TechNation - February 2017 by MD Publishing

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Vol. 8

ADVANCING THE BIOMEDICAL / CE PROFESSIONAL

FEBRUARY 2017

A Look At Medical Equipment Service Professionals Who Have Started Their Own Successful Business

16 Company Showcase FOBI

27 News and Notes

Industry Updates

46 Roundtable

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TECHNATION: ADVANCING THE BIOMEDICAL / CE PROFESSIONAL

HE ROUNDTABLE: T ULTRASOUND PROBES TechNation asks industry experts about the latest regarding ultrasound probes and transducers and what HTM professionals need to know to maintain these devices. Also, how can they help prepare their health care facilities for the future regarding probes and transducers.

BIOMED TO BUSINESMAN: A LOOK AT MEDICAL EQUIPMENT SERVICE PROFESSIONALS WHO HAVE STARTED THEIR OWN SUCCESSFUL BUSINESS From biomed to business founder, many HTM professionals have started successful enterprises after seeing a need within the industry they serve. Starting a new business involves a leap of faith, a business plan and more. Next month’s Feature article: Time Management and Professional Development

Next month’s Roundtable article: Real-Time Location Systems (RTLS)

TechNation (Vol. 8, Issue #2) February 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.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FEBRUARY 2017

TECHNATION

INSIDE PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Chandin Kinkade

ART DEPARTMENT

Jonathan Riley Jessica Laurain Kara Pelley

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

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

WEB DEPARTMENT

Taylor Martin Cindy Galindo Adam Pickney

ACCOUNTING

Kim Callahan

CIRCULATION

Lisa Cover Laura Mullen

EDITORIAL BOARD

Eddie Acosta, Business Development Manager, Colin Construction Company Manny Roman, Business Operation Manager, AMSP Robert Preston, CBET, A+, 2014 Salim Kai, MSPSL, CBET, Clinical Safety Engineer University of Michigan Health System James R. Fedele, Director, Biomedical Engineering Izabella Gieras, MS, MBA, CCE, Director of Clinical Technology, Huntington Memorial Hospital Inhel Rekik, Biomedical Engineer, MS, Clinical Engineer

Departments P.12 SPOTLIGHT p.12 Professional of the Month: John Jetchick p.16 Company Showcase: FOBI Medical p.18 Department of the Month: Intermountain Healthcare Clinical Engineering Department p.22 Biomed Adventures: Once Mentored, Now Motivator P.27 p.27 p.34 p.36

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

P.39 p.39 p.40 p.43 p.44

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

P.60 p.60 p.62 p.64 p.66 p.71 p.72 p.74

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

P.76 BREAKROOM p.76 Did You Know? p.78 The Vault p.80 MedWrench What’s on Your Bench? p.82 Index Like us on Facebook, www.facebook.com/TechNationMag Follow us on Twitter, twitter.com/TechNationMag

MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

TECHNATION

FEBRUARY 2017

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SPOTLIGHT

PROFESSIONAL OF THE MONTH John Jetchick, CBET By K. Richard Douglas

e work most of our lives with an eye on that golden watch. There will be a day when we can sleep in and not set an alarm. Although few actually get a gold watch anymore, the thought of taking it easy for awhile is a nice thought. John Jetchick, CBET, a senior technology manager with Aramark, works at Swedish Medical Center in Englewood, Colorado and has spent more than 40 years in the HTM professional. He is now making the transition into the life of a retiree.

Jetchick’s accomplishments and contributions to his department and the HTM field have not gone unnoticed. “He is a notable gentleman and professional in the field, especially in Colorado. A lifetime honored member of CABMET, former military-biomed instructor and veteran, John Jetchick is recognized by HTM and health care professionals throughout the area for his sincere warmth, great sense of humor and his passion for the field. He has fostered and supported mine, and countless others, careers,” says Dustin Telford, CHTM, CBET, CRES, CLES, supervisor in the Biomedical Department at Swedish Medical Center. Jetchick got his biomed career started in the Great Lakes state, growing up in Livonia, Michigan. The draft slightly detoured his plans. “I was introduced to biomed by a counselor at what was then Schoolcraft Community College in Livonia. He suggested I give it a try. I took some classes and enjoyed it,” Jetchick says. “Before I was able to complete the program, I was drafted into the Army. I met with a recruiter and found out the Army had a biomed program. I signed up for it and, after basic training, reported to Fitzsimons Army Medical Center in Denver for the basic course.” While in the Army, Jetchick became an instructor at the Medical Equipment and Optical School (USAMEOS).

TECHNATION

FEBRUARY 2017

JOHN JETCHICK, CBET Swedish Medical Center, Englewood Colorado

“Before I graduated from the short course, the warrant officer in charge asked me if I wanted to stay and become an instructor,” he remembers. “My wife and I really liked Denver, so I said yes. The program was taught in phases. I would sit in on the lectures, as a student in one phase, then be an instructor in another phase I had already completed. I again became an instructor after completing the long course.” After two enlistments, Jetchick transitioned to the civilian world. His first job was selling respiratory therapy supplies for a small company in Colorado.

“I discovered I was a terrible sales rep,” he admits “A former instructor from Fitzsimons, Mike O’Brien, was in charge of the biomed program at Hospital Shared Services in Denver. He hired me and I started in 1979. I moved up the technician ranks over the next several years. In 1996, I joined GE as a senior tech. I was promoted to Senior Program Coordinator; my first salaried position. In 2010, I joined Aramark Healthcare Technologies as a Technology Manager. My current title with Aramark is Senior Technology Manager.” Jetchick has been at Swedish Medical Center for 22 years, having been with GE for 14 years before joining Aramark. LEADERSHIP AND RECOGNITION Asked about any challenges during his career, Jetchick points to a recent project and one from the past. “This past year, I oversaw the replacement of the hospital’s telemetry system. I was asked to make all decisions on the project, including the number of telemetry transceivers for each department, and the setup of the tele tech monitoring area. At the same time, we were opening two new floors with a total of 40 beds, so my days were definitely extended,” he says. “Several years ago, I oversaw the transfer of equipment from a hospital that was closing, to one that was expanding. The equipment moves had to

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SPOTLIGHT

“ I am passionate about the biomed field. I believe it’s the greatest job in the world, and would recommend it to any young people looking for a challenging career.” be timed perfectly in order to have the equipment operational before the patients arrived in their new beds,” Jetchick says. Asked about any awards or positions held within the HTM field, Jetchick recalls several. “As for awards, I was awarded soldier of the year at Fitzsimons Army Medical Center in 1976,” Jetchick says. “I won a ‘Best of the Best’ award with GE. I am a lifetime member of CABMET, the local biomed society in Colorado, and was once its president.” Away from the job, he has enjoyed hitting the links. “Golf is my main hobby. I also enjoy organizing events, such as a church festival or classic car show,” he says. His family is important to him. He and his wife, Gayle, have a daighter, son-in-law and granddaugter in California. Jetchick leaves a field that he

ardently supports. “I am passionate about the biomed field. I believe it’s the greatest job in the world, and would recommend it to any young people looking for a challenging career,” he says. Those young people would find a good role model in Jetchick. With people like him retiring, the field has some big shoes to fill. Jetchick says that he might “kick back” for a short while, but he believes he might keep busy in retirement. His wife is the executive director of a business improvement district in Aurora, Colorado. Jetchick has already done some volunteer work to help his wife and will most likely continue to volunteer and keep the business owners happy. Since he has been a biomed for over 40 years in total, there is a likelihood that he will also continue to contribute to the field.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FAVORITE BOOK:

No particular book, but I have enjoyed many from Dan Brown, Michael Crichton, Dean Koontz, and John Grisham.

FAVORITE MOVIE: “The Sound of Music”

FAVORITE FOOD: Mexican

HIDDEN TALENT:

I’m pretty good with trivia.

FAVORITE PART OF BEING A BIOMED:

“People saying ‘thank you’ when we have helped them with equipment service or installation projects.”

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A coffee mug laptop large calendar chocolate or hard candy picture of my granddaughter

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TECHNATION

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SPOTLIGHT

SPECIAL ADVERTISING SECTION

COMPANY SHOWCASE FOBI

Medical, which began as FiberOptic Bulbs Incorporated in Texas in 1996, has adapted to keep pace with the health care industry to provide products and services.

“FOBI Medical began by selling Xenon and all types of medical lamps and by 2000 had expanded into medical batteries,” explains Keith Przybyla. “My background is in surgical sales. In the mid-1990s that market was experiencing a profound change — contract driven purchasing. The OR surgical market uses a face-toface sales approach, which I prefer. I shifted my efforts to biomedical engineering and brought the personal sales approach with me.” In its region, FOBI Medical is the official representative of Fluke Biomedical and Unfors RaySafe, as well as an exclusive distributor for Analytical Industries, Bay Corporation, and many others. FOBI is also a preferred vendor for several regional and national independent service organizations (ISOs). FOBI’s dedication to service, quality, and integrity has earned them a favored status with their vendors. Przybyla states confidently, “We regard each sale as an opportunity to pass on those qualities to our customers.” We want to provide value both before and after the sale. Hence our motto: Define. Discover. Deliver. We

TECHNATION

FEBRUARY 2017

Keith Przybyla President of FOBI Medical Define our partner’s needs. Discover solutions to those needs. And, Deliver the products and service requested.” “Our customers do not have to rely on a call center or a salesperson sitting behind a computer in a different time zone to identify their problem and offer a solution. We provide hands-on service whenever possible,” Przybyla says. “Our partners (customers) tell us repeatedly how much they appreciate the reciprocal connection.” “A position we are most proud of,” states Przybyla, “is our ability to continually provide value at a competitive price. We know our customers will shop a product, but we also know, after 20 years, that most respect the value we do provide. A major part of that value is the

personal assistance of a FOBI representative recommending the best products and services available. That’s trust a website cannot provide.” “Our internal staff is dedicated to perfecting the buying experience from the initial quote request to the packaging and shipping of that order,” he adds. “Our sales force of personable, knowledgeable, and helpful outside sales people, is combined with a super strong internal sales staff supporting them. FOBI brings a completely unique dynamic to the end user.” Another customer-friendly aspect of the FOBI customer support model is its new website. “FOBI Medical is extremely proud to announce the new website allowing customers to log in and secure their pricing and create custom quotes. When you have been totally personable with your customers for more than 20 years, it’s a little different to back off and let them do some of the shopping. Our initial response has been very well received. Our customers like the convenience and simplicity of the new site. But, they still love us stopping by,” Przybyla says. “We also shifted our focus to a more service-centric model,” Przybyla says. “We upped our investment in our customer’s well being and found a way to bring their cost of goods and services down.” “We have combined the buying power all our customers and made significant purchases for

WWW.1TECHNATION.COM

SPOTLIGHT

“Our customers do not have to rely on a call center or a salesperson sitting behind a computer in a different time zone to identify their problem and offer a solution.”

the items they need serviced most. Repairs and labor costs have been reduced dramatically.” “We are staying true to providing the total value solution and continuously looking for ways to provide the commodity and value added services at the most competitive prices,” he adds. FOBI strives to create strong personal relationships, strong brand recognition, strong customer loyalty, and local representation in specified areas with boots on the ground. FOBI has no problem going the extra mile for its customers. “Most products arrive next day in our core territories, which lower product costs and down-time to our customers,” Przybyla says. “We customize orders per the customer’s

request. When our customers express a need to have something assembled or designed, FOBI makes it happen.” Big things are happening at FOBI as the company finds new ways to help new and existing customers in 2017 and beyond. “We’ve recently partnered with Precision Medical to service and sell their products across most of the USA,” Przybyla says. “In addition, we will be introducing new products and partnerships in 2017. This will expand our capabilities and provide our partner/customer’s new products and services as per their requests.” Przybyla adds, “We’re excited about the massive surge in our air oxygen blender service, and anticipate it continuing through 2017.”

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

“Transitioning from a regional to a national company is definitely on the horizon. FOBI has traditionally relied on word of mouth and did not advertise or promote the company,” Przybyla says. “With growth in regional and national ISO accounts combining with a total reconstruction of the website and nationwide marketing plan, FOBI Medical is poised for growth during the latter half of the decade. We understand the importance of the electronic medium and will continue to use and design uncomplicated systems making the FOBI experience effortless.

FOR MORE INFORMATION about FOBI, visit www.FOBI.us.

FEBRUARY 2017

TECHNATION

SPOTLIGHT

DEPARTMENT PROFILE Intermountain Healthcare Clinical Engineering Department By K. Richard Douglas

ith an approximate population of 191,180, Salt Lake City, Utah sits in a mountain valley, but is still 4,330 feet above sea level. The four-season city is the capital of Utah.

Serving the needs of patients in the greater Salt Lake City area is Intermountain Healthcare. The not-forprofit health care provider has 37,000 employees as well as 1,500 doctors and caregivers. It’s clinical engineering department is responsible for 23 hospitals, over 185 clinics, 2,700 beds and has an inventory of over 100,000 pieces of medical equipment in service, including more than 8,600 unique models. To handle such a large number of assets, the department is staffed by 112 members. The size of the department, and the scope of its inventory, has resulted in an allocation of duties and responsibilities to cover the myriad of responsibilities that come with a large system. “The Central Depot provides repair services for all mobile medical devices and utilizes the Supply Chain System for transportation of equipment back and forth to the facilities. Also, they utilize a field service model on the repair and maintenance of surgical lasers and simulation lab equipment,” Busdicker says. “The Imaging Service Engineers are regionally based and receive service calls from the centrally located Service Coordination Center. Calls are updated through an automated process and we track response times

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The 112 member Intermountain Healthcare Clinical Engineering Department includes the leadership team of (from left) CE Compliance Manger Priya Upenda, CE Program Manager John Schafer, CE System Director Mike Busdicker, Imaging Equipment Services Program Manager Jeff Koford and CE Central Support Manager Dustin Smith.

through this process,” he adds. “The Hospital Operations group provides on-site support for the service and maintenance of the medical equipment for the hospitals and clinics located within their regions,” Busdicker says. RESPECTED TEAM Intermountain provides services to patients in three states, including Utah and parts of Idaho and Nevada. The medical equipment in the system’s inventory is valued at approximately $800 million. The various groups that make up the department go about their work with dedication and cooperation. “Each and every individual in this department is awesome, smart, creative, and dedicated to providing an extraordinary care to the community we serve. As the compliance manager, and someone

who became part of the organization just a couple months ago, I got the opportunity to visit most of the Intermountain facilities during the internal CE audits,” Updendra says. “During these audits, what I came across was extremely efficient and productive CE and IES folks. Everyone in the team was approachable and willing to share information, experiences, and challenges along with ideas for improvement,” she adds. Keeping tabs on the service requests that come from the various facilities under the team’s care is the Central Support Department, consisting of a support service manager, service coordination center, a parts inventory coordinator and two business/data analysts. “Each of our regions within the hospital operations group has a Regional CE Director and they provide support to local facilities

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SPOTLIGHT

within their area of responsibility. Each month, scheduled work orders are electronically assigned to technicians within the region and they close them through the CMMS,” Busdicker says. “Unscheduled work orders are created and closed within each of the regions by the local technicians. Monthly reports are generated through the Central Support Function and tracked by Clinical Engineering Leadership,” he adds. The reputation of the clinical engineering team, and the talent within its ranks, has been seen and heard outside the walls of Intermountain facilities. “Members of the CESS team have been invited to present at annual conferences with AAMI, MD Expo, RSNA, ACHE, HIMSS and numerous workshops across the nation,” Updendra says. “During a medical device security workshop at Mayo Clinic in Rochester, I was delighted when an eminent person told me ‘Intermountain is a model health system and an ally in the west working on remarkable initiatives providing extraordinary patient care at affordable cost.’” HOMEMADE SOLUTION The team at Intermountain has made great strides in cybersecurity with its own internal initiative. “Currently, the Clinical Engineering group is very involved with the cybersecurity project covering medical equipment. We have developed an internal application providing the organization with a risk score for each manufacturer and model within the health care system,” Busdicker says. “This allows the organization to focus efforts on legacy systems to implement mitigating factors and processes to reduce risk associated with the equipment. Also, the application is used in the pre-purchase evaluation for new equipment and in the life cycle management of existing equipment. The CE Department is intimately involved with the scoring methodology, mitigating factors, data protection, and data removal,” he adds. Some of the leadership of the department are also involved in the HTM profession beyond their duties on the job. Mike Busdicker is an active member of the AAMI Technology Management Council, member of ACHE, member of HIMMS and is involved with the local biomedical association in Utah. One of the Regional CE Directors is the president of the local Mountain West Healthcare Technology Association. Intermountain’s clinical engineering department stays on top of a mountain of medical equipment and achieves

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

results by directing specialized teams through a model of efficiency and good customer relations. VIEW MORE photos of all the department areas of Intermountain Healthcare at www.1technation.com.

WHO, WHAT, AND WHERE OF INTERMOUNTAIN HEALTHCARE The department consists of four areas including Central CE Support Services, Central Depot Repair Services, Hospital Operations and the Imaging Equipment Service Program. Department leaders include: • Mike Busdicker, MBA, CHTM, system director of Clinical Engineering; • Priya Updendra, BSBME, MSE, clinical engineering compliance manager; • Dustin Smith, MBA, clinical engineering central support manager; • John Schafer, MBA, clinical engineering program manager, Central Depot Repair Services; • Mark Hodges, engineering director, Hospital Operations at Primary Children’s Hospital; • Brian Bowles, clinical engineering supervisor; • Bryan White, clinical engineering director, Southwest Region; • Larson Holyoak, BS, CHTM, clinical engineering director, South Region; • Jason Komenkul, CE supervisor, South Region; • Kathy Pranger, clinical engineering coordinator; • Dallas Clark, CBET, clinical engineering director, Central Region; • Robert Howe, CE, supervisor for the Central Region; • Dave Snieder, CE, supervisor for the Central Region; • Steve Lewis, CE, supervisor for the Central Region; • Dana Bath, clinical engineering coordinator; • Scott James, CBET, clinical engineering director, North Region; • Dan Miller, CE, manager, North Region; and • Jeff Koford, MBA, CRA, RT (R) (MR), program manager, Imaging Equipment Service program.

FEBRUARY 2017

TECHNATION

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SPOTLIGHT

BIOMED ADVENTURES Once Mentored, Now Motivator

By K. Richard Douglas

here’s a good reason organizations that work with kids try to pair a child up with a mentor. In some cases, there is not a parent figure to fill this role. Other times, it is because an outstanding adult is an inspiration or experienced in a particular profession.

Douglas Redwine, an operations manager for the Healthcare Technology Management department (Central Region) at Texas Health Resources, was inspired by just such a person. The experience led Redwine to to pay it forward. “When I was 12 years old, I began attending Greater Saint Stephen First Church (GSSFC) in Fort Worth, Texas and became active in the church’s youth group; Youth Alive,” Redwine remembers. “The organization was led by a young guy named Stanley Williams, from Alaska, who had recently graduated from Howard University — first college graduate I had ever met. Stanley became my mentor and I was greatly influenced by his teaching ability and the way he related to myself and all of the youth,” Redwine says. That influence was enough to convince Redwine to follow in William’s footsteps and mentor young people. “After graduating college, I moved from Houston back to Fort Worth, Texas and began volunteering and speaking to a group of boys on Saturdays for a mentoring program called Men Under Construction. I eventually became the youth director at GSSFC and worked there for nearly 10 years. Through the position as a Youth Director, I realized my passion for

TECHNATION

FEBRUARY 2017

Program at Dunbar High School with the purpose of teaching Audio Engineering techniques, the business of the music industry and to promote student creativity. While creating the curriculum, I quickly realized science technology engineering and math (STEM) were major components of audio engineering and music,” Redwine says. “Once I made that discovery, I began researching and developing creative classes that I thought would be helpful in influencing youth who are not

“ The overriding theme of my talks is to motivate youth and young adults to recognize and tap into their unique giftedness and to encourage them to not only dream, but to wholeheartedly pursue their best academic and personal success, mentoring and developed my skills as a speaker,” Redwine says. TEACHING IMPORTANT SKILLS Most experts in education agree that the future of America, and any competitive advantage we can give the next generation comes out of an emphasis on Science Technology Engineering and Math (STEM) education today. The U.S. Department of Education says that there is an inadequate pipeline of teachers skilled in STEM learning. Redwine is helping to fill the void outside the traditional classroom. “I got into STEM education by chance. In 2011, I created a Media Arts Class for the Fort Worth After School

normally exposed to the opportunity to engage in STEM education,” he adds. “Because of my educational background, skill set and work experiences I lean towards focusing on the technology and engineering portions of STEM.” Redwine also shares his experience and insights through motivational talks. He began garnering experience as a speaker during the years he was a youth director between 2002 and 2011. He spoke at conferences, camps and programs. “I officially started doing motivational speaking in 2011 when I created my company, Redwine Edutainment Division (R.E.D.) and started my after school classes,” he says.

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SPOTLIGHT

“The overriding theme of my talks is to motivate youth and young adults to recognize and tap into their unique giftedness and to encourage them to not only dream, but to wholeheartedly pursue their best academic and personal success,” Redwine says. “During my talks I provide them with applicable principles for success, while challenging them to take personal responsibility for maximizing their potential. My talk themes usually include my social media motto: Dream — Explore — Create.” MAKING IT ALL HAPPEN When you do the kind of work that Redwine does, to benefit young people, you can’t just sit back and hope that your services will be discovered. Most of it requires deliberate actions and to some degree, a certain amount of luck. “I got connected with the Independent School District (ISD) by being proactive and believing that I had a program that would be beneficial to students in the district,” Redwine explains. “After creating the plan for the class, I took the brochure to a local school – Dunbar High School – with the intentions of talking to the principle, although I didn’t have a scheduled appointment.” “The first person I met in the school’s administration office just happened to be the After School Program Director who was on site visiting the school’s coordinator. Once he found out what I had to offer, he was excited about the idea and pointed me in the right direction to apply with, and sign on with, 21st Century and Clayton Youth Enrichment Services as a contractor to offer my class at Dunbar High School, where I remained for three years,” Redwine says. After the high school contract was complete, he offered programs at three other schools; Young Men’s Leadership

Academy (YMLA), Westcreek Elementary and Atwood McDonald Elementary. He then made a bid for the ISD vendor contract in February of 2016. He was awarded the ISD After School Program contract in July of 2016 and will offer various classes at multiple schools this year. While not mentoring young people, Redwine can be found on the job as an Operations Manager for the Healthcare Technology Management Department (Central Region) at Texas Health Resources. “I am currently responsible for the biomed activities at five hospitals and 20 joint venture sites. My Healthcare Technology Management duties cover staff management, working with

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

customers, administration, contracts, capital budgeting and leading the direction of HTM at Texas Health Resources for the future,” he says. “In February I will be attending SMU Certification program and will be taking the PMP certification test in March. I’m also an Adjunct Instructor at Brown Mackie College in the Associates in Biomedical Equipment Technology department.” Beyond mentoring other people’s kids, Redwine has experience as a dad also. “I am the father of three great kids; Nicholas 22, Kayla, 18, and Tyler, 14,” he says. Many young lives in Texas will find direction because of one HTM professional who learned about the value of mentoring from a young age.

FEBRUARY 2017

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1. Electronically accessed: www.jointcommission.org/issues/ 2. Trophon is a trademark of Nanosonics. Ltd. GE Healthcare is a distributor of trophon 3. Mattias Mårtensson et al. (2009). High incidence of defective ultrasound transducers in use in routine clinical practice. European Journal of Echocardiography. 10 (1), 389–394. 2 Weigang, et al. (2004). The methods and effects of transducer Degradation on image quality and the clinical efficacy of diagnostic sonography. J Diag Med Sonog. 20, 395-405 4. Weigang, et al. (2004). The methods and effects of transducer Degradation on image quality and the clinical efficacy of diagnostic sonography. J Diag Med Sonog. 20, 395-4053. 5. TD 100 is a trademark of CS Medical. GE Healthcare is a distributor of TD 100 © 2017 General Electric Company. GE and GE Monogram are trademarks of General Electric Company. GE Healthcare, a division of General Electric Company

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INDUSTRY UPDATES

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NEWS & NOTES

Updates from the HTM Industry AUE OPENS NEW FACILITY IN THE UK Advanced Ultrasound Electronics (AUE) has opened a new sales, repairs, and inventory warehouse facility in Northampton, England. “While we have been doing business overseas for quite a few years, the increased demands for the services we offer, and business we have from both OEM and hospital customers in the U.K. and Western Europe, have made the need for a full service repair, inventory, and sales facility in the U.K. a logical expansion to our growing ultrasound business,” according to John Hryshchuk, President of Advanced Ultrasound Electronics and AUE LTD. The new facility boasts two floors of modern space. The first floor is the repair and parts and systems inventory warehouse, and the second floor houses administration offices complete with a new training facility for our biomedical technician training classes. This is a state-of-the-art facility conceived from the ground up for ISO compliance and to provide the same level of technical expertise and service customers have come to expect from Advanced Ultrasound Electronics. AUE LTD launched the announcement of the new facility at the Medica Show in Dusseldorf, Germany on November 14-17, where the company received “very positive feedback and interest.” Advanced Ultrasound Electronics, was founded in Tulsa by John Hryshchuk in 2001, with a vision to provide a dedicated repair facility specifically for medical ultrasound systems. The company sells, repairs, and services all major brands of ultrasound systems and has a vast inventory of parts and probes in-stock to keep customers up and running. AUE currently offers sales and service to customers in all 50 states as well as Canada, Central America, and Western Europe. FOR ADDITIONAL INFORMAITON, visit www.aueltd.co.uk.

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AAMI RELEASES FRAMEWORK TO GUIDE BENEFIT-RISK ASSESSMENTS A new special report from AAMI lays out a framework for how the medical device industry and the Food and Drug Administration could embrace a new – and shared – way of thinking when it comes to considering the benefits and risks of products already on the market. The goal of the document is to make for a clearer and more efficient way of reaching corrective and removal decisions when a problem emerges with a device that is already being sold and used. The challenge of postmarket actions, especially product removals, has long been a source of contention between regulators and manufacturers. The report – Postmarket Risk Management: A Framework for Incorporating Benefit-Risk Assessments into Correction and Removal Decisions – comes as the FDA has signaled a stronger interest in strengthening the postmarket observation of medical devices and at a time when the industry says there’s a need to streamline premarket decisions so innovative products can get to patients faster. “In this environment, it is more important than ever that we have greater understanding and less acrimony,” said Mary Logan, who recently retired as the president and CEO of AAMI. “We saw a need for fresh perspectives and insights in considering how postmarket assessments ought to work. And, we realized that we needed to bring everyone together if we were going to find a meaningful and lasting solution.” Working with the FDA, Logan convened a diverse working group of experts, including representatives from the agency, device manufacturers, a patient, and four industry trade associations, to tackle the challenge of developing a predictable and transparent process that could be used by the FDA and industry alike. The framework is the product of 20 months of deliberations, drafts, and debates among members of the working group who sought to develop a practical and usable document that would delineate the steps and issues involved in a postmarket benefit-risk assessment and a potential recall. A free copy of the framework can be downloaded at www.aami.org/benefitriskframework. 28

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ACERTARA RECEIVES 2 U.S. PATENTS FOR TEST EQUIPMENT Acertara – an independent ISO/IEC 17025:2005 accredited medical ultrasound acoustic measurement, testing, and calibration laboratory, and ISO 13485:2003 certified probe repair and new product development facility – has been awarded United States patent No. 9,513,237 for its probe testing system, Active-Z and United States patent No. 9,525,257 for its electrical leakage omni-connector, accept. Active-Z is a portable, point-of-care test device for ultrasound probes that enables field personnel and sonographers to verify the proper functioning of their probe. By measuring the complex impedance of a probe the Active-Z user can quickly triage if a probe can be repaired or needs to be replaced. The omni-connector Accept is part of an transducer electrical leakage suite. Accept’s unique design will connect to virtually every ultrasound manufacturer and probe model eliminating the need for hospitals to purchase multiple adapters. Accept was introduced to assist hospitals with accreditation under the Intersocietal Accreditation Commission’s requirements to test probes for electrical leakage before every case. “Our approach has always been to develop novel test devices that position our customers to provide safe and effective care in an environment that controls costs. The Active-Z and Accept patents are examples of that approach that will enable better patient outcomes,” G. Wayne Moore, President and CEO of Acertara, said regarding the patents. WWW.1TECHNATION.COM

INDUSTRY UPDATES

SOUTHEASTERN BIOMEDICAL ASSOCIATES EARNS ISO 9001:2015

M.I.T. PRESENTED WITH NEUSOFT ROOKIE OF THE YEAR

Southeastern Biomedical Associates earned ISO 9001:2015, applicable to sales, service and calibration of medical and analytical test devices, after a review by ABS Quality Evaluations. Southeastern Biomedical Associates achieved this milestone in November 2016. “Our goal in obtaining our ISO certification was to further ensure that we continue to provide superior customer service, on-time delivery, and verified order accuracy and to prove that we are committed to continuously improving our company through our quality management system to meet and exceed our customers’ requirements,” Southeastern Biomedical Associates Inc. co-founder Boyd S. Campbell, CBET, CRES, said. “We are proud to have all segments of our company including sales, service, and calibration of medical as well analytical test devices certified.” “Obtaining our ISO certification was very important to us for a number of reasons,” Southeastern Biomedical Associates Inc. co-founder Greg Johnson, CBET, CHFM, added. “It has enabled us to consistently provide unsurpassed quality, service and value to our customers. The process also supports our commitment to continuously improve the products and services we offer.” Southeastern Biomedical is an independent sales and service organization. In addition to new and refurbished product sales, a variety of PM, parts and repair services are available as well as onsite and depot calibration services for biomedical test equipment.

Rick Player,President of M.I.T., recently accepted Neusoft Medical’s Rookie of the Year award on behalf of the entire Medical Imaging Technologies staff. It was awarded to M.I.T. for its work and dedication to bringing Neusoft Medical diagnostic imaging equipment to the U.S. market. This work began early in 2016 when M.I.T. announced it would be a new contact for sales and service of Neusoft Medical equipment. The service team at M.I.T. underwent training on various Neusoft modalities throughout 2016. The M.I.T. staff was honored to be the company that installed the first Neusoft NeuViz 64 CT in North America. Neusoft Medical is a leading manufacturer of medical equipment and service. Currently, Neusoft Medical’s products have been exported to over 100 countries and regions around the world, serving more than 9,000 customers, including M.I.T. M.I.T. offers system sales, parts and service on various Neusoft Medical Imaging products.

COOL PAIR PLUS EARNS ISO CERTIFICATE Cool Pair Plus has been awarded the ISO 13485:2003 Quality Management System certificate for calibration, service and repair of testing, measurement and process control equipment and devices. Certification was awarded by orion registrar inc. Of Arvada, Colorado. ISO 13485:2003 specifies requirements for a quality management system where an organization needs to demonstrate its ability to provide medical devices and related services that consistently meet customer requirements and regulatory requirements applicable

to medical devices and related services. The primary objective of ISO 13485:2003 is to facilitate harmonized medical device regulatory requirements for quality management systems. “We are extremely proud of our team and their efforts to attain the ISO 13485 certification,” said Dave Baldwin, Vice President of Cool Pair Plus. “This certification demonstrates our commitment to follow a quality control process that allows us to provide consistently superior products and services to our customers worldwide.”

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FEBRUARY 2017

TECHNATION

INDUSTRY UPDATES

STAFF REPORTS

HEALTHCARE IT AND ADVANCED ANALYTICS OFFER GROWTH OPPORTUNITIES Rigel’s latest electrical safety analyzer – SafeTest 50 – puts medical equipment such as beds, hoists and infusion pumps through its paces. The tests are vital for highlighting faults with equipment that does not require patient applied part testing – ensuring it is safe for patient use. Hundreds of medical industry people saw SafeTest 50 at MEDICA, the world’s leading trade fair for medical industries.

The device, which is produced in the United Kingdom and distributed worldwide, features a color-coded user interface and fast test routine to speed up the process. “The device’s simplicity makes it a great product for entry-level technicians, and it also gives all of the functionality that experienced engineers demand,” said Andrew Teasdale, principal systems engineer.

“We know that engineers perform a lot of tasks over the course of the day – our job is to streamline that process for them and save them time,” he added. Rigel Medical dates back to the 1970s when it created the world’s first electrical safety analyzer.

TJC APPOINTS CHIEF INFORMATION AND SECURITY OFFICER The Joint Commission has named Kin Y. Lee, MBA, MS, as its new chief information and security officer. Lee brings more than 20 years of extensive technology experience across a variety of industries, including the technology, manufacturing, human resources and financial sectors. In this senior leadership position, Lee will be responsible for the development and execution of information technology and computer systems for The Joint Commission, the Joint Commission Center for Transforming Healthcare, Joint Commission Resources and Joint Commission International. He will oversee technology strategies and operations that advance the enterprise’s high-performance operating environment in a secure and efficient manner. “With his record of achieving business results through innovation and collaboration, and his background as a certified Six Sigma Black Belt, Kin will be integral in developing and implementing a technical strategy that supports our vision of bringing high reliability processes to the health care industry,” said Lynn B. Dragisic, executive vice president, Support Operations, The Joint Commission. Most recently, Lee was senior vice president of information technology for Kforce in Tampa, Florida. He also previously held leadership positions as global chief technology officer and service delivery at Aon, vice president and global chief technology officer at ManpowerGroup and vice president and general manager of Asia Pacific Shared Services at Honeywell International. Lee started his career at AT&T Bell Labs as a member of its technical staff.

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FEBRUARY 2017

WWW.1TECHNATION.COM

INDUSTRY UPDATES

VARIAN NAMED TOP HEALTHCARE EQUIPMENT AND SERVICES COMPANY Varian Medical Systems was named America’s Most JUST Company in the Healthcare Equipment and Services industry, according to JUST Capital and Forbes magazine’s inaugural “JUST 100 List.” The rankings are based on criteria established from one of the largest surveys ever conducted on attitudes towards corporate behavior, involving 50,000 Americans over the last 18 months. This inaugural list ranks U.S companies against their peers within 32 major industries. The ranking rates companies based on fair pay, equal opportunity employment, job creation, safety, compliance, and respect for employees. “We are honored to be named one of the 100 Most JUST companies in the U.S. and the top ranked company in our industry,” said Dow Wilson, CEO of Varian Medical Systems. “At Varian our mission is to help save millions of lives every year around the world. That is why we all work at the company. One of our shared values is Doing Well by Doing the

Right Thing. By focusing on the mission and being guided by our values, everybody wins, whether they are a patient helped by our technology, a customer who can collaborate with us on the next clinical advance, an employee whose contributions are valued, or an investor who garners a good return based on our profitable growth.” The inaugural JUST 100 list appeared in Forbes magazine’s December 20 “Impact and Philanthropy” issue. JUST Capital will also make the rankings accessible and sortable on its website, justcapital.com. Its interactive “Explorer” tool goes inside the rankings to show how companies were scored.

UNIVERSAL HOSPITAL SERVICES ACQUIRES RADIOGRAPHIC EQUIPMENT SERVICES Universal Hospital Services Inc. (UHS), a provider of health care technology management and service solutions, has has acquired Radiographic Equipment Services (RES), a San Diego-based provider of medical imaging solutions. “The addition of RES further strengthens our growing clinical engineering segment and enables us to deliver a higher value service offering to customers,” said Tom Leonard, CEO of UHS. “The business complements our model for outsourced and supplemental biomedical equipment repair and maintenance services with advanced capabilities in medical imaging, localized service delivery and a shared commitment

to high-quality customer service. Together, we will have opportunities to better serve customers in Southern California and to work together to make a difference in health care.” RES specializes in diagnostic imaging services for high-end modalities, including MRI, CT, PET/ CT, cardiac cath, interventional radiology, nuclear medicine, mammography, ultrasound and other diagnostic radiology. The company serves several major health systems in Southern California, along with other regional care providers, and helps to minimize equipment downtime and ensure patient-ready technology for

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

advanced diagnostic procedures. The acquisition is part of UHS’ strategy to accelerate growth by advancing its capital-enabled, medical equipment service offerings including on-demand medical equipment rental services, onsite equipment management programs and general biomedical repair and maintenance services for acute and alternative care providers. With a network of 83 service depots covering all major U.S. markets, the company provides end-to-end medical equipment management solutions that help health care providers reduce the total cost of equipment ownership and deliver safer and more efficient patient care.

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INDUSTRY UPDATES

BY AAMI

AAMI UPDATE

AAMI Releases Guide to Prep for CHTM Exam

or those looking to join the ranks of the more than 70 certified healthcare technology managers (CHTM) in 2017, AAMI has published a new resource to help guide your exam preparation.

The CHTM Study Guide, written by Patrick K. Lynch, CBET, CCE, CHTM, provides a solid review of the five core topic areas found on the exam: financial management, risk management, operations management, education and training, and human resources. This resource also includes concise guidance on these core principles, as well as practical examples of sound financial planning, routine documentation, and a quality improvement tool. In addition, the guide lists other valuable resources, as well as organizations and agencies of importance to healthcare technology managers. As health care becomes more complex, certification is one way for healthcare technology management (HTM) professionals to highlight their ability to provide quality and trustworthy service. HTM professionals often seek certification as a way to demonstrate their accomplishments, mastery of skills, experience, and commitment. “I think anybody who is looking to continue in this field for the long run should be looking into certification,” said Jennifer DeFrancesco, a lead biomedical engineer with the Department of Veterans Affairs and one of the first HTM professionals to earn the CHTM designation. The 100-question CHTM exam covers two major areas: the management of healthcare technology operations and the management of personnel. Candidates for the exam are expected to have the skills and understanding to perform strategic,

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FEBRUARY 2017

business, and change management, as well as handle employee relations. “This certification provides the opportunity to demonstrate your operational and management skills, and it does measure a significantly different skill set than CBET,” said Mark Woods, CHTM, referring to the certification for biomedical equipment technicians. Woods is the director of clinical engineering at Cheshire Medical Center in Keene, New Hampshire. For more information about certification, visit the AAMI Credentials Institute at www.aami.org/aci. DEVICE SECURITY TO TAKE CENTER STAGE AT AAMI 2017 CONFERENCE Kevin Fu, a widely respected leader in the field of medical device security, has been selected to give the annual Dwight E. Harken Lecture during the AAMI 2017 Conference & Expo in Austin, Texas, June 9-12. This general session honors the significant contributions that Harken, AAMI president from 19691970, made to medical science and technology. Fu is CEO and chief scientist of Virta Labs, Inc. and an associate professor at the University of Michigan where he directs the Archimedes Center for Medical Device Security and the Security and Privacy Research Group. “This is a great honor,” Fu said. “I really appreciate AAMI recognizing the importance of the field, which is critical for the safety and effectiveness of medical devices.” In hospitals today, it would be

difficult to find medical device technology that does not critically depend on computer software. Network connectivity and wireless communication have transformed the delivery of patient care. But connectivity comes at a price – vulnerability to hackers, viruses, and other malware. Since federal regulators began tracking major health data breaches in September 2009, more than 1,700 incidents impacting nearly 170 million people have been posted to the Department of Health and Human Services Office of Civil Rights’ breach portal. More than 90 hacking incidents were reported in 2016 alone. “I think things will continue to get worse before they get better simply because there’s a lag time between deploying compensating controls and seeing improved outcomes. In 2017, health care delivery organizations will continue to struggle to maintain the security of their clinical networks and medical devices because of the number of legacy devices out there,” Fu predicted. “Most medical devices were not designed with security in mind, and we’re still trying to catch up.” During his presentation, Fu plans to provide insight into the risks, benefits, and regulatory issues for medical device cybersecurity and into the development of trustworthy medical device software. “I hope that people will come out of my presentation with a less sensational view of the issues and a more optimistic view of the future of medical device security,” Fu said. “It’s not about eliminating risk but about controlling and managing risk. It can be done – it’s not impossible.” Registration for AAMI 2017 is open, and those who register before March 20

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will receive an “early bird” discount. For more information, visit www.aami.org/ac. PUBLICATION HIGHLIGHTS CHALLENGES AND SOLUTIONS IN WIRELESS TECHNOLOGY AAMI’s most recent issue of its award-winning, peer-reviewed publication, “Horizons,” has a special focus on wireless technology in health care. The resource provides practical approaches, insights, and advice for professionals to safely and securely manage such technology. Health care is increasingly reliant on wireless technology as medical devices and systems grow more interconnected and mobile. But the freedom that wireless provides also brings news risks and challenges – how do hospitals protect patient data from cyberattacks? How will regulators and industry manage the spectrum on which wireless devices operate? Can different devices – and the diverse people who work with them – speak with one another effectively? This edition of “Horizons” – a publication distributed to AAMI members and subscribers – explores the challenges faced in the rapidly evolving world of wireless technology in health care, including wireless coexistence, spectrum

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

management, cybersecurity, testing and maintaining wireless systems, keeping track of hospital assets, and bridging the gap among people, departments, and devices that may not always speak the same language. “We’re hoping this issue of ‘Horizons’ will help AAMI members and others in health care who are grappling with the challenges posed by wireless technology,” said Sean Loughlin, vice president of communications at AAMI. “With each issue of ‘Horizons,’ we set out to offer unique insights and practical solutions to some of the more vexing challenges associated with one topic in healthcare technology. This particular edition should prove to be invaluable for health care organizations that are trying to figure out how to make wireless technology work safely and effectively.” The issue features an in-depth wireless “roadmap for success” checklist, developed by members of AAMI’s Wireless Strategy Task Force, which health care organizations and manufacturers can follow step-by-step to improve the state of their wireless systems. Tips range from common-sense approaches, such as eliminating legacy devices, to more in-depth advice, such as building a certificate infrastructure or wireless intrusion detection system.

FEBRUARY 2017

TECHNATION

INDUSTRY UPDATES

BY ECRI INSTITUTE

ECRI UPDATE

A Top Hazard – Deadly Infusion Errors Persist, But Simple Safety Steps Can Prevent Harm

arge-volume infusion pumps are commonly used to administer intravenous (IV) medications or other fluids with high accuracy over a specified time interval. Most pumps today incorporate safety mechanisms for reducing the risks of errors that can lead to the over-delivery or under-delivery of medication to the patient. These mechanisms have greatly improved infusion safety, but they can’t eliminate all potential errors. And the mechanisms themselves have been known to fail.

ECRI Institute continues to learn about and investigate incidents of infusion errors involving pump or administration set failures, staff unknowingly defeating a safety mechanism, or incorrect infusion programming. Such errors – particularly those that result in the uncontrolled flow of medication to the patient, known as “IV free flow” – can lead to patient harm and even death. These incidents, coupled with the organization’s belief that renewed attention to simple, previously commonplace safety steps can help prevent patient deaths, prompted ECRI Institute to highlight infusion errors as the number 1 hazard in its Top 10 Health Technology Hazards for 2017 report. OLD PROBLEM, RENEWED ATTENTION – PREVENTING IV FREE FLOW Decades ago, preventing IV free flow required that caregivers manually close a clamp on the IV tubing before activities such as removing the IV administration set from an infusion pump. Failure to clamp the tubing could allow the medication to flow freely to the patient, without restriction from the infusion pump. Awareness of, and solutions to, this

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hazard evolved over time: • In its 1982 evaluation of infusion controllers, ECRI Institute raised the issue of the need for safeguards to prevent the uncontrolled flow of medication to the patient. • Over the next decade, device designs evolved, and set-based free-flow protection mechanisms became available. These mechanisms are designed to prevent flow through the tubing when the administration set is removed from the pump, regardless of whether the user closes the clamp on the IV tubing. • By 1992, ECRI Institute recommended that hospitals phase out any electronic infusion devices that did not incorporate set-based free-flow protection mechanisms. • In 1997, ECRI Institute placed its “Unacceptable” rating on devices that lacked set-based free-flow protection. This meant that such devices should not be purchased; and any healthcare facilities that were using such devices should make immediate plans to eliminate them. • Fast forward to today: Free-flow protection mechanisms are commonplace on large-volume

infusion pumps and administration sets, and the risk of IV free flow has been significantly reduced... but not eliminated. Unfortunately, occasional incidents of uncontrolled flow are still reported. Causes include: • Broken or damaged components on the pump or administration set • Incorrect loading of the administration set • Failure of the free-flow mechanism to engage ECRI Institute’s investigations have found that damage to or failure of crucial pump components can affect the functioning of a pump’s safety features. For example, a damaged component could prevent an anti-freeflow clamp from engaging, thereby allowing free flow. Although some pumps are equipped to alarm for such conditions, they may fail to do so if the pump does not recognize that the anti-free-flow mechanism is not appropriately engaged. “The pump itself cannot detect uncontrolled flow,” notes Juuso Leinonen, a project officer in ECRI Institute’s Health Devices Group.

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“When a pump alarms for a potential free-flow condition, it is communicating only that the safety mechanism is not engaged. It has no way to tell whether medication is flowing through the set.” That is, the safety mechanism is not infallible. Factors that interfere with the proper functioning of the anti-free-flow mechanism can lead to uncontrolled flow, possibly without activating an alarm. Infusion pump manufacturers specify that the roller clamp on the IV tubing is the primary method of ensuring that no flow is going to the patient. A pump’s anti-free-flow mechanism should be considered a secondary protective measure. SMART, BUT NOT PERFECT—PUMPS CAN STILL BE MISPROGRAMMED ECRI Institute likewise continues to receive reports and investigate incidents of infusion errors that involve incorrect infusion programming. “Smart” pumps that incorporate dosing safeguards are now in common use. But even these pumps can be misprogrammed in a way that leads to gross flow-rate errors. Mistakes that can lead to entry of an incorrect dose rate, flow rate, or concentration include: • Field-swap errors – for example, a

dose rate is entered into the flow rate field, or vice versa • Zero-entry errors – for example, entering “20” as “200” • Entry or selection of an incorrect drug or concentration • Overriding of dose limit/concentration alerts A FEW SECONDS CAN SAVE A LIFE As ECRI Institute notes in its Top 10 Health Technology Hazards for 2017 report, a few simple steps can catch many use errors and component failures before patient care is affected. In many of the incidents that the organization has investigated, harm could have been averted if staff had: • Noticed signs of physical damage to infusion pump components • Made appropriate use of the roller clamp on the IV tubing • Checked the drip chamber beneath the medication reservoir to verify flow and to identify gross inconsistencies between the observed and the expected infusion flow rate “Closing the clamp and checking the drip chamber used to be second nature to nurses,” notes Erin Sparnon, engineering manager for ECRI Institute’s Health Devices Group. But

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with pumps becoming safer and more sophisticated, such steps can get overlooked – perhaps because staff implicitly trust the pump’s advanced safety features. “Nurses today may not realize these practices are still needed. Our report hopes to change that.” By highlighting these risks in its report, and by encouraging healthcare workers to refocus attention on these safety steps, ECRI Institute believes that deadly infusion incidents can be prevented.

STAY TUNED for the next issue of TechNation where more hazards from the list are uncovered. THIS ARTICLE supplements ECRI Institute’s Top 10 Health Technology Hazards for 2017. An Executive Brief of the report can be downloaded from ECRI Institute as a free public service. The full report, which includes detailed problem descriptions and recommendations for addressing the hazards, requires membership in certain ECRI Institute programs or separate purchase. For more information, visit www.ecri.org/2017hazards, or contact ECRI Institute by telephone at 610-825-6000, ext. 5891, or by email at clientservices@ecri.org.

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BY GREG GOLL

BIOMED 101 The Importance of Professional Conference Attendance

rofessional education, either by formal college classes or in-depth training by the military, is essential as a foundation for a HTM professional. The goal of formal education or training is to establish a basic skill set in order to function in the HTM environment. As practical skills grow there needs to be an ability to reach out into the HTM profession. No matter where you are employed your individual scope of equipment exposure can be limited simply by the mission of your employer. Exposure to other professionals is an easy way to gain access to knowledge, best practices, and creation of a network. The HTM profession is very dynamic in nature and continued exposure to the latest technology has become a basic survival skill.

There is saying in business: “It’s not what you know, but who you know.” This also is very true in the HTM profession. There is a wealth of knowledge available by attending profession conferences such as the MD Expo, AAMI’s annual conference, or many regional symposiums. The large conferences such as AAMI and the MD Expo change geographical locations routinely to allow for individuals to shorten travel time and minimize time away from work. Many of the more regional conferences offer some great educational opportunities and a smaller-scale representation by vendors. The final component of all of these is a local state HTM professional organization, which will conduct routine meetings/presentations of a local interest. If you have obtained any of the certifications such as CBET, CLES, CRES, or other professional certifications, a demonstration of ongoing learning is a requirement to maintain your certification. Many people struggle to find ways to access enough “points,” to maintain their certification. Attendance to a large professional conference allows for access to a variety of presentations/

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GREG GOLL

CBET, BS

courses done by respected individuals in the HTM profession. This allows an attendee to select a mixture of courses to meet either an immediate educational need or a potential future technical interest. In many instances some courses outside of an individual’s immediate scope of duties may allow their first technical exposure to an exciting aspect of the HTM profession.

Building a professional network is extremely important for personal growth in any technical profession. Some of the first exposure many HTM professionals have to the presenters at a professional conference is through an article in a trade publication. Published articles are an excellent resource, but the chance to be able to meet an individual and ask a question in person is extremely valuable. I have found presenters have a passion for the HTM profession and enjoy the interaction with attendees. Simply by attending a specific class a person is already surrounded by a group of individuals who share a common interest. I have made many valuable contacts by simply attending the same class as other HTM professionals. The more diverse a professional network the better the ability to learn different perspectives especially from different areas and different business models. Depending on the region of the country, different vendors will be on display. As the geographical location of the conference changes, many local vendors will offer tours of their home offices, the ability to tour these

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“ I have made many valuable contacts by simply attending the same class as other HTM professionals. The more diverse a professional network the better the ability to learn different perspectives especially from different areas and different business models.”

locations is extremely beneficial. During these types of tours there will be a diverse group of employees which can answer a variety of questions. Vendors work diligently to show their latest technologies and their overall current product lines. Interaction with the vendors is face to face, this allows the ability for both the vendor and attendee to gain a better understanding of support needs. Another major consideration is the ability to compare similar equipment/products with very minimal effort, especially when everything is in a relatively contained physical location. The environment of a conference is more relaxed, so this allows for the interaction to also be more relaxed. I make it a point to meet every vendor in the exhibit hall, because the needs of today will certainly change. No one can predict the future of their job, but simply learning about as many types of equipment as possible creates a more well-rounded technical background.

Each type of professional conference whether AAMI, MD Expo, or a regional conference, will provide access for an individual to gain valuable experience. Just like a technician’s tool kit, each component of these conferences serves a different need to an HTM professional. The more engaged HTM professionals are in our profession the better it is for everyone. In my experience there has never been a class or program that I have attended where I did not learn something. Exploring all forms of technology and new ideas will only enhance an HTM professional’s technical abilities. Also, HTM department management needs to remember that sending young technical staff will help to build depth of staff. The next time there is an opening for promotion, this simple investment in current staff may lead to the next senior technician. As with any form of education the more engaged the greater the benefit.

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SHOP TALK

Conversations from the TechNation ListServ Q:

Are there unions for clinical engineering? I have heard reports that management holds all the cards and are unwilling to negotiate or find middle ground. Policies are considered “optional” and enforced only when it benefits management. Actions are retaliatory but impossible to prove. HR does nothing to mediate the situations, thus nothing to do but show up and get through the day. What options are there?

The subject matter of the post fills me with emotion, not postitive emotion. In my career I have had the opportunity to work in and witness the kind of work environment this person is suggesting as a solution. The solution mentioned has tremendous negative impact on patient care, coworker morale, productivity, and personal career success. There is nothing positive that I have witnessed from the kind of work environment suggested. This is not anecdotal, this is fact. Obviously, without understanding this person’s exact situation it is hard to offer a solution, but I will make a few comments. The most wonderful thing is that this person lives, I assume, in the Unites States of America, and so far we still enjoy quite a bit of freedom. We still have the opportunity to pick and choose our employers. This person is not stuck at this particular employer. This employer does not owe this person anything. This person sounds as if a merit-based system of employment is not suitable. If this person is a top performer, then this person would never have an issue with salary, respect,

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advancement, etc ... There apears to be a “victim” mentality with this person. There is pervasive “victim” mentality being promulgated among people in the U.S. It’s pollution. It’s “stinking thinking.” Be a professional. Be an adult.

Yes. It is part of the International Union of Operating Engineers Local 501in Los Angeles and Kaiser Permanente biomedical technicians are members of this local. I had never worked in a union environment before becoming hired as a Biomed. Here’s a summary of my experiences: After working here for 30 days, I was told I needed to sign the union paperwork (and start having dues taken out) otherwise I’d have to leave my job. So, I signed (under duress), opening the pipeline for a monthly flow of money from my paycheck directly to the union. Because our small group of 5 Biomeds reported to Facilities at that time, we were in the same bargaining group as 20-plus Facilities guys. What was worse is that our union was the Operating Engineers union, for boilermakers, etc. Those guys couldn’t even spell Biomed, and had no idea what we really did. When we would try to negotiate a contract, the needs of the few (5 Biomeds) were either ignored or outvoted by the many (20+ Facilities). At this point you can understand my dislike for the union. Later I was required to represent our Biomed shop during contract negotiations. It was very embarrassing for me to sit across the table from the

people I work for and be associated with this group. I actually felt like apologizing! By this time we had a different union rep, who at first seemed to be interested in making things better, but expected us to do a lot of the work we were paying her to do. During this contract negotiation, the hospital wanted to institute an “on-call” policy (for Biomed only, not Facilities), which nobody in our shop really wanted in the first place. The hospital offered $1/hour for on-call pay. When we had a chance to talk about it, the union rep said that sounded fair and we should take it. I said no way, lady! The guys don’t want to do this in the first place, and $1/hour is an insult. We won’t do it for anything less than $3/hour. By standing my ground, we got what we asked for, instead of what the union was willing to settle for. The reps (in my experience) want to get in and out as quickly as possible, because they don’t really get paid any more for doing a good job. Eventually some of the guys in Facilities decided that things weren’t right, and wanted to switch to a different union. I got a call on the weekend from one of the boiler operators telling me I needed to get down to the hospital ASAP and sign a new union card “because we are currently without any representation and could be fired at any time.” I didn’t buy into the scare tactic and continued to enjoy my weekend. We had a meeting with our hospital’s HR department, and they helped to make us aware of our options. Needless to say, the paranoia of the larger group drove us right back into a union. We

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were picked up by the Teamsters. We had some meetings with them before joining, and the promises of better pension plan, health benefits, etc. were just what was needed for the majority to join. I was one of the last two people to sign my card and I actually wrote “under duress” beneath my signature. By this time, Biomed had already been reporting to IT which was a completely different chain of command, different cost center, etc. I asked the Teamsters if Biomed could be separated into a separate group, so our bargaining needs wouldn’t be diluted by 20+ others with different needs. The Teamsters rep said “of course,” but that never happened. The unions (both Operating Engineers and Teamsters) have had a “no-strike clause” in our contracts ever since I can remember. This makes the union a toothless dog, removing any potential of being taken seriously. Not that I would ever want to strike, but we can’t do anything about paying dues, nor strike if something is going wrong at work. How does this arrangement benefit us? Most of the wording in our contract either mirrors existing hospital policy, or simply refers to hospital policy (which could change at any time). So, we’re not really getting anything different than what non-union employees already get. One of the things I really wanted was to have an “open shop” so employees could choose whether they wanted to be union or not. If the union was really such a great thing, the non-union guys

working in the same shop would notice and do something about it. If we were to do it all over again (and wanted to remain union), we would have been better off joining the same union as the nurses, rather than the Teamsters. The nurses’ union is much stronger and actually works for their employees, rather than just taking dues and filling our ears with empty promises. The nurses’ union also includes housekeeping, respiratory, pharmacy, and more departments. Our hospital has recently affiliated with a much larger entity, and we seem to be the only union shop in their network, so our days of being a union shop will eventually come to an end. Time will tell if that’s good or bad. Now that I got that long story out of the way, I don’t know if there’s a “specific” union for Biomed. But definitely do your research first, because not all unions are equal, but they’re all happy to take your money.

April 9-11, 2017

I think there are unionized biomeds in New York. I’m sure there are unions willing to invite biomeds into their union.

My department is in a bargaining unit and it has benefitted us.

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 Ultrasound Probes

ltrasound transducers and probes seem to grow more and more important to health care each year. These sometimes fragile instruments are critical when it comes to diagnostic imaging and treatments.

TechNation recently contacted industry experts to find out the latest about ultrasound probes and transducers and what HTM professionals need to know to maintain these devices and help prepare their health care facilities for the future. The panel for this roundtable article on probes and transducers include Kyle Grozelle, Manager of Training and Education, Summit Imaging; Mike Justice, Senior Territory Manager for Trisonics Inc.; Tony Morales, Repair Director/R&D Engineer, Conquest Imaging; Kenny Scally, BSN, Western U.S. Account Executive, with Exclusive Medical Solutions; BjĂśrn B. Segall, CEO and Founder BBS Medical AB/ ProbeHunter Sweden; and Matt Tomory, Head of Strategic Advancement, Bayer Healthcare-Multi Vendor Service.

Q: What are the latest advances in ultrasound probes/ transducers in the past few years? Kyle Grozelle Grozelle: Recently the innovations in ultrasound can be found in both crystal density along with new wireless technology. By increasing crystal density systems are able to image at higher resolutions and also create 3D images without the need for moving parts. Adding wireless and new battery technology has enabled new bedside quick use transducers to be used with systems as simple as a tablet. Justice: The change in technology for transducers seems to be migrating to volume imaging and matrix style element configurations. The advantages are the ability to completely control the beam in multi-plane scanning while also providing 3D or 4D images. The manufacturing process has also been improved which creates crystals with less defects and higher signal to noise ratios along with larger gain. Morales: Just like everything else in the medical device industry, everything is moving toward smaller, faster, cheaper

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and mobile. The processing power available in todayâ&#x20AC;&#x2122;s technology is so powerful that what used to be considered hobby processors (i.e. Arduino, Raspberry Pi) are now being considered for ultrasound coupled with an FPGA. Processing is intensive, using either a computer or laptop. Also we are seeing more and more wireless probes on the market that are being used with handheld ultrasound devices. Even though itâ&#x20AC;&#x2122;s only been around for about 5 years, 3D/4D technology is now becoming more mainstream. This is opening up some exciting possibilities and outcomes. Scally: Transducers in the last several years have gone from between 64-256 elements to 3,000-6,000 elements (ex. x6-1 Matrix Transducer Philips). The more elements in a transducer the narrower the beam is. More piezoelectric elements mean better detailed resolution. Not only do transducers have more piezoelectric elements within the transducer, they have gone from being just 2 dimensional to having 3D/4D transducers as well. Along with general and endo-cavity probes becoming more advanced, TEE (Transesophageal-Echocardiography) probes are getting more advanced with 3D/4D imaging availability. More technology that used to be inside the ultrasound machine is now inside the transducer itself. We are seeing transducers that are able to tell you when they are overheating and handheld transducers with imaging screens attached to them. The biggest advancements in transducers has been the capability to use the actual transducer wirelessly. Clarius has put out one of the most advanced wireless transducers yet. Segall: One advance is moving from narrow band to broadband due to digitized delay lines. Also, pure wave, matrix probes, higher frequencies, an increase in the number of elements from hundreds to thousands, built-in beam former, combination probes with optics and ultrasound are some advances. Wireless transducers connected to apps on phones, PC and tablets. There are new materials for the arrays like soft silicon as an alternative to PZT. With software developments, the border between the probe and the system is fading away. Tomory: There have been several significant technological advances of ultrasound probes and transducers recently, such as the growing use of single crystal and high density matrix arrays. Such advances have provided clearer and more detailed images, improving image quality and diagnostic

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ROUNDTABLE

outcomes. However, these new techniques could lead to significant cost increases, as well as technical difficulties when it comes to repair.

Q: How will these advances impact the maintenance of probes/transducers and ultrasound systems? Grozelle: With these new compact high-density transducers the risk from impact damage and misuse increases. These transducers require a closer eye for care before repairable damage occurs. Mike Justice Justice: This is a hot topic for the industry. The care of transducers starts with the end users understanding the complete process of cleaning, disinfection, and handling. The advancement of technology adds to the high cost of replacement and repair which creates a lot of financial stress for medical institutions. I believe that as the cost of transducer replacement goes up it will drive the industry and manufacturers to offer more options for repair. Morales: Ultrasound technology is advancing in leaps and bounds compared to just a few years ago. All current systems, as well as units only a few years new, will soon be obsolete by

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OEM standards, placing a stop date on parts manufactured. However, that does not mean that older equipment will cease to produce accurate results and that facilities that rely on diagnostic equipment beyond the end of life date arbitrarily set by OEMs will stop doing so. As long as the systems are repairable and functioning, many hospital facilities can and should continue to service and replace parts. If the medical industry wants to maximize their return on diagnostic equipment investment, there will always be a vital role for firms that manufacture parts for systems deemed â&#x20AC;&#x153;obsoleteâ&#x20AC;? by the OEM. Lastly, as probes get more affordable, they are becoming less of a capital expense and more like a consumable. As a result, transducer budgets and purchasing behaviors will eventually change. Scally: Transducers are becoming more advanced and more expensive. This has opened a large marketplace for companies to repair them and offer loaners while being repaired, instead of purchasing a new probe directly from the OEM. Once new technology comes out on transducers it usually takes a year before Independent Service Organizations can develop the repair capabilities on the transducer. Hospitals need to make sure that their ultrasound engineers are being trained to find early probe defects on the transducer, and have them fixed before the problem becomes more significant. Thus driving down the actual cost of the repair, instead of having to replace the entire transducer.

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Segall: We see two paths; probes that are easily repairable and those that are very hard to repair. For the hard to repair probes, the customers need to use the OEM’s exchange program to a considerable cost. This increases the need for the facility to have a probe care program in place. You have to monitor and validate the performance of probes by frequently testing. The earlier a problem is detected the lower the cost to repair. Tomory: As with any transducer, proper care and handling is critical to ensure optimal functionality and to maximize lifespan. Due to the high cost and limited availability of repair options for newer technologies, it is even more important to care for your product in order to extend its shelf life and time between repairs. This will likely be the case until research and development teams create consistent repair solutions for these new products, thereby offering more options and reducing prices.

Q: How can a facility with a limited budget meet its probe and transducer needs? Grozelle: Maintain a PM schedule that involves inspecting transducers on a quarterly basis. Catching issues like cuts in the lens or noise when the cable is moved will lead to lower repair costs along with a lower total cost of ownership. Justice: It starts with the initial purchase of the ultrasound equipment. I am often asked to compare manufacturers for quality and service. There are very fragile and expensive transducers on the market. My advice is to make an informed purchase knowing what your replacement costs are going to be. Once an institution knows its replacement costs they can make informed decisions on alternatives to replace. Transducer repair is one of the most effective ways of reducing service costs. The repair process is a very technical and challenging process, but does offer a significant cost savings. Concerning capital equipment purchases, Trisonics has saved customers significant money by offering refurbished transducers. A facility may choose to purchase a new system from a manufacturer and then add refurbished transducers to complete the order.

Tony Morales Morales: To offset the cost of probe repair, it’s important to understand that an exchange option for damaged probes is the most economical choice with the least amount of risk. This is especially true when compared to the cost of a traditional repair and loaner model. Advantages include: no down time with continued exam flow since the exchange probe unit is sent next day; more complete warranty since probe is covered from tip to tail, unlike a repair, which only

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STAFF REPORTS

covers what is repaired; and no risk of loaner damage, which can be costly if the probe is dropped or exposed to cleaning agents while on loan. Scally: With more health care facilities having limited budgets, we need to look at what preventative measures clinical engineering departments are doing to prevent damaging the transducers, but most importantly what are the health care providers doing to protect their equipment on the floor. Making sure that facilities are cleaning and using the transducers correctly is key. Look at the ultrasound’s user guide to help determine the OEM specifications for that transducer. Newer technology is very cutting edge and lucrative. Being in this industry for several years I have noted that the newer the technology the more bugs and glitches come with it. This can drive up the cost of repair and having to go directly to OEM. Segall: Number one, check the exchange price locally and globally. The guideline is that the repair price should not exceed more than 50 percent of the global exchange price. The pricing on probes, new or refurbished, differs a lot around the globe. It is a big marketplace with fresh prices every minute; it is like a “stock market.” Also, implement testing upon arrival of a new probe (faulty frequency 5-10 percent), implement testing before the warranty ends, in month 11, (faulty frequency approximately 20 percent). Implement testing under the service contract. You will optimize the warranty within the service contracts. Tomory: Our primary objective is for our clients to maximize the lifespan of their transducers. In order to do this, on-site educational sessions should be provided, such as care and handling assessments, gap analysis and webinars to make sure that clinical departments are using the equipment in the correct way and handling it with care. In my department, we always contact our customers five or so days after repair to ensure that everything is running smoothly; this is a great opportunity for facilities to provide feedback on the repairs and make the most of our consultative offerings. Regular testing and inspection of transducers is another component to mitigate costs. If a damaged probe is identified early on, the repair cost is significantly less than waiting for the problem to progress, which could dramatically impact performance. Prevention and proper care is critical, not just for organizations with limited budgets, but for all users of diagnostic ultrasound.

Q: What criteria should be used to compare and select a probe/transducer repair company? Grozelle: A simple measure of quality from a repair company is an ISO 13485:2003 certification. Also consider their average repair time and use of OEM parts for repair.

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Justice: It is important to know the reputation of the company. Ask for references and ask for an explanation of how the repair will be handled. Make sure that the company provides a formal quote with pictures and an explanation of what is wrong and what will be replaced along with the cost of repair. Finding a company that has local service engineers is also helpful because of the support that they will provide if something needs attention after the repair. Find a company that offers the best repairs for multiple manufacturs. Not all companies can offer quality repairs for most manufacturs.

complex probes they are about to repair. In our fact-finding phase developing the test system ProbeHunter, we visited almost every repair lab around the world. We concluded that there is not one repair lab that can repair all brands and types to a high quality. Make sure that the company chosen really is the company doing the repairs, with no back door outsourcing. A loaner probe should be provided, with a test-protocol, and the repaired probe should be returned with a test-protocol as well. Make sure your returning probe comes in a new uncontaminated box.

Morales: Here are some questions you should ask everyone you are considering for probe or transducer repairs: • Is the vendor transparent in their repair capabilities? Ask to see a full list of options. • Do they provide minimal, mid-range, and maximum repair prices upon your call. Do they make you send in your probe before providing pricing, adding to your risk and down time? • Do they provide a 6-month warranty on exchange? 90-day on standard probe repair? 30-day on TEE repair? • What is the average vs. estimated turnaround time? Average is more accurate than estimated in most cases. • Does the company welcome a visit and tour of their facility? Are they certified by accrediting agencies? • Are they reputable? What do other facilities say about their repairs? Rather than getting a list of references who are handpicked due to positive experiences, look at their client list and cold call a couple.

Tomory: Despite the large number of repair providers in the industry, probe repair is an exact science. The discipline requires individuals specializing in a range of functions such as acoustics, materials technology, manufacturing operations and quality management. We believe an important criteria to look for is ISO 13485 certification – a quality standard required for medical device manufacturers, but optional for service providers. Having been in the ultrasound industry for 30 years, I thought I knew everything there was to know about probes; however, after recently completing an extensive study on repairing these devices, I realized that the complexity and precision of probe repair is not to be underestimated.

Kenny Scally

Q: What are the most important tips you can share when it comes to maintaining probes/transducers? Grozelle: Inspect regularly and be vigilant on issues that might just seem cosmetic, a simple crack on the housing of a transducer can lead to gel getting into electronic components and causing costly damage.

Scally: When it comes to transducer repair health care facilities need to look at several different things. Turnaround time is the most important part to repairs. A probe repair company should have a turnaround time of no more then 5 to 10 business days. Another important criteria is the almighty loaner. Does that repair company have a loaner probe for the probe you need to get repaired? Health care facilities cannot afford downtime when it comes to patient care. Making sure the company has the specific machines to test the image quality of the actual probe is a must. Customers do not want a repair if the image quality comes back worse due to not having the actual machine to scan the probe on. Many repair companies are now offering exchanges, does the company offer you an exchange because that probe is actually unrepairable or is it due to the fact that the company can’t actually repair the probe?

Justice: It is important that end users understand the cleaning process in detail and how it affects the longevity of the transducer. Make sure that they review the approved up-todate chemical list from the manufacturer’s website. They should know the minimum soak time to be affective and follow that time schedule. They should remove residual chemicals with water if allowed, to stop the chemical attach rubber lenses and plastic.

Segall: A basic requirement is that the repair lab has a testing functionality that is equivalent to the technology of the

Scally: When it comes to the maintenance of the transducers we need to make sure we are teaching ultrasound engineers

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Morales: Although they sound simple and obvious, everyone in imaging should refresh themselves on proper probe care to avoid mishaps. Handle probes with care. Store them in an appropriate packaging and location. Clean or disinfect according to the disinfectant guidelines. These basic guidelines will help in ensuring your probe is maintained throughout its lifetime. For more detailed information, visit http:// conquestimaging.com/education/resource-library/

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ROUNDTABLE

along with clinicians what to look for in a damaged transducer. Use a magnifying glass to look for pin holes or gaps around the transducer head or insertion tube. Early detection of failure in a transducer can lower the cost of repair later on down the road. This is why it is important to come up with a QA program for transducers and for the ultrasound systems. If you suspect the probe is not working, or has any type of failure, make sure you take it off the floor and get the transducer sent in for testing ASAP.

Björn B. Segall Segall: Start a probe care program at the hospital. This will increase quality and lower the costs. Educate the staff on the importance of how to handle the probes and how delicate they are. Only use OEM-approved ultrasound gel, cleanser and disinfection method. Also, implement leakage testing on TEE probes in between patients. An important observation, we have made, is that there is a big difference in going from a phantom test to a single element probe tester. We are now seeing the same going from a single element tester to a multi element tester, with real time capabilities. With the multi element tester we detect new kinds of defects on probes that we did not see before. Tomory: The three most important tips I would share would be to inspect the equipment early and often; follow the manufacturer’s recommendations for proper disinfection solutions/processes; and if any issues arise, have these repaired by a qualified provider and do this as soon as these are identified. Using a low-cost provider who doesn’t have the appropriate expertise may not only compromise the intended performance of a probe, but may also prevent the probe from being repaired in the future. Providing clinical departments with training on appropriate care and handling is another critical aspect in maintaining and mitigating the cost of probes.

Q: What else do you think TechNation readers need to know about purchasing and servicing ultrasound probes/transducers? Grozelle: Beware of “aftermarket” transducers. Many are available online, these items claim to be from the OEM but are mostly made up of low-cost substitute parts, and not cleared by the FDA for use on patients. Justice: Get involved with your facilities purchasing department and let them know that there is an alternative and cost savings available to them for capital equipment purchases. As far as service is concerned, education and understanding of

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ROUNDTABLE

what causes most probe failures can drastically cut repair and replacement costs. Morales: Know the OEM is not your only option. Savings can be as much as 70 percent in parts and probes. If the question is quality, know that the new standard is transparency. Vet all vendors by not only their pricing, service, certifications, warranties, track records, reputation, but also on their transparency. Let them show you how much they value your business. Conduct quarterly training for sonographers, sterile processing, and biomedical engineers. on proper care and handling techniques. This can extend the life of a probe and significantly reduce repair expenses. Scally: When it comes to TEE probes, electrical leakage testing is important before and after every use. This protects patients and is a way to find cuts or bite marks that may be causing leakage inside the probe and damaging it. When purchasing a transducer, make sure the company that you are purchasing from has the technical support for your transducer and the machine. This is important because failure rate does not always have something to do with the probe but can also have something to do with the machine. Going with the lowest costing repair and transducer doesn’t mean it is the best. Think about if you, your loved ones or friends were getting an exam. Would you want the best that’s possible for them? Segall: The OEMs are now moving into the MVS market. They want to regain the market they lost over 10 years ago. The prices on standard probes are dropping dramatically. The price and the repair cost on the advanced probes are maintained at a high level. For a facility, you need a probe tester to evaluate the performance of an ultrasound probe. If there is a problem on the Doppler you will almost never see it on the image. If you have a probe care program in place, you will save costs and you will increase the quality of care at the same time. You are more likely to get better pricing if you synchronize the purchase of probes with the purchase of a system.

Matt Tomory Tomory: An ultrasound probe is an extremely sophisticated medical instrument. An incredible amount of time and resources have been invested in their design, technology, materials and manufacturing, and the approach to repair should require the same diligence. When considering the purchase or repair of a probe, it is critical to ask the right questions on process validations, certifications, staff competencies, biocompatibility testing, electrical safety testing, acoustic intensity and focus analysis, to ensure the provider is suitable for the repair or replacement of your probe or transducer.

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COVER STORY

A Look At Medical Equipment Service Professionals Who Have Started Their Own Successful Business By K. Richard Douglas

oach Bruce Arians, of the Arizona Cardinals, is fond of saying; “No risk it, no biscuit.” The coach has even had the expression trademarked. While the phrase has great application in sports, it also is at the very core of entrepreneurship. Few business owners or founders have ventured into unchartered waters without being risk takers. It’s a hallmark of those who take this path.

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COVER STORY

“ I worked for a company that essentially provided the same services and I always felt I could deliver a better product to the customer. I thought I would work harder and come up with creative new ways to earn more business.” - Rick Staab, The InterMed Group

Unlike those who might buy stock in a new company or bet on a horse at the racetrack, the risk that most entrepreneurs take is more measured and calculated. Oftentimes, it is the realization that there is a need in the market that is not being met. Other times, they see an opportunity to offer more competitive pricing than what already exists. The notion that these entrepreneurs could simply deliver a better product was a recurring theme when TechNation asked several successful company founders how and why they decided to make the move and become self-employed. According to the Small Business Administration (SBA), there are 28 million small businesses in America which account for 54 percent of all U.S.

sales. The organization says that small businesses provide 55 percent of all jobs and 66 percent of all net new jobs. Those are impressive figures and point to the need for people to take their dreams and ambitions to the next level. But striking out on your own isn’t just a matter of waking up one day and deciding to start a business. It takes a lot of homework. Is there a need and market for the product or service you will offer? Is there a niche that can be filled that will allow the service or product to compete in an often crowded marketplace? You need to have capital, and often, a line of credit. Where will you find funding sources? Will you need collateral? How will you go about marketing your product or service

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

and what methods make the most sense? If you are going to have employees, will you offer them benefits and how will you pay for those benefits? Will you need to hire a general manager, bookkeeper, marketing assistant, sales manager or HR manager; or all of the above? The decision to become a business owner is not one to be taken lightly, but it can be part of the American dream for those with the intestinal fortitude to make the move. Several members of the HTM community have made the transition into selfemployment and business ownership. They have had to answer all of the questions above and ascertain that their gut feeling will become a viable service that will thrive.

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COVER STORY

TAKING THE PLUNGE You can build a better mousetrap if you think outside the box or allow the creative juices to point the way. “I worked for a company that essentially provided the same services and I always felt I could deliver a better product to the customer. I thought I would work harder and come up with creative new ways to earn more business,” says Rick Staab, president and CEO of The InterMed Group in Gainesville, Florida. “The owner of that company was Nicaraguan and was focused on getting some of his land back in that country, so he sold it to a large provider. During this time, I decided to take the opportunity to see what I could build on my own,” Staab adds. “At the time I was about to get married and took a big risk by having no income and figuring out a new career.” Robert Grzeskowiak, president of MW Imaging, headquartered in St.

brands such as Philips, GE and Siemens ultrasound platforms,” Grzeskowiak says. “Fortunately, one of my former customers approached and asked if I would service their existing 20 systems. The revenue from this customer and others lead to bringing on major hospitals. Soon my garage business lead to purchasing a major warehouse, with a lab area and administrative offices. With new space and opportunities MW Imaging began hiring additional engineers and administrative staff and built the company it is today,” Grzeskowiak adds. Staab says that he felt like he could provide a less-expensive, higherquality service. “It seemed to me like everyone in the business was concentrating on how much profit they could make and less on delivering a reliable, quality product to the customer,” he says. “I felt I could earn friendships and

within the biomedical field for a few years with the hopes of one day being able to do this full time,” says Boyd Campbell, CBET, CRES, co-founder of Southeastern Biomedical Associates Inc. in Granite Falls, North Carolina. “From 1996-2004 we were spending most of our nights, weekends and vacation time working on building Southeastern Biomedical while still holding down full-time jobs in the biomedical field. When we had built up the business to a point we felt we could support our families, and also seeing that many of the procedures were leaving the hospitals to be performed in the alternate care facilities, that is what helped us to make the transition from working for a hospital to working for ourselves. We took Southeastern Biomedical Associates Inc. full time in early 2005,” Campbell says. Campbell’s business partner, Greg Johnson, CBET, CHFM, explains

“ It seemed to me like everyone in the business was concentrating on how much profit they could make and less on delivering a reliable, quality product to the customer.” - Robert Grzeskowiak, MW Imaging

Charles, Missouri, remembers that humble beginnings can evolve into a lot more. “In 1991, I left my employer to become an independent service professional. My business model included servicing major OEM

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respect if I could help people in health care save money and approach service from a different perspective.” It can take time to launch a new venture. “Both myself, and Greg Johnson, had been doing consulting work

what it was like to transition from a part-time consulting business to the only source for putting bread on the table. His comments encapsulate the essence of what it is like to make the move from employee to dependence on yourself.

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COVER STORY

“ Being enterprising and entrepreneurial involves spotting an unexploited opportunity and making the most of it: essentially, identifying a gap in the market and filling it.” - Mark Conrad, Conquest Imaging

“Around June of 2004, we started really being able to visualize it becoming a viable full-time business. During that same time, a building that my father owned became available, and seemed to be a logical place for us to start,” Johnson remembers. “It seemed that everything was lining up and we knew it was the right thing for us to do. Even so, it was the biggest leap of faith of our lives. We both had very good and stable jobs. The perceived risks were obviously that we were leaving those very good jobs, that were hard to come by, and also in the location that we both chose to live. After lots and lots of thought, prayer and consideration we came to the realization that we had to do this. Neither of us wanted to look back in the future and regret not giving this a try,” Johnson says. Mark Conrad, president and co-founder of Conquest Imaging in Stockton, California, says that “being enterprising and entrepreneurial involves spotting an unexploited opportunity and making the most of it: essentially, identifying a gap in the market and filling it. However, it can also be about trying something new or improving a process to increase efficiency or

boosting results for the customer.” Conrad explains that enterprise and entrepreneurial skills are effectively a combination of many competencies, including: commercial awareness; creative and innovative thinking; prioritization and time management; problem solving and communication; and negotiation and persuasiveness skills. While many people making the move to create a business are entering a crowded marketplace, some make the move into a market that is void of a similar product. “The only risk I saw at the time was that nobody would show up for the training. My biggest trepidation about doing this was ‘Why is nobody else already doing this?’ I thought it was a great idea; it was needed in the industry and it’s a very specific market that nobody is taking advantage of; what am I missing?” asked Steve Maull, owner of Maull Biomedical Training, LLC in Aurora, Ohio. “And to be honest, I never really found out why that was. I guess it just turns out that everything that has ever been done, somebody out there had to be the first one to do it. In this case, I guess I was the first,” Maull says. “The biggest hurdle to starting my

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

own company from scratch was having the guts to do it. It was very scary. The job I had was a very good paying job, we had a nice house on the lake in Charlotte, North Carolina, my kids were about to enter middle school and high school; financially and professionally my family and I were in a very good place with a very good future. Now is not the best time to possibly blow it all up if you’re not sure. But I was sure (well, 95 percent sure),” Maull says. DRAWING ON EXPERIENCE For most business owners, their decision to go it alone, is often based on substantial first-hand experience. Unless somebody buys into a franchise, most business owners remain in a business that they already know well. It should come as no surprise then that so many of those in the business of servicing medical equipment, or selling parts, found their beginnings in the HTM field. Maull started his biomed career in 1991 in the military. “As a BMET, the benefits of providing great customer service to your customers – techs, nurses, doctors – was very apparent to me after working in the hospital environment,” Maull says.

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COVER STORY

“ The lessons learned as an HTM professional about patient safety are put into practical application as well. since we have been on the same side of the desk as they are, we knew their day-to-day struggle with running a successful biomedical department.” - Boyd Campbell, Southeastern Biomedical Associates

“Looking back, I believe having over 20 years of general biomedical experience including managing biomedical departments was essential when starting the business,” Johnson says. “One lesson learned was the overall experience gained while helping neighboring hospitals establish their own biomedical departments from the ground up,” he adds. “Coincidently, the president of the hospital where we were working, attended collaborative group meetings with other hospital administrators where they would discuss their problems in hopes to find resolutions and advice from their fellow colleagues. It was at these meetings where our work referrals originated.” “After the third hospital referral was received, the workload of our department was at a point where we needed additional resources to accomplish all the additional work. While seeking the resources, during a meeting with the same hospital president who was creating all the additional work, the request was denied. He responded that the

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hospital was a non-profit public hospital and creating a biomedical service business did not align with our core mission. He suggested that a non-compete agreement be signed and perform the work outside of the hospital. This was when Southeastern Biomedical was created,” Johnson says. Campbell adds that the lessons learned as an HTM professional about patient safety are put into practical application as well. He says that “since we have been on the same side of the desk as they are, we knew their day-to-day struggle with running a successful biomedical department.” Although vendors to health care providers are not direct caregivers, the experience that many have as former HTM professionals has instilled those patient care values that are common within the HTM ranks. “Starting my career out as an in-house engineer in a hospital setting helped me gain a clear understanding of the policies, procedures and guidelines that exist in this industry,” says Alex Maldonado, managing partner and VP of Service at Exclusive Medical Solutions in

Schaumburg, Illinois. “Directly dealing with OEM and third-party field service engineers was extremely invaluable, in that, it highlighted the expectations that the majority in the industry share. I experienced first-hand how hard work and diligence was needed in order to become a success,” Maldonado says. He adds that it was during his experience as an in-house engineer that he noticed that there were other businesses being created to support HTM. “I learned that people’s health, and the way they are treated and expected to be treated when they are seen at a hospital, is extremely important,” Staab says. “Health care is a very serious business, and my job is to eliminate the things that seem small, but have a huge impact with the equipment maintenance and technology management.” Conrad echoes those sentiments with a reflection on an issue that is second nature to every biomed; equipment uptime directly impacts patient care and a facility’s financial viability.

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“Everyone talks about the importance of relationships in business especially as it relates to sales and loyalty. Throughout my career, I learned how important relationships are to equipment service personnel as well,” Conrad says. “We are the ones that really stand a chance to be the hero or villain with a customer because either we get it right and get them up and running so they are heroes to their team, or we fail them and in turn set them up to fail a lot of people too.” Grzeskowiak explains that the same steps a hospital HTM professional goes through translate well into the approach he uses today. “Listen to customer complaints. Ask important questions such as ‘Is the problem intermittent?’ [or] ‘Does the problem occur in certain modes of operation?’ Formulate possible solutions and tell the customer your plan – time and date,” he says. “Bring necessary tools and parts to complete the job in one visit. Most importantly, show up on time and inform the customer of your findings and solutions. Call the customer back the next day and ask if everything is operational.” KNOWING THE RISKS One trait of entrepreneurs is that they are very often risk takers. But even that characteristic has to be qualified. According to a November 2013 article in Forbes Magazine, entrepreneurs are actually “calculated risk takers.” According to the article, entrepreneurs seek out ways to reduce risk at every turn. They do not dive headlong into something, but take small steps toward a goal. They figure out ways to do things at

less expense and how to do it faster and better. So, while the person who may walk away from a stable job to start a company may be willing to take on more risk in doing so than the average person, it isn’t always without forethought and knowing the risks.

about 18 months of my time while still holding a full-time job. The next six months were occupied by interviewing many other professionals in the health care industry as to the viability of having an independent service organization (ISO) [and] acquiring the tools for meeting the

“ My biggest trepidation about doing this was ‘Why is nobody else already doing this?’” - Steven Maull, Maull Biomedical Training

Grzeskowiak says that when he started his business, “the risks involved were working capital, buying parts and probes from various OEM dealers and building a customer base.” Sometimes the risk is also that you might get lost in a sea of competitors because advertising is expensive, and even more so, a major expense for a new business. The expense makes word-of-mouth marketing a critical necessity. “When we were in our infancy, we did not have a budget for marketing, so that avenue was all we had to rely on,” Campbell says. As calculated risk takers, the entrepreneurs invest a lot of time into carefully planning their move to self-employment. This effort reduces the risks involved in diving headlong into murky waters. “The business plan encompassed

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

customer’s expectations,” Conrad says. “Because, back in 1998, only the original equipment manufacturer (OEM) was performing the maintenance, which was perceived as the only option.” For HTM professionals with entrepreneurial spirits the path to business ownership has been paved by their adventurous peers. Their calculations, risk taking and sacrifice have proven that there is another destination for those with an understanding of medical equipment.

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TECHNATION

EXPERT ADVICE

BY TODD ROGERS

CAREER CENTER

Military Service and the Job Market

hat do the following words have in common: Terrorist, ammunition, enemy, war, destroy?

Each of them has something to do with armed conflict. These are also words that occasionally appear on resumes that I get from veterans who have typically been discharged from the armed services. Not surprisingly, there are plenty of veterans in the field of clinical engineering. This column can serve two separate perspectives. First, I want to convey to recently separated veterans the importance of deprogramming the military-speak. Second, for people who have never been in the armed services, you may benefit from being reminded that the military does a fabulous job at retooling the thought processes and language of its members. If you want to tap into that resource as a hiring manager, it would do you well to learn more about the military culture.

about the third hour of boot camp, many people find themselves totally confused with the language that is being forced upon them. On about the third month, the language fog lifts and a newly minted service member begins to make sense of all of the jargon that is commonly tossed around. The military is an industry that seeks to forcefully impose its will on other people. Even if you work in a field that has you repairing life saving equipment, you are constantly reminded that you are part of a much larger machine that takes lives as a means to an end. Thus, terms such as eliminate, target, and mission are used so commonly that they become part of your daily lexicon. When you get out of the service, it is essential that you reverse many of the language skills that you acquired. At least, you have to eliminate the subtleties of how you use those terms. The comment that I hear a lot is that being a military biomed isn’t

“All it takes is a tad of open-mindedness and encouragement and you’ll most likely end up with a loyal and committed employee.” First, to the veterans: When you are getting ready to ship off to your initial recruit training (a.k.a. “boot camp”), every veteran you encounter wants to tell you about their experience with a furiously mean drill instructor. On

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easy because of the tremendous amount of cross functionality that is needed when you’re 700 miles away from the nearest supply depot. Thus, you should hire me because I can do a lot more than the next guy with a roll of duct

TODD ROGERS Talent Acquisition Specialist for TriMedx

tape and a Swiss Army knife. Unfortunately, what I see conveyed on a resume is often tainted with the terminology that suggests you have not yet decompressed. My advice is simple: Make it a priority to get the military terminology out of your vocabulary. At least get it out of your self-promotional delivery. There are going to be things that can only be explained in a military context. However, in preparation for an interview or in writing a resume, it would probably be useful to go and find someone in advance who is purely non-military and have that person critique your style. The last thing you could possibly need is to find yourself sitting in an interview having that hiring manager wonder if after he hires you whether you’re going to start talking to the nurses about some gruesome thing that you saw when you were over in Iraq. So, let the military come out in how well your shirt is ironed or how shiny your shoes look.

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EXPERT ADVICE

Don’t let it come out with “When my unit got deployed, all the 68-Alphas had to do a pre-deployment work-up at Fort Whatever and half of us hadn’t touched five-five-six rounds in a better part of a year or more!” That just doesn’t work. So, my advice: Keep the can-do attitude, drop the jargon. To the employer: It’s true the military does a fabulous job at forcing people to do miraculous things with limited resources. You just can’t expect that it will be done in an orthodox way. So, how good would it be to have a staff that has been trained and forced to complete a job with failure possibly meaning death? That sounds a little creepy. However, the military has to program this consequence into its people because it is a daily reality. You’ll have to tolerate some griping and you’re going to have to get used to seeing things done in ways that seem backward. The

military isn’t terribly concerned with how things get done, just so long as they get done. Back to the jargon. Practice this phrase: “You’ll have to help me out, I never served in the military so I don’t really know what that means. Let’s try to stick to purely civilian terms.” If you say that or some variation of it, the person you’re interviewing will figure it out and drop the battalion-company-platoonspeak, but you may have to remind him or her about it from time to time. My advice – don’t get hung up on it, and if the candidate reverts to military jargon offer a gentle reminder to reel that person back in. All it takes is a tad of open-mindedness and encouragement and you’ll most likely end up with a loyal and committed employee.

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

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

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

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EXPERT ADVICE

BY JIM RICKNER

ULTRASOUND TECH EXPERT