TechNation - January 2017 by MD Publishing

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EMPOWERING THE BIOMEDICAL / HTM PROFESSIONAL

JANUARY 2017

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E R O M & W E I E V H T RE T A K N O O O I L T A A C I F I T R E S C T N W E E N M E R I REQU dard n a t S l na

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16 Professional of the Month

Michael Dugal, CBET, BSIT

23 News and Notes Address Service Requested MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269

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Vol. 8

Industry Updates

38 Roundtable

Patient Monitors

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

ATIENT MONITORS P Medical professionals often turn to patient monitor devices to diagnose and track patients. HTM professionals play an important role in every patient’s health by providing patient monitor devices that work as they are intended. TechNation reached out to a panel of experts to quiz them about what HTM professionals need to know when working on patient monitors.

CBET REVIEW & MORE The certification process for HTM professionals in 2017 has changed from a points-based system to one based on continuing education units, or CEUs, in an effort to be more consistent with other certifying bodies and to make maintaining certification less complicated and time consuming. TechNation outlines the process to become or maintain a certification. Next month’s Feature article: Tech to Tycoon: A look at biomeds who have started their own successful business

Next month’s Roundtable article: Ultrasound Probes

TechNation (Vol. 8, Issue #1) January 2017 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

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JANUARY 2017

TECHNATION

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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

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EDITORIAL BOARD

Eddie Acosta, MBA, BS, CBET, CLRT, Business Development and Marketing Manager at Colin Construction Company Inc James R. Fedele, Director, Biomedical Engineering, Susquehanna Health Izabella A. Gieras, MS, MBA, CCE, Director, Clinical Technology at Huntington Memorial Hospital Salim Kai, MSPSL, CBET, Manager, Biomedical Engineering at Kettering Health Network Robert Preston, Regional Service Manager at Siemens Healthcare Inhel Rekik, Clinical Engineer, University of Maryland Medical Center Manny Roman, CRES, Business Operations Manager, Association of Medical Service Providers Karen Waninger, Director, Healthcare Technology Management at Community Hospitals Indianapolis

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Proud supporters of

Departments P.12 SPOTLIGHT p.12 Department of the Month: University of Vermont Technical Services Partnership p.16 Professional of the Month: Michael Dugal p.18 Biomed Adventures: Volunteering Adventure P.21 INDUSTRY UPDATES p.21 Higher Standards: Quality Probe Repair Services p.23 News and Notes: Updates from the HTM Industry p.27 AAMI Update p.28 ECRI Institute Update P.30 p.30 p.32 p.34 p.36

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

P.46 p.46 p.49 p.50 p.52 p.54 p.56 p.58 p.60

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

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SPOTLIGHT

BY K. RICHARD DOUGLAS

DEPARTMENT PROFILE

University of Vermont Technical Services Partnership

uring the fall, the 460-acre campus at the University of Vermont (UVM) is adorned with a kaleidoscope of color. It may be the only thing more striking than the university’s architecture, which includes many historic buildings. Founded in 1791, UVM is located in the city of Burlington. The 225-year old institution sits on the shore of Lake Champlain, just a portion of its 587 miles of shoreline.

The campus includes a Medical Education Center and a teaching hospital. The UVM Medical Center works in alliance with the University of Vermont College of Medicine. Handling the needs of the medical equipment at the Medical Center, along with regional community hospitals, clinics, and private practitioners is the Technical Services Partnership (TSP), which is a not-for-profit shared service division within the University of Vermont covering facilities in Vermont, New Hampshire and New York. TSP’s inception was in 1973 and was originally borne out of the work of a UVM graduate student who conducted a needs assessment of all hospitals in the state of Vermont. The program blossomed after the Universities of Maine and New Hampshire got involved and grant money was secured to launch the new partnership. The grant funding continued through the fall of 1976, at which time hospitals picked up remunerating the services. “Technical Services Partnership is a department of the University of Vermont with 54 staff members

TECHNATION

JANURARY 2017

including biomedical technicians, clinical engineers, supervisors and administrative support staff,” says Michael W. Lane, MBA, CMQOE, CHTM, associate director of TSP. “We serve 30 hospitals in Vermont, New Hampshire and Northern New York along with more than 300+ clinics,” Lane says. “The University of Vermont Medical Center and Health Network covers five hospitals in the network.” “All of our clinical engineers are certified through ACCE. More than 60 percent of our staff are certified through ACI as CBETs and two of our supervisory staff are certified as CHTM,” he says. “The TSP University of Vermont program delivers high-quality online education for healthcare technology managers. TSP is dedicated to the profession locally and globally hosting international clinical engineering interns from across the United States, Peru and Columbia year round,” Lane adds. The TSP team includes technicians who specialize in anesthesia, laser and biological safety. “TSP provides services that cover the entire life cycle of healthcare technology management including planning (assessment, budgeting, acquisition and replacement services) and management (education, compliance, maintenance and safety),” Lane says. “TSP is actively involved in the integration of medical equipment at the University of Vermont Medical Center. Integration efforts include physiological monitoring, ventilation [and] SPO2,” Lane says.

“We manage service contracts through our program called CAPP, which is a centralized management program for all sites,” Lane adds. “We evaluate the service contract and identify the optimum terms and conditions through consultation with the department manager. The selection of the service vendor, terms of service and coverage is agreed upon. The information is entered into our CMMS including scheduled PMs. All information related to the service contract is reviewed annually,” Lane explains. Constant internal improvements are achieved through data collection and process refinements. “Clients can request work online through an online portal. Data Collection is performed by the healthcare technology management staff at the time of service in the field,” Lane states. “Standardization is accomplish through Best Practice routing to standardize equipment inventory information. A Best Practice team made up of biomedical technicians, clinical engineers, administrative staff and supervisors review ‘bright ideas’ submitted by staff monthly to take action to improve our data management and collection process,” he says. INNOVATIVE IDEAS “TSP aims to address the unique challenges of today’s Healthcare Technology Management challenges with unique and thoughtful solutions. Successful work along with challenges encountered along the way are pub-

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SPOTLIGHT

“We are working greatly on a project to develop the cybersecurity management process for medical device security.” lished through our bright ideas submissions and elsewhere. These include challenges related to mentoring, certification, AEM planning and more,” Lanes says. As mentioned, the group has brought creative thinking to readers though AAMI’s Biomedical Instrumentation & Technology (BI&T) Bright Ideas column over the past eight years. For instance, in the Spring 2015 issue, an article titled “Group’s Deep Data Dive Helps Optimize Medical Equipment Maintenance,” described how the TSP team undertook an initiative called the “Comprehensive Preventive Maintenance Frequency Adjustment Project.” The department utilized three

years of data collection to optimize risk-adjusted scheduling of PMs. An earlier Bright Ideas article discussed the group’s new hire orientation and how, through a five or six year process of fine tuning, they created a three-step process that makes new hires feel more welcome, imparts new training and assessment and real-time mentoring, along with spending an entire day at a client site. The entire process became very methodical and well-planned and included a scheduled follow-up checklist with each new hire. The TSP team will be offering up yet another bit of their shared wisdom with an article in 2017 titled; “PM Procedure Development

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

Process to Meet AEM.” Buttoning down medical devices and networks from cyber attacks and breaches is another project the group is busy with. “We are working greatly on a project to develop the cybersecurity management process for medical device security,” Lane says. “This project is focused on defining a Risk Management Program for our entire inventory related to information security risks, developing protection and threat analysis strategies. The process is based on the IEC 80001 standards and guidance from NIST.” TSP is also supportive of the HTM community outside its doors through presentations at the annual AAMI meeting, and through committee participation. The TSP team continues to be a thought leader in HTM, along with its unique structure and history. Along with its management team, technicians and engineers, the partnership benefits patients in three states and biomeds nationwide.

JANURARY 2017

TECHNATION

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SPOTLIGHT

BY K. RICHARD DOUGLAS

PROFESSIONAL OF THE MONTH Michael Dugal, CBET, BSIT

ery often, while profiling a biomed as our Professional of the Month, there is a description of how that HTM professional took a circuitous route to becoming a biomed. It isn’t always cut and dry. Many biomeds train for one occupation, and may work in another field initially, before finding their way to the HTM profession.

Back in 1990, Michael Dugal, CBET, BSIT, learned how that can happen. Dugal had spent a few years in the Army in the 1970s and then took classes through a community college to earn an associate degree in electronics. After getting his degree, he went to work for three different large computer companies and remained in that line of work for the next 27 years. He had grown up in northern Maine but left the area when he took the first job. In 1990, he decided it was time to return with his family to where he grew up. He got a job in the Maintenance Department at Cary Medical Center in Caribou, Maine. His wife, a nurse, had already accepted a job in the Special Care Unit. “The hospital quickly discovered that I had an associate degree in electronics and I was asked to fix a few pieces of medical equipment, as we had a contract with Technology in Medicine and the technician was only here once every two weeks,” Dugal remembers. “My manager saw an opportunity to get rid of the third-party service and have an in-house solution. So, less than three years from my initial start date, I became the biomedical technician at Cary Medical Center.” His fellow biomeds, outside of his facility, proved to be great resources for an electronics guy who just became the sole biomed at a hospital.

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JANURARY 2017

“Because I was the first dedicated in-house biomed at Cary Medical Center, I had to ‘grow’ the program. I created documentation – procedures, policies, databases, etcetera – for our program. I contacted Gary Harmon, the Clinical Engineering Director at Maine Medical Center in Portland and other nearby hospitals to see what worked and to acquire their documentation to use as an example. I then created what we needed to operate as a biomed shop,” Dugal says. Back at that time, Dugal had approximately 800 assets to maintain. He also took care of telecommunications equipment and some computer equipment because of his experience. AN HTM-IT BALANCE Ten years after beginning at Cary, Dugal’s current boss, who is the CIO, took over the biomed department and hired Dugal for the IT department. They then contracted with GE Medical for the next 10 years with the understanding that Dugal would oversee biomed. He still did device repair and helped the GE tech with equipment that Dugal had more experience with. He also continued maintaining the telecommunications equipment, as well as computers and networking. Dugal’s unique blend of experience and education allows him to straddle the HTM-IT divide with confidence in both areas.

“One major challenge I have encountered is to balance my time between biomedical duties, telecommunication duties, and IT/ networking duties,” Dugal says. “I may be installing a new IP phone for someone and programming their voicemail one minute and get a call to go up to the operating room ‘stat’ for an OR table malfunction. Or I may be installing and configuring a new network switch and have to leave that to fix an electrosurgical machine or a telemetry unit.” Dugal says he has a sign on his door that reads; “When it comes to safety, I maintain all equipment like my family’s life depended on it.” “The biggest challenge is to balance my time and still maintain a high level of maintenance with the emphasis on safety,” he says. “I use all of the hospital’s resources, i.e. the Maintenance Department and my IT coworkers to assist me when the work piles up. They have been very helpful and I could not do it without them.” In 2007, he acquired a bachelor’s degree in IT with an emphasis on networking and then acquired Cisco CCNA certification. “In 2010, I was asked if I would be interested in taking on the biomedical position again and the hospital let the contract with GE Medical lapse,” Dugal says. “I would still have to perform my IT and telecommunication duties. This would present a challenge, as our inventory had grown to approximately 1,000 pieces of equipment. The GE biomed was, at the time, full time at

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SPOTLIGHT

“ My manager saw an opportunity to get rid of the third-party service and have an in-house solution. So, less than three years from my initial start date, I became the biomedical technician at Cary Medical Center.” Cary Medical. I had to pretty much start over as I did at the beginning and help organize the department.” With the help of the CIO, they acquired test equipment and a new inventory management system. AWAY FROM THE MEDICAL CENTER Away from work, Dugal’s time and avocation runs from making people laugh to helping people learn. “I am currently an adjunct teacher at the University Of Maine in Presque Isle Maine. When there is a need I teach two classes; Database Management and Project Management,” he says. He has also been a Shriner clown for about 14 years. And, he has coached girls high school soccer for 13 years. He also enjoys the outdoors. “I love going out on the trails with my UTV. I especially like to fly my drone and take pictures of the beautiful landscapes in Northern Maine,” Dugal says. After doing biomed work for 28 years,

Mike Dugal CBET, BSIT is in his 27th year as a Biomedical Technician.

Dugal plans to retire at age 62. That is not too far off. The inventory, which was once 800 assets, has grown to 1,200, excluding diagnostic imaging and anesthesia equipment. Dugal reflects back on how things have progressed after first getting his electronics degree and his upcoming retirement. “That will mean that I will have been a technician for 44 years. From troubleshooting with oscilloscopes and analyzers to just popping boards out and replacing them, it has been an adventure,” he says. “I strongly believe that ‘the dash between the dates’ is indicative of your true character. I try to live a humble life, but I am proud of what I accomplished through the years. I could develop an ‘I don’t care attitude’ because my time to retirement is short, but I will finish strong. I made a commitment to my boss that I will help the hospital transition to however they decide to replace me,” Dugal adds.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FAVORITE BOOK:

“Outliers” by Malcom Gladwell

FAVORITE MOVIE: “Dances with Wolves”

FAVORITE FOOD: Seafood

HIDDEN TALENT:

I have a large amount of magic tricks I bought over the years and occasionally like to perform them.

FAVORITE PART OF BEING A BIOMED:

Troubleshooting a difficult problem and finding the solution myself and the interactions with the hospital staff.

WHAT’S ON MY BENCH • • • • • •

A small fan 2 laptops A lab DC power supply A Weller soldering station An old analog Triplett meter I always keep a granola bar handy and drinks in a small refrigerator under my bench. JANURARY 2017

TECHNATION

SPOTLIGHT

BY K. RICHARD DOUGLAS

BIOMED ADVENTURES Volunteering Adventure

ach Christmas season, including the most recent one, we are reminded that giving is often more enjoyable than receiving. Seeing the joy on the face of those benefiting from our generosity is reward enough. That doesn’t mean just giving financially, but giving of our time and talents. The self-satisfaction and rewards of donating one’s time and experience could fill a room. Just ask any HTM professional who has done it.

There are several not-for-profit organizations that facilitate bringing the skills of HTM professionals to people and health care systems in developing countries. This is a life-saving and life-changing experience for the biomed, as well as for the patients in those underserved areas. Often, these health systems rely on donated medical equipment, often requiring service or repairs, in order to serve the needs of the local communities. It is a fulfilling experience for the biomeds who have answered the call. Steve Vanderzee, director of Clinical Engineering for Advocate Healthcare in Oak Brook, Illinois, can attest to that last point. Vanderzee is no stranger to volunteering and sharing his talents as an HTM professional. He has done so domestically and recently had the opportunity to visit Ghana, Africa with a group of Project C.U.R.E. volunteers. It proved to be a much different experience. Project C.U.R.E. describes itself as “the largest provider of donated medical supplies and equipment to developing countries around the world.” The organization, founded in 1987, depends on donations and fundraising to provide medical supplies to the developing world. Two or three cargo containers of these supplies leave the organization’s ware-

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JANURARY 2017

houses every week, according to the organization’s website. Vanderzee’s employer, Advocate Healthcare, has partnered with Project C.U.R.E. AN ADVENTURE The trip to Ghana required a 10-hour plane ride, then staying overnight in the capital city of Accra. Vanderzee then took a regional flight further inland to the city of Kumasi followed by a two-hour drive over mainly dirt roads to a base camp at the Chirano Gold Mine. “The overnight stay at Accra was very nice. We stayed at what is probably considered a 4-star hotel by U.S. standards. Ghana has experienced several military coup in the past few years. It is currently a very stable environment, but there is evidence that the country has endured many difficult times,” Vanderzee says. “Our hotel compound, along with many others, was surrounded by a brick wall with serpentine wire. Our group went on an excursion the first day in Accra and we always felt very safe,” he adds. “The flight to Kumasi the next day was very short; 45 minutes.” Vanderzee says that from Kumasi, the mining company picked them up in a large van. The 2-hour drive to the mining compound was mostly on dirt roads

through many villages. He says that the roads are more suitable for Jeeps than the van they were riding in. “I was not prepared for the overall conditions of the clinics,” Vanderzee say. “With the exception of one of the clinics near the mine, and the regional hospital, the clinics were very dusty and had no air conditioning.” The group traveled as two separate teams. Each day started at 5 a.m. and the teams typically were not back to the mining compound until after 6 p.m. “It was very long days but they went by quickly,” Vanderzee says. “The clinics were on average no more than 5-6 kilometers from the mine, but the average time to travel to the clinics was 30-45 minutes.” “The local staff were very appreciative of our services and some assisted with repairs, while others helped with sorting and moving supplies,” he adds. Vanderzee says that at some of the clinics, the local community joined in. “At one clinic, we had over 25 kids all watching what we were doing and engaging our team as we left the site,” he says. IMPORTANT WORK “While in Ghana, we were able to test and validate a lot of basic medical devices (most not in use because we hadn’t sent transformers that could be used with their 220 power source). We converted more than 30 transforms while we were there,” Vanderzee says. “However, the issue of sustaining the operation of these devices is going to be a real challenge where there is basically no technical resources,” he adds.

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SPOTLIGHT

Project C.U.R.E. team seen with clinic staff.

Vanderzee also noticed that there was a gap between the clinical staff competency and the device technology that was being sent. “An example was a fetal monitor. I ‘in serviced’ clinical staff on the application of this device, but it was clear they did not understand the correlation between the contractions and the fetal heart rate. Their basic hand held, battery operated fetal heart monitor was their go-to device,” he says. “The most frustrating part of my trip was not being able to install a dental system that was sent to a hospital in the Bibiani district,” Vanderzee says. He says it was clearly a system that was needed and there was staff and space designated for the service. “The air compressor, intended to be installed in a separate room was incomplete, most likely when the equipment was taken from the containers the parts were separated,” he says. He says that they did not send any piping or regulators needed to connect the air compressor and the main dental system. “In addition to compressed air, the dental unit required a pressurized water source. This was clearly an opportunity

to better anticipate what the site could support and possibly modify the system to accommodate the limitation the site has,” Vanderzee says. The frustration still gets to him. “(It is) a very difficult situation for someone who is used to fixing this type of equipment to have to leave without providing a complete and operational system,” Vanderzee says During Vanderzee’s 37 years in clinical engineering, he has supported several not-for-profit organizations by redirecting medical devices no longer needed by his organization. “I currently have a program where we donate our time at a local Project C.U.R.E. facility in Chicago,” Vanderzee says. “We test and repair medical devices. Based on my recent experiences, we need to help organization like Project C.U.R.E. differently. We need to look for ways to modify devices so that they can be used within the country’s limitations. We must do better on-site assessments, both on the infrastructure, and clinical competency. We need to develop more technical development programs so they can support the devices; ‘teach them how to fish.’”

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

A look inside the hospital’s storage area.

As clinical engineering director at Advocate, Vanderzee and his team have responsibility for 12 acute care sites, one critical access site and over 400 clinics. They oversee an inventory of over 82,000 devices. “We have a very comprehensive program that includes a dedicated call enter, business office, technology team, along with site and regional support staff,” Vanderzee says. Vanderzee says he could write a book about his experiences in Ghana. The book would be for an American audience. For many Ghanaians, who depend on those clinics, they’re benefiting by the story firsthand.

JANURARY 2017

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HIGHER STANDARDS Quality Probe Repair Services

he medical industry is abuzz with discussions about the potential for additional government regulations regarding the manufacture, refurbish and maintenance of equipment. Ongoing conversations among industry leaders, stakeholders and experts revolve around the importance of quality standards and how new regulations will impact the service industry.

As an OEM of ultrasound equipment, GE Healthcare understands the need for quality and is focused on driving high standards for its multi-vendor probe repair services. TECHNATION: Why does quality matter for ultrasound users? GE HEALTHCARE: In Ultrasound, most service related issues involve the probe. In fact, we have seen evidence that 1 in 4 probes in clinical use today have some sort of defect. For ultrasound users, probe issues make up the most time, effort, and financial risk. Because of this, it’s critical for HTM professionals to understand what defines quality repair as they select their service provider. TECHNATION: Can you tell our readers more about GE Healthcare’s leadership in probe repair services? GE HEALTHCARE: We know how crucial it is that ultrasound equipment remains patient-ready. Downtime due to probe failures can cost valuable resources and reduce overall quality of care. That is why GE Healthcare has been expanding our probe solutions and services. On May 29,

SCOTT TREVINO

General Manager, Global Repair Operations, GE Healthcare

2013, GE Healthcare acquired Unisyn Medical Technologies’ Transactional Business, which includes their multivendor probe repair services and proprietary test equipment business. With this acquisition, we have been integrating Unisyn’s existing ISO 9001 and 13485 certification into our broader GE Healthcare QMS and investing in the capabilities of the business and operation.

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TECHNATION: How is GE Healthcare preparing for potential additional government regulations in the service industry? GE HEALTHCARE: Repairs performed on ultrasound probes should be benchmarked to OEM specifications. However, across the industry we are finding that repair quality can be inconsistent and not to the OEM performance standard. Because we manufacture probes and ultrasound equipment, our GE probe repair services are consistent with our manufacturing standards. Quality is foundational to our organization and drives our probe repair services in the way that we engineer, validate, and repair our probes. In the case of our multi-vendor repairs, our programs were developed to include risk management and regulatory activities to demonstrate compliance with safety regulations. And we apply the same QMS requirements for qualification, risk management, and production and process controls to our multi-vendor probe services as we do to our own probes. Since the acquisition of Unisyn’s probe repair business, we have taken their existing expertise and applied our knowledge and experience. When a customer sends us a probe, we don’t just repair it; we verify each and every probe to our high quality standard.

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NEWS & NOTES

Updates from the HTM Industry AUE EXPANDS PHILIPS CX50 REPAIR SERVICES

CESO CONFERENCE SET FOR FEBRUARY The Clinical Engineering Society of Ontario (CESO) conference will be happening this coming February 2017. The CESO 2017 Conference and AGM will take place on February 6-7, 2017 at the Sick Kids Hospital, Peter Gilgan Centre for Research and Learning in downtown Toronto. CESO 2017 will bring healthcare technology professionals together for two days of learning opportunities, networking, and advances in clinical engineering and healthcare technology. For details, visit www.ceso.on.ca.

Advanced Ultrasound Electronics (AUE) recently expanded its Philips CX50 Repair and Parts Department to provide greater and faster CX50 repair capabilities. In addition, AUE has enlarged its CX50 loaner inventory to more than 25 systems in-house ready for overnight shipment while a system is being repaired at AUE. “We understand ‘Mission Critical’ when being down simply isn’t an option,” AUE Vice President of Operations Henry Dinneen said. “We have a vast inventory of parts and common failure components on hand. Not only do we provide a system while yours is being repaired, but our team of technicians – specializing in the CX50 – will get your system repaired and returned to you faster than anybody else! Period.” Do you have multiple CX50 or CX30 systems in your facility? Let AUE help with a maintenance plan that includes preventive maintenance and priority service. From power supplies to probes, and everything in between, AUE can provide CX50 service, repairs, or maintenance. AUE can help diagnose the issue over the phone and recommend the best course of action. For more information, call AUE at 866-620-2831 or visit AUE’s new website at www.CX50REPAIR.com

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SMITHS MEDICAL LAUNCHES PHARMGUARD INTEROPERABILITY SOFTWARE Smiths Medical, a global medical device manufacturer, has launched version 1.1 of its PharmGuard interoperability software for use with Medfusion 4000 wireless syringe pumps. The new version allows bi-directional integration with IHE compatible EMR systems. The addition of smart pump programming is designed to allow a clinician order to be sent directly to the Medfusion 4000 pump, allowing nurses to validate the programmed information with less manual entry, while keeping nurses in control. PharmGuard interoperability software, released in 2015, already allows wireless communication of infusion data directly into patient records in the hospital’s EMR system, saving time in clinicians’ daily workflow, increasing documentation accuracy, and improving patient

safety by reducing manual data entry errors. It also forwards infusion pump alarms to hospital alarm management systems to alert clinicians. Smart pump programming, auto-documentation and alarm communication are supported by Integrating the Healthcare Enterprise (IHE) profiles. IHE is an initiative by health care professionals and the industry to improve the way computer systems in health care share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate effectively with one another, are easier to implement, and enable more effective use of information by care providers. JANURARY 2017

TECHNATION

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STAFF REPORTS

TRIBUTES, THANKS MARK RETIREMENT DINNER FOR AAMI’S LOGAN Mary Logan’s family and friends have long teased her about living in “Mary Land” – a place where unyielding optimism rules the day, no job is too big, people are always thinking kindly of one another, and the word “cannot” is simply not part of the vernacular. At a retirement dinner the AAMI Board of Directors hosted for Logan – who stepped down as AAMI’s president and CEO after eight years at the helm – one of her closest friends shouted out “Mary Land!” after listening to testimonials about her can-do spirit and Logan’s own account of her determination to forge a career at a time when many women were still struggling to find their place in the professional world. At AAMI, Logan said, she found the best job she ever had, inspired by its mission to make healthcare technology safer and more effective, impressed by the committed professionals on the frontlines, and supported by the Board of Directors and staff. “I never felt dissed as a woman for my leadership style, and I am so grateful for that,” Logan said. But it was her colleagues who had the most to say that evening, which was marked by heartfelt tributes, good-natured ribbing with lots of laughter, and a few tears. “AAMI as an organization is pretty amazing. Mary as a person is amazing,” said William Maisel, MD, chief scientist and deputy director for science at the Food and Drug Administration’s Center for 24

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Mary Logan, former AAMI President and CEO

Devices and Radiological Health. He saluted her “can-do attitude” and said her collaborative nature had made a huge difference in making healthcare technology safer. Frances Schrotter, senior vice president and chief operating officer at the American National Standards Institute (ANSI), hailed Logan as a “catalyst for change” who had the unique ability to both speak her mind and be the “first person to compliment a job well done.” Several speakers, including many who were featured in a video tribute, said that one of Logan’s greatest strengths at AAMI was building relationships and breaking down walls. “Mary’s done an amazing job of pulling the right people together to help solve problems,” said Erin Sparnon, an engineering manager in the ECRI

Institute’s health devices group, offering as an example Logan’s leadership in infusion system safety. The AAMI Board of Directors singled out Logan’s work in revitalizing the AAMI Foundation and making it a powerful voice in addressing patient safety issues through the prism of healthcare technology. In recognition of that effort, the Board announced that the Foundation’s new research fund had been renamed in her honor. Other speakers shared more personal anecdotes, whether it was remembering Logan’s willingness to don a cowboy hat and sing at one AAMI Annual Conference & Expo or, at another conference, recite for longtime AAMI member and healthcare technology management (HTM) leader Bob Stiefel a slightly bawdy and thoroughly funny story that mixed medical equipment maintenance programs and romance. (Stiefel returned the favor at the retirement dinner, regaling “Mary, Mary, Mary” with a sonnet of sorts.) Others took note of her initial outreach when she first took the reins at AAMI. Over the course of one year, she visited dozens of hospitals and businesses across the country, eager to learn about the work of HTM professionals, as well as those who work in the medical device industry. “The information she was able to take back to the organization … has been such a gem for us, and I think it’s helped a lot in understanding what we do,” said Vickie Snyder, an HTM consultant for the Veterans Health Administration. WWW.1TECHNATION.COM

INDUSTRY UPDATES SIEMENS PLANS TO PUBLICLY LIST HEALTH CARE BUSINESS Siemens intends to further develop its health care business, Siemens Healthineers, and give it even greater flexibility in implementing its growth plans. To this end, the company is planning to publicly list its health care business. “Healthcare technology is a highly attractive business in which we want to further expand our leading position. With this step, we continue to implement Vision 2020 launched in May 2014. The public listing will give Healthineers even more focus and flexibility in pursuing its growth strategy,” said Joe Kaeser, President and CEO of Siemens AG. In May 2014, Siemens announced its intention to set up its health care business as a “company within the company” so that the business could adjust to transformations in the health care market in a flexible and focused manner with its own market presence. This move is now practically complete. “The public listing is now the next

step in further strengthening Siemens Healthineers in Siemens for the future. We’re implementing this from an already leading position. Siemens Healthineers has already increased its market share and has an outstanding portfolio of top technologies that we’re further developing,” Kaeser added. Since May of 2016, Siemens’ health care business has operated under the uniform brand name Siemens Healthineers. The company will announce more precise details regarding the planned date and scope of the placement when plans for the public listing have been concretized. The listing will also depend, among other things, on the stock market environment. “The public listing is a key lever for reaching our strategic goal of being the enabler for health care providers worldwide,” said Bernd Montag, CEO of Siemens Healthineers. “Greater entrepreneurial freedom and agility will

Joe Kaeser, President and CEO of Siemens AG

allow us to help shape the development of the global health care market and the growth strategies of successful health care providers. We’ll enable our customers to participate successfully in the trends toward consolidation, industrialization and holistic health management with a high degree of clinical relevance, efficient workflows and financial value added.”

DANGEROUS INFUSION ERRORS TOP HEALTH TECHNOLOGY HAZARDS LIST The safe use of health technology – from infusion pumps to complex imaging systems – requires that health care facilities recognize the possibility of danger or difficulty with those technologies and that they take steps to minimize the likelihood of adverse events. The ECRI Institute has announced the launch of its Top 10 Health Technology Hazards for 2017 list. Produced each year by ECRI Institute’s Health Devices Group, the list identifies the potential sources of danger that ECRI believes warrant the greatest attention for the coming year. The guidance that accompanies the list provides practical strategies for reducing the risks, making the list a practical tool for establishing priorities and enacting solutions. “Technology safety can often be overlooked when hospital leaders are dealing with so many other issues,” says David T. Jamison, executive director, health devices group, ECRI Institute. “As an independent medical device testing laboratory and investigator of technologyrelated incidents, we know what can go wrong and what steps hospitals can take

to reduce patient harm related to specific technologies and processes.” This year’s No. 1 hazard calls attention to infusion errors that can still occur when using large-volume infusion pumps. Although today’s pumps incorporate features that reduce the risks of infusion errors, these safety mechanisms cannot eliminate all potential errors, and the mechanisms themselves have been known to fail. ECRI Institute continues to receive reports and investigate incidents of uncontrolled flow of medication to the patient – a potentially fatal circumstance known as “IV free flow” – and other infusion errors. Fortunately, as ECRI points out in its guidance document, a few simple steps can help catch use errors and component failures before patient care is affected. Inadequate cleaning of complex reusable instruments, including duodenoscopes, remains high on the list this year in the No. 2 spot due, in part, to the severity of the infection risks and also the persistence of the problem: ECRI Institute regularly sees reports of

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contaminated medical instruments being presented for use on a patient. Other topics on the 2017 list include ventilator alarm management, infection risks with heater-cooler devices, undetected opioid-induced respiratory depression, software management oversights, occupational radiation hazards in hybrid ORs, and more. To develop the annual list, ECRI Institute’s multidisciplinary staff of engineers, scientists, nurses, physicians, and safety analysts draw on the resources of the institute’s nearly 50-year history, as well as expertise and insight gained through testing and analyzing healthcare technologies. Topics on the list are selected by weighing factors such as the severity, frequency, breadth, insidiousness, and profile of the hazard. Additionally, all the hazards selected can, at least to some degree, be prevented by implementing appropriate measures. The Top 10 Health Technology Hazards for 2017 Executive Brief is available for free download at www.ecri. org/2017hazards.

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BY AAMI

AAMI UPDATE

B U I L D I N G T O M O R R O W S Since 1967

AAMI Celebrates 50 Years of Supporting Safe, Effective Healthcare Technology

ifty years ago, a group of pioneering medical device manufacturers, physicians, and inventors banded together to guide the development of healthcare technology. Today, AAMI – the result of their vision – stands as the preeminent organization in developing standards for medical devices, supporting the professionals who work in the healthcare technology field, and promoting the safe and effective use of this technology.

AAMI kicked off its golden anniversary celebration with the launch of a new website and the unveiling of a commemorative logo designed to honor its rich 50-year history. The celebration will continue throughout the year with special events, educational opportunities, and publications. “This anniversary is really about the extraordinary talents of our members and partners who have committed themselves to improving healthcare technology, supporting patient safety every step of the way,” said AAMI President Robert Jensen. “As healthcare technology evolves ever faster, AAMI is poised to have an even bigger role in shaping that evolution – through its standards; training, certification, and education programs; resource development; and its many patient safety initiatives.” Today, AAMI is made up of a diverse community of nearly 7,000 professionals, providing a critical forum for healthcare technology management (HTM) professionals, physicians, nurses, hospital administrators, educators, scientists, manufacturers, distributors, government regulators, and others with an interest in safety in healthcare technology. The theme of the 50th anniversary celebration is “Building Tomorrows,”

which recognizes that AAMI – and healthcare technology as a whole – continually builds on the past to create a brighter future. Since 1967, AAMI has made advances in its stated mission of providing global leadership to support the health care community in the development, management, and use of safe and effective healthcare technology. Its achievements include: • Helping to shape medical device regulation, especially in its early years as the Food and Drug Administration (FDA) emerged as the regulatory body for the industry. • Serving as a neutral convener – bringing diverse stakeholders together to advance the field. For example, since 2010, AAMI and the FDA have hosted seven summits to probe some of the biggest challenges in healthcare technology. • Taking a leading role in the development of hundreds of international and domestic consensus standards and related documents. The AAMI standards program consists of more than 100 technical committees and working groups that produce standards, recommended practices, and technical information reports covering all aspects of healthcare technology.

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• Working with clinical engineers, biomedical equipment technicians, educators, and other experts to coin the term “healthcare technology management” or HTM in 2011 and working with them to showcase the vital role these professionals play in modern health care. • Building a rich library of resources to support HTM professionals, sterilization experts, and those who design and develop medical devices. • Organizing a popular and growing annual conference and expo for HTM professionals. • Launching an eLearning portal, called AAMI University, that offers education and training related to the development and use of medical devices and technologies. • Expanding the AAMI Foundation to tackle some of the most critical and challenging issues faced in health care, including infusion therapy safety, clinical alarm management, and the continuous electronic monitoring of patients on opioids. • Expanding its certification programs to support professional development. The AAMI Credentials Institute now maintains five different certification programs serving biomedical equipment technicians, clinical engineers, radiology equipment specialists, and laboratory equipment specialists.

TO LEARN MORE about AAMI’s history and the events and activities planned throughout 2017, please visit www.aami.org/50. You can also join in the celebration by using #AAMI50.

JANURARY 2017

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INDUSTRY UPDATES

BY ECRI INSTITUTE

ECRI UPDATE

Not Too Hot or Too Cold – Getting Conductive Layer Warming Units Just Right

onductive layer warming units are most commonly used to help maintain normal body temperature (normothermia) during and after surgery; they are also used in postanesthesia care, labor and delivery, chemotherapy and dialysis treatments, orthopedic procedures, and emergency situations.

When the body loses too much heat and cannot maintain its normothermia of 36.6° to 37.5° C (97.9° to 99.5° F), it is considered to be in a state of hypothermia. Even mild hypothermia (a core temperature of 34° to 36° C [93.2 to 96.8° F]) can have severe repercussions for the patient, such as delayed wound healing, reduced resistance to infection, impairment of platelet function, increased intraoperative blood loss, and prolonged postoperative recovery time. Inadvertent perioperative heat loss typically results in average temperature drops of 0.5° to 1.5° C, but in severe cases the body temperature may drop 2° to 3° C. Surgical patients are at risk of becoming hypothermic due to significant heat loss sustained during surgery for a number of reasons, including: • Exposure of large areas of the patient’s body to the operating room environment, where humidity is low and room temperatures are typically between 18° and 19° C (64.4° and 66.2° F) • Evaporative heat loss from open body cavities • Application of volatile cleaning solutions to the skin and/or surgical wound(s) • Infusion of cold or roomtemperature fluids 28

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• Evaporative heat loss due to the inhalation of dry anesthetic gases • Impairment of normal thermoregulatory responses by anesthesia • Use of metabolism- or respirationsuppressing pharmacologic agents The body attempts to regain heat lost in the OR by shivering during the postoperative period. Shivering, which can intensify to tremors or violent shaking, poses extreme danger to the patient due to the increased metabolic demand. One study revealed a 92 percent increase in oxygen (O2) consumption in response to a drop in temperature of only 0.2° to 1.3° C; a 500 percent increase in O2 consumption was observed in response to violent shaking. The adverse consequences of the metabolic stress imposed by this increased energy demand include the following: • Increased risk of ventricular fibrillation, stroke, postoperative deep-vein thrombosis, and pulmonary embolization • Inhibition of hepatic and pancreatic activity, leading to changes in glucose metabolism • Decreased renal blood flow, resulting in decreased glomerular filtration, loss of proteins, and subsequent increased risk of wound infection • Interference with a patient’s emergence from anesthesia

In addition, tremors and shaking from shivering may adversely affect patient monitoring equipment. PRINCIPLES OF OPERATION Thermal conduction refers to the transfer of energy (heat) between adjacent molecules of a conducting medium in response to a temperature gradient. With conductive layer warming methods, effective warming of the patient is dependent upon direct contact between the patient and heated surfaces, in contrast with forced-air warming which involves moving heated air across the patient’s skin to raise the core body temperature. Conductive layer patient warming units are comprised of a heat-conducting (e.g., carbon polymer) layer in a blanket and/or a compressible underbody mattress. They are powered by a low voltage power source that is regulated by a temperature controller. The blanket(s) and/or mattress pad may contain water or gel to allow the warming layer to conform to the shape of the patient’s body for optimal heating. They should be made of a latex-free material that can withstand repeated cleaning and disinfection (e.g., urethane); they should also be nonflammable. Blankets are available in various sizes, including pediatric, adult, lower body, upper body, and full WWW.1TECHNATION.COM

INDUSTRY UPDATES

body. Specialized sizes designed for pre- and postoperative care are available from some manufacturers. Warming blankets used in the OR are designed to cover only the upper or lower body; a full blanket cannot be used because of the need to establish the operating field and to maintain sterility. Blankets for the postanesthesia care unit (PACU) or emergency department are full-body blankets. Both reusable and disposable blankets are available. Mattresses have straps or clips to secure them to an operating room table and may also be radiolucent. Some manufacturers offer mattress pads of pressure-reducing foam to reduce instances of vascular occlusion and heat-accelerated necrosis. The foam pad may be enclosed in a shell made of antimicrobial or disinfectable material. Conductive layer patient warming units have a controller for setting and regulating temperature and activating alarms, and some means (e.g., blankets) to deliver heat to the patient. The controller converts the mains input to a low voltage to achieve and maintain the required heating of the conductive blanket(s) and/or mattress layer(s). The controller may be mounted on a stand or IV pole, or attach to the bedrail via a hook or clip. At least one manufacturer offers a controller capable of regulating multiple

blankets and a mattress simultaneously. Blanket temperature is monitored by one or more thermistors, and controllers typically have primary and secondary alarms to ensure that clinicians are alerted if maximum temperature is exceeded. REPORTED PROBLEMS Conductive layer warming units, like other heating devices, have the potential to cause burn injuries. Patient burns can result from use of the device for extended periods of time on high temperature settings. A general guideline to follow is that the maximum temperature setting should not be used on patients in the presence of the following conditions, which could increase the risk of thermal injury: • Low cardiac output • Peripheral vascular disease (occlusive or diabetic) • Total immobilization • Unconsciousness • Poor peripheral perfusion • Marginal cutaneous perfusion The operator should frequently check patient temperature and vital signs during extended usage. In all cases, operators should reduce the temperature or end treatment when normothermia is achieved. ECRI INSTITUTE RECOMMENDATIONS As with any device or technology used in health care, organizations

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planning to purchase conductive layer patient warming units need to consider a wide variety of factors, including performance, safety, and maintenance. ECRI Institute recommends that conductive patient warming unit controllers have audible and visual overtemperature and malfunction alarms because they increase the likelihood that a caregiver will quickly respond to a device-related problem. The highest temperature setting should be limited to 43°C (109.4°F) and blankets and mattresses should not be capable of reaching temperatures greater than 46°C (114.8°F); higher temperatures increase the risk of thermal skin injury. The cable/hose connecting the blanket(s) and/or mattress to the control unit should be at least 3 m (9.8 ft) in length, and the unit should be equipped with adequate storage for the device components. For a warming unit that will be used in a post-anesthesia care unit, it would be advantageous for the controller to have outputs for more than one blanket and/or mattress. 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 /HPCS.

JANURARY 2017

TECHNATION

THE BENCH

BY MIKE POWERS

BIOMED 101 Mentoring Makes a Difference A

cherished friend of mine passed away recently. He was one of the first real “experts” I ever met when it came to image quality testing and the subsequent calibration of imaging equipment, cardiovascular equipment in particular. I feel like my life was enriched by the opportunity to know him and all those little life and work lessons that were passed on to me during long evenings poring over a broken room, and scratching my head wondering how to return it to service. As I look around our industry I see the gray hairs, and truth be told, I have a few myself. I know there are so many repositories of knowledge and I wonder how to champion the transfer of knowledge. I also consider what will happen if that knowledge goes away, and the people remaining in the HTM field have to “reinvent the wheel” and how that will impact our reputation as HTM departments and the security of our jobs.

So having given this some thought, it seems to me that there are people who can help you grow in three ways. There are those that are going to be your personal cheering section and they will support you even if you are going down a dead end route. These people are necessary because they will keep your spirits up when adversity strikes. They will believe in you through thick and thin. There are people who will advocate for you, think of those who you would ask to be your references, and visit those relationships often. See if they not only are advocating to you within their professional circles, but if they have advice that you need to hear or a new perspective within your own experience, that needs lifting and sponsorship. Finally there are mentors, people who will not be able to impact your personal or professional life directly, but can steer and provide insight to you in your journey toward excellence. Perhaps they can help you to see a potential set of career circumstances that will provide a measurable and attainable goal. Mentoring is an interesting idea for people at every level of the Healthcare Technology Management field. It allows for the exchange of knowledge and ideas and benefits both parties. I always have found that I never know anything so

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JANURARY 2017

MIKE POWERS

Clinical Engineering Supervisor at Christiana Care Health System

well as when I am trying to teach it to someone else. Conversely, when you have a high-potential employee one of the most exciting things is to see them grow and get more and more opportunities to contribute to your organization. So as our career field turns over, I am reminded of an axiom that the U.S. Navy taught me: Train your relief. Here are some things to consider when recommending someone on your team seek a mentor, or seeking out one

yourself. To begin, start with someone that you want to be like. For me, when first dealing with my friend, it was having the technical expertise that my colleague had and the knowledge to not only repair the unit but the user’s relationship with the unit. Essentially, why did I admire him? I had to study him, and also ask, if he was willing to make the effort to help me grow in this field. As our relationship grew I often reviewed the takeaways from each encounter, some being incorporated into my own skill set, others being understood but actively chosen to pursue at another time. I always felt it was important to follow up afterward and let him know how much I valued the time and help. We, of course, didn’t hurry our relationship. It grew some years at a snail’s pace. Other years it grew by leaps and bounds. However, the thing that I remember most was how when it was hardest and I wanted to put things on hold by walking away or taking a break, he encouraged me to stay engaged even though things were difficult. The process of working through those moments helped me and our relationship grow. I will miss him dearly, but am grateful that I had the opportunity to be mentored by someone as smart and caring as Jake Hess.

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Webinar

Wednesday

WEBINAR WEDNESDAY Educational Series Continues to Deliver

he TechNation Webinar Wednesday series continues to grow and serve the HTM community. The popular series eclipsed the 7,000 attendee mark in November.

AllParts Medical and Dunlee sponsored the webinar titled “Save Money and So Much More – Embrace the Circular Economy.” This webinar featured Steve Muniak, Regional Sales Manager, Central Region AllParts Medical & Dunlee – a Division of Philips. Muniak formerly served as the Director of Digital Services with SD Myers division where he was charged with growing the technology solutions division. During his presentation, Muniak discussed today’s linear “take, make, dispose” economic model, which relies on large quantities of cheap, easily accessible materials and energy, and is a model that is reaching its physical limits. He illustrated how a circular economy is an attractive and viable alternative that medical technology companies are already embracing. He also provided insightful tips and advice throughout the webinar. He even participated in a Q&A session at the conclusion of his prepared presentation providing additional information to attendees. Almost 300 people registered for the TechNation Webinar Wednesday presentation “Understanding Image Quality” sponsored by Summit Imaging. During the presentation, Carolyn Coffin, MPH, RDMS, RDCS, RVT, department chair and associate professor, diagnostic ultrasound at Seattle University discussed acoustic physics

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and principles as they apply to medical ultrasound, operator controls and the sonographer’s role in acquiring images and what sonographers expect from their ultrasound systems. She also touched on imaging artifacts and how to avoid them. Kyle Grozelle, Manager of Global Education and Training at Summit Imaging, was also on hand and answered questions following Coffin’s presentation. Grozelle manages the Summit training program that offers

featured insightful information from John DiPasquale, Technical Trainer for Technical Prospects LLC. The primary purpose of the presentation was to acquaint field engineers with the MQSA law that surrounds the mammography modality that is part of the imaging world. Those attending received an overview and a short history. Attendees were educated about the requirements under MQSA including the equipment, specific personnel responsibilities, some associated key

“ You can count on TechNation’s webinar series to keep you up to date...” –Mark H. personalized, interactive courses on ultrasound systems to health care organizations across the country. On November 9, almost 300 people attended “Pressure’s On: Non-Invasive Blood Pressure Testing in Today’s Market” sponsored by Fluke Biomedical. Non-Invasive Blood Pressure (NIBP) monitors have been on the market for decades. They are widely used by hospitals and medical facilities worldwide to gauge a patient’s blood pressure for diagnostic purposes and to gauge an individual’s overall health. The webinar, presented by Jerry Zion and Andrew Clay from Fluke Biomedical, introduced new standards of testing NIBP, the best methods for testing, and relevant standards to test against. They also addressed questions in an informative Q&A session following their presentation. The November 16 webinar “Mammography & MQSA – An Overview”

terminology and how the law applies to the digital equipment that is common in today’s health care facilities. An informative Q&A session followed the prepared session in which DiPasquale shared his expert knowledge with attendees. Participation in each webinar was eligible for 0.1 CE credit from the ACI. The TechNation Webinar Wednesday series continues to receive outstanding reviews. “You can count on TechNation’s webinar series to keep you up to date which is so nice, without TechNation we would be lost,” Mark H. wrote in a post-webinar survey. “I sincerely appreciate the training webinars provided by TechNation on the various imaging modalities that the clinical engineering services departments must service in today’s environment. The training seminars are very helpful in keeping clinical engineering departments up to date on current and

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GREAT NEWS

THE BENCH

ACI is increasing the CE value of webinars! In 2017 attendees will receive 1 CE credit per webinar.

“ Excellent! I have been in the biomed field for 15 years and I am looking at things differently and more knowledgeably by adding these webinars to my monthly to-do list.” –Greg H.

new regulatory and service requirements,” Bobby T. added. “This was the first TechNation Webinar I have attended and (it is) very relevant to my work,” Donald B. wrote. “My staff will be attending future webinars and I would strongly recommend it to all in the industry.” “TechNation’s webinars keep your mind fresh with great information and update you on test equipment to help you better serve your customer needs,” Corey R. wrote. “Love the webinars. I can listen and interact from the convenience of my office PC. I do appreciate TechNation’s efforts in the support of the modern-day BMET and for recognizing the challenge of reaching the CBET required annual credits,” David T. said. “Great job!”

“Excellent! I have been in the biomed field for 15 years and I am looking at things differently and more knowledgeably by adding these webinars to my monthly to-do list,” Greg H. shared in his survey. “These webinars are great,” Mike C. wrote. “Maximum training in minimum time. Keep rocking TechNation!” TO FIND OUT MORE about the TechNation webinar series, including a schedule of upcoming presentations, visit www.1TechNation.com/ webinar. TECHNATION WEBINAR WEDNESDAY would like to thank the sponsors who participated in thie webinars featured in this article: AllParts Medical, Dunlee, Summit Imaging, Fluke Biomedical and Technical Prospects LLC.

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Conversations from the TechNation ListServ THE FOLLOWING ARE COMMENTS REGARDING THE FDA WORKSHOP ON REFURBISHING AND SERVICING OF MEDICAL DEVICES BY THIRD-PARTY ORGANIZATIONS AND OEMS HELD OCT. 27-28.

Two points the OEMs are trying to make in this (FDA) workshop (Refurbishing, Reconditioning, Rebuilding, Remarketing, Remanufacturing, and Servicing of Medical Devices Performed by ThirdParty Entities and Original Equipment Manufacturers, October 27-28, 2016) are examples of horror stories of service by ISOs, which is a reporting requirement, and certification, etc. MITA just attempted to offset the silence yesterday when the OEMs were asked if they reported the horror stories. MITA failed in that no matter how (much) it wished the reporting problem away it appears that these horror stories were not reported as required by 21CFR and it turns out to be a reporting deficiency against those OEMs who did not report those horror stories to the FDA. Those deficiencies are part of an FDA inspection with the OEMs. Oops! Now let’s see what happens on who pays for certification? Expect dead silence.

I have a couple of issues with OEMs giving examples of horror stories. 1. Are you telling me that there are not horror stories that we could tell about OEMs? Did they report them on themselves? However, we fall in the same non-reporting category as them if we do not report them. 2. For every horror story that they tell

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(rightfully so), there are thousands that are not told. I know it only takes one bad repair or infection or whatever horror stories they are telling to cause a major issue. It is like plane crashes. You only hear of the one plane that crashed killing all passengers on board, not the thousands that are safe. I know I am not completely comparing apples to apples here, but I think it is unfair to show non-statistical repairs by ISOs or in-house biomeds, or imaging techs. I would be willing to bet the number of horror stories are a low percentage, but on the other hand, I do understand the possible outcome, especially if not reported. Let me just add by saying, just because you are certified on something doesn’t mean you can get the job done correctly either, no matter if you are in-house, ISO, or OEM employees.

I think after 40 years in this business I could show examples of horror stories that would shock people. I do not see anything wrong with bringing examples to this workshop provided those examples were submitted to the FDA, as required, and examined by the FDA to reach a conclusion before presenting the horror stories. The recorded horror stories in MAUDE show the OEM’s employees being suffocated to death, another one (a female) being crushed to death while lifting a heavy part by herself in an MRI room. She was found hours later and one can only imagine how long she suffered. Another OEM employee almost lost his life through decapitation because the OEM wanted to protect proprietary documentation from release to ISOs. He

will suffer the rest of his life. These are very dramatic real-life stories and are part of the MAUDE public database. Certification and OEM required parts are not an answer to patient safety, it’s a means to eliminate competitors and control the service market. However, the down side, which OEMs have not thought about, is that the law does not permit profiting by OEMs on these issues. The problem here is we need a fair and transparent trustworthy FDA CDRH and we are not there. There are hundreds of dedicated loyal and hard working FDA and CDRH employees. There are also some very corrupt FDA and CDRH employees that seem to be in control. I hope the end result of the current FDAIG, Congress and White House investigation, oversight and queries will help resolve CDRH corruption problems but that is idealistic at best. The bottom line is OEMs control CDRH and get almost all of what they want. Why, most of you do not participate in the daily work of CDRH. Most of you do not demand better of CDRH. Most of you do not support CDRH in a way that benefits patient safety and, finally, most of you do not understand or even know what the laws are and how that applies to you. If the FDA CDRH was more trustworthy I believe compliance would be more generally accepted and common place. The rest of the OEM issues would be a non-issue. A RECORDING OF THE FDA WORKSHOP sessions can be found online at http://www.fda. gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm511411.htm.

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Q: A:

o you have to use the OEM for training? What about D using an ISO?

Currently there is no law that requires OEM training. If such a law is passed, the FDA’s past communications dictate OEMs will provide that training on a no-profit basis.

I would image that it would be the same as any college, technical training institute or university where as if the ISO is certified to teach the course, they can certify others. As far as “for free” I don’t know of any free training in my industry. You either pay tuition or through the equipment purchase, but it would be extremely rare to receive no charge training.

From my past experience on training with OEMs, the people getting trained sat in on the same classes of the OEM’s employees. From a practical sense, the training must meet the basic concept outlined in 21CFR, adequate is used in radiographic, 1020.30-33, and service in 1040.10-11 and 1050. One could make a case that any training required by the OEMs to be certified must be at a level adequate to assure the trainee is capable of assuring the device meets all OEM performance specifications for all devices. The OEMs have a legal concern here if they intentionally under train and certify people other than their employees with a lesser degree of training. It’s not all that complicated and the framework in 21CFR could allow for training without generating new regulations.

Let’s not confuse “not for profit” with “for free.” Not for profit means, generally, at a cost not exceeding what can be reasonably expected for literature, accommodation of students, teacher salary, materials, etc. I believe Tom is referring to a section of 21 CFR which specifies service information must be provided, and in relation to conversations with the FDA and OEMs where the OEM has claimed a value on the service information, or required training to receive the service information, and the FDA has extended the “at cost” requirement of the service information to the training if it is a requirement.

Absolutely correct.

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I’ve been told that if a (laser) manufacturer wants to allow for third-party service they must provide in-house training. For smaller companies, that alone is enough of a reason to provide service only through them. I get free annual laser training from AMO for certification on the excimer. They used to charge for it many years ago. We don’t pay extra for it through consumables or other means either. I’m also certified on the Ellex yag and only had in-house training for two days many years ago. No annual training needed. 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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ROUNDTABLE Patient Monitors

very doctor’s office visit starts with a medical professional taking basic and important measurements including height, weight, temperature and blood pressure. This process provides a quick snapshot of the patient’s health.

If a patient is admitted to a hospital or undergoes an outpatient procedure medical professionals often turn to patient monitor devices to take similar measurements and track them for changes. These devices, as the name implies, monitor the patient. HTM professionals play an important role in every patient’s health by providing patient monitor devices that work as they should via PMs and repairs. TechNation reached out to a panel of experts to quiz them about patient monitors and what HTM professionals need to know when working with these devices. The panel is made up of Pacific Medical Senior Sales Manager Bobby Brosan, Tenacore Service Manager Oswaldo Chavez, Philips Senior Director of Field Marketing and Sales Support Julie Milner, Southwestern Biomedical Electronics Inc. President Larry R. Neilson, and Integrity Biomedical Services Owner Michele Shahbandeh.

Q: What are the latest advances or significant changes in patient monitoring and in the patient monitoring market in the past year? Bobby Brosan Brosan: With the hyper focus on health care costs, a connected OR can serve to cut the incredibly high cost of OR time. Better networking and integration of your OR through upgrades of existing networks, or through the creation of new network platforms, can definitely provide tremendous cost savings. Whether your facility has 50 operating rooms or just a few, networking your OR can save lives and make your facility much more efficient. Pacific Medical is constantly updating its software to ensure that the products we sell are up to date and comparable to the latest OEM equipment.

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Oswaldo Chavez Chavez: Patient monitoring has become much easier to use in the last decade. User interface is improved, things are now wireless instead of wired, and the data is easier to read. For example, in monitors, the screen is larger with a touch screen to make it easier to use. Another big advancement is that the monitors have a good interface with the central station and hospital network. Vital signs are easier to read and analyze which ultimately leads to patient safety. Julie Milner Milner: One of the most significant shifts we have seen is a convergence of the biomed and Information Technology (IT) sectors as patient monitoring is moving away from a device based business model to a clinical information system solution. These systems can be individually designed and scaled to meet a health care organization’s changing care models and clinical workflows. An example of this is the monitoring war room or cockpit. As organizations continue to look for creative ways to deliver higher quality care at lower costs, moving back to monitoring cockpit or war room is a care model that health care organizations are exploring. Larry R. Neilson Neilson: In the immediate past patient monitoring has had little change other than the always occurring software improvements. In the marketplace, SBE Inc. is receiving an above average request for refurbished patient monitoring and additions to existing telemetry systems. More facilities are using their budgeted money more wisely, taking advantage of the cost of re-furbished equipment with extended warranties than in the past.

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Michele Shahbandeh Shahbandeh: Patient monitoring, such as telemetry, has improved technology. The clinicians want real time data. They now have the information at their fingertips. They have a screen on the front to show ECG, SP02, and NIBP.

Q: How will those changes impact equipment maintenance? Chavez: Patient monitoring equipment keeps getting more complex, therefore it requires a higher cost to repair. Continued training and education is required as well as learning how the new components work. At Tenacore we are always looking for ways to be the leader in patient monitoring repairs so education and training of new equipment is a top priority. Milner: The industry is moving away from the device break/ fix model to a support model that incorporates commercial operating systems and application software updates and upgrades. As biomed and IT share patient monitoring support responsibilities of the real time clinical information system, remote access and remote support have become a larger piece of the organization’s strategy. As a result, proactive system health monitoring – a solution that monitors the health of the network and end devices – has become more prominent.

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Neilson: The software improvements present a challenge to the HTM community. If not a mandatory upgrade, we have seen that these changes may affect the soft key menus, or a combination of some menu driven operation. Regarding the market and purchases of refurbished equipment, a one-year warranty should be expected, and extensions to that are available from most ISOs. Purchases must be procured from a reputable company with references and history, or there may be unpleasant maintenance issues. Shahbandeh: The cost of replacing those screens and cases, if broken, will be considerably higher. Sometimes the only place to have those repaired is the OEM.

Q: How can a facility with a limited budget meet the patient monitoring needs of today? Brosan: Utilize a trusted third-party medical device supplier to repair your existing equipment and ensure its optimal performance as well as provide refurbished equipment with the same quality as OEM at huge cost savings. Pacific Medical carries an enormous inventory of recertified monitoring equipment for sale along with OEM compatible accessories and parts from all major manufacturers. Chavez: Facilities with low budget have many options in the third-party market. First, they need to identify their needs, and figure out a plan of action. Because a limited budget is

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always a concern, sending equipment to the OEM is sometimes not an option. There are many third-party companies that can do the repair at a fraction of the cost. At Tenacore, we are always providing an affordable alternative to OEM pricing without sacrificing quality. Milner: Many health care organizations are now looking at long-term solution total cost of ownership models, and long-term planning to examine patient monitoring utilization, requirements, needs and budgets. The successful patient monitoring vendor/partner has to design, engineer, and implement a platform that delivers on today’s needs and be capable of evolving with the health care organization’s changing needs over time. As the business of health care quickly evolves, adopting this mindset will become even more crucial. This is in stark contrast to the legacy approach where organizations and vendors were box-based and device-centric and had limited lifecycles. Neilson: We are repairing patient monitors from some facilities that are 15 years old, some older. I understand the budgeting problems facilities have and hope that our national health care system will soon get on better footing for all citizens. Repairing some models of older equipment is more expensive than a refurbished monitor with warranty, however much time may pass before approval of such improvements can be achieved. Facilities need their monitors fixed and returned fast. Shahbandeh: They can purchase from a reputable second source company. These companies can save them from 40 to 50 percent off the OEM list price. They can also meet or beat the warranty from the OEM. Also, delivery of the equipment can be within 10 business days from the receipt of PO.

Q: What technologies are worthy of the initial investment? Chavez: I think a worthy technology to invest in could be a more advanced monitoring system such as multimodality monitoring used in neurocritical care settings. It allows clinics and hospitals to track multiple parameters of brain physiology and function (such as brain tissue oxygen tension) to determine the brain’s relative health or distress. New advancements in modern medicine is the key to patient safety and the health of our communities. With new technology, we can quickly and efficiently identify the root cause of an illness to prevent any misdiagnosis of a patient. Milner: A large number of health care organizations are now evaluating clinical systems that provide the potential

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STAFF REPORTS

of improving patient care in areas of the hospital that previously did not monitor patients. An example of this is the Philips IntelliVue Guardian solution that is used to monitor patients in general care areas. IntelliVue Guardian with Early Warning Scoring aids in identifying subtle signs of deterioration in a patient, hours before a potential adverse event. It automatically acquires vital signs, utilizes algorithms and data (acquired by patient monitors and wearable sensors) to notify the clinician of changes in health status. By identifying which patients may need more focused attention, health care providers can make a significant difference in patient care. Neilson: In my opinion, asset management, or RF tracking systems is at the top. A facility must know how many pumps, portables, etc. they have and where they are, so they can be utilized to the fullest extent. I believe the investment in the in-house HTM department is as important as any technology. Management must learn the importance of their own departments, what and how they do what they do, saving department dollars.

Q: How will remote patient monitors and wearable’s alter the work of HTM professionals? Chavez: The new wearable technology is a huge opportunity in today’s market. This will alter the work of HTM professionals because the patient can be monitored wherever they are. It can help keep track of their vital signs, and shows promising benefits to automating hospital processes i.e. “smart hospitals.” Milner: As monitoring becomes more pervasive and technology is changing, HTM professionals may consider learning new and complementary skills that will enable the professional to help the organization realize the full benefit of these changing care models. In the future, the HTM professional will likely be taking a more active role in their organization by consulting, designing, delivering and remotely supporting the technology requirements for these changing clinical workflows. Neilson: It will be even more difficult to inspect and do performance tests that are so important on these devices. If a patient is wearing arrhythmia monitoring, or NIBP monitoring for diagnoses and treatment, these devices must perform as designed, and should always be inspected/tested before next use. Shahbandeh: They must all learn to work together, clinicians, IT, and the biomed department. Communication is key to this new technology.

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Q: What else do you think TechNation readers need to know about purchasing and servicing patient monitoring devices?

necessary. Always do your research and plan ahead before jumping into any purchase.

Brosan: Use an established third-party vendor with ISO certification and certified engineers working with the latest equipment to ensure each piece of equipment is ready for patient use. Patients and hospitals depend on equipment that is trusted and up to date. Hospital budgets want the best equipment at the best price. Pacific Medical understands and delivers innovative solutions for the greater good of our customers. This is why Pacific Medical has been able to grow its business year after year and become the leader in repair, service, exchange, parts and accessories.

Milner: The HTM professional should consider thinking outside the traditional device support role, and think in terms of a systems or solutions-based approach. “Systems thinking” is a rapidly expanding approach to creating and maintaining complex systems, thus looking holistically at the entire solution or technology ecosystem. This concept can be applied to systems of all sizes from a single entity deployment or to a large complex multi-site enterprise system.

Chavez: TechNation readers have to consider price and PROOF APPROVED CHANGES NEEDED availabilty of the parts as well as time frame. Turnaround

time isSIGN–OFF: very important because depending on the availability CLIENT

Neilson: Always contact a reliable source with references and history. Know that there are alternatives to parts and service, price should not be the only factor. Ask your service provider if there are options to the repair of an aging monitor or system.

PROOF SHEET

of parts and service, the unit will not be in service for that Shahbandeh: We believe using a ISO-certified company tells the amount of time.CONFIRM Ultimately patient the main hospital you are using an accountable quality company. We adhere to PLEASE THATsafety THEisFOLLOWING ARE CORRECT concern and being able to quickly reduce downtime is strict processes and the ISO standard, currently ISO 9001-2008.

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E R O M & W E I E V H T RE T A K N O O O I L T A A C I F I T R E S C T N W E E N M E R I REQU dard n a t S l na

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n 1972, AAMI wanted to raise the bar within the biomed profession and launched a certification program for individuals to show their expertise. Some of the first BMETs sat for the Certified Biomedical Equipment Technician CBET certification exam. Those who passed were part of a charter group that would redefine HTM in a significant way. In the intervening years, biomed professionals everywhere have taken time to study for the exam, and 44 years later, approximately 4,000 individuals hold the CBET certification.

Today, certification exams may be taken through AAMI’s Credentials Institute (ACI). The institute points out that certification demonstrates to potential employers a commitment to the healthcare technology field. ACI offers a number of resources for those preparing for a certification exam. The first is a handbook that provides an overview of each certification, a calendar providing testing windows, application deadlines and late registration deadlines for exams, eligibility requirements, scoring and results and other useful information. According to the AAMI website, the CBET certification means “that individuals have demonstrated excellence in theoretical as well as practical knowledge of the principles of biomedical equipment technology.” Other certifications include the Certified Laboratory Equipment Specialist (CLES) and Certified Radiology Equipment Specialist (CRES). The CBET, CLES and CRES certifications were recently accredited by the American National Standards Institute (ANSI), further enhancing the credibility of each as well as ACI’s commitment to quality.

To take the CBET, CRES and CLES exams an applicant must have both an associate degree in a biomedical equipment technology program and two years of full-time experience as a BMET. Alternative qualifications include having completed a biomedical equipment technology program in the military, along with two years of full-time BMET experience or an associate degree in electronics technology, along with three years experience as a full-time BMET. Without a degree, four years of full-time BMET experience will qualify an individual to take the exam. For applicants sitting for the CLES certification exam, there are two additional routes to qualification; an associate degree in medical laboratory technology and three years of full-time BMET experience or a bachelor’s degree in medical laboratory technology and two years of full-time BMET experience. AN EVOLUTION There have been recent changes to the certification maintenance requirements. Those changes can be found in the recertification/certification renewal requirements that will bring the ACI certifications in line with other professional standards. “The AAMI Credentials Institute is changing from a points-based system for certification renewals to one based on continuing education units, or CEUs, in an effort to be more consistent with other certifying bodies and to make maintaining certification less complicated and time consuming,” says Sherrie Schulte, CAE, senior director of certification and annual conference at AAMI. “The point system was confusing to many people. It was not easy to figure out how many points an

“ The AAMI Credentials Institute is changing from a pointsbased system for certification renewals to one based on continuing education units, or CEUs, in an effort to be more consistent with other certifying bodies and to make maintaining certification less complicated and time consuming.” activity was worth, and many of the items were not easy to verify,” said ACI Chair Larry Hertzler, vice president of technical operations at Aramark in Charlotte, North Carolina. “With the new system, an hour of training equals one CEU in most cases. The process should be much easier for certified professionals to track, and it should reduce the amount of time it takes to remain certified.” Schulte says that under the new system, certified professionals must complete 30 CEUs directly related to the healthcare technology management (HTM) field every three years to maintain their certification. CEUs can be accumulated through

CBET

REVIEW & MORE

a wide variety of professional activities, including attending educational meetings, classes, and seminars; participating in healthcare committees, work groups, or HTM societies; presenting, teaching, or developing educational content; publishing articles; and working in the HTM field. Individuals can find the complete recertification policy in the ACI Candidate Handbook which is available on the AAMI website. As an ACI certification holder, certificants not only add to their existing knowledge, but enforce the credibility of their certification through continual learning. This newfound knowledge has practical application to their work lives and in 2017 will be submitted using modern technology. “Documentation for these activities, such as certificates, transcripts, or letters from class sponsors, eventually will be submitted through a new electronic reporting system,” Schulte explains. “Certification is only as valuable as the standard it represents. Recertification programs are important because they require those with credentials to present evidence that they are maintaining the established standard,” Schulte says. Hertzler added, “The ACI Board wants to ensure that ACI-certified professionals are the best in the field. Having a reliable, meaningful, and credible system allows this to happen.” CHANGES IN THE NEW YEAR Change is afoot and it is incumbent on certification holders to know what is new. Schulte points out that four other changes are worth knowing about as well:

1 44

A minimum of 15 CEUs must come from professional

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“ Certification is only as valuable as the standard it represents. Recertification programs are important because they require those with credentials to present evidence that they are maintaining the established standard.” development activities, such as attending a class, in-service, vendor presentation, webinar (live or recorded), or HTM conference sessions.

2 3 4

No CEUs will be awarded for self-study or subscriptions to professional publications. Working full time during the three-year certification period yields 4.5 CEUs (1.5 CEUs per year – half a point more per year than under the old system). The ACI Board will audit randomly selected certified professionals to ensure compliance with the new process.

All of these changes go back to establishing, maintaining and publicizing one clear fact about HTM certifications; they remind everybody that they represent a profession. “As for the new continuing ed requirements, I like the fact that it puts a little more focus on having certification holders being more active on professional growth,” says Richard Marshall, studying for the Certified Healthcare Technology Manager CHTM exam. “The changes that I see in the journal all seem geared to helping our community grow professionally and become more recognizable to the facilities that we work for.”

Those professional credentials are what led to the inclusion of two newer certifications that are targeted towards managers and quality system managers. There is the Certified Quality System Manager (CQSM) certification and the CHTM certification. “This HTM certification (CHTM) covers two major areas in healthcare technology management: the management of healthcare technology operations; and, the management of personnel,” according to the AAMI website. The CQSM certification currently requires that an applicant have 10 years of experience managing quality system programs with five years of management work experience. They must also hold a bachelor’s degree in the field of engineering, or science, plus five years as a quality systems manager, according to AAMI. The CHTM exam requires that the applicant have current certification as a clinical engineer, a biomedical equipment technician, a radiology equipment specialist or a laboratory equipment specialist with at least three years of work experience as a supervisor or manager in the past five years. Those who don’t have manager or supervisor in their title would have to confirm that they perform these duties. There are several eligibility paths that would allow an individual to qualify to sit for the exam.

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As an alternative to the eligibility route just mentioned, the applicant could instead have successfully completed the Department of Defense biomedical equipment maintenance technician training program with at least three years of military or civilian work experience as an HTM supervisor or manager in the past five years. As with the previous route, if the applicant does not have the title of supervisor or manager, they should be able to confirm that they perform these duties. EXAM PREPARATION There are a number of ways to study for the certification exams. Self-study is always an option. There are established study methods, like the study group offered through the Colorado Association of Biomedical Equipment Technicians (CABMET), that have a history of helping people prepare for the test. The CABMET offering (http:// www.cabmet.org/study-group/) is well known and has a loyal following. It offers preparation courses for the CBET, CLES and CRES. Dave Scott, CBET, is the organizer of the study group and has guided many an exam taker to a favorable outcome. The study group offers group learning or a self-paced approach. Both offer website access with downloadable class material available. “They are small groups, but we have a self-study option which includes videos,” Scott says, referring to the two newer certifications. “We have talked about offering the CHTM course as a self-study module. That’s how we do our CLES portion too. There just aren’t that many people doing the CLES to offer an online course for it. We don’t have any plans for a CQSM course.” “We do a live presentation study group once per year for the spring test in May. That has live call in and

videos. Also, all study materials. Then, for the other tests offered throughout the year, we have the self-study option. Our next group for 2017 will be starting in March,” Scott says. Scott also provides a one-day CBET interactive review session at every MD Expo. He will be providing this course at the upcoming event in April in Irvine, California. He also writes a column for TechNation that appears every other month. At both the Expo, and in his column, he will cover the changes outlined by AAMI. There is also HTM Certifications, through John Noblitt, an experienced educator who has designed a program to aid the certification exam taker in preparing to sit for the CBET exam. More information is available at http://htmcertifications.com/. “Last year (2016), there were four testing periods. I see that in 2017, they have gone back to two testing periods per year – May and November tests,” Scott says. “The same recommendations I have made in the past still apply; start early; at least eight weeks out. Divide the test into sections. Study each section at a time. Leave some time at the end to review all sections of the test,” he says. Scott says that there are now 165 questions on the CBET exam. “You have to get 116 correct to pass. There used to 150 questions and needed 105 to pass. The addition of the Healthcare Information Technology added more total questions to the test,” he says. AAMI also offers a study guide, titled the “BMET Study Guide: Preparing for Certification & Sharpening Your Skills,” which is available on CD. It includes more than 800 interactive questions and answers and allows the user to create a practice test using those questions. Find out more at http://www.aami. org/productspublications/

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

ProductDetail.aspx?ItemNumber=1502. In some cases, those who have sat for the exam and not passed on the first try, have a clearer insight into what to expect on the test and where their study may have fallen short.

“ The first time I took the test earlier this year, I missed a passing score by one. Although I did not pass, it gave me an idea of what areas I needed to focus on.” “The first time I took the test earlier this year, I missed a passing score by one. Although I did not pass, it gave me an idea of what areas I needed to focus on,” Marshall says. “One resource that has been helpful in my studying has been the AAMI ‘A Practicum for HTM.’ The publication covers many of the topics that were on the test. Other resources and topics to know would be some of the labor laws, American Disabilities Act and some general HR knowledge.” As the HTM field shrinks due to the retirement of baby boomers, and fewer new biomeds enter the field, certification offers a way to distinguish oneself to potential employers, as well as current ones. It also adds a designation or credential after the holder’s name that speaks to that person’s professional standards and knowledge. The new recertification system took effect Jan. 1, 2017. For more information, visit www.aami.org/aci_ handbook.

JANUARY 2017

TECHNATION

EXPERT ADVICE

BY CINDY STEPHENS

CAREER CENTER The Unspoken Rules

n business, and in life, there are rules. The most important of these rules are the unspoken ones that are simply implied. Knowing the unspoken rules will take you further in life and in your professional career.

CINDY STEPHENS Stephens International Recruiting, Inc.

UNSPOKEN RULE #1 The rules apply to everyone. Know the official policies and guidelines in your organization, and accept that they do indeed apply to you. Sure, some rules will seem ridiculous and unfair. Chances are there is a reason they were put into place to begin with. Just because you know your jeans are designer brands that cost a small fortune, don’t assume that it’s OK to wear them if the policy says differently. Enjoy texting? Great, just make sure it’s within the guidelines of your organization to do so during work hours. Don’t try to change the system by being defiant about rules. You will be the one to lose in the end. UNSPOKEN RULE #2 Arrive to work on time and ready to work. At most companies it’s an actual written rule when to arrive. But, it’s unspoken that an employee will be ready to work at the start of that time. Gathering your coffee, eating breakfast, or even still dealing with wardrobe or grooming issues should be done at home, before you need to officially start your day at work. Too many employees today assume that if they are in the office, then “it counts” as being on time. That’s not quite the case.

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UNSPOKEN RULE #3 Err on the side of conservative, professional dress. Today, it’s not uncommon to have body piercings and tattoo art. Dynamic haircuts and loud colors are also in right now. However, you represent your company, your hospital, or your organization. How you appear can cost you career advancements. Ask yourself if it’s worth the risk and assume the unspoken rule is to be clean cut and traditionally professional. Most companies have policies established about appearance and it’s very important to know what these guidelines are. UNSPOKEN RULE #4 You don’t know everything. We live in a society that asks us to be confident in our work. Confidence does not mean you know everything or that you should act like you know everything. Your boss, manager, supervisors and even your co-workers have valuable insight. Being respectful is very important, but being humble is even more critical! If you are asked to do something that you don’t want to do, don’t argue about it. If you don’t understand something, then use a simple phrase like, “help me understand.” Asking questions shows your interest in learning and allows you to be better informed of the entire picture. Not knowing something isn’t a negative. It’s simply an opportunity to learn and become a more valuable team member. UNSPOKEN RULE #5 Don’t go around your immediate supervisor. If you have a connection with the boss of your immediate

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supervisor, do not try to use that to your advantage. We see this time and time again where an employee will disregard something their immediate supervisor will ask because they have a connection (family, friend, etc.) with someone higher up. UNSPOKEN RULE #6 Accept reality and know success will only come after hard work paves the way. Too many employees today feel they are worth $65,000+ right out of school, and have an expectation of a phone, laptop, and even expense accounts. The reality is very different. Nothing will be handed to you, so plan to work hard and earn it. In today’s market, top paying jobs are competitive and must be earned.

UNSPOKEN RULE #10 Perception is reality. Take a good long look at yourself and your behavior. Do you complain a lot, or are you generally a positive worker? Do you do your job but grumble about the work, or do you gladly take on additional tasks? Are you punctual and well groomed? While these things may seem trivial to you, they create a picture that, for your employer, conveys a reality about you. You control how others perceive you, so take the lead. It is our sincere hope that you are successful in your career and you can put some of these unspoken rules to good use. Please feel free to share these with your peers, staff, future employees. Hopefully you can help influence others in their quest for a strong career.

UNSPOKEN RULE #7 Do one more thing each day than you think you should. Sure, you are hired to do a job. But, doing just what you are asked to do isn’t enough in today’s marketplace. Go a step further and improve how others view you by continuously going above and beyond basic expectations. UNSPOKEN RULE #8 Yes, it IS your job! Just when you think something is not your job, stop and correct yourself. Often we are asked to do tasks that fall into the “other duties as assigned.” When assigned something like this, a task you do not want to do, smile and get it completed. This goes back to rule number seven. Do the work, and do better than expected. UNSPOKEN RULE #9 Be present and leave the phones and other devices out of your work day. We live in a remarkable world of technology. It’s tempting to bring that technology to meetings and other work settings. However, know when this is, and is not, appropriate in your workplace. For example, if you are texting or emailing during a meeting, you appear to be unengaged and not able to complete the tasks being talked about. Since perception is reality, supervisors may find that to be poor work ethic. Consider this the next time you are reaching for your phone at work.

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JANURARY 2017

TECHNATION

C O M E GR OW WIT H US Build Your Career at Crothall Healthcare Technology Solutions H O W FAR 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.

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 BETH MORRISON

Sponsored by:

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Because Quality Matters ISO 9001:2008 CERTIFIED

Troubleshooting ‘No Power’ Issues in Ultrasound Systems

BETH MORRISON National Service Director, Conquest Imaging

hat exactly does it mean when your customer tells you that their ultrasound system has “no power”?

First, ask the customer, “When you hit the power button does anything happen? Can you hear the system try to come on?” If the answer is yes, “Does it boot to imaging? Does the monitor come on?” If the system starts to boot but there is no video to the monitor, check the monitor. You can verify if the system is booting to imaging by taking a print with the black and white printer. If the printer prints an image, your “no power” issue is the monitor. If the printer beeps at you, the system is not booting up completely and your “no power” issue is most likely related to the computer in the system. If you do not have a printer connected to your system, you can connect an external LCD monitor to one of the outputs on the back of the system to verify the system boots completely and goes to imaging. If your customer indicates the system does not respond at all, this indicates your “no power” issue is, in fact, a power supply issue. If the system has had an over-current or over-voltage failure, sometimes you can unplug the system and let it sit for a few minutes to

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

let the power supply reset – the system will power back up after a reset. Troubleshoot what probe was being utilized and what else is running in the room, to determine if the power issue was generated internal to the system, or external from the room. Pull the AC input tray out, it is usually located at the bottom of the system and do an ohm check of the fuses, this can be a quick easy resolution to the issue. Keep in mind, heat can also be a contributing factor with power issues with ultrasound systems. The rooms can be small with minimal air flow. Please advise your customer to put a fan in the room near the rear of the ultrasound system, to increase airflow in order to prevent latent damage to the power supply and other printed circuit boards in the ultrasound system. This should give you a great head start when you get that call regarding “no power” on an ultrasound system. If you need further help troubleshooting your ultrasound system, please feel free to call Conquest Imaging for our world-class free technical support at 866-900-9404.

JANURARY 2017

TECHNATION

EXPERT ADVICE

BY JEFF KABACHINSKI

TECH SAVVY

The Dark Side and The Onion Router

here’s another Internet web riding along with the one we normally see. It’s called the Deep Web, a system of overlay networks that use the Internet infrastructure but require specific software, configuration and allowed access or authorization to use. The Deep Web has a number of uses for business but is especially useful for hackers and cybercriminals.

Router A

Router B

Router C

Message or data

Destination The Deep Web is not indexed and lies beyond the reach of conventional search engines. Therefore, these deep websites are not a part of “clearnet” search results. There may be 500 times more content in the Deep Web than there is in the conventional web.

Source

THE DARK WEB The Dark Web is a small part of the Deep Web. The also un-indexed Dark Web uses protected or encrypted traffic. It’s a place where cybercriminals conduct their trade and legit businesses may conduct transactions. Mainly, however, the protected Dark Web is a supermarket for illicit and illegal activity. It’s a place for hackers and cyber criminals to conduct business – selling credit card information, electronic health care records and illegal drug transactions. Major Dark Web uses: • Botnets – a network of infected computers with malware that controls a group of private computers without the owners’ knowledge. The allocated bot may send spam email messages or with hundreds or thousands of other bots hit a website to the point where ‘denial of service’ is obtained,

TECHNATION

JANURARY 2017

JEFF KABACHINSKI Senior Director of Technical Development, ITD

essentially shutting it down. • Bitcoins – digital currency where encryption is used to control and regulate the creation of currency units. It also used to validate the transfer of funds, operating independently of a

control mechanism like a central bank. • Darknet market – Or “cryptomarket” is a commercial website that operates using TOR. • Hacking groups and services • Fraud services – for example cash register hacking that programs the cash register to send credit and debit card information back to the hacker. • Hoaxes and unverified content • Phishing and scams • Illegal and ethically disputed pornography • Illegal animal trade • Terrorism • Protected social media • Journalism – where journalists report and record their findings in private • The Silk Road – was known as a large enterprise on the Dark Web, it included: o Secret eBay mostly for illegal drugs o Special cryptographic software o Anonymous interface and traceless payments o Connecting thousands of drug dealers with millions of users

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• Organizations that want to protect their an onion, TOR has several layers as shown most confidential information. in the figure. As web privacy continues to • Multi-national organizations that erode, TOR promises to maintain free communicate in places that have speech and thought fluctuating levels of legal privacy Onion routing is a process for protection. anonymous communication. TOR uses • Government groups (military) that layers of encryption and a series of operate in struggling geographical areas onion routers. that censor web use. As shown in the figure – the source • Reporters and whistleblowers that need of the communication sends the onion anonymity and private communication to Router A. Router A then determines to hide their identity. where to send it next by removing the • General consumers concerned about firstNEEDED layer of encryption. Router A also PROOF APPROVED CHANGES protecting personal privacy. sees the source address but does not know if it is the address of origination. CLIENT SIGN–OFF: TOR Router A sends the remaining data to OnePLEASE of the mainCONFIRM enablers of theTHAT Dark Web Router B. Router ARE B removes another THE FOLLOWING CORRECT is “The Onion Router” known as TOR. An layer of encryption to find out where to LOGO PHONE NUMBERsend it next WEBSITE ADDRESS onion router system has several encryption (Router C). Router C layers intended to hide the message’s source decrypts the last layer to send the data and destination addresses. (See fig.1). Like to its final destination. WIDTH 7”

Like a VPN, the secured pathway or tunnel lets users browse to public and secured Dark Web sites without conceding delicate information like IP addresses, cursor movement, your location, and other personal data stored in cookies. TOR helps to prevent deep packet analysis, and protects website data payload and header information. SUMMARY One comment I saw online was that you do not have any privacy on the Internet so get over it. Processes like TOR can help but the FBI recently claimed to be able to infect TOR nodes revealing personal information of TOR users. So use caution when using TOR. SPELLING GRAMMAR Hopefully the TOR continuum will continue to upgrade and patch any new-found holes.

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JANURARY 2017

TECHNATION

EXPERT ADVICE

BY ALAN MORETTI

THOUGHT LEADER Medical Equipment Replacement – What’s Your Plan?

appy New Year and Welcome to 2017! To say the last quarter of 2016 was “eventful” would be an understatement. Let’s quickly review a few notables - the Chicago Cubs finally “Reversed the Curse” after 108 years and were crowned World Series Champions! GO CUBS GO! Then there was the Presidential Election of 2016 which has brought a new era. As Americans we now embark on a new executive branch administration with the soon to be inaugurated 45th President of the United States Donald Trump. The Affordable Care Act (ACA a.k.a ObamaCare) is about to take a ride into new turbulent waters! Well … it should be a very exciting 2017. Hang on as we are all in for a ride.

Well, this first Thought Leader column of the new year is very timely and meant to be thought provoking for all HTM professionals envisioning their responsible medical equipment landscapes. A very valuable resource resides within just about every health care organization that many times goes untapped when the topic of medical equipment replacement is discussed. Sure, the request may come into the Biomedical Department from the nurse or radiology clinical manager asking for service histories, though usually this is in an effort to support “their desire” in replacing the “old” medical equipment. But wouldn’t it make more sense for the Biomedical Department to be that forward thinking resource champion of the organization that proactively plans medical equipment replacement looking three or five years out? The norm across the country has been that medical equipment replacement is not “planned” but more of a “crisis by crisis” or in some cases a political physician chess

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JANURARY 2017

game. I can tell you first hand from a personal career now in its 32nd year of HTM experience, I have seen $1 million spent on “emotional purchases” of medical equipment in the “name of patient care.” In these unfortunate situations many of those medical equipment purchases turned out to be under-utilized with no sustainable business plan and in some situations, if the clinical program it supported fizzled out or the physician champion exited the organization, the equipment was stowed away to “depreciate off the books” in a distant storage room somewhere on the campus. Talk about health care dollars wasted – you can’t blame the Affordable Care Act on this one! In my travels around the country, I have seen a few biomedical programs become engaged in proactive medical equipment planning and some of those have established pretty good replacement forecasting tools. This ability in medical equipment planning and replacement resources has never been more critical to a

ALAN MORETTI Healthcare Technology Management Advisor

health care organization since the current and future day capital dollars allotted each year now represent about one-third of the funding needed to purchase replacement medical devices and stay current with advancing technology. Here’s a couple of take-aways for you to noodle on. What is your health care organization’s medical equipment replacement plan for this year and the next five years? How can your team be a contributing resource to that replacement planning strategy? There is no better medical equipment “knowledge source” than yourself Mr. and Ms. HTM service professional. Here’s another opportunity for you to shine!

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EXPERT ADVICE

STEVEN J. YELTON

THE FUTURE

The Clinical Engineer – Systems Engineer integration

have mentioned in this column before that I have an interesting position in that I am a Healthcare Engineering Technology professor, a senior clinical engineering consultant for the Christ Hospital Health Network in Cincinnati, Ohio and an AAMI board member. In these roles, I am constantly interested in “The Future” as it relates to Healthcare Engineering Technology and how it affects technicians. In all of these areas, the common theme that presents itself is that we must take a “systems approach” in order to be successful and highly effective in the future.

I wrote a previous column on “The CE-IT Technician” and now I see a similar relationship with Clinical and Systems Engineering, therefore I ask the question: “The CE-SE Technician?” I am currently updating job descriptions in my position as senior consultant and what sticks out to me in doing this is that we are no longer referring to “medical devices” in our job descriptions. We are now referring to “medical systems” almost exclusively. My colleague Greg Herr, Director of Clinical Engineering at the Christ Hospital Health Network, has commented to me that he has seen the shift from managing stand-alone medical devices to medical systems that are integrated. This is a common message that I hear from many Healthcare Technology Management (HTM) professionals. AAMI is currently working with the International Council on Systems Engineering (INCOSE ) to figure out how the two organizations may effectively work together to advance the systems thinking approach to HTM. In our roles as biomedical technicians and clinical engineers, we are working daily with interconnected systems. In troubleshooting a medical system, we must determine if the problem is related to component failure, software issues, network

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JANURARY 2017

communications, issues with interconnected systems, etc. We are troubleshooting a mix of many systems, a “system of systems” if you will or any other trendy term that you may have heard lately. My feeling is that we are applying systems engineering approaches without realizing it in many, or even most, cases. As educators, we are always looking for what skills our students need to possess in order to attain gainful employment upon graduation. In my opinion most of us are teaching systems troubleshooting in places within our curriculums, but I also feel that we must continue to expand this approach throughout our curriculums. As I mentioned in “The CE-IT technician” column: According to AAMI’s “Core Competencies for the HTM Entry-level Technician: A Guide for Curriculum Development in Academic Institutions,” in addition to their training in biomedical systems, electronics, digital and microprocessor systems, telecommunications, etc., biomedical technology students should attain training in the area of installation and maintenance of computer networks, security of networks, technologies such as “Voice over IP, business communication systems, as well as training in the areas of HIPAA regulations, HL7 protocols,

STEVEN J. YELTON, P.E., CHTM

and device integration with the electronic medical record to name a few. This is considered basic IT knowledge needed by biomedical technicians today. As a reminder, this is a nationally vetted guide and it shows specifically how biomeds are working with systems. I feel that this shows us specifically that we must be able to troubleshoot a “system of systems” just by virtue of the vast array of competencies that the BMET must possess. In the March/April 2013 issue of Biomedical Instrumentation and Technology, “All Systems Go, How Systems Engineering Can Improve Healthcare Technology,” Herr noted the following 10 changes that he has seen at the Christ Hospital Health Network: 1. Device/system integration with EHR;

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2. Increased software support vs. It was also mentioned in the article hardware support; that “Systems thinking advocates believe 3. Adoption of change management there is an emerging, but largely unfilled, practices; need for systems integrators in hospitals 4. Regulation/oversight requirements; and other healthcare delivery 5. Closer alignment with IT services and organizations.” applications; Even though these 10 changes are from 6. New specialists and roles-changes in 2013, I feel that they are still true and PROOF APPROVED CHANGES NEEDED CE organizational structure; relevant today. As educators and/or HTM 7. Intensity and speed of change; professionals, we have to make sure that CLIENT SIGN–OFF: 8. Greater visibility in organization; we are striving toward these goals and 9. Capital planning and selection toward systems level thinking. It is more PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT dependent on systems requirements; and more obvious that we are no longer LOGO PHONE NUMBER WEBSITE ADDRESS 10. Balancing traditional clinical break/fix technicians. We are truly engineering roles while moving into Healthcare Technology Managers from the new systems roles. entry-level biomedical technician on. WIDTH 7”

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STEVEN J. YELTON, PE, CHTM; is a Senior Consultant for HTM at The Christ Hospital Health Network in Cincinnati, Ohio and a Professor at Cincinnati State Technical and Community College where he teaches biomedical instrumentation courses. He is a member of AAMI’s Board of Directors-Executive Committee, AAMI’s Foundation Board of Directors, Chair of AAMI’s Technology Management Council, Chair of AAMI’s HTAC committee and is a member of the ABET Board of Delegates.

POST TO THE COMMUNITY Ask tough medical equipment repair questions & help solve problems by sharing your expertise.

Create your FREE account today at www.medwrench.com EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

JANURARY 2017

TECHNATION

EXPERT ADVICE

BY DAVID SCOTT

BEYOND CERTIFICATION I

t seems like this time of year is when a lot of hospitals get new medical equipment. It either comes at the end of the year or the beginning of the next year. Whenever we get new equipment at the hospital where I work I like to be involved to a point. If it is going to be equipment that is widespread across the hospital system, then I what to be involved for sure. If it is not in an area I normally work I might not be able to be involved, but I can at least find out what it is and maybe how it works.

For me, the arrival of new equipment is a learning opportunity. Most everyone I work with knows little about the equipment unless they had the same stuff at a prior job. So, it is an opportunity to learn the ins and outs of this new equipment. What is the best way to learn? Sometimes time at a training school is purchased with the new equipment. Someone, or maybe more than one person, will go to a manufacturer training school at some point after the equipment is installed. This is usually for bigger and more complex items. You can’t always count on getting time at a manufacturer school with every new piece of equipment. A practice that I have resorted to is getting involved on the installation of the new equipment. In the past I have learned the most about monitoring systems by being part of the install and asking questions. This goes for other systems like X-ray systems, down to smart infusion pumps. Knowing how something is put together is always helpful later. It lets you know how the system is tied together and what the components are that make up the system. Sometimes during the install, you can learn tricks to working on the system from the techs doing the install. They work with the new equipment more often and sometimes are willing to

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JANURARY 2017

share tips and tricks. Another tip is looking at the service manual. It seems like a lot of the time the manual comes with the equipment and is put aside while you unpack and start assembling whatever is needed. I always refer to the service manual to see if there is an installation or assembly process to follow – especially if it is something I have never worked with before. It’s funny because since this is such a part of my work life I do the same thing at home when we get something new. My wife thought it was funny when she first saw me reading the directions to assemble something. She said “I didn’t think anyone used those.” I told her in the work I do I use this type of instruction all the time. I don’t ever try to guess how something goes together. People’s lives depend on me doing my job correctly and that kind of attention rolls over to everyday life outside of work. One more tip is the user or operator manual. I know, I know, it says “user” or “operator” on the manual, but that doesn’t mean it is just for the user. The user manual tells how the equipment is operated. You need to know this to be able to efficiently troubleshoot problems. You can also usually find great information in this manual relating to equipment performance specifications, cleaning directions,

DAVID SCOTT CABMET Study Group Organizer, Children’s Hospital Colorado

setting time and date, and more. These items will help you do your job as a tech at a higher level. I was recently arguing with another tech about setting time and date. His argument was if it is in the user manual it should be done by the users. As we all know that is not always the case. You shouldn’t draw lines on whose job it is, but rather become the go-to person for all equipment related issues, even something as small as setting the time and date. Next time your workplace gets new equipment take some time and go through the equipment. This might even involve taking home a copy of the manual and going through it. The best thing about all of this is you can claim recertification points for doing this under the new 2017 standard category called “Professional Development.”

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TECHNATION

EXPERT ADVICE

BY GEORGE HAMPTON

TECH KNOWLEDGE Taking the Lead

GEORGE HAMPTON President of Tech Knowledge Associates

arrying a tool kit is everyday life for a healthcare technology management (HTM) professional. We all do it or did it. If you do it long enough (for me that was 16 years), you might have an opportunity to move into a leadership position. It’s a major decision, and one rife with uncertainties. Moving from hourly to salary seems to be foremost in most candidates’ minds, you can do the math, and it’s possible to calculate a first year loss of income when considering no overtime pay. More responsibility is a less tangible worry. You will be the face of your program. Earning the respect of your peers in this new role is also a matter for concern. I hope I haven’t painted a hopeless picture. All of these concerns can be overcome with the right attitude and a bit of aptitude, which is the point of this article.

One of the unfortunate trends I have observed in my roles as an HTM consultant, and in my own experience in leadership, is that in our industry we don’t do a very good job preparing our techs for leadership opportunities. We often promote individuals into leadership positions based on technical accomplishments, such as skill level or tenure, as opposed to leadership traits. To be fair, both skills and experience in the field are great contributors to the success of an HTM leader, but they don’t prepare one for the additional performance elements, such as financial analysis, team building, and leadership. There are several factors that contribute to this oversight. One is that in the overall management structure of a hospital or health care

TECHNATION

JANURARY 2017

system, HTM operations might report to a larger body that doesn’t fully understand the necessary skillset for a successful leader. Consequently, these important considerations are lost in the recruitment process. Secondly, the potential candidate can be blind to their own shortcomings in this area. The good news is these skills can be learned. New managers can transform themselves and their shop operations by investing in these key learning areas: Financial Analysis – What seemed to be the most difficult area of learning for me in my development as a manager turned out to be one of the most satisfying. I found that my technical abilities provided a great common sense platform for understanding the finances of HTM. The more I learned the more I was able to create programmatic changes that produced substantial cost savings. As a consultant, I found that too many clients I worked with didn’t have full access to the financial information regarding their operations. They had their arms figuratively tied behind their backs. In our current health care environment, leaders of HTM programs need to know if their programs are effective and provide appropriate cost savings. Contract reduction, benchmarking, and longterm planning are impossible without access to, and an understanding of, monthly financial reports. The ideal scenario is that the monthly financial analysis is pushed up from the HTM manager to administration. This shows appropriate professionalism on the part of the manager, creates an

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environment of trust between the manager and his supervisor, and protects the program from speculative cutbacks that could adversely affect their operations. Opposite of this is a world where the manager is called on the carpet to explain financial variances, noted by parties unfamiliar with some of the crazy but necessary expenses in our industry. Team Building – It is very challenging to move from being on a team to leading that team. One popular author likens it to moving from the dance floor to being on a balcony, where the dance can be seen in more clarity. There is first of all the need to understand that “building” a team is essential, when one’s previous point of view might have been that such matters were more accidental. Additionally, an effective leader must understand the personality traits of individual team members, use the performance review and goals process to drive team behavior, and model desirable team member traits for their subordinates. Team building is a process that demands attention and intentional communication. The results can revolutionize shop operations and create best-in-class performance. Leadership – There is apparently no limit to the volumes of books detailing essential strengths for effective leaders, the surveys that help one discover their leadership style, and the matrices that show the important change in focus for leaders as opposed to frontline workers. If I had to summarize those ideas, I would say the following: Leaders need to be very self-aware, able to dynamically determine their roles based on the challenges they face. Additionally, they need to guide their own development based on their innate skills and traits. The fact that so many books are written on this topic by so many enlightened people is proof that we don’t typically figure this out on our own when thrust into a leadership role. In my own experience, the early days of self-discovery and exposure to leadership philosophies were a bit disheartening. I had to deal with the revelation that my knowledge of the daily operations of the shop and my technical skills weren’t enough to ensure my success as a leader. I was unaware of how my personal style would affect and influence my team members based on their own style. I became a student at a time when I felt I needed to be an educator. In retrospect, that humbling experience was the best first lesson. A great way to minimize the length of time

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you find yourself inadequate in the esoteric world of leadership is to find a coach or mentor within your organization. Regular meetings to discuss experiences and solutions will accelerate your understanding and aid you in your evolution. A final word of advice: Be true to who you are. We all need to grow into our roles, but that shouldn’t come at the expense of your natural gifts and sensibilities. George Hampton is the president of Tech Knowledge Associates, a clinical technology management provider that was formed to bring unique value to its clients by guaranteeing savings, capping their expenses and protecting them from catastrophic failures. For more information, contact TKA at info@ii-techknow.com or visit www.ii-techknow.com.

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EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

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ALTERNATIVE EQUIPMENT MANAGEMENT What Works Best?

Versus Technology 5 Tips to Convince Leadership to Invest in RTLS

Biomed Adventures It Starts with a Good Movie

The Roundtable Digital Radiography

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EXPERT ADVICE

BY MANNY ROMAN

THE ROMAN REVIEW Intuition, Wine and Ancient Persians

ave you ever been in the presence of someone who makes quick, decisive and correct decisions without analyzing the situation? These people just seem to know what to do. They may even say that their “gut” tells them what is correct. They have a heightened intuition about things.

I was studying an article that describes the role of intuition in decision-making. The article points out studies indicate that intuition outweighs analytical methods. The analytical methods have been shown to be ineffective in the real world. Reality contains challenging, confusing, complex, time-bound and high-stake decisions. Research points out that intuition is greatest when a person is experienced in a particular field. Intuition is a direct outcome of experience. Experience allows us to recognize patterns in the available information and make appropriate judgments leading to the correct action. I was about to distill all this useful information for you in this article. Then, I remembered that I had researched decision-making before and found the following. While performing “research” on the Internet regarding decision-making, I came upon a quote from Herodotus that made my eyes perk up. Herodotus was the 5th century BC Greek who is credited with being the first real historian for his works describing the war between the Greeks and the Persians. This work is known as “The Histories” and was written “to preserve the memory of the past by putting on record the astonishing achievements both of the Greek and the non-Greek peoples; and more particularly, to show how the two races came into conflict.” What made his work special is that it was based on research rather than on

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inspiration from the Muses, as was the works of previous writers like Homer. This work is full of great stuff, or so I hear, since I am not about to read it. One of the great quotes from “The Histories” is “If an important decision is to be made [the Persians] discuss the question when they are drunk and the following day the master of the house ... submits their decision for reconsideration when they are sober. If they still approve it, it is adopted; if not, it is abandoned. Conversely, any decision they make when they are sober is reconsidered afterwards when they are drunk.” So let me get this straight; get drunk, make decision, get sober, make decision, if the decision is the same it must be correct, act on it. If you make the decision sober, get drunk and reevaluate. Wow! How would one have time to get sober and wage war? Oh, wait. He specifically mentions “important” decisions. Would it not be important to decide whether or not a decision is important and thus require us to get drunk and follow the process? It seems to me that this is indeed a weird way to make decisions. It does provide for both emotion and logic to be used during the decision–making process. There are stranger, and possibly less effective, ways to make decisions. We could consult horoscopes, palm reading, psychic hotlines, etc. We could resort to hope and fear when we can’t control the circumstances. We could attach special meaning to the most

MANNY ROMAN, CRES AMSP Business Operation Manager

recent evidence or the known rather than research possible alternatives. Why not set up a committee? Won’t that arrive at a good decision? As for me, I tend to agree with the famous Herodotus. I use this process myself, probably more often than I should. Some of my most important and successful decisions have been made using this process. I did not know that I was following a successful historical precedence established 2,500 years ago. My wisdom amazes me. Unfortunately, Herodotus also has another quote that applies to me. This one hit home and brought me pain. “The worst pain a man can suffer: to have insight into much and power over nothing.” As wise as I am, as knowledgeable and loved, I have power over nothing. With all my talent, I should be emperor of the solar system.

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THE VAULT

o you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your chance to prove it! Check out “The Vault” photo. Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will be entered to win a $25 Amazon gift card. To submit your answer, visit 1TechNation.com/vault-january-2017. Good luck!

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

DECEMBER PHOTO This device is a 1950 GE Radiographic Fluoroscopic Room

NOVEMBER WINNER The Vault winner for November is George Brown, Biomed III with McLeod Health Cheraw.

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OVER 20 YEARS OF EXPERIENCE IN TALENT ACQUISITION FOR THE MEDICAL EQUIPMENT SERVICE INDUSTRY. EMPLOYER SERVICES • Talent search and acquisition • Talent retention and training • Workforce planning

CANDIDATE SERVICES • Career placement • Career advising • Resume critiques • Interview training

JENIFER BROWN Jenifer@HealthTechTM.com Ph: 757.563.0448 | www.HealthTechTM.com

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