TechNation - November 2016 by MD Publishing

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Vol. 7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

NOVEMBER 2016

TIPS FOR ACQUIRING PARTS S T R AT E G I E S T H AT H E L P T H E B OT TO M L I N E

22 Biomed Adventures

Flipping Over Coaching

44 Roundtable

Computed Tomography

76 Bulletin Board

Industry Resources for Medical Equipment Professionals

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

HE ROUNDTABLE: CT T Computed tomography (CT) is a useful tool and some health acre professionals have even suggested that it be used as a revolving door at the entrance to the hospital to provide quality images and information on every patient. TechNation contacted several experts and asked about the latest advancements as well as purchasing and maintaining equipment.

TIPS FOR ACQUIRING PARTS- STRATEGIES THAT HELP THE BOTTOM LINE You need the right part to get the job done. Fortunately, there are resources for determining the right part, finding it, and maintaining costs. Many providers exist who offer ways to cut costs in light of shrinking health care budgets. Many of these businesses can also offer insights into trends, the supply chain and the growth of the parts market.

Next monthâ&#x20AC;&#x2122;s Feature article: How Does Your Department Measure Up?

Next monthâ&#x20AC;&#x2122;s Roundtable article: Test Equipment (Biomedical) TechNation (Vol. 7, Issue #7) November 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.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

NOVEMBER 2016

TECHNATION

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Chandin Kinkade

ART DEPARTMENT

Jonathan Riley Jessica Laurain Kara Pelley

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

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

WEB DEPARTMENT

Taylor Martin Cindy Galindo Alicia Dent Adam Pickney

ACCOUNTING

Kim Callahan

CIRCULATION

Lisa Cover Laura Mullen

EDITORIAL BOARD

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

P.12 SPOTLIGHT p.12 Company Showcase: Injector Support and Service p.16 Department of the Month: Peninsula Regional Medical Center Clinical Engineering Department p.18 Professional of the Month: Jeremy Westkamper p.22 Biomed Adventures: Flipping Over Coaching P.26 p.26 p.30 p.32

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

P.34 p.34 p.36 p.38 p.40

THE BENCH Shop Talk Biomed 101 Tools of the Trade Webinar Wednesday

P.58 p.58 p.60 p.62 p.64 p.66 p. 68 p.70

EXPERT ADVICE Career Center Ultrasound Tech Expert Sponsored by Conquest Imaging Tech Savy The Future Beyond Certification Thought Leader Roman Review

P.72 BREAKROOM p.72 Did You Know? p.74 The Vault p.76 MedWrench Bulletin Board p.78 Index Like us on Facebook, www.facebook.com/TechNationMag

MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 â&#x20AC;¢ Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

TECHNATION

NOVEMBER 2016

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SPOTLIGHT

SPECIAL ADVERTISING SECTION

COMPANY SHOWCASE Injector Support and Service

oday, the health care industry in the United States requires hospitals and health care facilities to maintain a laser focus on cost-saving measures. As a result, biomed departments are bringing the annual maintenance of their equipment in-house; this increase in self-service maintenance has created an increased need for quality, low-cost support alternatives beyond PMs – and beyond the OEM.

WHO WE ARE The mission at Injector Support and Service (ISS) is to provide professional, timely, and superior support and service for medical contrast injectors. The family-owned and operated company started in 2011 in Ryan Clarke’s spare bedroom, and quickly grew to the present 2,700-square-foot space that serves as service department and depot center. Each of the eight employees is committed to providing outstanding customer service. Their genuine dedication, hard work, and ISS’s competitive pricing have contributed to the company’s success. WHAT WE DO Clarke has served the biomed community in various capacities since 2001. He earned his Bachelor of Science in Electrical Engineering and Master of Engineering in Industrial and Systems Engineering with an emphasis in business management. After a decade servicing injectors – his experience and educational background gave him a

TECHNATION

NOVEMBER 2016

Ryan Clarke, Co-Owner of Injector Support & Service unique perspective of an emerging market and the need to provide support to on-site biomeds. “[I wanted to provide] an alternative to the practice of simply opening a service call ticket and charging extensive on-site service costs for what many times were simple resets,” Clarke recalls. And that is how ISS was realized. Today it is the only company to provide national and international support solutions exclusively on contrast injectors. When dealing with extensive repairs, ISS offers invaluable and technical expertise through telephone technical support and parts hero kits for on-site troubleshooting. “We bring our comprehensive knowledge to our partner ISOs to provide the end user hospitals and imaging centers with prompt, costeffective solutions,” says Clarke.

ISS is there for customers when it comes to expert insights and options regarding medical contrast injectors via numerous services, including: • Error message explanation/walkthrough, as well as PM and calibration verification support via our telephone support service • Through years of experience, ISS has identified a multitude of high-risk and high-failure parts that should be replaced during each PM. From seals and gaskets to fans and batteries, these PM kits offer a comprehensive equipment reset, affording confidence in the injector’s reliability • ISS recognizes that it is not always financially viable for a trained service engineer to arrive at your location. The company’s depot services are an ideal reliable and cost-effective alternative to on-site service response • Limiting lab downtime is critical. ISS can offer loaner injection systems for use during repair, testing, or even lab retrofit. The company stocks injectors for most all modalities with rental periods to meet a customer’s specific needs • On-site service response options are also available and include: o Preventative Maintenance/ Calibration Verifications o Corrective Maintenance o Professional Install o User Operations Training • ISS provides service and support for the leading injectors, including Avanta™, Stellant® D, Stellant® Sx, Envision CT™, Vistron® CT, MK

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SPOTLIGHT

IV™, MK IV/CT™, MCT™, MCT Plus™, MKV™, MKV Plus™, MKV ProVis®, Spectris™, Spectris Solaris® MR, Spectris Solaris® EP, Angiomat™ A6000, Angiomat™ Illumena™, CT 9000™, CT 9000™ ADV, CT 9000™ ADV with Optibolus, Optistat, OptiVantage™, Optistar™ MR, Optistar™ LE, Optistar™ Elite, Percupump®, Empower™ and Empower CTA®** EXCEEDING EXPECTATIONS Our customer-centric business model has earned us global recognition. ISS has been known for “Saving the Day.” “A new site located in Hawaii called for immediate service on a Saturday afternoon,” Clarke recalls. “Calls to other vendors had ended with the requirement for a $10,000 minimum P.O. and an approximately two-week lead time to arrive on site. This […] was of course unacceptable!” Clarke quickly put together pricing

options for an on-site visit and entertained the idea of getting on the next flight to Hawaii from Florida. However, it would be impossible to get to the location earlier than Monday evening. “I then offered our loaner with depot service option, which if shipped out on Monday, could arrive on location Tuesday morning (only a few hours beyond the best possible arrival time for a technician). With the use of our loaner, the lab was back up quickly and the repair of the customer’s equipment was completed at a fraction of the cost to have someone arrive on-site,” Clarke says. FOR MORE INFORMATION about Injector Support and Service please visit the company’s website at www.injectorsupport.com or call the company toll free at 888-667-1062. The general email address for requesting information is Ryan@injectorsupport.com. Customers can order parts by sending an email to order@ injectorsupport.com.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

**Product and company names mentioned herein may be trademarks and/or services marks of their respective owners. Injector Support and Service is neither affiliated with, sponsored nor endorsed by, any third party manufacturer. Reference to third-party products or services, including the products of Medrad, Inc., Covidien and Liebel-Flarsheim Company, is for informational purposes only and does not imply the endorsement, affiliation or recommendation of such third parties.

NOVEMBER 2016

TECHNATION

WIDTH 7”

HEIGHT 4.5”

INJECTOR SUPPORT & SERVICE • Loaner injectors • Depot service • Parts identification and sales • Preventative maintenance tools • On-site service

PROOF APPROVED

CHANGES NEEDED • Injector sales

PROOF SHEET

CLIENT SIGN–OFF: PLEASE THAT THEwww.injectorsupport.com FOLLOWING ARE CORRECT or call 888.667.1062 To CONFIRM learn more visit LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR WIDTH 7”

PUBLICATION MEDICAL DEALER

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BUYERS GUIDE

OTHER

ORTODAY

AD SIZE HALF PAGE HORIZONTAL NOTES

MONTH F

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HEIGHT 4.5”

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SPOTLIGHT

BY K. RICHARD DOUGLAS

DEPARTMENT PROFILE Peninsula Regional Medical Center Clinical Engineering Department

onstructed from portions of the names of three states, the Delmarva Peninsula contains the entire state of Delaware and portions of Maryland and Virginia. At 183 miles long, and 71 miles wide, the peninsula makes up a portion of the eastern coastline that is hard to miss. There are 1.4 million residents on the peninsula. There is also a lot of beach culture, with two coastlines, and nine of Maryland’s 23 counties can be found there.

In one of those peninsula counties sits the Peninsula Regional Medical Center (PRMC), a subsidiary of the Peninsula Regional Health System, in the city of Salisbury, Maryland. With 292 beds, the PRMC has a history dating back to 1897 making it the region’s oldest health care institution. PRMC’s Clinical Engineering department keeps the medical devices humming to benefit patients on the peninsula. “We are a third-party service provider employed by Horizon CSA,” says the department’s director Mark Cornelius. “We have a wide variety of technicians with a good balance. Our technicians spend time sharing their skills and knowledge with other technicians.” Horizon CSA provides medical equipment maintenance, repair and management services and specializes in biomedical technology services. The company is headquartered in Mooresville, North Carolina. The clinical engineering team has been such an integral part of PRMC, for so many years, that most of their customers only know them as an in-house department. A perception that is a testament to Horizon and the CE team. In addition to Cornelius, the department is made up of Shop Supervisor Tom

TECHNATION

NOVEMBER 2016

Purchase, BMET III John Vaughn, BMET II Ashley Goforth, BMET I Justin Levett, Administrative Assistant Candy Oglesby, ISE V Darrell Jackson, ISE III Lee Solomon and Equipment Technician Brandon Gemeny. Gemeny’s position handles the checking in of patient-owned CPAPS and keeping the batteries maintained within RFID tags throughout the facility. Purchase specializes in anesthesia, heart lung bypass and ventilators. Vaughn specializes in ultrasound, dialysis and heart/lung bypass. On the imaging side, Jackson specializes in cath labs, specials, MRI and nuclear medicine. Solomon specializes in portables and X-ray. “Over 50,000 patients a year receive care at this facility,” Cornelius says. “We also service several family medicine and specialty offices that are part of the Peninsula Regional Health System.” EVERYONE ON THE SAME PAGE The department is a cohesive unit by following a methodical routine. “We start every day with a shop meeting. Each tech updates the shop on their current issue, major repairs and vendor info,” Cornelius says. He adds his own remarks, updates and other things the team should be aware of during the day. He says that after the

meeting, techs are dispatched for service and the day starts. The meeting could only take 10 minutes but the meeting ensures that everyone is “in the loop.” “Our department maintains a close relationship with the employees of the facility. In fact, most employees don’t even know we are third party. Because of this relationship, we are called on for most any question or type of help related to the equipment here. This allows us to minimize equipment downtime and prevent user errors — including how to use, clean and obtain accessories,” Cornelius says. “We send letters to the department directors every month, to advise them of upcoming PMs on their equipment, and status of equipment after their PM month,” he adds. Along with keeping each department well informed on equipment status, the CE department solicits feedback from their customers. “We do an annual Customer Satisfaction Survey that is sent to the department heads,” Cornelius says. “This helps us gauge how well we are doing. We also get a lot of feedback from around the facility on how something can be changed or (mostly) how much they value our service and call outs for certain techs.” The CE team also gets involved in the procurement process and works jointly with PRMC in obtaining a Pre-Purchase Evaluation Form that must be filled out by every manufacturer equipment is purchased from. After that equipment is added to inventory, the department uses a software program called Sunrise to track and keep

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SPOTLIGHT

“We also get a lot of feedback from around the facility on how something can be changed or (mostly) how much they value our service and call outs for certain techs.” maintenance records on it. “With this software, we pull reports, generate PMs and maintenance repair records. We can easily assign a PM schedule to equipment based on manufacturer recommendation and create a manufacturer checklist on the actual PM work order,” Cornelius says. Training is tweaked annually. “Every year a training schedule is created. Many factors play into this process. New equipment or systems coming into the facility, contracts expiring or equipment that would benefit from someone in-house at all times. It could be a new training for a technician or training that builds on existing knowledge,” Cornelius adds.

SPECIAL PROJECTS Projects have included implementing technology that has been widely adopted in recent years. The implementation of an RFID system in 2009 was one such project. “With over 4,000 pieces of equipment tagged, the process of equipment retrieval, retention and monitoring has changed the structure of the entire medical equipment environment here. Since then, this system has grown to include temperature monitoring and badges that ring emergency to security in target locations of the facility when the button is pushed. This system requires constant maintenance and updating to be accurate,” Cornelius says. Other technology-related projects have

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

included the transition to wall-mounted VSMs at the bedside and additions for electronic medical records. “We are heavily involved in the testing of equipment during the migration to EPIC for our patients EMR system,” Cornelius adds. That migration has stretched resources a little bit in order to keep everything the department does adequately covered. “The biggest challenge we have had recently is the move from McKesson EMR to EPIC EMR. They interface completely differently and have required extensive testing,” Cornelius says. “Of course, we have the same amount of technicians doing the same preventive and corrective maintenance – and then add all the testing and things become very challenging.” The department is no stranger to challenges and continues to deliver to meet PRMC’s needs and the needs of patients on the Delmarva Peninsula. They can rest assured that their visit to PRMC will include medical equipment that is maintained by a well-trained and attentive group of professionals.

NOVEMBER 2016

TECHNATION

SPOTLIGHT

BY K. RICHARD DOUGLAS

PROFESSIONAL OF THE MONTH Jeremy Westkamper

t’s often been said that the apple doesn’t fall far from the tree and that is the case for Jeremy Westkamper, a biomed who is now a clinical engineering account director. His father was a GE field service engineer, who enjoyed his work, and that rubbed off on Jeremy while he was growing up in Carlotta, California.

Westkamper got an early education about how machines worked from listening to his dad. “Since a very early age, I have been fascinated by machines and how they work. My father encouraged this and educated me by teaching me the basics in our garage and doing science experiments,” Westkamper says. “My father is retired now, but he got his start in the medical field working for GE as a field service engineer. His original training was actually on nuclear submarines in the Navy. My father loved having me do his gopher work when fixing things around the house. Also he made a point that if you asked him for help with anything you had to be present to learn how he resolved the issue,” he adds. “My mother recently passed away but she was a stay-at-home mom and part-time book keeper. Before she had a family, she worked in banking in various departments. I attribute some of my attention to detail to her since her record keeping was immaculate and she never would just accept an answer. It had to make sense to her,” Westkamper explains. He even got some hands-on experience after he turned 18 by doing some work on an MRI with his dad. His education did not follow this path initially, but it led to HTM in the end. “I had completed three years of college where I focused on business and

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NOVEMBER 2016

psychology. I also took an EMT course prior to my employment as a biomed tech apprentice,” Westkamper says. “As an apprentice, I was required to take anatomy and physiology. I was also sent to specialty trainings and, based on my scores from those trainings, I qualified to take more advanced courses. I was sent to the Radiological Service Training Institute (RSTI) when it was decided that I had the aptitude and interest in imaging. I completed RSTI’s 10-week course and obtained a certificate for imaging equipment.” ON THE JOB Westkamper heads up the Tech Knowledge Associates (TKA) apprentice program. Prior to attaining his account director position, he had worked as a biomed apprentice, biomed tech I and imaging specialist. His apprentice work was at St. Joseph Hospital in Humboldt County, California. Challenges help us grow and learn and Westkamper has been up to those challenges. “I have been a director for a little over a year now and I have finally started to hit my stride. The last year has been one of the most difficult of my life. I was promoted to a director and given the responsibility of re-staffing the department, learn the ins and outs of being a director, while having to keep up a workflow with limited staff,” he

recounts. “My mother even passed shortly after I became the director and my father went through hip surgery. Luckily, I had amazing support from regional staff and my boss John Pollard, and I pulled through successfully.” In his role as director, he coordinates all internal and external training, including the basics of cleaning, safety, and hazards of the job. On the soft skills side, he teaches apprentices how to interact with staff and directors. In the awards department, he has been nominated five times for Values in Action. He has also received four Star cards, which recognize dedication and service. Values in Action is an employee recognition program that awards employees who exemplify: Dignity, Excellence, Service, and Justice. “I have been nominated for Values in Action by the staff at St. Joseph Hospital in Eureka, California for three years in a row,” Westkamper says. “I sit on the Capital Committee and work with the hospital to purchase new equipment in a planned and educated manner,” Westkamper adds. “I have been able to offer insight into machines that need to be replaced and new equipment that has been proven at other facilities. Doing this has allowed us to standardize system-wide and get significant discounts with group purchases.” Westkamper says that with the help of the directors and facilities, TKA has developed a clinical equipment technology assessment that helps the hospital plan its capital spending. He says that with this tool, they are able to point out the needs of the facility years

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SPOTLIGHT

“The biggest factors to being successful are a willingness to be patient and understanding. No one calls me when they are having a good day.”

FAVORITE BOOK: “Ender’s Game” series

FAVORITE MOVIE: “Deadpool”

FAVORITE FOOD: Sushi

HIDDEN TALENT: in advance. “Recently, I have helped them acquire new equipment in prep for getting a Trauma 3 Certification. An upcoming project, I am excited about, is expanding our service line to help with departments that have unique needs,” he says. HTM IN PERSPECTIVE Away from work, Westkamper’s pastimes are dependent on the season. “I spend my free time mostly in the outdoors and play video games during the winter,” he says. He enjoys backpacking, white water rafting and disc golf. “I read a recent article in Scientific American on video games and brain activity and it suggested that people

who play certain types of video games tend to do better at multi-tasking and making quick, correct decisions. Not sure if this has really helped my job, but I use it as a justification for playing video games,” he says. Westkamper waxes philosophically about his work in the HTM profession. “The biggest factors to being successful are a willingness to be patient and understanding. No one calls me when they are having a good day,” he says. Passing his wisdom on to HTM apprentices will assure that they always keep things in perspective and, since the apple doesn’t fall far from the tree, result in some very talented biomeds.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

I can whistle like a cricket chirps.

FAVORITE PART OF BEING A BIOMED: No day is ever the same.

WHAT’S ON MY BENCH • • • •

Pile of pens Post it notes galore Volt meter Lots of water – staying hydrated is important • Dual screen monitors

NOVEMBER 2016

TECHNATION

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SPOTLIGHT

BY K. RICHARD DOUGLAS

BIOMED ADVENTURES Flipping Over Coaching

he recent Olympics in Rio De Janie“That started back in 2004, when we ro put the sport of gymnastics front lived at Fort Lewis in Washington and center as the U.S. women’s State. As my daughter moved to higher team garnered international attention. levels/skills, I would learn those coaching techniques. I took and passed the USAG (USA Gymnastics) safety The skills of gymnasts often test the certification and began coaching part laws of gravity and logic as they achieve time at a gymnastics center. I now live tumbling sequences that the average in the Fort Bragg/Fayetteville area of person could not imagine doing. The North Carolina and coach at Omega U.S. women’s team won nine gold and Gymnastics,” she says. silver medals and took the team gold Jones has done volunteer coaching, medal. Their coach, Martha Karolyi, but her current sideline is a paid characterized them as the best team part-time position. She clearly loves ever. playing the role of teacher or instructor. Some of the the gymnastics greats who have become household names include Nadia Comaneci, Mary Lou Retton, Kerri Strug and Kim Zmeskal. Add to those names, Simone Biles and Aly Raisman, after this most recent Olympics. All of these gymnasts started learning the basics of gymnastics early in their lives, from dedicated coaches who guided them through the different levels of skills and technique. This may seem like the last place that you might find an HTM professional, “Kids have a way of making your but that perception would be wrong. day bright. They have a great desire to Linda Jones, a senior biomed technician learn, and watching them progress by at Womack Army Medical Center at Fort conquering skills and sometimes fears, Bragg in the Fayetteville area of North is amazing. Plus, I love to teach (at Carolina, would be the exception. Jones gymnastics and at my biomed job). My has coached gymnasts for several years. future plan is to teach biomed classes “When my oldest daughter was of some sort. Either OEM or college progressing quickly in gymnastics at a level,” Jones says. young age, her coach wanted me to start working with her at home. She (Laurie COACHING EXPERTISE Dillon) would teach me how to correctly “I have coached all Levels 1-10 — recrespot back handsprings, hand stands ational and competitive — but mostly [and] backward rolls,” Jones says. coach Levels 1-3. The ages of children I

coach start at age 18 months — parent and me class — and can continue through teenage years. I have coached both boys and girls,” Jones says. “I have also coached tumbling classes for cheerleaders.” Jones says that gymnastics training progresses through different skills as the gymnast gains more confidence and experience. “At the lower levels, the students are learning the basics of gymnastics. As they move up in levels, the basic skills are built on. For example, a student will learn a bridge, then progress to

“ Kids have a way of making your day bright. They have a great desire to learn, and watching them progress by conquering skills and sometimes fears, is amazing.”

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NOVEMBER 2016

back bend, then back walk over, back handspring and so on,” Jones explains. “Skill building can be achieved through the use of mats/training equipment, repetition, and muscle development. For younger students, getting them engaged is achieved with a little imagination and creativity,” she says. “An example would be, if I told a young student to do a handstand, that may not be understood using those words. But if I ask/show them a ‘donkey kick’ that would get them mimicking that kicking action to get up to a

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SPOTLIGHT

handstand. Animals, objects, colors, counting, alphabets all aid in the learning of skills, especially when super young, but is not limited to that. Games that are fun and a little competitive influence skill development as well.”

ALWAYS ATHLETICS When not engaged in teaching tumbling skills or working on medical devices, Jones enjoys spending time supporting a variety of local sports. It’s a family affair. “I am a huge sports fan. I will watch almost any sport. I love the competitive nature of it and the talent that can be displayed,” she says. “Although, I am a huge Seattle Seahawk fan, local high school football games are where I spend my Friday nights during the fall season. I believe supporting local kids, whether by attending their sports events, music/ theater events, etcetera, has an impact on their future success. Probably another reason I love to coach,” Jones says. “Being a positive influence in a young life is a great feeling. I have two daughters. My oldest, who I mentioned, did competitive gymnastics up to Level 7, then switched to All-Star Cheerleading. She has just graduated

high school this past June. My youngest daughter has tried multiple sports but volleyball is her favorite. She is a 10th grader and captain of her junior varsity volleyball team,” Jones adds. Jones is a military-trained biomed and still works on base as a civilian. “My biomed career began in the Army in 1992. I was trained at Fitzsimmons in Aurora, Colorado in the USAMEOS course; [which] now has been renamed and moved to Fort Sam Houston in San Antonio, Texas. After about 10 years in the Army, I hung up my beret and boots and transitioned back to the civilian life,” she says.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

“I am currently working at Womack Army Medical Center on Fort Bragg as a senior technician. My primary specialty is ultrasound and the patient monitoring network. At work, I love being able to ‘teach’ as well. It could be teaching classes, why or how a piece of equipment is used, teaching protocol, etcetera. And it could be to fellow technicians or to nursing staff, doctors, housekeeping, and so forth,” she adds. Not only does the skill set of Jones’ students evolve, but she sees her own skills as a coach as a continual work in progress. “For me, as a coach, I have to constantly learn new training techniques,” she says. “Learning can be achieved through hands-on training/ coaching from a higher skilled coach, watching tutorials/videos, conferences, and knowing the requirements/skills for each level (USAG has changed those when necessary).” “Sometimes just watching my peers teach their students will inspire new ideas to keep training exciting,” she says. This biomed’s goal of being the best gymnastics coach has touched the lives of countless children in a positive way, just as her work as a biomed has benefited many patients.

NOVEMBER 2016

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NEWS & NOTES

Updates from the HTM Industry AAMI ANNOUNCES NEW PRESIDENT AND CEO AAMI’s Board of Directors has named Robert D. Jensen, a longtime executive in the health care industry, as the association’s third president and CEO. “I am honored to be asked to serve as AAMI’s next president and CEO. Most of my professional life has been dedicated to the service of others, and this will be a capstone in my career,” said Jensen. “Throughout the process of working with the recruiter and the search committee, it was clear to me that AAMI is a high-quality organization with a culture of teamwork and collaboration, and a community of members that cares a lot about the organization and its mission.” Jensen has been with the MITRE Corporation since 2003. He currently serves as vice president and director of the CMS Alliance to Modernize Healthcare (CAMH) Federally Funded Research and Development Center (FFRDC). He conceived of and established the MITRE Center for Transforming Health, dedicated to improving health care nationwide through systems thinking, advancing technology, and transformative services for government health-related organizations. AAMI Board Chair Phil Cogdill, who also led the Executive Search Committee, was enthusiastic about the search process and the final selection. “We interviewed a number of truly extraordinary candidates, and I think that fact speaks to the respect and recognition that AAMI has earned in the healthcare technology world and in health care in general,” he said. “I’m confident that we’ve chosen the right person to build on our recent success and take us to new heights.” The selection of Jensen, 57, comes 10 months after outgoing President and CEO Mary Logan, 62, announced her planned retirement and just ahead of AAMI’s 50th anniversary in 2017. Jensen is expected to officially start on Nov. 14. Logan will end her tenure with AAMI at the end of this year, meaning there will be a roughly one-month overlap during the transition. Logan will serve in a supporting role during that time to help with the onboarding responsibilities.

TECHNATION

NOVEMBER 2016

BAYER MVS OFFERS NEW SERVICE Bayer MVS now offers full repair capabilities on both the 6T and 6Tc family of ultrasound transducers. According to an email, this means that transducers that have been deemed unrepairable may now be able to be recovered. This service from Bayer MVS provides health care professionals with a cost-efficient repair option, eliminating the need for a full market-priced exchange or replacement. The Bayer MVS business formed as an extension of the Medrad MRI coil manufacturing business to repair multi vendor coils in 1996. Although Medrad (a part of Bayer) discontinued coil manufacturing in 2010, MVS continued to grow. The MVS third party service business expanded by adding ultrasound transducer repair in 2001 and CR system and dry film printer service in 2006. MVS continued to evolve by expanding into product distribution and manufacturing. The DR product line was added to the MVS portfolio in 2014 and the MRI Accessories product line was added in 2015. MVS operates 3 depot repair centers located in Pittsburgh, PA (MRI coil, ultrasound transducer), Tulsa, OK (ultrasound transducer) and Maastricht, the Netherlands (ultrasound transducer). Each depot maintains an ISO 13485 certification. More than 15 engineers support the field service business, providing repair and preventative maintenance services for CR systems and dry film printers. The field service team operates nationwide, in the United States only. FOR MORE INFORMATION, visit www.mvs.bayer.com.

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REPORT ‘FOLLOWS THE MONEY’ TO ASSESS CRIMINAL OPERATIONS BEHIND HOSPITAL RANSOMWARE Intel Security has released its McAfee Labs Threats Report: September 2016, which assesses the growing ransomware threat to the healthcare industry; surveys the “who and how” of data loss; explains the practical application of machine learning in cybersecurity; and details the growth of ransomware, mobile malware, macro malware, and other threats in Q2 2016. Following a rash of targeted ransomware attacks upon hospitals in early 2016, Intel Security investigated the attacks, the ransomware networks behind them, and the payment structures enabling cybercriminals to monetize their malicious activity. The researchers identified nearly $100,000 in payments from hospital ransomware victims to specific bitcoin accounts. While health care is still clearly a small proportion of the overall ransomware “business,” McAfee Labs expects a growing number of new industry sectors to be targeted by the extensive networks launching such attacks.

In the first half of 2016, McAfee researchers identified a ransomware author and distributor who claimed to have received $121 million (BTC 189,813) in payments from ransomware operations targeting a variety of sectors. Dark net discussion board communications with network affiliates suggest that this particular cybercrime actor had accumulated profits of $94 million during the first six months of this year. The scale of the operation is in line with research McAfee Labs conducted with its Cyber Threat Alliance partners in late October 2015, when the group uncovered a ransomware operation using the CryptoWall ransomware strain to extort nearly $325 million over the course of two months. The research team attributes the increased focus on hospitals to such organizations’ reliance on legacy IT systems, medical devices with weak or no security, third-party services that may be common across multiple

organizations and the need for hospitals to have immediate access to information to deliver the best possible patient care. “As targets, hospitals represent an attractive combination of relatively weak data security, complex environments and the urgent need for access to data sources, sometimes in life or death situations,” said Vincent Weafer, vice president for Intel Security’s McAfee Labs. “The new revelations around the scale of ransomware networks and the emerging focus on hospitals remind us that the cybercrime economy has the capacity and motivation to exploit new industry sectors.” For more information on the financial impact of ransomware attacks on hospitals, see the blog titled “Healthcare Organizations Must Consider the Financial Impact of Ransomware Attacks.” FOR MORE INFORMATION, visit www. mcafee.com for the full report.

ST. JUDE MEDICAL CONTINUES TO REFUTE ALLEGATIONS St. Jude Medical Inc. has issued a statement regarding allegations made by Muddy Waters Capital and MedSec. “Patients are our highest priority. St. Jude Medical takes our commitment to patients very seriously because we understand that the 20,000 patients around the world who receive our lifesaving and life improving therapies – every business day – count on us to always put them first. And we do,” according to a company news release. “The allegations made by Muddy Waters and MedSec are irresponsible, misleading and unnecessarily frightening patients,” said Michael T. Rousseau President and chief executive officer at St. Jude Medical. “We want our patients to know that they can feel secure about

the cybersecurity protections in place on our devices. This behavior speaks volumes about the profit-seeking motives and integrity of these organizations.” The news release also states that further demonstrating their fundamental lack of understanding of St. Jude Medical’s medical device technology, Muddy Waters Capital and MedSec presented a video that actually demonstrated the Radio Frequency (RF) Telemetry Lockout security feature of our pacemakers – not a “crash” as they claimed. The video also confirms that the device’s clinical functions are operating as expected under these conditions. “The video clearly shows a security feature, not a flaw. The pacemaker is actually functioning as designed. If

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

attacked, our pacemakers place themselves into a ‘safe’ mode to ensure the device continues to work, which further proves our commitment to safety and security,” said Phil Ebeling, vice president and chief technology officer at St. Jude Medical. “Patient safety is and has always been our top priority,” said Mark Carlson, M.D., vice president and chief medical officer at St. Jude Medical. “Our devices are safe and we have taken and continue to take appropriate steps to address the dynamic challenges of cyber security. We do this because it is the responsible thing to do for the patients and physicians who rely on our devices.”

NOVEMBER 2016

TECHNATION

INDUSTRY UPDATES

STAFF REPORTS

AGENCY ANNOUNCES MOBILE-FRIENDLY WEBSITES FOR GUIDELINE, QUALITY MEASURES CLEARINGHOUSES Clinical practice guidelines and quality measures are now literally in the hands of health care professionals. The U.S. Agency for Healthcare Research and Quality (AHRQ) has announced that the National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) websites are now optimized for use on mobile devices. These websites are known as the No. 1 places to go to search for evidence-based clinical practice guidelines and quality measures, respectively. ECRI Institute, a nonprofit dedicated to researching the best approaches to patient care, developed, maintains, and enhances the

clearinghouses under contract to AHRQ. The updated NGC website lets users browse by clinical specialty and organization, while the NQMC website gives users the ability to browse by measure domain, measurement setting, and organization. Both websites enable users to personalize their searches with specific filters to access content of interest faster, and compare clinical guidelines and quality measures right in the search results. The redesigns were spearheaded by ECRI Institute and its technology subcontractor, Silverchair Information Systems. TO LEARN MORE, visit www.ecri.org.

AUGUST CALHOUN HAS JOINED SIEMENS HEALTHINEERS August Calhoun has been named Senior Vice President (SVP) of North America Services at Siemens Healthineers. In this role, Calhoun is responsible for all services business lines in the U.S., including customer services (preventative maintenance and repair for imaging and laboratory diagnostic equipment, and education and training), enterprise services (advisory services, multi-vendor management, asset management and other enterprise services offerings) and digital services (workflow, data and analytics software and services). Calhoun is based at the U.S. Services headquarters in Cary, North Carolina. Before joining Siemens Healthineers in 2016, Calhoun was Senior Vice President and General Manager of Provider Solutions at Truven Health Analytics, a cloudbased health care data and analytics firm in Ann Arbor, Michigan. In this role, he oversaw global sales, marketing, services, consulting, operations and product management, providing products and services that leveraged data and analytics to guide business leaders and clinicians. Calhoun holds a doctorate in physical chemistry from the University of Pennsylvania in Philadelphia and a bachelorâ&#x20AC;&#x2122;s degree in chemistry from the University of Delaware in Newark.

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ECRI UPDATE

Don’t Stress About It: Purchasing Stress Exercise Physiologic Monitoring Systems

tress exercise physiologic monitoring systems, typically used in conjunction with treadmills or bicycle ergometers, evaluate a person’s physiologic responses to physical stress. Clinicians use stress exercise testing to confirm or rule out a diagnosis of coronary artery disease, to differentiate between cardiac and pulmonary disease, and to predict, diagnose, and monitor the course of pulmonary and vascular disease. These systems also help determine an individual’s functional capacity for work, sports, or rehabilitation, and for early warning and detection of physiologic issues. In addition, researchers use stress exercise monitoring systems to study the physiology of exercise.

Clinicians evaluate an individual’s response to physical stress through two primary types of stress exercise systems: cardiac systems, which primarily analyze electrocardiograms (ECGs), and pulmonary systems, which analyze respiratory gases/volumes and other parameters of pulmonary function. Some stress exercise systems can provide both types of data by interfacing with peripheral devices; for example, some cardiac stress testing systems interface with respiratory gas analyzers, providing information about carbon dioxide (CO2) and oxygen (O2) utilization, as well as ECG data. The ECG in exercise stress testing differs from a resting ECG in the length of the monitoring phase and in the parameters measured. Typically, a resting ECG measures 15 to 30 seconds of the heart’s electrical activity; stress exercise test protocols monitor the patient’s ECG for longer periods under different degrees of exercise. The ECG data is analyzed; reports can be generated from the system’s printer. Before beginning the cardiac stress test, the clinician typically performs a three-phase pretest ECG protocol: ECG readings are taken with the

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NOVEMBER 2016

subject supine, standing at rest, and hyperventilating. The purpose of the pretests is to provide baseline data to compare with the ECG during the stress exercise test. The subject then begins the stress test according to a predetermined protocol that gradually increases the speed and/or grade of the treadmill exercise or the work performed with the ergometer. Most systems are preprogrammed with standard exercise protocols, such as Bruce, Balke, and Naughton, and can also be easily programmed by the user for a physician’s personal protocol. Each user can individualize the system by programming the frequency of blood pressure prompts, ST-segment measurement criteria, and leads displayed. Some systems allow the user to design the entire screen display to the clinician’s preference. Protocols can be modified with manual override for individual patients. Final report formats can include printing raw data and summarizing the activity of the ST segment and arrhythmias. Some systems use a Microvolt T-Wave Alternans test to identify patients with life-threatening heart

rhythms. This test requires an elevated heart rate; a treadmill is typically used. The clinician applies electrodes to the patient, which are then connected to the Microvolt T-Wave Alternans equipment. This test measures the T-wave at a microvolt level allowing clinicians to observe variations of the T-wave that can be indicators for risk of sudden cardiac death. Pulmonary stress testing systems use O2 and CO2 analyzers to measure respiratory gases during exercise. For most systems, O2 concentration is measured by either an electrochemical or a paramagnetic method. Electrochemical methods include the use of a solid state electrolyte O2 sensor that uses zirconia stabilized with yttrium and the use of aqueous electrolyte electrochemical cells. Paramagnetic methods rely on the high magnetic susceptibility of O2 molecules. When drawn into the paramagnetic analyzer’s cell, the O2 causes a change in an applied magnetic field that is detected by the sensor. These various sensors can be used to measure the partial pressure of O2 in the sample. CO2 analyzers for stress exercise

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INDUSTRY UPDATES

testing typically use the principle of infrared (IR) absorption spectroscopy to measure the concentration of CO2 in expired gas. CO2 and water vapor selectively absorb specific wavelengths of IR light, making it possible to differentiate these gases from other commonly respired gases. Because the amount of IR light absorbed is proportional to the absorbing molecule’s concentration, the sample’s CO2 concentration can be determined by comparing its absorbance to that of a standard of known concentration. Pulmonary stress exercise systems use either breath-by-breath analysis or mixing-chamber analysis. In breath-bybreath analysis, gases are measured and calculated from each breath as the subject exercises. In mixing-chamber analysis, several breaths are collected in a mixing chamber, and an average output of these breaths is used to calculate gas exchange. Breath-bybreath systems typically use a mask or mouthpiece attached to tubing that is connected to the gas analyzers; mixingchamber systems use a mouthpiece, mask, or hood to obtain samples. There are three basic types of pulmonary stress exercise protocols:

steady-state testing, in which the subject stays at one workload for five minutes, while O2 and CO2 exchange is evaluated during the last minute; incremental testing, in which the clinician increases the workload each minute by 15 to 25 watts until a predetermined work goal is reached; and ramp testing, in which work is increased gradually and continuously until the patient can no longer perform. Some cardiac and pulmonary stress exercise testing systems may link to ECG or cardiology data management systems, which electronically store results for patient record keeping and for statistical analysis. REPORTED PROBLEMS Because clinicians often use standardized exercise testing for patients with compromised cardiovascular and pulmonary capabilities, the stress induced during testing can cause life-threatening disturbances that require immediate attention. Appropriate personnel and equipment for emergency resuscitation should always be available, and patients should be monitored closely to ensure that they are not overtaxed.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

OTHER CONSIDERATIONS Before purchasing a stress exercise system, the prospective buyer should analyze the clinical setting’s present and future requirements regarding the projected volume of stress testing, patient diagnoses, and method of record keeping. The specific features of these systems vary; therefore, each model’s specifications should be carefully evaluated. Users should ensure that the cost of disposables, electrodes, recording paper, filters, calibration gases, spirometers, breathing circuits) is identified before purchasing the system. Discounts may be available when a disposables contract is included in the original purchase. Some suppliers offer upgrade packages that allow the user to adapt or improve an existing system at a lower cost than that of a completely new system. THIS ARTICLE IS ADAPTED from ECRI Institute’s Healthcare Product Comparison System (HPCS), a searchable database of technology overviews and product specifications for capital medical equipment. The source article is available online to members of ECRI Institute’s HPCS; learn more at www. ecri.org/components/HPCS

NOVEMBER 2016

TECHNATION

INDUSTRY UPDATES

BY AAMI

AAMI UPDATE

AAMI Updates Core Competencies for Entry-Level HTM Professionals

AMI has released an updated guide to the functional and personal competencies – and related academic topics – that graduates need to master to be fully prepared for employment in the HTM field. These skills and knowledge were compiled by a committee of experts from academia, health care delivery organizations, independent service organizations, device manufacturers, the U.S. Department of Defense, the U.S. Veterans Administration and others.

According to Barbara Christe, healthcare engineering technology management program director and associated professor at Indiana University-Purdue University Indianapolis, the major difference between the two editions is the specificity of the competencies. The new version offers more details to make the document easier to use. “We worked to more narrowly define the competencies and topics to provide greater clarity. For example, instead of listing ‘information technology concepts’ as an educational topic, the second edition talks about communication protocols, address schemes, and microprocessor fundamentals like memory and registers,” Christe explained. The primary objective of the core competencies is to provide academic institutions with the information necessary to develop and validate their curricula; however, students can use the guide to ensure they have everything employers expect in entry-level employees, said Steve Yelton, an HTM professor at Cincinnati State Technical and Community College. “Students can use this information to make sure they have the tools and skills that employers are looking for,” Yelton, who also contributed to the core competency guide, said. “They may find that there are areas where they are

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NOVEMBER 2016

lacking and may choose to take additional coursework while they are still in college. This is very valuable information that would be hard for them to obtain on their own.” Because the technology associated with health care is constantly changing, the committee fully expects to continue to update the guide. “Competencies will shift and evolve, as in every technology-based discipline. As a result, the document will continue to be updated in order to remain relevant and useful,” Christe said. AAMI ASKS HIGH SCHOOLERS TO ENVISION THE FUTURE OF HEALTHCARE TECHNOLOGY AAMI is inviting all high school students to enter its second annual essay contest for the chance to win a $500 gift card. To participate, students should describe in 500-700 words a piece of healthcare technology – a medical device or system – of the future. Essays should explain: 1) what the device or system would do, and 2) how it would improve patient care. “Last year’s contest was such a great success, we decided to start a new tradition,” said Patrick Bernat, AAMI’s director of healthcare technology management. “This is a chance for high school students to learn about the opportunities that exist within the healthcare technology field and flex

their creativity.” To enter the contest, students should email their essays to Bernat at pbernat@ aami.org by Dec. 1, 2016. Participants should use the following format for file names and email subject lines: ESSAYLASTNAME. For example, a submission from Bill Smith should have “ESSAY-SMITH” in the email subject line and “ESSAY-SMITH.doc” as the file name. Winners will be announced in January. First prize will be a $500 gift card; second prize: a $300 gift card; and third prize: a $200 gift card. All prize winners also will receive a one-year AAMI student membership. In addition, an article about the winning authors will be published in an AAMI publication. “Next year will mark AAMI’s 50th anniversary, and we will be celebrating the innovations and milestones that advanced healthcare technology to what we see today,” Bernat said. “But we also recognize that the next 50 years of innovation lies with students. We are excited to see what the future looks like through their eyes.” VETERAN CLINICAL ENGINEER JOINS AAMI FOUNDATION James Piepenbrink, who most recently served as director of clinical engineering at Boston Medical Center, will join the AAMI Foundation this month as its deputy executive director. Piepenbrink has more than 30 years of clinical engineering experience and has served as an active member of the AAMI Foundation’s National Coalition for Alarm Management Safety since its inception. “I enjoyed working at Boston

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INDUSTRY UPDATES

Medical Center and view my time there as a great His experience and insight will be a major asset as we responsibility and a privilege,” Piepenbrink said. “I have met continue to strive to improve patient safety. He is going to be and worked with amazing people whose dedication and a wonderful addition to AAMI and the AAMI Foundation.” energy made the time fly by. In the end, though, a change in focus and the opportunity to participate fully in the work of DID YOU HEAR? AAMI PODCAST SERIES TURNS TWO the Foundation was something that I welcomed. I see this as a It was just two years ago that the AAMI podcast series made tremendous opportunity to be a part of something special and its first appearance. Since then it has racked up 18 episodes important.” (and counting) and nearly 17,500 downloads. Piepenbrink, who received the 2016 AAMI Foundation & The award-winning series, which is developed in Institute for Technology in Health Care’s Clinical Solution partnership with the studios of Healthcare Tech Talk, Award, will bring a new perspective to the work of the AAMI explores today’s most pressing healthcare technology Foundation – that of the healthcare technology management challenges and the multidisciplinary approaches that are being (HTM) community. used to clarify and resolve them. “Having a hospital-based engineering perspective will “AAMI developed the podcast series to connect with the hopefully provide some insight into the challenges that the health care community in a new way. People may not always clinical staff deal with on a daily basis and how HTM have the time to read a journal article, but they can enjoy a professionals can help bridge the gap between devices, podcast while on the go. The conversations are always lively PROOF CHANGES systems, APPROVED and patient care,” Piepenbrink said. NEEDED and informative,” said Sean Loughlin, AAMI’s vice president This is a perspective that the AAMI Foundation’s of communications. “We are excited about their growing CLIENT SIGN–OFF: Executive Director Marilyn Neder Flack welcomes. popularity and have been fortunate to work with fantastic “I am thrilled that Jim accepted this position,” Flack, who hosts and partners, Terry Baker and Kelley Hill.” CONFIRM THE FOLLOWING alsoPLEASE serves as AAMI’s senior THAT vice president of patient safety ARE CORRECT To listen to the series, go to www.aami.org/podcasts. The initiatives, said. “I have known him for years because of his podcasts are free.. LOGO PHONE NUMBER WEBSITE ADDRESS SPELLING GRAMMAR significant contributions in the area of alarm management.

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SHOP TALK

Conversations from the TechNation ListServ Q: A:

What is your favorite part of the MD Expo and why?

All of it! The camaraderie, the learning, the vendors … knowing how others work through similar problems with their programs ... benchmarking program information presented against what my program is doing. You always come away from the MD Expo being a better person than when you walked up to the desk to pick up your registration packet.

Well said! Unfortunately, I don’t get there as often as I would like, mainly due to budget constraints.

I have received this error code on my Trophon, DFV0008. The indicator never changes color. Can anybody help me out?

Just had this issue on one of our units. The Nebulizer Valve was broken at the axle. We had to have this sent in for repair. I believe it is a “Depot Only” repair. The Process Board (Part# 5730843) and the Nebulizer Assembly (Part# 5537371) had to be replaced. Not sure if these are parts that GE sells for you to do the repair. Cost of the service was

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NOVEMBER 2016

$2,482, parts and labor. If you need a rental device, that’s an extra $840, rental fee & handling.

I have received that error DFV0008 many times on several Trophons. This is the explanation I received from Nanosonics. • DFV0008 – Mist Dosage Under • Unit is not misting enough chemical • Attempt to correct by running a few more cycles • If still not cleared, purge system and load new Sonex I have done that on several of my units and the error continued every month (when new Sonex was loaded). I ended up sending my units in for repair. The nebulizer was changed and my units no longer have had any issues. Update: Wish me luck, I’m about to attempt to replace my first neb in-house. They charged us $1,300 for it. They also harassed my purchasing department for additional information like serial number. The reason for replacing is that we get the 0008 error once every month or two. Purging the unit and reloading the Sonex works, but only for a short while. I got the new neb assembly and it was different! The old one has a billet cup that

the neb disc holder screws into, the new one has a plastic cup, and no place to screw in the components from the original billet cup. Is the plastic cup just a placeholder? is it assumed you will reuse the billet cup? The service manual says that the neb disc and holder are all that need to be replaced, so I took the new neb disc and holder off the new assembly and installed it into the original neb assembly with the billet cup. Juiced it up and its just not any better. It passes most cycles, but it’s failing on the chemical indicator. It’s coming out almost exactly the color of orange on the package. Still getting 0008 error from time to time. Waiting on another call from GE. Working on this thing is very easy, getting information out of the manufacturer is not. Found out the nebs have been revised and they don’t work unless you replace other parts, as well. Always something new. I’m trashing these parts and sending these trophons out to GE for service. THE SHOP TALK ARTICLE is compiled from TechNation’s ListServ and MedWrench.com. Go to www.1TechNation.com/Listserv or www. MedWrench.com/?community.threads to find out how you can join and be part of the discussion.

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12 of the Top 15 U.S. Hospitals Rely on PartsSource. For more expert tips on acquiring parts and industry trends, go to partssource.com/tips Over 7,000 total clinical sites turn to PartsSource for medical replacement products and technology solutions.

Source: U.S. News & World Report.

THE BENCH

BY KEVIN HUTCHERSON

BIOMED 101

Breaking Down the Walls: A Look at Team Organization

nurse from the intensive care unit calls frantically because they have a critical patient on life support and their central station is not receiving patient vitals from one of their rooms. Unfortunately, the biomedical technician that is trained to work on the patient monitoring system is out of the shop on vacation. The technician is on a cruise to the Cayman Islands out of telephone contact. She has attended all of the manufacturers training available and everyone knows that Tina is the “monitoring person.” She knows passwords that were only available to factory-trained personnel. Tina is very protective of the information. Knowledge is power is the motto she lives by. Without her, there was practically nothing we could do except contract the manufacturer to resolve the issues.

These silos existed throughout the entire shop. Tony specialized in the lab, Mark was the sterilizer guru, Christy handled all of dialysis, Perez did anesthesia and surgery, and Jessie works on infusion pumps, period. No one dared to cross the line because that is just the way it is and has always been. If you train someone to become very good at one thing, the subject matter expert, then you can rest assured that those items are being maintained correctly. Likewise, if Jessie was the only person who knows infusion pumps, her position was safe. However, when Christy is sick, Tony has a sick baby, or Tina takes a cruise we are left with holes in the program ultimately degrading the ability to address urgent needs, timeliness of repairs and the quality of customer service your program provides. This scenario is an extreme example of the vulnerability of this type of organizational process, but not too unlike how things were when I was hired as the shop supervisor. This was my first exposure to the civilian world, as until this point I had spent my entire career refining my Biomed skills in the United States Air Force. I had been assigned to eight different duty stations in my career and while each assignment varied in size and scope, with the exception of a one

TECHNATION

NOVEMBER 2016

KEVIN HUTCHERSON

Supervisor of Biomedical Engineering, Dayton VA Medical Center

man shop in Denver, they all shared the same basic fundamental theme. Without effective teamwork the Biomed mission could not succeed. In the DoD, the possibility of deployments, humanitarian missions, etc. made it extremely important that technicians were trained on a wide spectrum of modalities which also contributed to each person’s career development path. Everyone shared core Biomed tasks that they were required to be fully competent in, so if SSgt Smith left for deployment, although he spent the majority of his time working on

anesthesia units, SrA Johnson could step in and the shop wouldn’t miss a beat. Likewise, although SrA Johnson didn’t handle the anesthesia units on a regular basis, if he were to be deployed to a hospital he could step in and support them immediately because his home station ensured that he was familiar enough with the equipment to do so. When I transitioned to the VA from DoD, I was able to take the team mentality from my prior departments and formulate a new way to ensure cross-training and coverage for the betterment of the department. The department had a team structure at some point in the past, so it seemed like it would be a logical transition. I started with a simple structure – the department had two different sides of the house consisting of imaging and general biomedical technicians. When we began this process, there were only two imaging technicians, each having their own areas within that world. One technician specialized in nuclear medicine and the other had the rest of diagnostic imaging, so consolidating their efforts was the easy part. The most difficult part of the process was assigning members to each team on the general biomed side of the house. During this initial trial, I felt it was

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extremely important to combine the right technicians together on each team who would complement each other’s strengths. It was also important to place technicians together whose skills and departments of responsibility naturally overlapped. The Biomed who handled surgery had a couple sterilizers that they were responsible for. So it made sense to group him with the person who took care of the rest of the sterilizers in central sterile processing. These crossover skills are a reason why careful consideration is extremely important

complete their own scheduled work. This teammate concept also provides built-in continuity. If someone is sick, on leave, or at training the team doesn’t miss a beat which improves our customerfacing service. After the initial structure for the teamlets was established, I’ve allowed each team to manage their own processes. This has allowed change and structure, but provided buy-in from each individual who could provide input into the process for their particular areas of responsibility. Each team works together to train each other in the areas where

“ When I transitioned to the VA from DoD, I was able to take the team mentality from my prior departments and formulate a new way to ensure cross-training and coverage for the betterment of the department.” for a successful transition to a teamlet structure for Biomedical Engineering department coverage. Initially, we set up the department in three teams of three, two on the general biomed side and one on the imaging side. The overarching thought is that each teammate can cover for the others, which provides us with multiple backups for each equipment modality. For instance, for one week two of the team members would be working on PMs while the other would respond to repair calls, rotating throughout the month to ensure each member was able to

they had previously specialized. The next step in this process is to get additional technicians sent to manufacturer training to ensure that every technician is manufacturer certified where necessary. After assigning the teams, I looked at how the scheduled work was split up throughout the year. There were months that would have left Team 2 overwhelmed and Team 3 with very little to do, additionally there were PMs being accomplished in sections much more frequently than the manufacturer had recommended. In the next step, I did an in-depth look at each

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

equipment category and extended over 500 equipment item PM inspections from semi-annual to annual based on manufacturer’s specifications. By doing this, I was able to reduce unnecessary workload, providing technicians more time to focus on completing quality planned maintenance inspections, in turn reducing unscheduled repair call volume and increasing availability for other professional services for our customers and organization. We also have a handful of sections that are able to be covered by any team. These PMs and repairs can be assigned to any team allowing me to balance the workload as needed. These sections mostly have items such as beds and scales, or other general equipment any Biomed should be able to open a book and resolve the issue for. Since its conception, we’ve expanded to four teams, as one person has begun a hybrid-IT team to focus on networking. This reorganization has, to this point, provided extremely successful results. Prior to the structural change our completion rates were in line with VA and Joint Commission standards which is to complete 90 percent of non-high risk PMs. Since implementation in October 2015, our team has successfully completed 90 percent of our planned maintenance work orders during the month assigned every month since November 2015, with the exception of one month, and even completed 100 percent once. These improved results can be attributed to the fact each team member has embraced this new concept, or as one of my staff says, they’re “drinking the Kool-aid.”

NOVEMBER 2016

TECHNATION

THE BENCH

STAFF REPORTS

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TECHNATION

NOVEMBER 2016

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Webinar

Wednesday

WEBINAR WEDNESDAY Educational Series Continues to Deliver

echNation Webinar Wednesdays through a patient’s finger to measure continue to provide insightful knowl- oxygen saturation levels or Sp02. edge to biomeds around the globe. During the webinar, Donald Gessling, Senior Engineer at Fluke Biomedical, explained why this simple The recent Summit Imaging-sponsored procedure is extremely important, and webinar “Minimizing Transducer how it works. He also covered the basics Failure through Proper Care and Early of pulse oximetry, along with the Detection” was a hit with 200 people concepts of light wavelengths, attending the live presentation. calculations, R-curves, and the most Summit Imaging Manager of Global reliable way to test Sp02. Education and Training Kyle Grozelle Attendees learned the history of discussed keys to preventing transducer pulse oximetry and how the need to test failures, how to implement proper care evolved from the operating room. They methods and best practices to ensure that also learned how a pulse oximeter everyone who handles a transducer is able non-invasively measures oxygen to identify early warning signs. Grozelle saturation and the ranges of testing that broke down a transducer explaining the can be performed. function of each part and where failures The webinar received high marks typically occur. He provided real-life from attendees. examples of transducers in various The recent Universal Medicalconditions so participants could see what sponsored webinar “The Importance of a damaged probe looks like, making it Understanding Clinical Nuclear easier for them to identify problems at Medicine for Health Care Technology their facility. Managers” provided insights into Grozelle demonstrated useful nuclear medicine. techniques for detecting common Nik Iwaniw, MM, CNMT, RT(N), problems, such as interior probe the Vice President of Corporate Quality damage. He also reviewed proper care & Customer Support Services/Clinical methods and techniques to help alleviate Support Specialist at Universal Medical, unnecessary problems. presented an informative webinar for The webinar was a hit with attendees biomeds at all levels. earning a high rating and compliments. Iwaniw discussed several aspects of Another recent installment of the nuclear medicine beginning with the TechNation webinar series basics: What is nuclear medicine and “Fundamentals of Pulse Oximetry,” how it assists in managing diseases? sponsored by Fluke Biomedical, He went over several of the acronyms attracted a crowd with more than 300 that are used and took time to explain people viewing the presentation live. each one. Pulse oximetry is an important He also addressed nuclear patient monitoring technology based on medicine’s contribution to quality the simple technique of shining light patient care and a positive patient

TECHNATION

NOVEMBER 2016

“I look forward to taking part in future webinars, and growing as a biomed tech in this ever-changing and progressing field of work.” - Tevan E.

experience, understanding terminology and procedures utilized in clinical nuclear medicine and what they mean for HTM professionals. Iwaniw continued the webinar with a look at equipment maintenance and how that contributes to positive outcomes. He stressed the significance of a collaborative effort to maintain equipment. Almost 300 people registered for the webinar and attendees gave positive reviews. Attendees of all three of these webinars expressed gratitude for the Webinar Wednesday series. “TechNation’s webinars have been a tremendous help in troubleshooting, diagnostic courses presented, and the amount of resources you pick up from attending the one-hour sessions. I greatly appreciate the information being presented,” Bill P. wrote. “TechNation’s webinar series has

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proven to always be helpful and informative. I am now including other staff members in the webinars. It has been a great training tool,” Tim B. shared in his survey. “Whether learning something for the first time or dusting off the cobwebs of information nearly lost, TechNation’s Webinar Wednesdays are a great way to stay on top of your career in biomed. These webinars add expertise and confidence to any technician’s toolbox and give you the chance to pick the brains of the experts that lead the way in their fields of endeavor,” Todd K. wrote. “This was my first TechNation webinar, but it will not be my last. Very

educational, well presented and the time slot is perfect. I will recommend it to my co-workers,” Elie S. wrote. “I love TechNation’s webinar series. The information I received regarding the pulse ox measurements and its clinical use was outstanding! I look forward to taking part in future webinars, and growing as a biomed tech in this ever-changing and progressing field of work,” Tevan E. wrote.

TECHNATION WEBINAR WEDNESDAY would like to thank the sponsors who participated in the webinars featured in this article. For more information on the companies, just visit www.mysummitimaging.com, www.uni-med. com, or www.flukebiomedical.com.

FOR INFORMATION about the TechNation Webinar Wednesday series, including recordings of previous webinars and a schedule of upcoming sessions, visit www.1TechNation. com/Webinars.

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NOVEMBER 2016

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ROUNDTABLE

STAFF REPORTS

ROUNDTABLE Computed Tomography

TECHNATION

NOVEMBER 2016

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ROUNDTABLE

omputed tomography (CT) is an imaging procedure that uses special X-ray equipment to create detailed pictures, or scans, of areas inside the body. It is also called computerized tomography and computerized axial tomography (CAT). This high-tech imaging modality has advanced since its inception. It serves as a useful tool and some health acre professionals have even suggested that it be used as a revolving door at the entrance to the hospital to provide quality images and information on every patient. TechNation contacted several experts and asked about purchasing and maintaining equipment. We also asked about the latest advancements. The panel members are Matthew Dedman, Director of Strategic Accounts for CT at Siemens Healthineers; Sarah Lee, Vice President, MIT; Josh Raines, Vice President Technical Services, Tri-Imaging and Ed Sloan Sr., President and CEO, Ed Sloan and Associates.

WHAT ARE SOME OF THE BIGGEST CHALLENGES OF PURCHASING AND MAINTAINING CT EQUIPMENT? Dedman: A big challenge today is that our customers are acquiring a CT scanner now with the expectation that we are not going to change out that piece of equipment for maybe 8 to 10 years or even longer; in the past, they bought a CT scanner with a 5- to 7-year replacement cycle. The challenge is finding a solution with the flexibility to allow for future upgrades that expand critical services. A big challenge on the service side is that CT is becoming the frontline gold standard imaging modality for many hospitals – a critical modality to the point that if their CT scanner is down, they may have to put their hospital on diversion and no longer accept imaging patients. So, obviously, uptime is even more important. In short, finding a key solution that is flexible, adaptable, and upgradeable to meet future demands and critical needs as well as a CT service provider that can proactively monitor and maintain CT equipment to avoid downtime is crucial. Lee: From our standpoint, as the service company, the biggest challenge would be being able to find the system with everything on it that the customer wants. It is always doable, it just takes some time. The only challenge with maintaining equipment is finding parts for the older equipment hospitals still have.

WHAT ARE SOME OF THE LATEST ADVANCEMENTS IN CT EQUIPMENT THAT FACILITIES SHOULD CONSIDER WHEN PURCHASING NEW?

MATTHEW DEDMAN,

Director of Strategic Accounts for CT, Siemens Healthineers

Raines: Some of the biggest challenges are tube availability and parts for newer systems. Another challenge is finding qualified service engineers to work on the newer equipment. Sloan: The most glaring challenge is the cost associated with buying and maintaining new equipment. Many of our customers overcome this hurdle by purchasing quality preowned systems. Selecting the appropriate technology to suit the current and future procedural demands of the department. In reality, not everyone needs a 512-slice CT or a 32 channel MRI.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

Dedman: CT scanners, like many other technologies, are becoming more efficient than ever. As a result, manufacturers such as Siemens Healthineers are introducing CT platforms with smaller X-ray generators, lower power requirements, lower cooling requirements, and a smaller footprint. All of this translates into lower operational expenses for the hospital, so Siemens Healthineers has invested in efficiency technology to allow these lower power requirements and lower cooling requirements to reduce that operational expense for our customers. This is being done without compromising the critical care. Many new technologies in the industry are related to efficient operation of a CT scanner, to ensure that the scanner operates within ideal parameters to extend the life of the equipment and specifically the life of its X-ray tube. Technologies exist – particularly from the biomed aspect – that are important advances to consider in CT, knowing that biomeds will be maintaining this asset up to 8 and 10 years or longer, and how critical CT has become to hospital operations. These efficiency features all help ensure lower downtime for that equipment. Lee: If they are buying refurbished equipment, specifically GE, the console is

NOVEMBER 2016

TECHNATION

ROUNDTABLE

what they need to look for. The extreme console is faster and does not go down like the older consoles.

because this will increase the life and reliability of your equipment.

HOW CAN PURCHASERS ENSURE THAT THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS WHEN THEY PURCHASE CT EQUIPMENT?

Raines: One of the latest advancements is the improved image quality of scans available with a lower dose than what was needed with previous systems. Sloan: Buyers should be sure they will use the technology. Sometimes getting it loaded with all the bells and whistles is great, but always look into how needed it is for your operation. What needs to be a priority is enhancing patient care and streamlining productivity.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A CT EQUIPMENT AND/OR SERVICE PROVIDER? Dedman: I see three big things. One is the remote servicing and remote acting service monitoring capabilities of the equipment vendor and equipment service provider. The reactive break-fix model in CT is not enough anymore since that modality has become critical to several hospital service lines, particularly the emergency department. CT scans are the gold standard of ED imaging. CT’s demands are so much higher, and as a result, remote servicing and proactive monitoring are very important. Additionally, the efficiency element of new CT scanners is designed to extend the life of the CT gantry as well as that X-ray tube – this is a very important element. And lastly, the scanner’s future upgradeability is important, showing that it has an 8-to-10-years-and-beyond roadmap to be able to expand critical capabilities and meet that hospital’s changing demands – whether that involves offering new service lines or increasing the capacity to handle new patient volumes. Lee: You need to look for a company that is reputable and actually refurbishes the equipment not just paints it. For service

TECHNATION

NOVEMBER 2016

SARA LEE

Vice President, MIT

you need to look for a company that knows what they are doing and one that is not a one-man show that will have enough personnel to get to you right away. They do not have to have a 100 engineers, a few is fine as long as they have enough for the customers they have. Everything does not break at once, one engineer per 10 CT contracts is plenty. Raines: It is always important to check references and to speak with their current customers to find out what types of experiences they have had with the company. My top criteria include finding a company with the specific expertise needed for a facility’s equipment, parts support and pricing as well as the company’s reputation. Sloan: Dependability, flexibility, availability and reputation. Develop a relationship with your equipment and/or service provider. Being able to trust them is a must. Always consider parts availability, you don’t want to get a system that you can’t find parts to service. Make sure your service provider completes PMs in a timely manner

Dedman: This is a very customer-specific answer. It really depends on the service relationship that they have with the OEM. If it is a full OEM service, there probably is not much need for training materials at all. But we all know there are varying levels beyond full OEM service, including shared service all the way to complete in-house biomed servicing. So, the question is very customer specific and depends on their master service agreement. I would advise working with your OEM to ensure that those necessary elements are included in a master service agreement. Lee: They need to put it in the stipulation up front before purchasing the equipment and make sure they see it in the contract. Raines: It is important to get a written agreement that states that the necessary literature and training tools will be provided. Sloan: When purchasing, you should always ensure that equipment contracts include a demonstration of the mechanical operations of systems. Having a system staged so you can inspect it and verify that it meets OEM specifications is always something to look for. It’s cliché, but you wouldn’t buy a Ferrari without giving it a test drive first, would you? Being able to see the systems running and analyze it’s quality is a big part of purchasing a system. Used equipment sellers do not typically include clinical procedure training in a system purchase, so make sure you discuss your options with the provider if that is needed for your site.

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ROUNDTABLE

Raines: I think we will see continued movement toward CTs that can provide improved images with lower dose. There has been a lot of advancement in this area, but I predict that it is going to get even better.

JOSH RAINES

Vice President Technical Services, Tri-Imaging

HOW WILL THE MARKET FOR CT EQUIPMENT EVOLVE IN THE NEXT FIVE YEARS? Dedman: We are seeing several new CT market trends. One is a pronounced shift toward the “front lines of health care.” Increasingly, you see CTs being placed directly in the emergency department as opposed to the radiology department. We now see CTs installed in freestanding emergency departments that actually accept ambulance patients, and they need CT systems to retain that designation. We are also seeing new, unique mobile imaging configurations utilizing CT: CTs within an actual ambulance to perform remote imaging for suspected stroke patients. So, I see a shift of CT toward the front lines of health care, with an increased focus on uptime and reliability of CT equipment. Lee: Like always, you will see higher slice equipment come in and the older stuff will start to phase out because parts will become hard to find. Also, the government will probably make new laws that might make this happen quicker.

Sloan: As the current population ages, and we see a push to reform health care, the market will demand an increase in technology while decreasing the cost associated with the imaging procedures. I’m seeing more non-minimally invasive procedures, complex diagnosis of patients, and a deeper integration of the clinical information regarding the overall care of the patients. Overall, a smaller margin between price and performance.

WHAT ELSE DO BIOMEDS NEED TO KNOW ABOUT CT EQUIPMENT? Dedman: I can’t stress enough CT’s growing importance in health care today. Roughly 50 percent of patients who present at an emergency department receive some type of imaging, and most of that imaging is CT. And the fact that CT is the gold standard of imaging for many areas in the hospital highlights the importance of maintaining that equipment and ensuring that it operates at its optimal performance level, because it really is a critical component of the care pathway. Biomeds need to recognize the importance of data derived from a CT scanner in relation to a patient’s care in today’s health care environment. It’s an indispensable, critical element of efficient, effective patient triage within the hospital. Lee: If they are servicing themselves they need to buy parts from a trustworthy company to eliminate down time. If they don’t service CT, don’t be afraid to use third party for service, you can find really good companies and it will save the hospital money.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

ED SLOAN SR.

President and CEO, Ed Sloan and Associates

Raines: Biomeds need to know that they will benefit from strong software skills. They should also consider attending training from a service provider and/or seek education at trade shows like the MD Expo. Tri-Imaging Technical Training is a unique and intuitive training program that will prepare a service engineer to efficiently and effectively troubleshoot diagnostic imaging systems. The 2017 training calendar will soon be available on the Tri-Imaging website. Sloan: We are in a “fix it NOW” industry. Something that needs to be understood is that it’s not an 8 to 5 thing. With trauma centers, no one is going to want to take the risk of leaving a system down for any prolonged period of time. Biomeds need to be able to asses the problem, have an accurate parts supply, and have a trusted technical support provider at all times.

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TIPS FOR ACQUIRING PARTS S T R AT E G I E S T H AT H E L P T H E B OT TO M L I N E BY K . R I C H A R D D O U G L A S

The old adage about needing the right tool for the job might be appended by also saying it takes the right part for the job. You don’t bring a knife to a gunfight and you don’t tackle a repair with the wrong tool or the wrong part.

uckily, there are resources for determining the right part, finding it, and maintaining costs. Many providers exist who offer ways to cut costs in light of shrinking health care budgets. Many of these businesses can also offer insights into trends, the supply chain and the growth of the parts market. The OEMs are also aware of the changes wrought by an evolving health care environment that seeks efficiencies from every participant. The theme of budgets, and more accurately, tightened budgets, seems to find its way into every story about health care and HTM departments. It has become an unavoidable fact of life that weighs on every decision. It is a symptom of changes made to modern day health care, pitting the smooth operation of important medical devices against the challenges the C-suite faces from CMS and other considerations. The challenge cuts both ways though, as suppliers seek ways to reduce costs, operate more efficiently, remain competitive and satisfy stockholders or profit margins. For purchasers, it’s about finding quality parts that are tested and reliable and affordable; that makes pinching pennies either a cost-conscious exercise or a corner-cutting one. In an effort to avoid the latter, there has been a necessary evolution in finding creative solutions to acquiring parts that fit the need, while keeping an eye on the bottom line. As with so much else in this connected world, the Internet has changed the parts search horizon significantly, making the nearest computer much like the proverbial card catalog at the local library. And then, there are the logistical concerns; getting that part in a timely manner or finding something in the first place. How do

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

you solve these problems? Does the supplier test their parts and assure accountability that the part won’t be DOA? The suppliers lend their perspective and insights on meeting these issues and on the market as a whole. Experienced parts buyers also lend insights, tips and cost-lowering ideas that will prove useful. There is also helpful information about Device Supportability with the help of AAMI’s Supportability Task Force. The task force’s checklist can help HTM departments make wise choices. Ken Maddock, an HTM consultant with a long history of involvement with AAMI, points out that the checklist is not only a good read for every HTM professional for tips on acquiring parts, but also for tips about saving money and considering the total cost over that parts entire life cycle. He also points out that this is a living document; HTM professionals, who have good suggestions from experience, should submit their ideas to AAMI Director of Healthcare Technology Management Patrick Bernat for possible inclusion. The checklist also offers pointers for manufacturers regarding notifications, more in-depth information and tampering.

AS CLOSE AS THE NEAREST COMPUTER “The parts market is more competitive since Google. Everyone can hop on Google and type in their part number and it will show vendors who have stock,” says Nicole Hemphill, business development director at PartsSource in Aurora, Ohio. Tim Smith Sr., vice president of sales at First Call Parts in Salem, Virginia, agrees that the Internet and software have changed the parts procurement landscape.

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COVER STORY TIPS FOR ACQUIRING PARTS S T R AT E G I E S T H AT H E L P T H E B OT TO M L I N E

NICOLE HEMPHILL, Business Development Director at PartsSourc

“From the third-party parts supplier perspective, we have seen an increased interest in technology-based solutions,” Smith says. “Companies are leaning more toward exploring avenues like computerized maintenance management system (CMMS) integration to help with time management. Engineers, HTM departments, purchasing departments, and customers in general are more interested in online shopping for parts now as well.” Luckily for those in need of parts, the market continues to grow and access is just a keyboard away. At the same time, more obsolete equipment parts may be more of a challenge. “We are starting to see some of the older equipment parts fade out. Older single slice CT parts are getting harder to find. This is understandable,” says Sarah Lee, vice president of sales and marketing at Medical Imaging Technologies in Thomson, Georgia. “I guess it happens with all technology. We have definitely seen the parts market grow. There are more parts companies than there have ever been before. With that being said, you have to be careful and use a parts company you trust that actually tests the parts and makes sure they work correctly. We have gotten many parts over the

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NOVEMBER 2016

years that were bad when we received them,” Lee adds. Supportability includes the availability of the right parts, at a cost that is within the device user’s practical budget, and the ability to use that part in a repair. This is only one ingredient in a recipe that includes many; a part’s quality, price and the frequency of use of a part and it’s environment during use. With many hospitals feeling a budget crunch that makes capital expenditures more difficult, equipment is kept in service longer. “The overall trend in this business sector seems to be related to health care facilities keeping equipment in service much longer today than in previous years,” says Greg W. Johnson, CBET, CHFM, co-founder of Southeastern Biomedical Associates Inc. “As a result, manufacturers tend to discontinue support on older equipment as an attempt to drive new equipment sales. This requires biomedical technicians in the field to seek alternative sources for acquiring parts and it has become an ever-increasing challenge for them to keep older equipment operational.” “The parts trend that we’ve been noticing lately has to do with compact portable systems. Over the past weeks/months, we have been receiving more and more requests for transducers and parts for these portable systems,” says Norma Robles, customer support specialist at Exclusive Medical Solutions in Schaumburg, Illinois. Along with these changes in the market is the challenge of comparing prices accurately. As Maddock stated, the cost of a part is not just about the price being charged on the invoice. Perry Kirwan, vice president technology management at Banner Health, agrees about the importance of a part’s total cost over its life cycle. “Clinical technology standardization – as we remove clinical variation in our care delivery processes – this has necessitated standardizing equipment decisions to realize those goals. Standardization by itself will most save you money

GREG W. JOHNSON, CBET, CHFM, Co-founder of Southeastern Biomedical Associates Inc.

over the life cycle,” Kirwan says. “Life cycle has to be thoroughly researched and incorporated into the purchasing process so that this plays a major role in the selection process. When you get it right, then you can negotiate everything from that point on from a volume perspective. OEMs and third-party parts suppliers are both integral in determining the market and then you negotiate from there.” Some of parts buying is just common sense. Stay focused on what you really require. “One of the most common mistakes in purchasing medical equipment replacement parts, or capital equipment, is to buy impulsively without fully considering the effects of your decision,” says Andrew Geidel, national sales manager for MW Imaging in St. Charles, Missouri. “Take the time to analyze your requirements carefully and be true to heart. To avoid the bear trap of buying more than you need or can use, ask yourself if you really need all the bells and whistles. In other words, make sure the ‘ways fit the means.’ Consider the warranty and the supplier’s track record as well as your own customers’ needs.”

CHANGES IN THE MARKETPLACE “The third-party or alternative to OEM parts market is always moving and chang-

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COVER STORY

ing. You have seen a lot of M&A activities in the space over the past five years as a continuing trend of consolidation. I believe you will see more of this activity as health care continues to be where investors and service organizations are focusing on,” says Jeremy R. Probst, chief operating officer at Technical Prospects LLC in Appleton, Wisconsin. Probst says that companies that operate in this space are finding the need to differentiate and continually innovate to remain relevant. He says that competition is becoming more apparent however all companies are not equal. Many are simply “parts/harvest” companies that have very few processes or quality standards and feel they too shall play in the parts space. There is a big parts market out there and there are ways to benefit in your transactions from both suppliers and OEMs, according to Nicole Serwetnyk, parts procurement specialist at Advocate Health Care in Downers Grove, Illinois. Serwetnyk has 22 years in the business, including 11 with a major OEM. “Knowledge of where to source from is important to help contain service costs. What we feel HTM programs need to re-

ANDREW GEIDEL National Sales Manager for MW Imaging

buying agreements as visibility to current market pricing is effectively ‘lost’ unless you have some type of annual market comparisons done, with the contract stating discounts will adjust accordingly. In many cases, it is not unusual for an OEM to not have a certain part readily available, but the supplier market can ship you a warranted part the same day – at a significantly reduced cost,” Serwetnyk adds.

“ EQUALLY IMPORTANT IS A LEDGER OF CONSISTENT RECORD KEEPING/HISTORICAL DATA FROM THE SELLER, COUPLED WITH A GOOD HISTORICAL MAINTENANCE PROGRAM THAT CAN BE REVIEWED BY THE PURCHASER. - ANDREW GEIDEL member is that repair and PM kit parts are not really a ‘fixed’ price item, be it from an OEM or an after-market supplier. It is not unusual for OEMs or suppliers to drop pricing, or up warranty offerings, – or both – once they realize you can buy a part from somewhere else,” she says. “Because of this, it is rarely advantageous to lock in any sole-source parts

Buying parts doesn’t allow for kicking the tires, but it does allow for a review of the historical data and a review of condition upon receipt. “Always consider the most common influence on resale value. The closer a part or product is to its recommended time between overhauls/refurb/reconditioning, also considered as end of life (EOL),

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

the less its value,” Geidel says. “Equally important is a ledger of consistent record keeping/historical data from the seller, coupled with a good historical maintenance program that can be reviewed by the purchaser. This is also known as a quality assurance (QA) validation.” He suggests that upon receipt of goods, visually inspect/test the item(s) prior to taking possession or acceptance to assure yourself that no damage has occurred since the pre-purchase inspection and/or the shipping process and that all conditions have been fulfilled. He says that following these guidelines will create a systematic process of good hygiene in acquiring your inventory and everyday maintenance needs. It will make your customers very pleased and make your job a lot easier and manageable at every juncture. “We’re seeing a shift towards a circular economy model, often referred to as ‘closed loop manufacturing.’ It’s a supply chain approach wherein raw materials, parts, and components are kept in the system for as long as possible, providing higher value and utility over time,” says Jim Salmons vice president of Philips Multi-Vendor Services and AllParts Medical in Nashville, Tennessee. “It’s an alternative to the linear ‘planned obsolescence’ model that still drives a large portion of parts purchasing. But this familiar ‘take, make, dispose’ economic model relies on large quantities of cheap, easily accessible materials, and energy,” he says. “Today, contemporary notions ranging from environmental stewardship to total cost of ownership have made clear that this consumption-based economic model is reaching its physical limits.” “Another less obvious factor is the impact on your organization’s patient flow and bottom line,” Maddock says. “Saving a lot of money on a part but keeping a unit down for a longer period of time as you look for an alternative to the manufacturer may not be the best decision. I’m sure many readers would

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TECHNATION

COVER STORY TIPS FOR ACQUIRING PARTS S T R AT E G I E S T H AT H E L P T H E B OT TO M L I N E

say ‘thank you Captain Obvious, we already know that’ for those comments. But with considerable budget pressures it can be easy to make decisions that are better for your budget than the organization’s budget, and/or decisions better for the short-term than the long-term. A reminder never hurts,” he adds. The new replacement parts market has come a long way and offers good quality, cost savings, same-day shipping and extended warranties, according to Nate Smith, co-owner/vice president of Elite Biomedical Solutions. “If looking at purchasing new replacement parts, hospitals should look at the vendor to ensure a few items: ISO certified, FDA registered, In house R&D, 2D scanning, 3D printing, design reviews, risk analysis, strong development team, and USA manufacturing partners to ensure an OEM equivalent part,” he suggests.

IMAGING PARTS; A BREED APART “There has been tremendous growth in the marketplace for imaging parts solutions. Both OEM and third-party providers offer competitive alternatives to typical parts replacement models,” says Joseph A. Haduch, MBA, MS, senior director of Clinical Engineering at Pensiamo, a UPMC/IBM collaboration. “The growth in this market has brought with it more competition and an opportunity for biomeds to leverage this competitive environment to their advantage. The major OEMs now offer multi-modality, multi-vendor parts options that directly compete with third-party companies,” Haduch says. He says that OEMs have been very aggressive in marketing these services. Haduch says that this presents a great opportunity for HTM departments to compare parts discounts between vendors, but also to negotiate new or higher parts discounts with their OEMs. “In order to gain either parts provider exclusivity or first-stop consideration, companies are willing to lower their OEM parts costs, which already have consider-

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JEREMY R. PROBST, Chief Operating Officer at Technical Prospects LLC

able margins, in order to gain a bigger piece of the pie,” he says. “Some OEMs may even consider service labor discounts as a means of increasing their parts revenues. The market has become so competitive that we recently converted our TEE probe repair agreement to an OEM replacement agreement. Seldom have I ever seen OEM replacement be a more cost-effective solution than third-party repair. OEMs

looked at the average replacement of tubes and probes per year and created a pool,” says Sharon Wray, program manager, Clinical Engineering Services and Medical Device Monitoring Office for the University of Virginia Health System. “As for other parts, if I know that a certain battery or part is needed for PMs and the cost is high, I try to negotiate a lower price for that item in the service agreement,” she says. “As for the parts market, we are continuing to look for opportunities to streamline parts management.” David Sulak, national sales director at PartSource, agrees that competition has increased in the market at a time when hospitals are budget focused while still needing quality parts and that this is a trend. “OEMs are more competitive than ever with not only secondary parts suppliers, but also with secondary service companies. Service companies are getting more aggressive in sourcing their own parts, and keeping stock of high dollar/exposure items,” Sulak says. “Hospitals are caught in the middle, looking for value without sacrificing quality and increasing exposure to risk and increased downtime. There is an increased

“MANAGING EQUIPMENT MAINTENANCE AND PARTS REPLACEMENT – WITH AN EYE TO OPTIMIZING RESOURCE UTILIZATION – IS AN ESSENTIAL PART OF EVERY HTM’S SOLUTION.” - JIM SALMONS like the thought of booking guaranteed revenue. Use this to your advantage when negotiating any parts agreement.” Resourceful thinking can result in lower costs through negotiation and pooling. “As for imaging parts, we were able to lower service contract costs by pooling tubes and probes in the agreement. Rather than having one-to-one coverage, we

awareness around savings realized beyond the parts themselves, enabling departments to become more efficient in the procurement process, through the use of technology and partnership,” he adds. “It’s more important than ever for providers to navigate the delicate balance between delivering quality health care and controlling costs,” Salmons says.

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COVER STORY

JIM SALMONS Vice President of Philips Multi-Vendor Services and AllParts Medical

“Managing equipment maintenance and parts replacement – with an eye to optimizing resource utilization – is an essential part of every HTM’s solution.” He says that maximizing the material spend efficiency to include a range of repair options may help in reducing costs for hospitals. He also points out that the circular economy approach can lengthen the interim between wholesale replacements of equipment while assuring the latest technology is in the hand of practitioners and at the service of patients.

MANAGING AVAILABILITY An optimized supply chain, and supply chain management, results in lower costs and a faster production cycle. Planning and coordination impact parts availability, pricing and logistical considerations. Technology, once again, plays a crucial role. “Supply chains are narrowing down their preferred vendor lists by seeking supplier qualification. They are taking into consideration issues like quality, cost savings, part availability, fill rates, and support capabilities to help them thin out the suppliers they purchase from,” Smith says. “Supply chains are also asking for customized solutions. It is important that they be able to purchase from vendors who can save them time and money without sacrificing quality. They are looking for suppliers

who will work with them to come up with solutions that fit them specifically,” he adds. The importance of parts availability cannot be overstated. While pricing often takes priority, the ability to supply the part needed is what should be at the top of the buyer’s priority list, according to Haduch. “Though everyone wants to lower their parts spend, the cost of a part is meaningless if your parts provider can’t find your part. Before entering in to any agreement with a parts provider make sure they can fulfill the overwhelming majority of your parts needs,” he says. “Do an analysis of your parts orders over the past 2-3 years. Ask your prospective parts vendor what percentage of those orders they can fill. You’ll have additional leverage, and additional convenience, if you can minimize the number of vendors you utilize. Only consider vendors that can fill at least 85 percent of your parts orders. This will minimize the amount of time your staff spends researching parts and allow them to do what they want to do … work on equipment,” Haduch adds. He also emphasizes that technology is key in getting the most out of available resources, when adding staff is not always a reasonable option. “Price and availability are key metrics when evaluating parts solutions. What is often overlooked is the chance to increase workplace efficiency,” Haduch says. “It’s been more than five years since we’ve integrated our CMMS with a parts supplier. Doing this streamlined our ordering process, increased oversight of our parts orders, and completely eliminated the need for our engineers to research parts, allowing them to spend more time on PMs and repairs.” Kirwin agrees that CMMS offers capabilities that help get the most from a supplier network. “Establish a broad network of parts and labor suppliers and build that intelligence into the CMMS,” he says. “You need primary, secondary, tertiary suppliers for each modaility cataloged so that

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DAVID SULAK National Sales director at PartSource

you can query the broader market quickly. Spend time vetting your parts suppliers – quality, reliability, ability to deliver as expected can be offsets to some degree for price. In other words – shop smart.” “We continue to see trends in supply chain consolidation to create a more lean purchasing process with higher levels of quality controls,” Probst says. “In the end, the customer wins if they can correctly align their organizational goals with a vendor that can support them. This, however, is not always relevant in health care facilities that do not have centralized or process-related purchasing. The general shift, though, is moving to reduce the vendor base.”

IT WORKS AT THE GROCERY STORE Consumers are also in need of saving money as the costs of many daily essentials climbs. Household budgets are often impacted when a major appliance goes on the fritz. Some consumer strategies extend to the parts buying scenario as well. “Price-matching is a strategy we employ as well. An HTM department can negotiate price-matching as something done ‘on the fly’ on a transaction level, and introduce it as a term into service agreements with OEMs,” Serwetnyk says. “For example, through aggressive sourcing and price-matching written into our contract

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TIPS FOR ACQUIRING PARTS S T R AT E G I E S T H AT H E L P T H E B OT TO M L I N E

terms with one OEM, we were able to reat sourcing, you can really impact costs duce overall parts spend on one OEM’s fairly quickly.” entire product line by a net 35 percent, which was beyond the 40-50 percent AAMI RESOURCE off we were already paying under our The link to AAMI’s Replacement Parts mix of OEM and market sourcing.” Checklist can be found at www.aami. “We are not required to buy all parts org/productspublications/articledetail. through the OEM, which was a key aspx?ItemNumber=2784. The checklist, strategy to keep the price-matching developed by AAMI’s Supportability Task function viable. An example of this was Force, includes pointers for both HTM a deal where two defective $125,000 professionals and manufacturers. It suppleimaging components – not covered unments the suggestions contained here and der the contract for the particular sysprovides guidance. tems – were quoted to us for $80,000 In closing, the message is clear; techeach under our OEM agreement. The nology, combined with strategic thinking PROOF APPROVED CHANGES NEEDED same OEM ended up providing them to and planning, can make the parts buying us brand new for under $35,000 each challenge less so. CLIENT SIGN–OFF: due to a competitive sourcing situation “Growth of the parts market, done we invoked, as CONFIRM per the terms THAT of our THE FOLLOWING through strategic partnerships – both OEM PLEASE ARE CORRECT contract with them,” Serwetnyk adds. and secondary market – and ability to LOGO PHONE NUMBERidentify WEBSITE ADDRESS “One can see that if you actively look the next group of parts that will be

most likely to be needed for replacements (tubes/detectors, etcetera),” Sulak says. “Also, the use of electronic procurement will promote growth at the most cost-efficient manner, setting the direction of the new standard for procurement to be used by OEMs, vendors, and end users.” “I think the HTM industry needs to support the quality vendors in the parts market so it can continue to grow, as it is really a key component in helping lower support costs for the organizations we serve,” Serwetnyk says. “This is especially important in light of the continued trend in reductions for reimbursements many organizations have been seeing the last several years.“ Unless budgets begin to expand, an unlikely scenario, the ability to procure high-quality parts, with the most favorable entire life cycle cost, is a reality into the SPELLING GRAMMAR foreseeable future.

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EXPERT ADVICE

BY CINDY STEPHENS

CAREER CENTER

Maintaining High Standards in Business Communication Etiquette

don’t know when it became acceptable to not return phone calls or emails, but it seems to be a complaint we hear often from hiring officials and human resource managers. As recruiters in our firm, we have also experienced this.

CINDY STEPHENS Stephens International Recruiting, Inc.

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NOVEMBER 2016

There seems to be a serious breakdown in professional courtesies and business communication etiquette today. Maybe social media has taken over and has potentially made people less socially conscious and less professional. I am not sure of the reason or the cause of the breakdown, but I find the lack of responsiveness to phone calls and emails inexcusable and unacceptable behavior especially in today’s world of technological advances that have made communication so easy. I understand that this inadequate or inexcusable communication behavior is experienced by candidates and hiring officials. It goes both ways. The sad thing is that so many people have been left with a very “bad taste” about the person involved and whether it is the company or the prospective employee, the reputation of unprofessionalism soon gets around about that particular person or company, regardless of the situation. The reality is that health care in general and specifically the medical device industry is a very small niche. Lack of professional courtesy can negatively influence an individual’s career success very quickly or give a company’s hiring official a bad reputation quickly. On occasion, we see a lack of professional courtesy when it comes to communication during a candidate’s job search. There are times that the reason a candidate doesn’t go further in the hiring process is simply because of their poor communication skills. When a candidate becomes complacent in their responsiveness, they are quickly perceived as not interested, unmotivated, and very unprofessional. This is a detriment to their job search success. Just as important is the response time of prospective employers. As a recruiting organization, we see the results of compla-

cent or nonresponsive managers who do not respond in a timely manner to candidates. Great candidates do not wait to hear from employers as they are being courted by several employers simultaneously. Those employers that keep a dialog going and show an interest in the candidate will prevail. Those who don’t will be continuing to conduct a candidate search and will significantly delay the hiring process. They will soon find the candidate has moved on and has lost interest in the opportunity. The other result is that the candidate loses respect for the employer or company. The rules of common courtesy have not changed, though, and we, in the healthcare technology management career field, need to be reminded how important it is to respond promptly to calls, emails and other forms of communication. Being busy is never a valid excuse for not responding or communicating in a timely manner. Using proper communication etiquette makes a lasting business impression and politeness never goes out of fashion, no matter what age you are nor how busy you think you are. Don’t ever believe this doesn’t matter. Effective communication is critical in business and how you communicate with others greatly affects the way they perceive you. Whether you are responding to a phone call, voicemail message, or email message, professionalism is very important. Equally significant is how soon you respond to messages and calls. If you do not respond promptly, you may be perceived as a person lacking in professional courtesy. Remember, always maintain your professional courtesies and use effective and timely communications skills daily. •R eturn phone calls and email messages

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immediately. Respond promptly or within 24 hours of a phone call or email message. If an excessive amount of time goes by, explain why it took you so long to get back to them. There is nothing that says “I’m really not interested” more than a delay in either of these areas. Don’t waste time during your business day on email messages that are not business related or important to your job and career. • Remember, it is never acceptable to not return phone calls. If you are pressed for time, return the call to determine

the urgency and the topic of discussion. Let the caller know whether you can help them or not, or tell them you will have to call them later when you are not so pressed for time. People who return phone calls are trusted and respected. You do not need to make the calls long. In fact, scheduling time to return calls several times a day will help manage your time more appropriately and a prospective employer will be impressed that you are managing your time effectively. Your ability to effectively and quickly

return phone calls or messages may be a factor that generates the perfect job offer or a promotion. Be sure to use excellent communication skills and professional courtesies to ensure success. Maintaining high standards in business communication etiquette and using common courtesies continues to be very important today. If you want to be remembered, trusted and respected, you will practice or convey these courtesies with every business contact daily. Treat others as you would like to be treated.

C O M E G RO W WIT H US Build Your Career at Crothall Healthcare Technology Solutions H O W FA R CAN YOU GO? Career opportunities abound when you are part of a growing Team. Crothall Healthcare Technology Solutions (HTS) has grown 373% in just the last 5 years and an amazing 20 times over in the last 10 years. With growth comes new jobs and new opportunities.

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ISN’T IT TIME FOR YOU TO FIND OUT MORE? Come grow with us. Please contact: Come see why Crothall has earned Modern Healthcare’s Best Places to Work four years in a row.

Theresa Howell Talent Acquisition Manager Theresa.howell@compass-usa.com

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BY MATT TOMORY