinar Wednesday series continued in July and August with insightful presentations. In July, “Priorities for Today’s CE Leaders: Key Considerations for Defining Your Supply Chain Strategy” was presented by Allina Health IS and Clinical Engineering Services Director Nadia Ayoubzadeh and Clinical Engineering Services Manager Mara Pare along with Erin Tournoux from webinar sponsor PartsSource. Ayoubzadeh and Pare shared with attendees the process of identifying current pitfalls and opportunities, goals, strategy, RFP, and ultimately finding the right supply chain partner or partners. They provided an in-depth presentation that answered many frequently asked questions. Tournoux added to the webinar with an informative presentation. She reviewed critical data and analytics necessary to certify an optimized procurement process along with vendor evaluation metrics that can be implemented in any clinical engineering department. The webinar did a great job of outlining four key areas. It discussed project planning and approach, managing change within an organization, Allina’s RFP

1TECHNATION.COM

OCTOBER 2016

approach, as well as monitoring and project reporting. Following the webinar, the presenters fielded questions from attendees sharing additional knowledge and insight. The August 10 webinar, sponsored by Fluke Biomedical, stressed safety. The presentation “AEDs: What You Need to Know – FDA Updates, Best Practices, and More” provided expert knowledge on Automated External Defibrillators (AEDs) from the team at webinar sponsor Fluke Biomedical. The webinar proved popular among HTM professionals setting a new all-time attendance record. Presenter Ashton Solecki, Fluke Biomedical Product Marketing Manager, said the FDA has increased its scrutiny of AEDs due to an increased high failure rate. She shared her insights into one of the most highly regulated medical devices in the industry. The webinar also stressed the importance of testing AEDs, reviewed global testing standards, and highlighted upcoming FDA changes impacting AEDs. Solecki discussed best practices for testing AEDs to ensure their safety and proper performance. The webinar concluded with an informative Q&A session. The presentation was a hit before it even started with a record 1,035 people registered to attend. A new record for the number of attendees was set with 576 people joining the live webinar.

A new record for the number of attendees was set with 576 people joining the live webinar. Another Fluke-sponsored webinar focused on t electrical safety of medical devices. The key concern is leakage current, which even at a very low voltage can cause harm or be fatal. With health care patients often simultaneously connected to several medical devices, testing for leakage becomes crucial. During his presentation, Jerry Zion increased attendees’ knowledge of electrical safety testing, including unique situations such as testing double-insulated IEC 60601-1 Class II and Class IP medical devices, differences in testing IEC62353 and IEC61010 medical devices, and requirements of testing medical devices used in clinical laboratories in universities, health care facilities and research institutes. Attendees were taught the variations

in performing tests on medical devices, including those connecting to a mains power. Participants were shown how to measure electrical leakage of medical devices inside electrically isolated power systems such as intensive care units. Also, Zion discussed why electrical safety analyzers need to be a specific size, and various types of electrical safety analyzers. Imaging service professionals received a special treat in August with the free TechNation webinar “CT Best Practices and More” presented by Jerome Howard, a sales support engineer at Dunlee, a division of Philips. The Dunlee-sponsored webinar provided insights for the 162 people who watched the webinar live and is available online

for on-demand viewing. Howard discussed failure modes of X-ray and CT tubes to kick off his presentation focusing on the “and More” portion of the webinar first. He listed arcing, track damage, broken filament, bearings, port window damage and overheating as some common issues. He addressed each in detail and provided troubleshooting tips. In the “CT Best Practices” portion of the webinar, Howard talked about OEM planned maintenance schedules and the success many have had doing more. He said there are benefits to performing additional PM procedures including improved tube life and system reliability. In summary, Howard expressed the importance of understanding failure

modes to help reduce downtime before taking questions from attendees during a Q&A session. Howard said more information is available from the Dunlee Academy, including step-by-step guides for field service engineers. Also, he said an updated version of the Dunlee app will soon be available for download. FOR INFORMATION about the TechNation Webinar Wednesday series, including recordings of previous webinars and a schedule of upcoming sessions, visit www.1TechNation.com/Webinars. TECHNATION WEBINAR WEDNESDAY would like to thank our sponsors Dunlee, Fluke Biomedical and PartsSource.

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PARTS

ROUNDTABLE Anesthesia Devices

1TECHNATION.COM

NOVEMBER OCTOBER 2016 2014

ew technology and updated features can make maintaining medical devices difficult and that is true when it comes to anesthesia devices. TechNation contacted industry experts to find out how biomeds can extend the life if anesthesia devices, what to look for when purchasing equipment and more. Members of the roundtable panel include Mindray Strategic Marketing Manager for Perioperative Care Scot Carriker, Paragon Service President Thomas Green, DrĂ¤ger Technical Product Manager Ken Horsfield and CE-Tech Anesthesia Specialist Matt Strickley.

HOW CAN A BIOMED EXTEND THE LIFE OF ANESTHESIA DEVICES? Carriker: Authorized biomeds play a vital role in extending the life of anesthesia devices, and they can accomplish this through various means. First, biomeds should ensure they are properly trained and should consider periodic re-training with the device manufacturer. Staying current with supplier recommended preventative maintenance schedules should ensure optimal uptime, while utilizing additional products like specialty filters may help prolong the life of the machine by managing typical equipment exposure to moisture and material degradation. Green: The life of an anesthesia machine is limited to either the desired new features of newer equipment or the availability of parts and service. If an anesthesia machine is no longer supported by the manufacturer, then the service provider must have all of the parts available to immediately return the life support device back into use by the anesthesia provider. If the service technician cannot do so, then I would say that the device has reached the end of its life.

Horsfield: Perform the periodic maintenance in accordance with the manufacturerâ&#x20AC;&#x2122;s recommend testing interval. Also be sure to replace all recommended maintenance parts at the correct replacement interval as these items are usually wear and tear items that have a known limited service life. When implementing device repairs always use only genuine OEM parts that are obtained either from the manufacturer or a qualified distributor source. Strickley: Proper maintenance will extend the life of any machine. A machine that looks good and works well is very likely to have a long service life. Biomed can definitely ensure that the equipment is thoroughly cleaned and cosmetically well-maintained. Biomed can prevent failures by following maintenance plans and regularly replacing parts that are known to fail over time. When problems do occur, a biomed that communicates well with the customer can help to alleviate maintenance-related concerns or perceptions that might otherwise shorten the service life of a perfectly good machine.

WHAT ARE SOME IMPORTANT FEATURES TO

SCOT CARRIKER

Mindray Strategic Marketing Manager for Perioperative Care

LOOK FOR WHEN PURCHASING ANESTHESIA DEVICES? Carriker: It is important that anesthesia devices not only meet all the clinical challenges that one would expect over the life of the device, but it is also extremely important to evaluate the total cost of ownership of the device, device connectivity and overall safety concept. Total cost of ownership includes acquisition price, regular consumables costs, and regular maintenance costs over the life of the device. Service, maintenance kits and consumable costs can vary greatly between suppliers. It is important to understand length of standard warranties and what consumables are proprietary as these items can not only impact the total cost ownership of the device but may also require more of the biomedsâ&#x20AC;&#x2122; time. As facilities and systems drive toward improved interoperability, interfacing with devices of

THE ROUNDTABLE

ROUNDTABLE

Anesthesia Devices

various suppliers can be challenging and expensive. Utilizing non-proprietary, open standards like HL7 can simplify implementation and reduce costs. Finally, safety is paramount. The machine should be able to ventilate and deliver agent in case of complete power failure, have an extended battery life, and the ability to protect against surgical fires with the advantage of blending O2 and air to reduce the combustible percentage of oxygen.

improve clinical care and help administration manage costs, but it is important that any incorporation of electronics does not negatively impact the safety concepts behind the machine such as maintaining the ability to deliver fresh gas and agent to the patient even without power.

Green: Service support. The hospital or surgery center must have dependable and responsive service. Horsfield: Because each customer is different, this really depends on the goals of each institution. However, clinicians today are being asked to ventilate sicker and more obese patients. In addition, tomorrow’s health care payment models are designed to reduce a patient’s length of stay. In order to accomplish this, hospitals will look to deliver therapies to patients in order to discharge patients faster and reduce the opportunity for hospital-acquired infections. Health care institutions should be looking for anesthesia technology that offers advanced ventilation capabilities, supports streamlined infection control, and provides connectivity to your EMR in order to monitor and improve best practices. Strickley: Many new devices have software that includes an automated machine checkout. I believe that this is preferred as it guarantees that a level of safety has been established by the user prior to patient use. Software in newer models has also been developed to assist the end user in determining efficient levels of anesthetic agent and fresh gas flow rates. Another consideration would be the ventilator modes that are needed versus the ventilator modes that are available from the machine. Some newer machines are capable of being integrated with the electronic medical record to capture key parameters such as anesthet-

1TECHNATION.COM

THOMAS GREEN

Paragon Service President

ic agent consumption and fresh gas usage. This is an important consideration as it may also affect patient billing. I would also recommend to a facility looking to maximize on its investment to look for a machine that has been a big seller. The more machines that are out there in hospitals, the longer that particular model is generally supported by the manufacturer and third-party organizations. Once the manufacturer’s end of support date hits, the more machines that were sold will determine how much longer the device can be supported by third-party vendors and the used/refurbished parts market.

HOW WILL NEW TECHNOLOGY AND OTHER ADVANCES IMPACT THE ANESTHESIA DEVICES MARKET? Carriker: Many new advancements are focused around IT integration and software enhancements but, generally, technology is moving anesthesia machines from mechanical to electronic systems where possible. Electronic controls and advanced algorithms can help clinicians

NOVEMBER OCTOBER 2016 2014

Horsfield: Dräger’s focus with its new technology development surrounds improving patient safety, maximizing uptime, and enhancing the service experience. With the Perseus A500, Dräger introduced its “turbovent” ventilator, which enables the Perseus A500 to become the first anesthesia machine in the U.S. capable of delivering Airway Pressure Release Ventilation (APRV) in the operating room. This enables patients from the ICU to continue their ICU ventilation therapy even during surgery. In addition, Dräger is focused on improving the service experience by offering “remote” service offerings in order to better maintain uptime, implement updates more quickly, and improve service processes. Strickley: As a biomed tech, I am not necessarily an expert on the sales market, but as a technology insider I expect to see more and more organizations upgrade their anesthesia systems with newer technology. I think that the manufacturers have done an excellent job in developing new safety technologies such as the automated machine self-tests. I also think that improvements in mechanical design and software have helped to improve the efficiency of gas usage.

WHAT TYPE OF CREDENTIALS SHOULD THIRD-PARTY ORGANIZATIONS POSSESS OR MAINTAIN? WHAT SHOULD BE CONSIDERED WHEN EVALUATING THIRD-PARTY ORGANIZATIONS? Carriker: There would be no difference in credentialing in-house biomeds, direct service representatives or third-party

organizations when it comes to maintaining medical equipment. It is important that all service providers receive authorized training from the manufacturer. If a facility is considering a third-party service provider, it would be incumbent on the facility to ensure the third-party organization was up-to-date with all equipment in question.

measured data, user settings, device errors and operational data. The biomed’s access to the full spectrum of imperial tactile information will enhance investigations about root cause determination of use errors and equipment malfunctions. The lessons learned will often lead to additional training aimed at improving clinical outcomes and also reduce the likelihood of similar equipment malfunctions.

Green: Are the technicians factory trained? What is the response time? Experience of the service technicians? How long has the company existed? What is amount of liability insurance? Parts inventory? References. Horsfield: For each specific model device they propose to perform repairs and or maintenance on, verify the individual has received a certificate of proper training from an accredited trainer such as an IACET authorized provider. Obtain references from several other satisfied customers. Verify the organization is in good standing with the Better Business Bureau. Verify the organization is bonded and has sufficient and extensive liability coverage to work on life support equipment. Strickley: In my opinion, third-party vendors ultimately are selling their engineers and technicians. They should be able to provide the qualifications (e.g. certifications, degrees, experience, manufacturer service schools, etc.) of the employees that will be working on the equipment. When considering third-party organizations, obviously the first question that comes to mind is, “how much does it cost?” Next, the customer should evaluate what services are being provided for the indicated cost. For instance, when it comes to anesthesia, will trace gas testing also be performed to ensure that the working environment is safe for OR personnel? Can and will the third-party organization service anesthesia gas monitors and modules? What PM procedures does the third-party organization follow for anesthesia

MATT STRICKLEY

CE-Tech Anesthesia Specialist

machines? Do they follow manufacturer recommendations? Is there a regular parts-replacement schedule for each machine? How many makes and models of anesthesia machines can the third-party organization support? Is the third-party organization current on the newer makes and models?

HOW CAN BIOMED HELP ENSURE PATIENT SAFETY IN REGARDS TO ANESTHESIA DEVICES? Carriker: Biomeds can play a large role to ensure patient safety by following manufacturers’ procedures listed in operators and service manuals. By following manufacturers’ recommendations and using original manufacturers’ replacement parts, biomeds can help improve equipment up-time and be certain that only validated components are used. Horsfield: The device should include the means for providing robust real-time data logging of the important “flight data” parameters such as alarms,

Strickley: Biomed plays an important role in ensuring patient safety. Anesthesia systems are comprised of many safety mechanisms that run in the background; end users do not necessarily see or test them during normal operation. Biomeds test these safety mechanisms during regularly scheduled maintenance. We not only ensure that anesthesia devices are functioning properly and meeting manufacturer specifications at the time of inspection, we prevent failures from occurring during clinical use. Another safety role of biomed techs is to assist as trainers and educators to clinical staff.

WHAT ELSE DO YOU THINK IS IMPORTANT FOR TECHNATION READERS TO KNOW ABOUT ANESTHESIA DEVICES? Carriker: Anesthesia machines are critical life support devices, and as such require the appropriate level of attention from biomeds, anesthesia techs, CRNA, doctors and anyone else who may interact with it. It is highly recommended that all manufacturers’ procedures are followed to ensure optimal run time. OEM suppliers will track, where possible, failure rates and analyze life cycles in order to continually make improvements to component designs. Biomeds can be an integral part of this process by reporting unexpected component failures back to OEM suppliers. In addition, anesthesia platforms should be scalable to allow for new functionality (ventilation modes, low flow tools, etc.) when available or

THE ROUNDTABLE

ROUNDTABLE

Anesthesia Devices

KEN HORSFIELD

DrĂ¤ger Technical Product Manager

required by users in order to lengthen the useful life of the product and provide more value to the institution. Green: Choose a manufacturer that treats ISOs fairly in regards to service training, parts availability and parts pricing. Horsfield: Modern anesthesia devices are very complex life support systems. You should never attempt repairs on such devices unless you have received an appropriate level of specialized training on that specific product. When uncertain how best to approach a device repair, you are encouraged to seek advice from a very experienced peer or expert in this field. Most reputable device manufactures provide free 24/7 technical support and more often than not you are not the first customer to report a particular behavior. It is quite likely that these folks have already responded to reports of this nature and have provided accurate information to get the problem resolved in a timely manner.

1TECHNATION.COM

NOVEMBER OCTOBER 2016 2014

THE ROUNDTABLE

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ecently, Banner Health, based in Phoenix, announced that it had been hacked. The cyber attack is thought to have affected 3.7 million â&#x20AC;&#x153;patients, health plan

members and beneficiaries, food and beverage customers and physicians and health care providers,â&#x20AC;? according to the Phoenix Business Journal. The health system offered those impacted a free one-year membership in a monitoring service.

he attackers went after payment card data. Payments made for food and beverages were affected, but payment cards used to pay for medical services were not. Also, according to Banner’s website, patient information may have been compromised which included “patients’ names, birthdates, addresses, physicians’ names, dates of service, clinical information, possibly health insurance information, and Social Security numbers if one was provided.” While this attack doesn’t appear to be related to medical devices in any way, when attackers can engage in identity theft and Medicare fraud, the temptation to go after health care data sources is great. Hollywood Presbyterian Medical Center paid cyber attackers $17,000 when the hospital was hit with a ransom ware attack. This hospital made the information public, which isn’t always the case when a company, organization or health system falls victim to this kind of attack. During 2013, this kind of attack increased six-fold in just that year alone. Major hotel chains like Marriott, Hyatt and Intercontinental have also had a data breach with hackers suspected of accessing payment card data from tens of thousands of transactions. The attack is thought to have originated with malware on payment systems earlier this year and during much of last year. These incidents, and others, point to the vulnerabilities that exist when personal information is stored on servers and people with nefarious intent target that information. In other cases, just the connection between a business’s network and the Internet is enough to invite trouble. Unfortunately, it is a profitable

1TECHNATION.COM

OCTOBER 2016

devices in 1999. A lot has been discussed regarding premarket and post-market management of cybersecurity in medical devices,” says Priyanka Upendra, BSBME, MSE, compliance manager in Clinical Engineering, Intermountain Support Services/Supply Chain at Intermountain Healthcare in Midvale, Utah. “Healthcare Technology Management (HTM) professionals work tirelessly to make sure the diagnostic, monitoring, and therapeutic devices are available for safe and high-quality patient care. Keeping these devices safe from cyber attacks is a shared responsibility between the manufacturers, healthcare delivery organizations (HDOs), regulatory agencies, and law enforcement,” she adds. PRIYANKA UPENDRA, BSBME, MSE, Compliance manager in Clinical Engineering, Intermountain Support Services/Supply Chain at Intermountain Healthcare

business for the bad guys – referred to as malicious threat actors – who can sell personal information from medical records for top dollar. The EHR has revolutionized health care, but it has also opened a security vulnerability door that did not exist at one time. Ironically, the requirements under Medicare and Medicaid for the adoption of electronic records, and the penalties for non-adoption, have caused health care providers to open that door to the malicious threat actors more so than in the past.

NEW RESPONSIBILITIES FOR HTM Responsibility for systems is usually determined by the point where the data enters the network. A server specifically intended for medical use is often the responsibility of clinical engineering, such as an infusion server or a patient monitoring database server. The HTM professionals, along with their IT counterparts, have a litany of regulations to consider today. “Medical device cybersecurity has been a topic of debate since FDA released the guidance document for off-the-shelf software use in medical

THE PROBLEM AND RESPONSE The threat of cyber attacks on health care facilities has become such a concern that the Healthcare Information and Management Systems Society (HIMSS) Foundation’s Institute for e-Health Policy and the College of Healthcare Information Management Executives (CHIME) recently held a briefing on Capitol Hill titled “Hacking Healthcare: The Cybersecurity Threat Landscape.” The briefing featured “a panel of leading hospital Chief Information Officers (CIOs), Chief Information Security Officers (CISOs) and healthcare data security experts,” according to HIMSS. In a recent article, Lorren Pettit, HIMSS North America vice president of HIS and Research wrote; “over 85 percent of the respondents to our study claimed cybersecurity efforts within their organization were elevated as a business priority during the past year,” referring to the organization’s 2016 Cybersecurity Study. “Not only is losing a bunch of patient records catastrophic enough, but then the Office for Civil Rights (OCR) could add insult to injury by assessing a fiveor six-digit HIPAA breach fine to boot,” says Jeff Kabachinski, MS-T, BS-ETE, MCNE, senior director of Technical Development for ITD (Independent Technical Development) in North Carolina. “Did you know that an electronic protected health information (ePHI)

“ Did you know that an electronic protected health information (ePHI) record can be sold for 50 times a valid credit card number on the black market? It’s lucrative to exploit healthcare IT.” – Jeff Kabachinski record can be sold for 50 times a valid credit card number on the black market?” he asks. “It’s lucrative to exploit healthcare IT.” Kabachiniski has written about the efforts of the National Institute of Standards and Technology (NIST) and the Cybersecurity Framework that the NIST has developed. That framework, first established in 2014, was then refined with feedback from participants in industry, government and academia. NIST will soon offer a tool that will allow organizations to assess its cybersecurity risk management process. For the health care sector, the Health Information Trust Alliance (HITRUST) has developed a model implementation of the NIST Cybersecurity Framework, which is discussed in a white paper. (https://hitrustalliance.net/content/uploads/2015/09/ImplementingNISTCybersecurityWhitepaper.pdf) According to HITRUST, the number of cyber attacks targeting “health care entities” has been on the rise. They cite a 2013 study that found that health care data breaches exceeded those in “credit, finance and banking.” With the changing role of the biomed comes new concerns and areas of training that address privacy concerns and nefarious activities that can compromise patients. It’s not enough anymore to address electrical malfunctions or mechanical

malfunctions that might harm patients; there is data that must be protected, deleted, secured or monitored. This new kind of harm doesn’t end when the patient walks out of the hospital door.

MAINTAINING DEVICE SAFETY Cybersecurity has been a buzz word in the health care community out of necessity. Patient information is ripe for the picking by scam artists in the next city or on the other side of the earth. While IT plays a major role in protecting servers and acting as gatekeepers on the connection to the outside world, the HTM department has an ever-growing role at the device level. “The HTM and Information Security (IS) folks provide a safe infrastructure for medical devices while maintaining clinical workflows that don’t hinder effectiveness of the care we provide to our patients,” Upendra says. “The development of standards, policies, procedures, processes, and awareness campaigns goes a long way towards a successful medical device cybersecurity program,” she adds. “As a HTM professional working in a HDO, I would recommend all HTM teams to work alongside information security, risk management, clinical staff, facilities, and supply chain departments at HDOs to build a robust and effective medical device cybersecurity program.”

JEFF KABACHINSKI, MS-T, BS-ETE, MCNE, Senior Director of Technical Development for Independent Technical Development

It is the HTM professional who is the medical device expert. When it comes to networking a new device, it is HTM that is most familiar with it. “We support Scripps cybersecurity efforts best by being subject matter experts and liaison for medical devices in the clinical environment,” says Scot Copeland, BSITSec, MCP, Sec+, medical IT network risk manager for Scripps Health in San Diego, California. Copeland says that there are several things that biomeds can do to keep devices safe and help aid in prevention of cyber attacks. “Help coordinate vulnerability scanning of medical devices and verify all of the latest OS patches, security updates and malware definitions are up to date on the medical devices that support those capabilities,” he says. On this point, the HIMSS survey found that many organizations’ procedures were woefully lacking. “Only 61.3 percent of acute care providers and 41.9 percent of non-acute providers admit to having a patch and vulnerability management program,” according to their findings. Copeland also says that the HTM

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“ Any equipment that goes back to a manufacturer or distributor for trade-in has either had its ePHI media removed and destroyed or there is a legal Business Associate Agreement on file to protect our liability.” – Scot Copeland SCOT COPELAND, BSITSEC, MCP, SEC+, Medical IT Network Risk Manager for Scripps Health

department should provide input to the IT department regarding the network/ ePHI capabilities of medical devices and to participate in IT Due Diligence and Technical Reviews of incoming medical equipment and systems so that networking vulnerability, privacy issues and other risks are known before the acquisition process begins. “Provide the on-site security incident response to research the device in the clinical area,” Copeland says “Maintain networking properties of all networked medical devices in the CMMS and apply all hospital information security policies for networked equipment to medical devices as much as can be supported by the manufacturer and regulatory agencies,” he adds. “New incoming medical devices need to include cybersecurity documentation in addition to the incoming quality checks that our technicians and engineers perform,” Upendra says. “At the very least, this cybersecurity documentation should include the operational and network configurations, Manufacturer Disclosure Statement for Medical Device Security (MDS2), hazard mitigation considerations, recommended 52

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compensating controls, and manufacturer guidance on vulnerability disclosure and patch management,” she adds. She points out that policies that govern acceptance testing of new incoming medical devices, and disposal of old devices, should be included in HTM workflows. It is also necessary to communicate this information to the clinical staff – physicians, surgeons, and nurses – so they are aware of the risks that arise from connected medical devices. Upendra says that HTM teams need to establish a service model with IS teams where: New medical devices are inspected for cyber-hygiene, existing medical devices have PHI and facility information wiped out before they are shipped for service operations and old medical devices have PHI and facility information wiped off and drives re-imaged before disposal. “Risk assessments should be performed on any and all medical devices that are capable of connecting to the network,” Upendra says. “Stand-alone medical devices, that capture and/ or store PHI, should be inspected for local tampering. The information from these risk assessments need to be communicated to the leadership teams on a quarterly basis so they are aware of the ‘health’ of medical devices in their facilities.” To keep track of acceptable medical devices, Upendra says that developing a catalog that can be used in the procure-

ment process is important. “Medical devices that do not meet the organizational standards need to have appropriate compensating controls that are reviewed on a regular basis,” she says. “I would also recommend HTM departments to develop a standard catalog of acceptable medical devices. This catalog validated and signed off by the clinical and IS staff will serve as a reference guide to the purchasing department(s) and the leadership when acquiring medical technologies, new facilities and outreach clinics,” she adds.

DISPOSING OF OLD EQUIPMENT “By maintaining the ePHI and network risk level data in the CMMS and screening all medical devices before disposal. We have a policy and process that assesses the ability to contain ePHI and/or connect to the network and such devices have their ePHI media removed and destroyed prior to disposal,” Copeland says. “There is an audit trail that can identify networked/ePHI medical devices and track all the way to proper disposal. The effectiveness of that audit trail is verified annually.” The procedure for ascertaining that a device does not contain any sensitive facility information or patient information has a solution that might seem counterintuitive in some instances. “By removing and destroying all ePHI

media before disposal,” Copeland says. But, he concedes, “yes, this causes a problem sometimes with trade-ins and as you can imagine precludes donation of a working device,” he says. Copeland says to use a service that can be relied upon to properly dispose of equipment and devices. “We use a certified equipment recycler that properly dismantles and recycles all devices in an environmentally friendly and cost-effective manner,” he says. “Any equipment that goes back to a manufacturer or distributor for trade-in has either had its ePHI media removed and destroyed or there is a legal Business Associate Agreement on file to protect our liability.” “Prior to these open-source tools, health care organizations were on their own when it came to ensuring cybersecurity compliance,” says Kabachinski of the tool provided by the National Institute of Standards and Technology and HITRUST. “It was up to individual facilities to stay on top of all the current regulations and keep their frameworks up to snuff,” he says of the environment before these tools became available. He says that they have now “created a viable, robust CSF template that maps to all the current regulations and helps ensure cybersecurity protection levels remain high. Both organizations allow you to customize a framework that best fits your needs and budget. This grassroots, community-driven approach to cybersecurity is long overdue,” he adds. In this regard, the HTM department must join IT in creating a unified and informed environment that keeps the bad actors out and patient information in. In a connected world, the challenges increase right along with the convenience. FOR MORE INFORMATION: HIMSS Cybersecurity Survey can be downloaded at: http://www.himss.org/hitsecurity HITRUST: https://hitrustalliance.net

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CAREER CENTER Behavioral-based Questions Hold the Answer By Todd Rogers

ost of the reading I do is self-improvement related. I’ve read the Steven Covey books, books about emotional management, and I’ve read plenty of books geared toward helping people find jobs.

In those job-seeker books, I frequently see commentary that the interviewer is typically more frightened than the interviewee. I don’t believe that claim, just like I don’t believe that snakes are more frightened of people than we are of them. What I do know is that most hiring managers tend to have below average interviewing skills. I’m talking about when the hiring manager is interviewing candidates for a job. They don’t typically have a plan or don’t have a method that helps them reliably uncover the necessary details to enable them to make a good hiring decision. At our company, we require all of our managers to attend interview training. The training is conducted by yours truly in conjunction with the other recruiting manager. It’s a four-hour session that covers the dos and don’ts. Also, most importantly, it covers the fundamental questioning technique called “behavioral based interviewing.” In the next few paragraphs, I’m going to explain behavioral-based interviewing. I’m also going to explain why it’s an incredibly useful means to getting what you, as a hiring manager, need to know in order to make a sensible hiring decision. When you’re interviewing candidates you have a few different types of questions you can ask. You can ask hypothetical questions. These are questions whereby you ask the candidate to speculate how

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they would respond to a made-up scenario. For example, you might ask, “Suppose that you had several customers who all had urgent demands, but you had a limited amount of time. How would you go about handling that situation?” You can ask factual questions such as, “Can you please tell me about the different kinds of equipment you’re able to repair?” The behavioral-based question asks the interviewee to describe in detail a specific life experience when they were confronted with something and to explain in detail what he or she actually did. For example, you could ask, “Give me an example of a time when you had to write a magazine article under a deadline, but also had equally pressing commitments at the same time.” As an aside, my answer to this question would include, “Friday, August 19, 2016, which happens to be right now.” However, my answer would also include situational details, how I prioritized the demands, what I actually did, and how the situation was resolved. The interviewee is asked to recall and relate a chronological experience. This serves the end of determining how the person will act when confronted with similar circumstances. The experience has been imprinted. This is important because it reveals tendencies. When things get difficult, people rely on their tendencies or habits to quickly find resolution. As a hiring manager, you want to know how

OCTOBER 2016

TODD ROGERS Talent Acquisition Specialist for TriMedx

your staff is going to respond to demands. This technique doesn’t come without possible pitfalls. There’s a very good chance that the interviewee is nervous. When you ask nervous people penetrating questions, frequently they will draw a blank. Interviews can be confrontational. Confrontation can trigger the fight-or-flight response, which is part of survival. When your brain is in survival mode, digging up subtle anecdotes can be extremely difficult. So, don’t be surprised if you ask a good behavioral question and then you get the deer in the headlights look. To ease the tension, it’s helpful to supply an example of your own experience that ties into the question you’ve just asked. “Give me an example of a time when you didn’t have enough time to complete an assigned task. One that comes to mind for me was last week when I was working on…” This gives the interviewee time to think about something that’s relevant to your question. Interviewees may not recognize that you’re asking for a real-life step-by-step

Leader –Healthcare Technology Management & Medical Systems Engineering Technologist Universal Health Services, Inc. Founded in 1978, Universal Health Services, Inc. (UHS*) is one of the nation’s largest and most respected healthcare management companies. UHS subsidiaries own and operate 235 acute care and behavioral health facilities and surgery centers in 37 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the United Kingdom, and employ more than 74,000 people.

story. When this disconnect occurs you’re going to get an answer The Leader - Healthcare Technology Management provides leadership and is responsible for the implementation of the UHS corporate HTM program that uses platitudes. It is imperative that you not accept this sort of and services. The Medical Systems Engineering Technologist performs answer. You must redirect the interviewee back to what you’re evaluations, repairs, inspections, and preventive maintenance on devices used in the care and treatment of patients at UHS facilities, affiliates, and other seeking: a detailed account of actual life-experiences. Let me institutions that have UHS relationships either owned or contractual. illustrate, and pay close attention because this is how these We are currently hiring for Leader - Healthcare Technology Management questions usually play out. You ask a behavioral based question: positions in 14 of our locations. These openings are located at our facilities Give me an example of how you’ve dealt with a stressful situation. in: Texas, South Carolina, Nevada, California, Texas, Florida, Oklahoma, and Washington, D.C. The candidate responds with, “I handle stress pretty well. I just take a few deep breaths, clear my head, and then figure out what’s We are also hiring Medical Systems Engineering Technologists in 19 of our locations. These openings will available at our facilities in: Texas, South most important and work on that thing first.” Carolina, Nevada, California, Florida, Oklahoma, and Washington, DC. STOP RIGHT THERE! This is unacceptable. You politely go back to your question and ask the candidate to talk about the last For more information and to apply online, please visit: jobs.uhsinc.com time he or she was under stress, “Describe what was going on that We are an equal opportunity employer. caused you to experience stress.” You may have to do this a few PROOF APPROVED CHANGES NEEDED times before that interviewee finally says, “A couple of weeks ago this colleague and I were on a project together and he didn’t get his Committed to CLIENT SIGN–OFF: part of the work done. It was 30 minutes before the deadline and I Service Excellence PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT knew this was a no-fail project … ” Once you get the person LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR talking about the experience you might have to lead him or her

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through the details; you should slightly nudge the person through to the end. Then, you turn that example into the topic for further discussion. This will tell you what causes stress for the person and it will tell you how he or she is likely to respond to stress, which is pretty important in today’s working world. I cannot emphasize it enough: do not let the interviewee off the hook with generalizations or platitudes. If you do, you will have wasted your time with the interview and you will move yourself closer to making a bad hire. Here’s my relatable task. On a sheet of paper, write down three characteristics that you as a hiring manager find desirable in a team member. They can be single word attributes. My three would include “creativity.” Next, write out a behavioral-based question that is related to that desirable characteristic. In my case, I’d ask, “Give me an example of a time when you had a problem to solve and all of the usual solutions just would not work; a time when you had to come up with something new in order to resolve an issue.” If the person needs a moment to think, let him or her have that time. As noted, you can even supply an example of your own to get the person into the right frame of mind. The next time that you conduct an interview, ask one or all of these questions. But remember, if you get a generalized platitude, don’t punt and let the candidate off the hook. You must demand a specific life experience. There you have it: a simple definition of a behavioral-based question, examples of what they sound like, examples of answers, and examples of non-answers. This technique works, I promise you. Now take five or 10 minutes and write down what you want in a candidate and what you will ask in order to determine if it’s present in candidates.

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