ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL
OCTOBER 2017
16 Company Showcase
Southeastern Biomedical
22 Biomed Adventure
BMETs in Mongolia
24 Company Showcase Address Service Requested MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269
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ReMedPar
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Defibrillators
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CONTENTS
FEATURED
50 56
TECHNATION: ADVANCING BIOMEDICAL / HTM PROFESSIONALS
50
HE ROUNDTABLE: T DEFIBRILLATORS In this article, TechNation asked members of the HTM community to share the scoop on defibrillators (including AEDs). Our panel shares tips regarding the latest advances for these devices as well as their unique individual insights.
56
RIGHT TO REPAIR The fight for the right to repair continues in biomed and HTM departments throughout the country. State and federal legislation could impact the ability of in-house departments to be able to repair all medical equipment in a positive or negative way. TechNation re-examines this hot topic.
Next month’s Feature article: Tech Hazards: Cybersecurity
Next month’s Roundtable article: Digital Radiography
TechNation (Vol. 8, Issue #10) October 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
OCTOBER 2017
TECHNATION
9
CONTENTS
INSIDE
PUBLISHER
John M. Krieg
VICE PRESIDENT
Kristin Leavoy
ACCOUNT EXECUTIVES
Jayme McKelvey Nicolle Endoso Lisa Gosser
ART DEPARTMENT
Jonathan Riley Sarah Sutherland Karlee Gower
EDITOR
John Wallace
EDITORIAL CONTRIBUTORS
Roger Bowles K. Richard Douglas John Noblitt Todd Rogers Manny Roman David Scott Cindy Stephens Steven Yelton Alan Moretti Jeff Kabachinski
DIGITAL SERVICES
Cindy Galindo Jena Mattison Travis Saylor Kathryn Keur
ACCOUNTING
Kim Callahan
CIRCULATION
Lisa Cover Melissa Brand
WEBINARS
Linda Hasluem
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: Michael McDonald p.16 Company Showcase: Southeastern Biomedical Associates Inc. p.18 Department of the Month: Providence Regional Medical Center p.22 Biomed Adventures: U.S. BMETs in Mongolia p.24 Company Showcase: ReMedPar P.28 p.28 p.34 p.37 p.38
INDUSTRY UPDATES News and Notes: Updates from the HTM Industry AAMI Update Northwest HTM Mixer ECRI Institute Update
P.40 p.40 p.42 p.45 p.46
THE BENCH Shop Talk Biomed 101 Tools of the Trade Webinar Wednesday
P.64 p.64 p.66 p.69 p.70 p.72 p.75 p.76 p.78 p.81
EXPERT ADVICE Career Center Ultrasound Tech Expert Beyond Certification Tech Tips The Future Sodexo Insights Tech Knowledge Thought Leader Roman Review
P.85 BREAKROOM p.85 Did You Know? p.87 The Vault p.90 What’s on Your Bench p.95 CABMET Scrapbook p.97 NCBA Scrapbook p.100 Service Index p.105 Alphabetical Index
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SPOTLIGHT
PROFESSIONAL OF THE MONTH Michael McDonald, MS, CCE Managing HTM with a Clear Head BY K. RICHARD DOUGLAS
W
orking within the U.S. Department of Veterans Affairs (VA) has provided a number of HTM professionals with challenges and experience to advance their careers and contribute to innovations at the same time.
One member of leadership in the VA’s HTM ranks knew that biomed was for him just out of high school. “The mix of biology and engineering intrigued me and that is why I selected biomedical engineering after high school. When I graduated high school, I passed the AP biology and AP physics classes and wanted to keep on that track of learning,” says Michael McDonald, MS, CCE, chief biomedical engineer in the VISN 20 Healthcare Technology Management (HTM) department for the VA in Seattle, Washington. McDonald’s training and education started at Marquette University in Biomedical Engineering with a focus on mechanical engineering and biology. “I then participated in a co-op program with the Department of Veterans Affairs,” McDonald says. “The co-op program is where HTM students go to school for a semester and then work in the clinical engineering department at the VA for a semester.” He says that after graduating, he was accepted to graduate school at Marquette University and received a master’s degree in biomedical engineering.
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“ The excitement of the job is getting diverse groups to work together for a common goal. You have executive leadership, physicians, nurses, technicians, environmental management, IT and facilities management that all play “At that time, I critical roles in getting safe and effective returned to the VA and was selected into their equipment installed and in the hands of the Technical Career Field (TCF) program. This is the evolutionary step to clinical providers.” – Michael McDonald the co-op program. The TCF program is for degreed engineers and technicians and is in the medical center to ensure that they a two-year training program focusing on have the technology required to provide HTM in the VA,” McDonald adds. the best care to our nation’s veterans.” He found that the constant change, McDonald says that the position and staying updated on healthcare allowed him to manage and implement technology, provided a good challenge. technologies from thermometers to During his time at the VA, he has MRIs, PET/CT, and linear been a co-op student, TCF biomedical accelerators; always trying to engineer, staff engineer, chief continuously improve the service of the biomedical engineer and regional chief technicians to ensure that the facility biomedical engineer. had safe and reliable medical equipment “I was the chief biomedical engineer at all times. for the Indianapolis VA Medical Center “The regional chief biomedical in Indianapolis, Indiana and the Puget engineer or VISN chief biomedical Sound VA Medical Center in Seattle, engineer, in the VA, allows the same Washington,” McDonald says. breath of technology support and “Being a chief is a great position; it implementation just across multiple allows you to assist all of the care units facilities,” he explains.
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SPOTLIGHT
FAVORITE BOOK There are so many – I am more of a series fan. “Repair Man Jack” by F. Paul Wilson, “Harry Dresden” by Jim Butcher, and “Jack Reacher” by Lee Child are my current favorites
FAVORITE MOVIE “Superman”
FAVORITE FOOD Chicken Burrito
HIDDEN TALENT
Michael McDonald back row, enjoys working with fellow HTM professionals in Seattle.
I was the Bratwurst for the Milwaukee Brewers during school so I can run a 5K as a 10-foot sausage.
FAVORITE PART OF BEING A BIOMED BRINGING RESOURCES TOGETHER The challenges McDonald sees as a leader revolve around encouraging cooperation and overseeing installations. “The excitement of the job is getting diverse groups to work together for a common goal. You have executive leadership, physicians, nurses, technicians, environmental management, IT and facilities management that all play critical roles in getting safe and effective equipment installed and in the hands of the clinical providers,” McDonald says. He points out that some of the installations can take over a year to fully implement and the turnover of the groups involved make it a challenge to ensure that all the right players are included. “However, it is an opportunity to review the goal of the technology implantation and spread the goals of the facility and region. This was particularly evident when I was charged with replacing the physiologic monitoring system for all of the medical centers in Michigan and Indiana,” McDonald says. “The facilities provided different care and each facility had different workflows. Creating a framework, to allow everyone to focus on their goal
while still standardizing the technology, was a great achievement,” he adds. McDonald has been recognized for his efforts along the way, winning the 2013 RHCC/Intelligent Hospital Grand Award, the 2013 RHCC/Intelligent Hospital Award: Improving Regulatory Compliance, The Best of 2013: Biomedical Departments Nomination, The Best of 2012: Biomedical Departments Nomination and the 2010 VHA Biomedical Engineer of Year awards.
“The ever-changing environment. We are always finding new issues to solve and improve on. Everyday has something new and it is almost impossible to get bored because there is always a new challenge.”
WHAT’S ON MY DESK? • • • •
FITNESS AND FAMILY When not on the job, staying fit and helping out with his kid’s school are pastimes. “I really like to exercise I train for half-marathons and try to at least do three a year,” McDonald says. “The time to run really helps clear the mind and allows me to be ready for the challenges that come up when trying to implement new technologies in the medical center. I also volunteer my time at my children’s schools to spend additional time with them and ensure that they have good programs that will enrich their lives.” On the home front, he has a supportive family. “I have two smart and lovely daughters that are eight and five. My
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
•
My Laptop – Data, data, data is a key to improving performance My iPhone – Communication is necessary too My water bottle – hydration clears the mind TechNation and BI&T; you have to stay current Milwaukee Brewers Sausage figures – you need to have fun
wife is a constant support, being flexible to allow me to support the 24-hour business of health care,” McDonald says. McDonald breaks down two of the fundamental areas that are important to him this way: “I have a passion for Healthcare Technology Management with always looking for ways to improve the effectiveness and safety of the technology. I also pour the same passion into my family,” he says.
OCTOBER 2017
TECHNATION
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SPOTLIGHT
SPECIAL ADVERTISING SECTION
COMPANY SHOWCASE Southeastern Biomedical Associates Inc.
S
outheastern Biomedical Associates Inc. 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. The company continues in its goal to provide unparalleled equipment sales, service and support to the biomedical community.
Located in picturesque Granite Falls, N.C., Southeastern Biomedical has certainly made a name for itself nationwide as an innovator in the biomedical industry. Although Greg Johnson and Boyd Campbell initially founded SBA for the sole purpose of developing in-house biomedical
departments from the ground up, the company has since significantly expanded its offerings. Southeastern Biomedical provides a variety of new and refurbished monitoring equipment, parts and depot repair nationally for the hospital and alternate care market. Originally only doing business close to its headquarters in North Carolina, the company has expanded to provide the same high level of customer service it has established a reputation for over the years to customers along the East Coast. Johnson and Campbell want customers to understand one thing – something that current customers already can attest to: “We’re biomeds first, salespeople second,” Johnson says. The duo has experience in the hospital setting and “Biomeds helping Biomeds™” is more than just a
trademarked motto for them, it is a truth in how they do business. Both had extensive careers as hospital biomeds before going into business as Southeastern Biomedical Associates Inc. Johnson, a 32-year veteran of the profession, is a certified biomedical equipment technician(CBET) and certified health facility manager(CHFM), while Campbell, a biomed of 30 years, is a CBET and certified radiology equipment specialist(CRES). It is clear that promoting the biomedical profession is a priority. They also believe in lending a helping hand. Both are active in the NCBA and various charitable organizations, and both have taken medical mission trips to developing countries. SBA regularly donates equipment to medical missions as well. Also, Southeastern Biomedical is committed to providing convenient,
Reed Bumgarner calibrating a Fluke ProSim 8 Multifunction Simulator.
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SPOTLIGHT
MEDICAL EQUIPMENT SALES AND SERVICE
cost-effective on-site calibration and repair service of test, measurement, and diagnosis equipment operated by biomed departments in hospitals. The company’s onsite test equipment calibration service eliminates shipping costs and shipping damage. It reduces downtime from weeks to hours and increases productivity for their customers.
Stacy Lail doing QA on a EKG machine after repair.
With full-time BMETs on staff, the company performs repairs on all kinds of equipment. One of Southeastern Biomedical’s most sought-after services is its Mac 5500 repair. “We’re one of the few companies that go in and do the optical bench that analyzes the anesthetic agent,” Johnson says. Southeastern Biomedical stresses
“ Our goal in obtaining our ISO certification was to further ensure that we continue to provide superior customer service, on-time delivery, verified order accuracy and to prove that we are committed to continuously improving our company.” – Boyed Campbell Southeastern Biomedical’s new high-end test devices provide the company with a wide range of capabilities allowing it to calibrate a wide variety of manufacturers’ test equipment. Southeastern Biomedical’s calibration management software allows the company to identify and notify customers when their equipment is due for calibration. It also provides a history of calibration services performed on the test equipment. All calibrations are traceable to the National Institute of Standards and Technology (NIST). UNIQUE DEPOT REPAIR SERVICE In addition to providing GE monitoring and cardiovascular equipment, SBA also provides parts and has a unique depot repair division. The company has an inventory of parts for the equipment it sells. “It depends on what it is, but usually if it’s still in the hospital, we’ll have the parts for it,” Johnson says.
patient safety in all aspects of the company because, after all, “the reason we’re all here is for the patient,” Johnson says. That’s the philosophy Southeastern instills in all employees. To ensure repairs are of the highest quality, we only hire biomedical technicians with degrees. “They all have a biomedical degree, and we encourage them to go beyond and get the CBET certification,” Johnson says. When Johnson was working as a hospital biomed many years ago, he worked closely with the nurse manager, who told him something that’s stuck with him throughout his career. She told him that every time he performed a repair, he was not done until he felt safe putting one of his own family members on that equipment. He still lives by that mantra today. SBA’s mission statement is: “We believe that by concentrating on patient safety, our customer, the health care
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
provider, can focus on providing their ‘core competency,’ which is patient care.” “We want to be good stewards, and we’re always just trying to do the right thing,” Johnson says. ISO 9001:2015 Southeastern Biomedical has 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, 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,” Campbell 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,” Johnson 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.” For more information, visit sebiomedical.com.
OCTOBER 2017
TECHNATION
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SPOTLIGHT
DEPARTMENT OF THE MONTH Providence Regional Medical Center Everett Clinical Engineering Department BY K. RICHARD DOUGLAS
I
n 1856, before the state of Washington was even a state, five Catholic nuns arrived in the area of Fort Vancouver, Washington, on the banks of the Columbia River from Montreal. Once established, Mother Joseph of the Sacred Heart and four other Sisters of Providence, served the needs of orphans and the elderly. They opened hospitals, schools and orphanages across the Northwest. This was the humble beginnings of what would become Providence St. Joseph Health.
Providence St. Joseph Health, the third largest not-for-profit health system in the U.S., now has over 50 hospitals and 106,000 employees. As a part of this large health system, Providence Health and Services is the largest health care provider in Washington state, according to the health care systems’ website. Providence Regional Medical Center in Everett, Washington is part of both systems. The hospital opened its doors in 1905. It has the 10th busiest single-location emergency department in the nation. The city of Everett, Washington, with a population of 103,000 sits 25 miles north of Seattle. Taking on the equipment maintenance and repair duties is the clinical engineering team at Providence. “The department began in 1991 and has grown with the medical center in reputation and volume,” says Jaran Friday, supervisor of clinical engineering. The department is led by Bud McIrvin, director of facilities and clinical engineering. Tricia Nelson is facilities coordinator. The team’s biomeds include April Winters, Nick Van Veen, Dan Price, David Francisco, Gina Christensen, Akif Cetinkaya, Kirk McGarity, William Pickett and Eric Le. The team
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also includes imaging service professionals – Jeff Funke, Jerry Harju and Tom Markham. “We cover most specialties in-house including X-ray, MRI, CT, CVL, anesthesia, respiratory, lab, SPD and surgery,” Friday says. “Technicians are assigned to primary departments for responsibility and to enhance relationships with clinical departments.” Friday says that the department maintains and repairs all medical devices and imaging equipment in the hospital as well as for their clinic group. They also provide retail services for their community clinic groups. They also provide equipment consultation to leadership and provide capital information for cost of service ratio(COSR). The CE group has also realized the shared goals they have with their IT colleagues and have established a relationship to accomplish those shared goals. “Our CE group has a great relationship with our IT partners. Over the past two to three years, it became apparent that more and more medical devices are connected to IT systems and we needed to solidify the bond between the departments,” Friday says. “There is
often a struggle to keep some of our older medical equipment connected to IT systems, as they often use outdated protocols, that force IT and our department to work hard to find safe solutions.” The CE team also plays a part in determining the need for service contracts. “Biomed reviews all contracts and works on limiting the amount of coverage if it can be sourced internally as well as partnering with our vendors to maximize uptime with cost efficiency,” Friday says. MEETING SPECIAL CHALLENGES Apart from their more routine duties, the department has been active in the purchasing arena, helping the hospital to evaluate potential imaging equipment. The team “recently arranged and hosted a mobile X-ray vendor fair where we had four manufacturers bring in their units for the imaging technologists and other staff to evaluate in advance of a purchase,” Friday says.
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SPOTLIGHT
The clinical engineering department at Providence Regional Medical Center in Everette covers most specialties in-house.
The hospital has been growing in volume and acuity over time and did not have an appropriate number of portable X-ray units to cover all the patients, according to Friday. “Biomed reached out to the leading manufacturers of portable X-ray units and arranged to have them bring their latest units on-site for an evaluation/fair where the hospital staff was able to drive the units around and see the latest technology,” he says. “During this event, they evaluated the different units and were able to ask questions of the different vendors and see which features would help them the most in our environment.” The department also renders retail support to an extended community of health care providers beyond the walls of the hospital. “In Snohomish County we have a large independent clinic network in addition to our own Providence Medical Group. That clinical group supports the same patients as our hospital, so our biomed group reached out and found a way to support them, with retail biomedical services. In essence, we support and maintain all of their biomedical devices with our hospitaltrained biomeds,” Friday says.
The team has also faced down the challenges of integrating devices into their network. “We also are tasked with connecting more and more medical devices wirelessly to our intranet and keeping them secure,” Friday explains. “One of the most common problems we face in our department is new technology. We are constantly challenged by new medical devices that integrate with hospital infrastructure. We are working on our final phases of EMR integration and finding new and creative ways to connect medical devices to populate real time physiological data into our EMR,” Friday says. Another recent problem was helping to design a new CVL room for TAVR (transcatheter aortic valve implantation) procedures. The CE team helped find a way to fit all the equipment needed for those procedures into the surgical suite and remain useable at a moment’s notice. “TAVR is a new procedure to our hospital and required an enormous amount of equipment to be available in addition to the standard cath lab,” Friday says. “During the procedure, they will often need to rotate between
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
the cath lab equipment to an ultrasonic TEE probe. This requires the cath lab to function as a hybrid OR with full fluoroscopy and ultrasound capabilities, while remaining sterile for the procedures. In addition to this the staff also wanted to have the ability to remotely view the procedures in remote conference rooms.” Friday says that an effort to keep up with regulatory changes keeps the department busy. One recent change that the department has been navigating is in regards to relocatable power taps (power strips). “We had to deal with multiple regulatory bodies, who each had a different interpretation of the regulation, and we had to push back with our understanding, which ultimately ended up being what the regulatory bodies surveyed for,” Friday says. In addition to these projects and challenges, the group has been involved in a capital strategy replacement effort; prioritizing capital needs based on service history and obsolesces. The active CE team at Providence Regional Medical Center would make the “founding” five Catholic nuns proud today; and with good reason.
OCTOBER 2017
TECHNATION
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SPOTLIGHT
BIOMED ADVENTURE BMETs from U.S., Mongolia Exchange Technical Knowledge BY FLAVIA HULSEY
U
.S. Army Sgt. 1st Class Jose Maldonado, noncommissioned officer in charge, Medical Maintenance, Tripler Army Medical Center, traveled to Mongolia recently as part of a Nursing and Medical Logistics Subject Matter Expert Exchange (SMEE) between the militaries of the United States and Mongolia.
He said he expected interaction with other logistics service members, but what he didn’t expect was to be reunited with a former student. Senior Sgt. Javkhlan “Jay” Purevdorj, a member of the Mongolia Armed Forces (MAF), was Maldonado’s student when Jay attended the Department of Defense Biomedical Equipment Maintenance Technician School in 2012 in San Antonio, Texas. “It’s a full circle. You teach them and you explain to them the importance of their job…his education and his level for fixing equipment has grown so much,” said Maldonado, who served as an instructor for the SMEE. The two reunited, unexpectedly, during the SMEE, which took place June 5 to 9 at the Military Medical Center of Mongolia in Ulaanbaatar, Mongolia. The medical logistics portion of the SMEE focused on biomedical equipment management. It was presented for biomedical equipment engineers, technicians, administrative staff and equipment operators, and it included courses on biomedical equipment management,
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preventive maintenance and operator maintenance. “You could really see how interested they were in learning,” said Leading Sgt. Bayasgalan Olonbayar, Military Medical Center of Mongolia, about the biomedical equipment technicians (BMETs) who participated in the course. “This course was very effective; I hope we continue to improve in this area.” A hands-on exchange approach using various pieces of test measurement and diagnostic equipment allowed for a more realistic training environment. “That existing relationship between the BMETs relaxed the atmosphere in the shop and enabled a group of
technicians with a wide spectrum of capabilities to overcome language barriers and dig into the training agenda,” said U.S. Army Lt. Col. Elizabeth Gum, chief of Logistics, Tripler Army Medical Center, who was part of the U.S. team. While the BMETs learned hands-on skills and technical capabilities, Gum said she also hoped they enhanced their level of confidence as advisors in their facilities. “I want them to be the experts in their hospital that BMETs are in ours. I want them to be the trusted agents of the command and clinical staff,” she said. “They’re so much more than
U.S. Army Sgt. 1st Class Jose Maldonado, right, and Senior Sgt. Javkhlan “Jay” Purevdorj, biomedical equipment technician, Mongolia Armed Forces, test biomedical equipment June 7 in the Military Medical Center in Ulaanbaatar, Mongolia. (Photo by Flavia Hulsey)
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SPOTLIGHT
A group photo was taken at the Military Medical Center in Ulaanbaatar, Mongolia as part of a Nursing and Medical Logistics Subject Matter Expert Exchange between the United States and Mongolia. (Photo by Flavia Hulsey)
technicians. They are a part of the bigger strategic operations for the organization.” After all, Gum said, patient care begins with logistics. Even a technician needs to understand how a piece of equipment impacts the health and safety of a patient. “We explained the importance of anatomy and physiology of the body, and we explained that if settings are incorrect on a piece of equipment, it can harm a patient,” Maldonado said. Understanding the importance of patient safety is one of the key takeaways the medical logistics team wanted to convey to the MAF BMETs and biomedical engineers.
“That’s why we have all these analyzers we’re showing them. That’s why we’re teaching the operators – the end user – how to properly use and maintain equipment, because it all comes down to patient safety,” he said. As part of the exchange, members of the medical logistics team from the U.S. Army learned about the equipment currently in use at the MAF. “In some ways, they are limited, but they are really resourceful, and they figure things out,” Maldonado said. Gum added that the exchange gives U.S. service members a broader perspective of other facilities and the strengths and weakness of their systems.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
“All of the (U.S.) BMETs here have deployed, so they’ve seen different degrees of technology at medical facilities. They’ve seen a tent with aid bags all the way to fully capable hardstand buildings. This is just another exposure for the degree of technology,” Gum said. Other members and instructors of the medical logistics team representing the U.S. included U.S. Army Chief Warrant Officer 3 Ramon Pagan, Chief, Equipment Management Branch, Tripler Army Medical Center; and U.S. Air Force Senior Master Sgt. John Whitley, superintendent, Medical Logistics, Joint Base Elmendorf-Richardson, and Air Force Pacific BMET manager. The U.S. and Mongolia Nursing and Medical Logistics SMEE has taken place since 2010. It is one example of U.S. and Mongolian military cooperation. This year, 2017, represents the 30th anniversary of diplomatic relations between the two counties. It is this form of medical diplomacy that drives positive change in an increasingly global atmosphere. Medical diplomacy through global health engagements such as the SMEE support the Chief of Staff of the Army’s top priority: Readiness. This mission is accomplished while working jointly with partners in Regional Health Command-Pacific, U.S Army Pacific (USARPAC) and Pacific Command (PACOM).
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SPOTLIGHT
SPECIAL ADVERTISING SECTION
COMPANY SHOWCASE ReMedPar
R
eMedPar began as a small business in Nashville, Tennessee in 1987. Since that time, it has grown in technical capability to be an industry leader in the diagnostic imaging parts space. Since re-engineering the operational process and relocating to Charlotte, North Carolina, ReMedPar has expanded its parts offering into X-ray, vascular, CT, ultrasound, ultrasound probes, MRI and injectors. Currently, the ReMedPar team is developing multiple programs to support the diagnostic imaging and biomedical repair processes.
“Our organization is built upon four core service offerings; our world-class medical parts program, capital equipment sales and installation program, technical support services, and our depot repair services,” Dan Siler, Senior Director of ReMedPar, said. “Our inventory consists of parts from all of the leading industry manufacturers which enables us to deliver the part needed, on time and within your company’s budget. Our parts are tested in one of our 65 live, fully functioning quality assurance bays to ensure their performance before being sent back to the customer.” ReMedPar’s capital equipment program offers new and reconditioned equipment. We are able to streamline purchases and service experience with site-planning services, equipment disposition services, competitive trade-in programs, and flexible payment options. “By quickly identifying problems and balancing your needs and price range, we are able to provide reliable depot repair services that reduce the downtime of your assets at the best possible price, so you can concentrate on more important issues” Siler added. As part of its continued growth, ReMedPar is powered by Aramark allowing for rapid expansion by leveraging the Aramark Healthcare Technologies’ technical experts to guide the technology roadmap. Also, this year ReMedPar rebranded to provide a fresh market experience that highlights stronger processes, a highly skilled technical team and its robust partnership with Aramark Healthcare Technologies.
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“ ReMedPar is committed to providing exceptional customer service with our staff being available 24/7 to help your team through the technical support and repair process – from identifying parts to on-site installation support and hands-on training.” – Dan Siler In what can be seen as a crowded marketplace, ReMedPar continues to stand out among the competition via its experience and expertise. “Our people drive our success,” Siler said. “The ReMedPar team has over 150 years of experience and is staffed with highly skilled and trained modality managers, repair technicians and test technicians, resulting in one of the strongest repair teams in the medical parts industry. In addition, we have made significant investments in technology to enhance our product and service offering.” ReMedPar is aware of the time crunch aspect its customers’ face and is ready and able to provide solutions. “Our carefully monitored inventory allows us to deliver the part you need on time and within your price range,” Siler said. “As technology evolves, so does our inventory and parts repair processes. Each part is tested in one of our 65 live, fully functioning quality assurance bays to ensure its reliability before it arrives to your location.” “ReMedPar is committed to providing exceptional customer service with our staff being available 24/7 to help your team through the technical support and repair process – from identifying parts to on-site installation support and hands-on training,” Siler added.
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SPOTLIGHT
The continued escalation of health care costs results in tight budgets for health care facilities and ReMedPar is aware of these challenges and crafts solutions for customers so they can continue to provide quality patient care. “Our clients have seen an increasing need to remove costs from their operating expenses. This has increased our need to develop strong programs that help drive quality and control costs,” Siler said. “The pace of program development has strained our engineering and leadership teams. The results of these challenges have led to a leading ultrasound parts and probe department. Additionally, the team has developed depot repair services on injectors, which speeds the customer’s time to repair by offering a loaner for every repair.” ReMedPar’s support of diagnostic
imaging devices continues to excel as the company develops many new capabilities. “In products we have traditionally supported, such as CT, we have developed repair capability on high-end computers. This has given the market a new standard in quality when buying,” Siler said. “Our ultrasound department is our newest, and becoming the largest program within the organization. The team is focusing its efforts on bringing in high-quality parts on all major manufacturers and currently supports Philips and GE product lines. In addition, the ultrasound probe repair department has expanded the ultrasound offering and gives customers a one-stop shop for all of their ultrasound needs.” “The X-ray department continues to be the most diverse in product offering. Supporting portables, C-arm, RAD, R&F and vascular; the X-ray team is
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
leading the way in new repair development,” Siler added. ReMedPar will continue its march to support all the leading products within the diagnostic imaging marketplace. This will come by expanding products within current programs and by adding programs such as nuclear medicine, which will launch in 2018. “In addition to the diagnostic imaging growth, ReMedPar is focusing on the biomedical market as well. Currently in development, we are building programs for patient monitoring repair. This program is also set to launch in 2018,” Siler said. “There are many other programs in development and we look forward to rolling them out once developed, stay updated on all the exciting developments by connecting with us on LinkedIn and frequently visiting us at www.remedpar.com.”
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INDUSTRY UPDATES
STAFF REPORTS
NEWS & NOTES
Updates from the HTM Industry PRIVATE EQUITY FIRM BUYS BAYER’S MULTI VENDOR SERVICE, WETSCO AND MD MEDTECH Acquired Firms to be Consolidated in New Innovatus Imaging Corporation The private equity firm Resilience Capital Partners announced today that a fund managed by the firm has acquired three medical device service and manufacturing units. The move establishes Resilience Capital Partners as one of the leading providers in this growing segment of the health care industry, which is relying on these third-party device repair companies to control costs. The units acquired by Resilience Capital Partners are the Multi Vendor Service (MVS) unit of Bayer’s Radiology business; Wetsco Inc.; and MD MedTech LLC (MDMT). All three businesses – MVS, Wetsco and MDMT – are being combined and will operate under a new holding company, Innovatus Imaging Corporation. The fund also has reached a definitive agreement to acquire the European operations of MVS, based in Maastricht, the Netherlands. This transaction is expected to close by March 31, 2018. In the interim, Innovatus Imaging will continue to serve European customers through a transitional service agreement with Bayer. “The creation of Innovatus Imaging through the acquisitions of MVS, Wetsco and MDMT gives us the scale and synergies to succeed in a market that is projected to grow by double-digit figures over the next five years as health care providers are asked to do more with less and extend the life of costly medical devices through repair and servicing,” said Steven H. Rosen, co-CEO of Resilience Capital Partners. Ensuring continuity, Innovatus Imaging will draw its leaders from the senior ranks of the acquired companies. • Dennis Wulf, former president of Wetsco and chief executive officer of MDMT, will serve as chief executive officer (CEO) of Innovatus Imaging and is a co-investor in the new company. • Bill Kollitz, formerly general manager of MVS, will serve as president and chief operating officer (COO) of Innovatus Imaging. • M ichael LaBree, co-founder, chief operating officer and vice president, engineering of MDMT, will serve as chief technology officer (CTO) of Innovatus Imaging. “All three of these businesses have enjoyed strategic partnerships and customer relationships over the years, and
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so it is a natural fit to combine them under a single company umbrella,” said Bassem Mansour, co-CEO of Resilience Capital Partners. “This combination of talent and resources will enhance performance in high-growth areas, helping increase the new company’s offerings in medical equipment repair while enabling it to develop groundbreaking medical imaging products.” Pittsburgh-based MVS previously was part of Bayer’s Radiology business. It is a market leader in the third-party service-repair business for radiology devices, including ultrasound probes, magnetic resonance imaging (MR) coils and computed radiography readers, dry film printers and the sale of digital radiography detectors. MVS has been a frequent customer of MDMT, purchasing its ultrasound probe replacement components. Tulsa-based Wetsco is a leading third-party ultrasound probe repair provider that has an exclusive alliance with MVS since 2008, specializing in repair and capability development on standard and 3D/4D probes. Based near Denver, MDMT designs and manufactures specialty medical ultrasound products for the OEM, thirdparty repair and research markets. “The combination of MVS, Wetsco and MDMT within Innovatus Imaging will ensure our ability to support customers and the imaging community. It also will enable us to expand our service strategy and new product development,” said Wulf. Resilience Capital Partners, which manages in excess of $625 million, has now completed 12 transactions over the past 12 months and 18 transactions in the past two years. Funding for the Innovatus Imaging transaction comes from Resilience Fund IV, which closed in October 2015 with $350 million in investable capital, and from co-investors including Pittsburgh-based North Park Capital Partners. The transactions involving MVS (U.S.), Wetsco and MDMT closed on August 31, 2017. Financial terms of the transactions are not being disclosed. • For more information, please visit www.resiliencecapital.com.
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INDUSTRY UPDATES
REPAIRMED TAPS NEW DIRECTOR OF SALES Scott Kinkade has joined RepairMed as director of sales. Kinkade brings about 15 years of industry experience to his new position at RepairMed. RepairMed President and CEO Diane Geddes said Kinkade will oversee corporate sales and handle all sales and marketing. “We just needed somebody who I knew had experience, foresight and is an industry veteran,” Geddes said. RepairMED is a leader in component-level depot repair capabilities that provides biomedical services to health care facilities, medical equipment resellers and independent service providers of various sizes. RepairMED’s services include comprehensive and costeffective flat-rate pricing with a warranty on all repairs. RepairMED also offers committed, one-stop and cost-plus contracted flat rate pricing. • For more information, visit repairmed.net.
BDI GLOBAL LAUNCHES DEDICATED CYBER RISK INSURANCE PROGRAM Health and telehealth providers face complex and rapidly evolving cyber risks. Generic off-the-shelf cyber risk programs have been unsuccessful in providing adequate protection for these unique exposures. BDI Global and The Medical Risk Institute joined forces to develop a specialized cyber risk insurance program, SafeHealth, exclusively for the cyber risks, compliance, and regulatory issues confronting health and telehealth providers. The SafeHealth coverage is designed to wrap around coverage in medical malpractice and health care professional liability policies to eliminate coverage gaps, multiple deductibles and coverage clashes. SafeHealth has first-party coverage for ransomware, social engineering, business interruption, data restoration and incident response expenses. SafeHealth also covers third-party liability claims for regulatory, medical board and administrative proceedings from privacy breaches including violations of HIPAA, HITECH, FDA, state, federal, and international regulations as well as any resulting fines and penalties. SafeHealth also covers unique health care cyber risks such as bodily injury caused by cyber perils, breaches of business associate agreements, the cost of implementing corrective action plans under HIPAA, and vicarious liability for using medical devices. “SafeHealth is the only cyber risk policy built to cover the specialized cyber risks at health and telehealth providers. There is nothing else like it,” said Michael Flanagan, BDI Global. •
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
AAMI FOUNDATION TO AWARD $80,000 IN RESEARCH GRANTS The AAMI Foundation has launched its 2018 grant cycle and will award up to $80,000 to support research directed at enhancing the safe adoption and safe use of healthcare technology. The objective of the Mary K. Logan Research Awards program, named in honor of a former AAMI president and CEO, is to encourage and fund studies that promote positive patient and health care provider outcomes through healthcare technology. “Making sure that healthcare technology delivers on its promise and does not unintentionally lead to patient harm requires well-designed scientific studies, but finding funding for this type of research is getting harder and harder,” said Marilyn Neder Flack, senior vice president of patient safety initiatives at AAMI and executive director of the AAMI Foundation. “Through the Mary K. Logan Research Awards program, the AAMI Foundation is dedicated to providing the necessary resources to advance the safe use of healthcare technology.” The foundation is particularly interested in funding projects that address its main areas of focus: the continuous electronic monitoring of patients on opioids, clinical alarm management, infusion therapy safety in hospitals and nonclinical environments, and the training of clinicians in the use of complex healthcare technology. “Although projects that offer a defined and direct path to implementation, with clear and positive results, are encouraged, studies of problems for which deeper understanding is needed before effective solutions can be developed are also important,” Flack said. In 2017, the foundation awarded grants to researchers at Cincinnati Children’s Hospital in Ohio and Saint Alphonsus Regional Medical Center in Boise, Idaho, which is part of the Trinity Health System. Awards are restricted to 501(c)(3) organizations in the United States and tax-exempt charitable organizations in Canada. Grants will be made to the sponsoring organization (hospital, university, clinic, etc.), not to individuals or departments. • Applications should be submitted to Flack at mflack@aami. org by Dec. 31. Awards will be made in June 2018.
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THE INTERMED GROUP SELECTS NUVOLO’S CLINICAL EAM PLATFORM The InterMed Group has selected the Nuvolo cloud-based enterprise asset management (EAM) platform to deliver next generation service efficiency, quality and reliability to its clinical health care clients. Built on ServiceNow, Nuvolo is a cloud-based EAM company. Nuvolo was honored this year by ServiceNow and its clients for achieving the Americas’ highest customer satisfaction rating and ranking as the top independent software vendor (ISV) globally. InterMed’s focus on clinical engineering services delivers better patient care by ensuring that some of the most complex and essential equipment used in the medical industry today – including digital radiography, X-ray computed tomography (CT), magnetic resonance imaging (MRI) and other nuclear, ultrasound and optical-imaging techniques – are safe, compliant and operational. The company provides a range of services including a group of on-call, mobile professionals that supplement internal resources called “jump teams”, to fully managed services for ultra-sophisticated and lifesaving health care equipment. Reliable online and offline mobile and timely access to operational data is mission critical to InterMed for excellence in service delivery, maximum equipment uptime and safe, quality patient care. Nuvolo’s modern, cloud-based clinical asset management platform is purpose-built to deliver these results. “We evaluated more than 10 CMMS or EAM technologies in the market, and chose Nuvolo because no other provider even came close,” said Rick Staab, CEO of InterMed. “It is by far the most flexible, advanced and modern health technology management platform. The company’s responsiveness is excellent and their platform is fully optimized to manage the complex and expensive devices we service and maintain. We always strive to bring the best capability to our clients, and Nuvolo is clearly the best.” “InterMed is a progressive and innovative services organization that has built a national network of top-tier technicians. The InterMed team delivers industry-leading service management for a fleet of complex and sophisticated medical equipment,” said Tom Stanford, CEO of Nuvolo. “We are pleased to have such an exceptional group of clinical health care technology specialists select our EAM platform as a critical enabler of their health care service management business. We are excited to be moving ahead in this strategic partnership.” • For more information on Nuvolo and The InterMed Group, visit www. nuvolo.com and www.intermed1.com.
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TRIMEDX SELECTS PILGRIM QUALITY SOLUTIONS Pilgrim Quality Solutions, a global provider of enterprise quality management software and services for the life sciences, announced that TriMedx has selected Pilgrim’s SmartSolve to automate key components of its quality and regulatory operations. TriMedx will implement SmartSolve to provide its global operations with integrated and automated processes for tracking data and reporting quality events, including corrective and preventive actions (CAPA) and customer complaints. SmartSolve will also support TriMedx’s CE Quality Audits and Supplier Quality Audits, allowing the company to strengthen and sustain its ongoing global compliance while improving overall quality and operational efficiencies. “We were seeking an enterprise-class system that is flexible, provides built-in industry best practices, and most importantly, unifies our quality processes across our entire enterprise,” said Doug Folsom, chief information officer for TriMedx. “Pilgrim’s experience with the expectations and regulatory requirements that medical equipment providers face, and the best practices inherent in SmartSolve, will help us expedite critical quality and compliance processes.” SmartSolve provides a platform and solutions for continuous improvement under one fully integrated, closed-loop quality system. It offers TriMedx flexibility and processes to drive efficiencies, allows for enhanced data tracking and analysis, and simplifies quality system reporting both internally and externally. “Pilgrim helps enterprises like TriMedx improve operational efficiencies while reducing risk and enhancing compliance,” said Rick Lowrey, Pilgrim’s president and chief executive officer. “TriMedx was seeking a solution to help harmonize quality processes and enhance quality-related information flow throughout the entire organization. This is exactly what SmartSolve does. We look forward to being a strategic business partner and working closely with TriMedx to address their quality management goals.” •
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INDUSTRY UPDATES
FDA RELEASES PLAN FOR DIGITAL HEALTH REGULATION Recognizing that the traditional approach to regulation cannot keep up with the fast-paced iteration of digital health products, the Food and Drug Administration (FDA) has released a plan to promote “digital health innovation.” As part of this regulatory plan, the Center for Devices and Radiological Health (CDRH) will issue new guidance, pilot a firm-based approach to reviews, and strengthen its digital health unit. ”The challenge FDA faced in the past is determining how to best regulate these non-traditional medical tools with the traditional approach to medical product review,” FDA Commissioner Scott Gottlieb wrote in a recent post on the FDA blog. “We need a regulatory framework that accommodates the distinctive nature of digital health technology, its clinical promise, the unique user interface, and industry’s compressed commercial cycle of new product introductions.” To accomplish its objectives, CDRH launched a software precertification (PreCert) pilot program that focuses on assessing the makers of the software, not the product itself. “The Software PreCert Pilot Program is a voluntary program that will enable us to develop a tailored approach toward regulating this technology by looking first at the software developer and/or digital health technology developer, rather than primarily at the product, which is what we currently do for more traditional medical devices. This pilot will help FDA establish the most appropriate criteria for standing up a firm-based precertification program for these new tools,” the agency said on its website. The FDA will select up to nine participants from across the spectrum of software developers that produce both low- and high-risk products. During the pilot, the agency and participating companies will “explore the use of external software development standards to reduce premarket software documentation burden,” according to a July 28 Federal Register notice. “The goal of our new approach is for FDA to, after reviewing systems for software design, validation, and maintenance, determine whether the company meets the necessary quality standards and pre-certify the company. Pre-certified companies could submit less information to us than is currently required before marketing a new digital health tool. In some cases, pre-certified companies could not submit a premarket submission at all,” Gottlieb wrote. This approach should reduce the time and money it takes for developers who “reliably manufacture high-quality, safe, and effective digital health devices” to enter the market, according to the FDA. Eligibility requirements and procedures for applying to participate in the pilot program are available in the Federal Register notice. The agency will hold a public workshop in January to report on and review its initial findings. •
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HTMA-MW PLANS 2017 SYMPOSIUM The Healthcare Technology Management Association of the Mid-West (HTMA-MW) will hold its 2017 Symposium and Vendor Fair on October 21 in Olathe, Kansas. The event kicks off at 8 a.m. “The HTMA-MW is holding a one-day symposium and vendor exhibition at the Embassy Suites Kansas City/Olathe Hotel and Conference Center. We will offer educational classes for technicians and managers, a lunchtime keynote speaker and ample opportunity to socialize with other healthcare technology professionals from the Greater Kansas City area,” according to the HTMA-MW website.
“Our exhibit space will feature a wide variety of healthcare technology vendors showing off their newest and greatest products and services. We expect over 75 attendees and 30 exhibitors.” Attendance is complimentary and includes lunch and door prizes! There will be four breakout sessions, two in the morning and two in the afternoon, and the association has applied for ACI approval for 6 CEUs for attending the maximum number of sessions. One morning session will feature Neil Blagman, Product Engineer at Replacement Parts Industries Inc., followed by a session on cybersecurity
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by Cody Bruce from the Kansas Intelligence Fusion Center. Herman A. McKenzie from The Joint Commission will present a keynote address during lunch followed by afternoon presentations from Kenny Scally, Account Executive at Exclusive Medical Solutions Inc., and Doug Dreps, Director Eastern Regional Operations, Mercy, Clinical Engineering Services. The Vendor Fair will be open from 9 a.m. to noon and again from 1 to 5 p.m. with a raffle at 4 p.m. • For information, call 913-210-4334, email symposium@htma-mw.org or visit htma-mw.org.
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INDUSTRY UPDATES
Orlando, FL • October 5-7, 2017
MD EXPO PRE-APPROVED FOR 11 CEUS MD Expo returns to Orlando, Florida bigger and better than ever! The MD Expo, to be held October 5-7, has been pre-approved for a total of 11 CEUs and will be listed in the AAMI University Course Catalog as well as on the pre-approved webpage. “The AAMI Credentials Institute (ACI) awards certification credentials to healthcare technology professionals and entities in higher education, industry and health care delivery,” according to the AAMI website. “As health care becomes more complex, certification is one way to demonstrate and showcase competencies. It strengthens the public confidence in safer health care systems.” “Please feel free to inform all attendees that this course has been pre-approved and if they are claiming it on their ACI journals, it will be accepted for a maximum of 11 CEUs,” an AAMI spokesman wrote in an email regarding the pre-approval. MD Expo has set the bar for HTM conferences for over 15 years by providing world-class education, top-flight networking opportunities and an exhibit hall filled with the latest technology, service and equipment options. It also provides opportunities for meaningful interactions with HTM thought leaders and peers from around the nation. More features of the MD Expo include: • Industry leading speakers covering the hottest topics in HTM, compliance, IT, management and equipment service • The industry’s best networking events to connect and share best practices with other leading HTM professionals • CBET Review • Keynote address presented by The Joint Commisssion • World-class exhibit hall featuring latest technology, products and services • MD Expo Finale Party For additional information or to register for MD Expo, visit MDExpoShow.com.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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BY AAMI
AAMI UPDATE
HTM Needs You to Set the Standards
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very year, a wide variety of professionals with an interest in healthcare technology devote themselves to developing and revising the standards that establish the basis for the safety and effectiveness of medical devices and equipment.
Standards such as ANSI/AAMI EQ56, Recommended practice for a medical equipment management program, and ANSI/AAMI EQ89, Guidance for the use of medical equipment maintenance strategies and procedures, create a foundation for efficient, effective, and timely maintenance of medical equipment and can be valuable tools for hospitalbased healthcare technology management (HTM) professionals. By joining an AAMI committee or working group, you can take an active role in shaping medical device standards such as these – working side by side with industry colleagues and participating government agencies. “I’ve learned and gained varied perspectives from very experienced, knowledgeable members of the HTM, manufacturing, and regulatory community. This broader exposure helped me learn the benefits of listening and developing truly consensus-based standards,” said Stephen L. Grimes, managing partner and principal consultant at Strategic Healthcare Technology Associates LLC in Swampscott, Massachusetts. Grimes is a member of the standards committee that developed EQ56 and EQ89. There are several ways to get involved: proposing a new work item, joining a technical committee, submitting comments on public review drafts, or attending open meetings of AAMI committees and working groups. To learn more about the AAMI Standards Program or to apply to join a committee, visit www.aami.org/standards or email standards@aami.org. NEW RESOURCES PROMOTE HTM TO STUDENTS, C-SUITE AAMI has published two new brochures aimed at promoting the HTM field. The first focuses on encouraging students to pursue a career in HTM by showing how managing technology saves lives. “AAMI has heard loudly and clearly about the challenges the HTM community faces with respect to filling positions, bringing new blood into the field, and the closing of several
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HTM educational programs. As just one small step in addressing these issues, AAMI has developed a new brochure about pursuing a career in the HTM field,” said Patrick Bernat, AAMI’s director of HTM. “The brochure is ideal for anyone who wants to help raise awareness of the opportunities that can be found in an HTM career, including HTM professionals who volunteer at career fairs or other community events.” The second brochure aims to educate members of the C-suite about the benefits HTM departments can provide to their organizations. The brochure includes testimonials from C-suite professionals, as well as concrete examples of ways specific HTM departments have helped control costs, improve patient care and support other services critical to their organization’s mission. A PDF version of the career brochure can be downloaded from www.aami.org/HTM (located under the “Career” heading), while the C-suite brochure is available at www. aami.org/Csuite. Free printed copies of both brochures can be requested from http://connect.aami.org/participate/ volunteeropportunities. CHECKLISTS PROVIDE EASY-TO-USE RESOURCE TO PREVENT HAIS AAMI has published a complimentary resource to help health care delivery organizations reduce the risk of transmitting healthcare-associated infections (HAIs). Checklists for Preventing Healthcare-Associated Infections: Key Considerations for the Purchase and Use of Reusable Medical Devices includes recommended steps when purchasing a new medical device, training considerations and stakeholder-specific checklists for sterile processing, infection prevention, environmental services, and HTM personnel. This tool draws from the lessons learned during AAMI’s 2016 HAI forum, in which AAMI and its partners met with more than 100 stakeholders concerned about the safety of reusable medical devices – health care administrators, clinicians, researchers, instrument processing personnel and device manufacturers – to explore how and why device- and equipment-associated infection transmissions occur and to identify solutions to the problem. The checklists are designed to be filled out electronically or printed out and completed by hand. Download them at www.aami.org/HAI_Checklists.
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Working in Healthcare Technologies at Aramark enables you to make a meaningful difference in the lives of millions of people, and in your own. As one of North America’s largest independent providers of healthcare technology management services, we offer our team members the unique opportunity to work across multiple client organizations and hone their skills through 500+ training courses.
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NORTHWEST HTM MIXER Offers Education, Networking
T
his year, the Washington State Biomedical Association (WSBA) and the Oregon Biomedical Association (OBA) are joining forces to host the Northwest HTM Mixer, proudly supported by TechNation. The HTM Mixer will be held Nov. 10-11 at the beautiful Hyatt Regency in downtown Bellevue, Washington. Registration is free for all WSBA and OBA members!
The two-day event will feature a welcome reception, educational opportunities, a keynote address and various valuable networking opportunities for HTM professionals as well as leaders from the medical device equipment and service industry. Each year WSBA and OBA host individual conferences with excellent attendance and vendor support, but this year the associations felt a combined event would best serve their members and corporate sponsors. OBA President David Gillaspie said the HTM Mixer is an opportunity for quality education and networking. “You really can’t lose,” he said. Gillaspie said he would tell anybody thinking about attending that “this is a great opportunity. This is a once in a year opportunity to get out there and be local and attend a conference without having to travel.” The outstanding educational offerings will include CE credits that can go toward certification or recertification. Gillaspie is especially excited about the networking opportunities for OBA and WSBA members as well as area HTM students. “With the networking, you get to know fellow biomeds from Oregon, Washington, Idaho and beyond. You
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The Northwest HTM Mixer will offer an outstanding keynote address on “DNV Accreditation - Combining ISO and Medicare conditions to focus on patient care”.
can connect with more resources, training and, the big one is, job opportunities,” Gillaspie said. Summit Imaging Manager of Global Education and Training Kyle Grozelle described the HTM Mixer as an exciting and unique opportunity. “The Northwest Mixer is a chance to gather the HTM community from Washington, Oregon, Idaho and even western Canada in a central location for education, networking and a chance to meet vendors from all over the country,” Grozelle said. “Nothing of this nature has been attempted before and with the support from the Oregon Biomed Association and the Washington State Biomed Association this event will not be something to miss!” On Friday, November 10 the WSBA will hold its annual members meeting from 4-5 p.m. followed by the 2017 Northwest HTM Mixer Welcome Reception for all attendees and exhibitors. The HTM Mixer continues with a full day on Saturday, November 11 beginning with a continental breakfast at 7:30 a.m. followed by opening
remarks and scholarship information. The keynote address “DNV Accreditation - Combining ISO and Medicare conditions to focus on patient care” is set to begin at 9 a.m. followed by educational sessions. The exhibit hall opens at noon and lunch will be provided. The exhibit hall will remain open until 3 p.m. and attendees are encouraged to meet with the exhibitors displaying the latest service and equipment offerings from throughout the HTM industry. Another round of educational sessions runs from 3-4:15 p.m. followed by a Happy Hour event from 4:30-5:30 p.m. For more information, including vendor and attendee registration, visit northwestmixer.com. Next year, one of the HTM industry’s most popular conferences will be in the great northwest! MD Expo will be held in Seattle, Washington, on October 5-7 at the Hyatt Regency Bellevue. For more information about MD Expo, visit MDExpoShow.com or join the Facebook group at https://goo.gl/a3SKtD.
OCTOBER 2017
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INDUSTRY UPDATES
BY ECRI
ECRI UPDATE
Recognizing Exceptional Technology Management: Penn Medicine’s Center for Health Care Innovation Develops Custom Apps to Improve Patient Care DATA, DATA, EVERYWHERE . . . There’s no shortage of data that care providers can access to facilitate patient care. What providers often lack, however, are tools to help them make optimal use of that data. Traditional electronic health records (EHRs) are built as information stores, not information delivery systems. Thus, care providers must actively seek out the data they need. As a result, their situational awareness is only as good as the timing and quality of their last search. The team at Penn Medicine’s Center for Health Care Innovation (Philadelphia, Pennsylvania) developed a way to bridge the gap between what is stored in an information system and what is known by care providers at the time they are caring for the patient. Their solution earned the team ECRI Institute’s 11th Health Devices Achievement Award. The award was presented to team leaders in June during an Innovation Speaker event at the University of Pennsylvania’s Perelman Center for Advanced Medicine. ENTER “AGENT” Care providers need to be aware of events that can affect a patient’s care, such as an expiring order for a critical medication; and they should be informed when actions are required to keep the patient safe, such as conducting an extubation risk screen for intubated patients. To improve providers’ situational awareness, the Center for Health Care Innovation team developed a technology platform for creating apps that prompt care providers when actions are required for targeted clinical populations – that is, for groups of patients that meet clinician-defined criteria. The custom apps built on Penn Medicine’s “Agent” platform, as it is called, and can pull real-time data from multiple EHR and clinical data sources to address a clinical need. Apps can be designed to proactively identify patients who require a particular intervention – say, ventilator patients who are due for an extubation risk screen – and then deliver that information to appropriate care providers via push notifications or on a shared dashboard. By bringing to clinical teams relevant, timely data that
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ECRI Institute’s David T. Jamison presents the Health Devices Achievement Award to project leaders from Penn Medicine.
previously was not easily accessible, the Agent platform helps Penn Medicine’s providers make better use of this data to improve patient care. PROJECT HIGHLIGHTS Features of the Agent platform include: • Data extraction – Custom-built APIs (application program interfaces) enabled by the Penn Medicine Information Services department allow data to be pulled from the University of Pennsylvania Health System’s EHRs and other data warehouses. • Data delivery – The platform can deliver information through a secure push notification channel (e.g., text, email) or through a “pull” view using a dashboard with a live-updating patient list. • Application customization – The team works closely with clinicians to identify potential use cases (i.e., problems that can be solved) and then uses the Agent platform to build an application to address the
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INDUSTRY UPDATES
problem. The iterative and agile approach that the team takes to designing, testing and implementing solutions allows it to experiment quickly at low cost, scaling only when highimpact solutions are identified. Penn Medicine reports that the Agent dashboard and alert platform has enabled teams across multiple entities within the University of Pennsylvania Health System to improve patient safety and reduce harm. The power of this approach is illustrated by one of the group’s first use cases: preventing missed doses of critical medications due to an expiring order. In an effort to limit unnecessary antibiotic usage, Penn Medicine implemented automatic stop dates for antibiotics at seven days. One unintended consequence of this effort, however, is that it led to orders for medications expiring without the awareness of the primary team. If the patient needed to remain on the medication beyond seven days, missed doses would sometimes result. With the Agent solution: An automatic reminder was sent to frontline clinicians about expiring medication orders – this was limited to only critical medications not reordered at the time of expiration. Additionally, a list of expired medication orders was provided to the inpatient pharmacist so the pharmacist could verify, reorder or engage the front-line clinician to address impending expirations before doses were missed. In the two months after the start of the intervention, the number of missed doses was decreased by 45 percent compared with before the intervention. On average, pharmacists were catching one case every other day in which an antibiotic expired inadvertently at two
hospital sites. Additionally, during the first year, more than 350 interventions were made by pharmacists at five hospital sites using Agent. Additional use cases that have been implemented to date include the following: • Coordinating cross-disciplinary and continuous ventilator weaning protocols for intubated patients. • Managing, in real time, patients with a history of high emergency department utilization. • Coordinating transitions of care for patients on hemodialysis from inpatient care to an outpatient hemodialysis unit at the time of their discharge. • Pushing evidence-based pathways to providers treating patients suspected of having a gastrointestinal bleed, delivering this information at a time when it can inform the care provider’s decision making. • Enrolling patients who are discharged with IV antibiotics in a monitoring and management program that has helped decrease readmission rates. KEYS TO SUCCESS The Center for Health Care Innovation team notes that forming partnerships with passionate clinical champions was absolutely critical to Agent’s success. The team solicits ideas for potential use cases from front-line clinicians and staff and works closely with those individuals throughout the design and testing phases. This helps assure that each app will successfully meet a clinical need. Such collaboration facilitates another key to the team’s success: rapid iteration. App designs are adjusted based on feedback from the end users,
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leading to designs that effectively meet the users’ evolving workflow and complex needs. Finally, the Information Services department provided a key technological component: custombuilt APIs that provide access to real-time data from multiple EHR and clinical data sources. ALSO DESERVING RECOGNITION . . . In addition to honoring the team from Penn Medicine’s Center for Health Care Innovation, ECRI Institute recognized three organizations as finalists for the 2017 Award. We’ll highlight those organizations in next month’s issue. Next year, it could be you. If your organization has engaged in a health technology management project that deserves recognition, ECRI Institute wants to hear about it. The nonprofit research institute presents its annual Health Devices Achievement Award to the member health care facility that has carried out the most exceptional initiative to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute will begin accepting submissions for next year’s Award starting in October 2017. For additional information, visit www.ecri.org/ HDAward. This article is adapted from ECRI Institute’s membership website. The full article features additional details about the Penn Medicine project and about other honorees. To learn more, visit www.ecri.org/HDAwardwinner; call (610) 825-6000; or email communications@ecri.org.
OCTOBER 2017
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THE BENCH
SHOPTALK
Conversations from the TechNation Listserv Q:
CMS and The Joint Commission require an “incoming inspection” before a medical device can be used on a patient. What is actually required for that inspection? Are there written regulatory requirements detailing what my inspection and documentation has to include? Is an electrical safety inspection and a basic mechanical “yes it works” enough? I’m assuming (love that word) the manufacturer sent me the new device fully functional and it survived transport to me intact? On a brand new device, do I need to do a full performance and output verification or can I just tag the unit, add it to my inventory, schedule the PMs, document an electrical safety inspection and call it done?
A:
I do not know of any detailed requirement from TJC or CMS other than you need to do an incoming inspection. Always perform an electrical safety inspection if applicable and operational check. Over my career, I have seen many out of box failures with both electrical safety inspections and/or operational checks. There will always be equipment that your staff is not trained on, so electrical safety and making sure the unit turns on would be the minimum you would do. You can check with the representative that sold you the device or call the company directly on any operational check that might need to be done.
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A:
Basically, all you have to do is an electrical safety check and physical inspection. We require the manufacturer to provide the factory specification sheets, GE has been really good at providing this information without having to hunt it down. I don’t think this is required by TJC and CMS, but we require it. We feel that categorizing the item and getting it into our database with the proper documentation (such a PM schedule, risk analysis and vendor contact information) is equally important.
A:
We have a checklist sheet that we use. Listing Lab, Hospital grade plug, EST, Performance Test and included Ops and Service manual.
A:
Incoming Inspection should be done aaccording to The Joint Commission EC.02.04.03 EP1. “Before initial use and after major repairs or upgrades of medical equipment on the medical equipment inventory, the hospital performs safety, operational, and functional checks.”
A:
We review the manufacturer’s manual to see what it says needs to be done prior to first use. If the manufacturer details incoming inspection requirements or has checks required prior to first use then they must be done to meet The Joint Commission requirement that you
follow manufacturer’s guidelines. From my experience, there can be anything from a detailed procedure to just turning it on and verifying the self test passes. If there are no requirements we at least verify the electrical safety and that any scheduled PMs have been completed. We often have vendors bring equipment in for short-term use and act like they have never heard from anyone else that a manual is required or that anything other than electrical safety needs to be done. One vendor brought a piece in that the manual clearly stated an annual PM was required, but had not been serviced in the five years the rep had the equipment. It had been checked by several biomed shops and passed through for use on patients. He contacted service and sure enough they wanted it back for PM and sent him another unit overnight. We are the frontline for this equipment and have to make sure that not only are we following requirements, but that the manufacturer is following their own requirements as well. If we don’t then no one will.
EDITOR’S NOTE: Stay updated, get tips and help your peers via the TechNation Listserv. Sign up for this FREE resource today at 1technation.com/ listserv/.
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BY RYAN SANDERS
THE BENCH
BIOMED 101
How BMETs Can Drive Biomedical Device Integration
H
ospitals can generate enormous benefits for patients and increase their own productivity by creating technology networks that enable medical devices to share information. Those that are able to achieve this goal will be able to improve accuracy and timely access to real-time data, monitor patients remotely, reduce paperwork and improve decision-making. They will also generate enormous gains in productivity, giving nurses and clinical staff significantly more time to care for patients instead of manually monitoring hospital equipment.
cross-referenced with information in the electronic medical record chart entries. Finally, measuring vital signs is a unique challenge because of the device’s mobility. An additional module must be purchased from the EMR vendor to connect this equipment to the network. This is a critical aspect to understand and ensure a successful implementation.
RYAN SANDERS Resident Regional Manager
During the past five years, I’ve served as the healthcare technology project manager for Crothall Healthcare at several hospitals that have made the leap to a seamless technology network. Bulky manual charts were replaced long ago with network-based systems, giving caregivers the ability to manage “big data” and making the timing right for more hospitals to undertake this task now. HOW BMETS CAN HELP To build a network that will connect a hospital’s biomedical equipment, it’s important for BMETs to understand several pieces of information. For starters, they need to know that one protocol – Health Level 7 – is now the international standard used to transmit all health and medical records electronically. Commonly known as HL7, this protocol can send specific messages to key personnel. For example, ADT is Admission, Discharge, and Transfer messages and data. The channel transmits data about bedside admitting and for patient transportation within the hospital. To connect a hospital’s technology network, it’s also important to understand
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the hardware in a Bedside Monitor Device Inferface (BDMI) configuration, largely because nursing floors and operating rooms are moving to BDMI. The key hardware components include: • M iddleware, which consists of dongle adapters, interface engines and gateways. Dongle adapters convert one COM type (typically serial) and add a device identity that is unique. It typically needs additional programming to device type, baud rate, etc. • Interface engines connect serial feed DA units or directly to the device outputs to convert to HL7 output. • Gateways connect multiple devices – though typically one OEM – and then send and receive data in HL7 format. BMETs will also need to understand mapping, which connects HL7 outputs to meaningful entries into all electronic medical records. To create the map, a list of data headers is needed from the device manufacturer. This information will be
BUILDING A COALITION TO SUCCEED As a project manager, I’ve worked closely with the nursing, informatics and information technology departments, as well as the device manufacturers. The role includes needs assessment, design concept, gathering price quotes and working with subcontractors. Teamwork among all of these groups is the key to developing, implementing and connecting the biomedical equipment. In most cases, the IT department will be charged with connecting all of the biomedical equipment into the technology infrastructure. Because the nursing and clinical informatics departments use the equipment to monitor patients, their expertise and buy-in is critical to the integration. BMETs can play a strong role as well, especially if they can demonstrate basic knowledge of BMDI equipment and other devices. Because of the number of different groups involved in creating the network, it’s important to organize and create partnerships among these different groups from the start. BENEFITS Once all bedside monitoring devices have been integrated into a single network, the return on investment for the hospital can be extraordinary. Connecting electronic health records with the BMDI immediately enables clinicians to focus much more of their efforts on the patient instead of manually monitoring a slew of equipment.
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HOW IT CAN WORK In 2016, I helped lead a team of hospital managers that implemented a comprehensive patient monitoring solution, as well as some other medical device integration, at a 150-bed hospital in Texas. The hospital’s IT department developed a network cabling plan, and installed the middleware and a gateway. We worked closely with Cerner, the device’s manufacturer, to map all data points for all electronic medical records to the network. Once the connections were made, we were able to monitor a patient’s heart rate,
vital signs, EKG, blood pressure and ventilator data. Without the network, medical staff would be needed to monitor this information every 15 to 30 minutes. A clinician would need to manually enter all data points. This is not only timeconsuming and a poor use of this person’s time, but one typographical error could lead to a possible misdiagnosis of a patient. Now, instead of focusing on the computer, the clinician was focused on the patient. They were getting more data and were more productive. Even with these benefits, there is one note of caution; hospitals must be wary of
creating the possibility of potential security breaches. HIPAA data can reside on any biomedical device or on network devices, so this information must be cleared when a device is retired or sent to service depots. In addition, viruses and malware are especially risky on scaled-down operating systems, such as embedded Windows. As security threats continue to emerge, BMETs will be a crucial part in any hospital’s technology solution. Ryan Sanders is a Resident Regional Manager for Crothall Healthcare in Tyler, Texas.
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THE BENCH
STAFF REPORTS
TOOLS OF THE TRADE Tripp Lite Power Strips
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ripp Lite has introduced three new models to its selection of power strips approved for use in patient-care vicinities in hospitals, clinics and other health care facilities. The power strips are fully UL 1363A-approved for use in patient-care rooms, therapy rooms, imaging environments and administrative areas. Each of the new models has a 7-foot power cord, an ideal length for mobile applications when a standard 15-foot cord is too long and bulky. The shorter cord length is also suitable for smaller exam rooms or when equipment is not moved far from the wall outlet. Two of the new models feature NEMA 5-15R-HG outlets and a 5-15P-HG plug: PS-407-HG-OEM provides four outlets and PS-607-HG-OEM provides six outlets. The third new power strip, PS607HG20AOEM, features six NEMA 5-20R-HG outlets and a 5-20P-HG plug to power both 15A and 20A loads.
F or more information, visit www.tripplite.com.
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THE BENCH
STAFF REPORTS
Webinar
Wednesday
WEBINAR WEDNESDAY
Supply Chain, Nuclear Medicine Education a Hit
T
echNation Webinar Wednesday continues to share valuable knowledge with attendees. The session “Nuclear Medicine Roundtable: The Importance of Equipment Service and Maintenance” sponsored by Universal Medical (UMRi) was eligible for 1 CE credit from the ACI.
UMRi Vice President of Corporate Quality & Customer Support Services Nik Iwaniw, joined National Service Manager Craig Snodgrass and Senior Product Manager Craig Diener to discuss the importance of equipment service and maintenance. Proactics Consulting Founder Wayne Webster was the moderator for the discussion. The webinar was different than other sessions as it featured a roundtable format where the panel of nuclear medicine experts fielded questions to help service professionals keep their equipment and departments running at peak performance and efficiency. The webinar was a hit with more than 200 registered attendees. In post-webinar surveys, attendees shared what made the session stand out. “The webinar was very informative and gives us a lot of ideas to better our nuclear medicine department. We also have some more background on what we need to do as a clinical engineering department to provide better service for the nuclear cameras,” biomed T. Demi wrote. “This was a very educational webinar. I look forward to learning more about nuclear medicine in the
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future,” Imaging Engineer R. Pitts said. “This was a very informative and realistic webinar. Gave advice on practical matters such as looking at the pathway for installing new cameras,” Clinical Engineering Technician M. Romano said. “Very informative and educational webinar. I learned a lot and there were some very important guidelines to utilize as a BME to benefit the institution and the clients,” Biomed Manager C. Shaw said. Participation in the TechNation Webinar Wednesday session “Best Practices to Improve Quality in the Supply Chain: Lower Your Supply Chain Risks and Cost of Quality” sponsored by PartsSource was eligible for 1 CE credit from the ACI. PartsSource Vice President of Client Services Will Kinsey and UnityPoint Health Executive Director of Clinical Asset Management Greg Doherty discussed how to continually manage costs and improve performance by selecting the right supply chain partner and, more importantly, monitoring and proactively managing quality in the supply chain to reduce business risks and prevent revenue losses. The session drew a wide audience with 174 people logging in for the live presentation and many others have already viewed a recording of the webinar on the TechNation website. The webinar was well received as shown by the positive comments shared via a post-webinar survey. “This will help me to understand more the importance of quality in the supply chain that affects my clients and
“ Webinar Wednesdays allow a economical way to earn CEU credits and allow my staff to further increase their staff development knowledge.” -J. Trujillo, Biomed Account Manager
my business as well,” Alain L. wrote in his survey. “Great information!! I am fairly new to the business and I really appreciate the tips, advice and information,” wrote Patricia E. “The webinar was a great representation of how the process can limit the downtime of equipment from relieving the engineer of the time it takes to search and process orders,” Phonesalo S. shared. “We are a rural 49-bed hospital with many rural health facilities and clinics. And, we experience the exact same concerns as the big guys like Unity Health only on a smaller scale. Working with our supply chain is my
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exposed to industry discussion straight from seasoned pros,” BIS Manager C. Rabenberg said. “I really appreciate how easy Webinar Wednesday is to attend. I always leave learning something I can apply to my daily job requirements,” Senior Repair Tech Q. Lockwood said. “Webinar Wednesday has been a great asset for our biomed program. It can be used by both first-year and second-year students. It is real world and current information,” Biomed Educator M. Kalis wrote.
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lifeblood for efficient medical equipment uptime and patient safety. This webinar confirms that we are on the right track and I am armed with good questions for our new supply chain director who I’m sure is already working on these improvements. Thank you PartsSource and TechNation for the webinar,” Mike P. said. The Webinar Wednesday series also received praise from attendees. “Webinar Wednesdays allow a economical way to earn CEU credits and allow my staff to further increase their staff development knowledge,” write J. Trujillo, Biomed Account Manager. “The webinars provide valuable opportunities for students to be
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ROUNDTABLE
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OCTOBER 2017
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ROUNDTABLE
ROUNDTABLE DEFIBRILLATORS
I
n this roundtable article, TechNation asked members of the HTM community to share the scoop on defibrillators (including AEDs). Our panel shares their tips regarding the latest advances for these devices as well as their unique individual insights.
Participating in the roundtable article are David Braeutigam, System Director, Healthcare Technology Management, Baylor Scott & White Health; Ashish Dhammam, Sales Director, Soma Technology Inc.; RepairMED CEO Diane Geddes; and Juan Ortiz from Tenacore Holdings Inc. Q: WHAT ARE THE LATEST ADVANCES OR FEATURES IN REGARDS TO DEFIBRILLATORS?
David Braeutigam, Baylor Scott & White Braeutigam:Many of the newest defibrillators now have wireless capability. This is used for recording events during codes and can be used to create reports of the actions taken during a code event. Most of the defibrillators now do automatic internal diagnostics usually once a day to ensure the defibrillator is working properly. Some also test the battery and report the status back to a central computer. Many can be used as a full-fledged patient monitor with some having 12 lead ECG, pulse oximetry and CO2 monitoring. Dhammam: CPR Feedback is a new advancement that most manufacturers are adopting and SpCO (Carbon Monoxide) measurement for pre-hospital models is also becoming popular. Along with ETCO2, I expect wireless data transmission and daily self-test function to be features in the near future.
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Geddes: Newer models have the capability to transmit ECG via WiFi or cellular connection to the health care facility before the patient arrives. Some models have improved CPR coaching and/or real-time feedback. Newer systems indicate when there is an issue with a lead or if it is not capturing pacing data which are often missed in an emergency. Aside from ECG, SPO2 and etCO2 are also added features. Ortiz: The latest advances include, but are not limited to, having a more consistent shock with a higher confidence level. Another advancement is the ability to deliver more current. These are important because it is a matter of life and death and these devices need to be reliable. Jumper: Target controlled, low-flow anesthesia systems have been around for a few years now, but these machines can automatically adjust flow and vaporizer settings based on end values preset by the anesthesiologist. Also, new technology for the Co2 absorbers such as the spiralith which is a lithium-based absorber that does not generate the dust that traditional soda lime canisters do. Soda lime dust is a huge issue in maintenance. Q: WHY ARE DEFIBRILLATORS (AEDS) SO IMPORTANT FOR HEALTH CARE FACILITIES? Braeutigam: Defibrillators are so important not only because they can save lives with defibrillation but also can be used as a transport monitor. Most defibrillators are configured with ECG, most have external pacing capability, pulse oximetry and even CO2 monitoring. They are one of the most important and versatile devices in the hospital.
OCTOBER 2017
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ROUNDTABLE
Automatic External Defibrillators (AEDs) are also important outside a nursing floor. They can be found in an office area, cafeteria, at your child’s school or even at an auto dealership. AEDs allow the non-clinical person to perform defibrillation with no training. They are truly life-saving devices. Dhammam: A defibrillator is a crash cart/patient safety item used to resuscitate patients from cardiac arrest, and is also a requirement of state and accrediting organizations.
Diane Geddes, RepairMED Geddes: Defibrillators are essential equipment used to respond to lifethreatening cardiac arrest. Defibrillators also provide physiologic information while caring for sick patients. Ortiz: Defibrillators (AEDs) are crucial to any health care facility because they increase the chances of survival from a sudden cardiac arrest. These devices need to be readily available and easily accessible because they are only effective when administered within the first few minutes of a sudden cardiac arrest.
Q: WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A DEFIBRILLATORS (AED)? Braeutigam: You must have buy-in from the critical care doctors and nurses on the type of defibrillator you will want to purchase. A committee should be formed with doctors, nurses, HTM and supply chain to evaluate the features everyone would like to have. The doctors and nurses will be interested in the ease of use, type of output and the options available. HTM will be interested in the reliability and the cost of maintenance. Remember if you are purchasing the wireless options to get the IT department involved if it requires a server, IP addresses, etc. Also don’t forget to calculate the additional annual cost of any servers, software, licenses and support costs for the wireless add-ons. Supply chain will be interested in standardization, supply cost and capital costs during the evaluation.
Geddes: Biomed technicians need to be trained on the proper use and maintenance of defibrillators. Performing preventive maintenance as recommended by the manufacturer is vital in extending the service life of a defibrillator. Juan Ortiz, Tenacore Ortiz: Biomeds can extend the life of defibrillators by doing a routine inspection and sending the unit in for a preventative maintenance check. At Tenacore we recommend defibrillators be inspected monthly, and sent in for preventative maintenance every six months. This will ensure that the device is always functioning. Q: WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT DEFIBRILLATORS (AEDS)? Braeutigam: Defibrillators are a very easy device to look at when rounding. You can easily look at the defibrillator to see if the charging light is on so it is plugged in. You can also stop and check the expiration date on the electrodes and the defibrillator pads. You don’t want these to be expired. AEDs will usually have a check mark or a visual indicator to say if the last automated test passed. That is a real easy check. Don’t forget about AEDs in public areas or your doctor’s office also. Dhammam: For defibrillators, I would recommend always keeping a battery charger in the shop and maintaining a good stock of back-up batteries, pads and other essential accessories as they do go on a back order from time to time from the manufacturer. Geddes: Biomed technicians are charged with maintaining these devices. Training is essential on providing proper repair and maintenance. Ortiz: Always remember to do a thorough check of the defibrillators. We all have a common goal and that is to keep our patients safe. Tenacore is always here to help answer any questions you may have.
Ashish Dhammam, Soma Technology Dhammam: As with all equipment, timely PMs help extend the life of units and avoid unforeseen failures. More specifically for AEDs, maintaining a log for changing batteries is helpful.
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COVERSTORY
• BY K. RICHARD DOUGLAS •
COVERSTORY
I
n an atmosphere of cutting costs within health care, it would seem that every opportunity to do so, that preserves patient safety, would be considered and endorsed. Yet, that produces a conundrum of
sorts in regards to the ability for an in-house biomed department to repair all equipment at a reasonable cost to their employer. This is one of the costs, after all, that a health care system must bear and pass along to its customers.
Automobile dealers know that there is good reason to have salespeople direct the customer to the “finance guy” after they have made a purchase. Between the service department, and the add-ons that the finance department can sell the customer, there is more profit than in the actual sales department. Getting so much more profit, after the sale, does not seem to benefit the customer, who was only interested in buying transportation and already had their budget stretched in many cases. The analogy seems to hold true in the medical equipment marketplace as well. At least, this is the perception of many people who are closely involved in maintaining medical equipment. Very often, the biomed department, or an imaging engineer in that department, will want to help ensure that a patient gets a needed diagnostic imaging procedure when a piece of equipment goes down. In many cases, their good intentions are met with frustration because only the OEM can make the repair, and at an increased cost. The frustration for the HTM profession for several years has been the general inaccessibility of service manuals, passwords, replacement parts and/ or access to training that fits into their employer’s budget.
As of this writing, the issue of new federal standards, that relate to the servicing of medical devices by trained service technicians or ISOs, is in flux. It is the fluid nature of the topic that dictates that we revisit it at a time when state and federal lawmakers are reviewing language for new laws. At the federal level, a bill that was passed by the House on July 12, and the Senate on August 3, 2017, which is titled H.R.2430; the ‘‘FDA Reauthorization Act of 2017,’’ has been signed by the president. In March of 2016, the FDA had requested comments from all stakeholders for any future proposed rules, which could be found in a docket titled: “Refurbishing, Reconditioning, Rebuilding, Remarketing, Remanufacturing, and Servicing of Medical Devices Performed by Third-Party Entities and Original Equipment Manufacturers.” The request was met with 176 comments from OEMs, ISOs, biomeds, The Joint Commission and other interested parties. The biomeds who responded pointed out that there was a crucial time element involved in waiting on an OEM, that injuries at their facilities resulting from repairs or maintenance were negligible or non-existent and that there are other levels of oversight related to HTM department procedures.
STORY CONTRIBUTERS CURTIS ANGE MANAGER OF BIOMEDICAL ENGINEERING
THE MAKING OF LOCAL LAWS It’s often said that the best decision making, from a legislative perspective, is when it is closer to the people that it impacts. While Congress and the FDA wrestle with the issue of servicing medical devices, and who has the right to all the information needed to do so, the debate has been addressed in state legislatures as well. In those cases, there is more action taking place that moves the ball forward. There is proposed legislation in a dozen states. In Nebraska, where a large percentage of the population works in the agriculture business, the ability to repair farm equipment is a concern very similar to medical equipment. If a piece of farm equipment is down at a time of year when a farmer needs it, the need to repair it in a timely manner or wait for a technician, is not a practical solution. The bill in Nebraska, (LB67), recognizes that the issue is also like repairing automobiles. With on-board computers in both, the ability to read a fault-code could lead to an expedited repair. FRUSTRATION AT THE POINT OF REPAIR The arguments on both sides of the right to repair debate haven’t changed much since day one. The OEMs maintain that they, or their designated representatives, are the most qualified to repair their devices. They, and their advocacy groups, also argue that if anyone else makes certain repairs, it can put a patient’s well-being at risk. There are other arguments centered on the OEMs rights regarding proprietary information and intellectual property. Within the HTM ranks, the arguments for right to repair include the urgency created by inoperative equipment, that is
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so often a reality, cost and budget considerations, and the time consumed when shipping and packaging is required. Biomeds also cite the fact that restrictions by OEMs tie the hands of those tasked with repairing and maintaining equipment in their own facilities or restricting local ISOs from attending to quicker, or most cost-efficient, repairs. Biomeds also cite the reluctance of OEMs to share service manuals or make a replacement part available. The obstacles, according to Curtis Ange, manager of biomedical engineering at Kennestone Hospital in Marietta, Georgia, include “tooling, training and certification.” “The typical manufacturer warranty period, with any new purchase or installation, is 12 months. So, during this warranty period, I’ll need to plan then [to] purchase any necessary or required test equipment or tooling in order to perform any scheduled or unscheduled service interventions once that new manufacturer warranty has expired,” Ange says. Ange says that in addition to the capital needed to obtain the required tools or test equipment, operational expenses will also be needed to train and/or certify the person or persons who will maintain the new device, devices or system. “This tooling and training, if pricing or travel expenses have not been negotiated up front, can become costly, so it’s important to include these amounts and expenses as part of the planning and budgetary costs when considering a new product,” Ange adds. Dean Stephens, EET, CBET, in the biomedical engineering department at Penn Highlands Healthcare, says that there are two camps when it comes to the OEMs approach.
DEAN STEPHENS, EET, CBET, BIOMEDICAL ENGINEERING DEPARTMENT
“ ON THE OTHER END OF THE SPECTRUM, THERE ARE THE OEMS WHO FEEL THAT EVERY ITEM THEY HAVE EVER PRODUCED SHOULD BE PROTECTED MORE CLOSELY THAN THE U.S. NUCLEAR ARSENAL.” DEAN STEPHENS “Refusal to provide service and repair documentation has always been a problem. Some manufacturers seem to realize that we the biomedical engineering departments can be [a] great asset when it comes to how their product appears to the end users. This type of OEM makes their documentation and parts breakdowns easily available and provides knowledgeable tech support technicians who aren’t lost as soon as your issue goes off of their script,” Stephens says. Stephens points out, with some intentional sarcasm, that for other OEMs, the end game is all about loosening the purse strings. “On the other end of the spectrum, there are the OEMs who feel that every item they have ever produced should be protected more closely than the U.S. nuclear arsenal. I have contacted one in particular attempting to purchase a service manual. Their reply was that they had never produced any service or technical manuals for the device in question, but if I was to send the broken one to them, with a small basket of shekels, they would be glad to tell me how
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GAY GORDON-BYRNE EXECUTIVE DIRECTOR OF THE REPAIR ASSOCIATION
many more shekels I would need to send in order for them to complete a repair,” Stephens adds. He said that a recent experience illustrates the frustration with parts accessibility. “There are now several OEMs who won’t sell parts, but insist that the only means to have a piece of equipment repaired is to send it in for depot repair. In one case, I needed a small plastic clip, that’s smaller than a dime, in order to repair a charger base for a handheld pulse oximeter. Not only did their tech support insist that I had to send the base in for a $250 flat-rate depot repair to have this replaced, the tech I was speaking with insisted that this piece was part of the plastic chassis and isn’t removable. I had the piece, which is removable with a small screw, in my hand as he was telling me this,” Stephens says. Sometimes OEMs will claim that their equipment is too “complicated.” In many cases, HTM professionals have the basic knowledge to handle these repairs. “Many times I’ve been told that ‘their’ equipment is too complicated to work on, but over my career, I’ve learned that whether it’s medical, aviation or audiovideo, electronics is electronics, no matter what type of box you stuff them into,” Ange says. “The only exception to this observation is that typically each manufacturer will have their own patented component or components within ‘their’ box, and it’s that component or application or software, you won’t understand or know how to repair or operate until trained,” he adds. Stephens says that one solution can be leveraged at the point of purchase.
STEPHEN L. GRIMES FACCE, FHIMSS, FAIMBE
“When we have advance warning that a department is considering new equipment, we ask that department to make it a requirement of the contract that it includes service manuals,” he says. “In the case of new ventilators, anesthesia machines, etcetera, make a bid requirement that it includes training for one or two techs. This has worked for me in the past, though I had never seen such grumpy salespeople as when some would try to weasel out of the training requirement, and be reminded that if their
“ NONE OF THE BILLS HAS PASSED YET. THIS IS NORMAL FOR ANY SIGNIFICANT PIECE OF LEGISLATION IT TAKES MORE THAN A FEW MONTHS TO WORK THROUGH THE ISSUES SUFFICIENTLY TO GET LEGISLATORS COMFORTABLE WITH PASSAGE.” GAY GORDON-BYRNE bid didn’t include the training, it would be summarily tossed,” Stephens adds. He points out that the request isn’t for “free training,” but requests training for a certain number of technicians. REPRESENTING CONSUMER RIGHTS While large corporate concerns have lobbyists representing their interests in Washington and in state legislatures, The Repair Association represents the purchasers, including medical device
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
SCOT MACKEIL, CBET, SENIOR BMET
purchasers, to fight for repair rights and the passage of Fair Repair legislation. “Right to Repair aka Fair Repair aka Digital Right to Repair legislation has been filed so far in 12 states. Most include medical equipment, along with everything else, from a cellphone to a tractor. Two bills were set up to cover only farm equipment,” says Gay Gordon-Byrne, executive director of the Repair Association in North River, New York. “None of the bills has passed yet. This is normal for any significant piece of legislation it takes more than a few months to work through the issues sufficiently to get legislators comfortable with passage,” she says. Gordon-Byrne says that Massachusetts is one of those locations where her group has invested enough time and education to be serious about passage this year. “The legislature is still in session and has a public hearing set for September 26 (2017). We will have members of the medical community, such as Stephen Grimes, helping to testify in favor of legislation, but opposition will also be there in force to block passage,” GordonByrne adds. In the debate within Massachusetts, Gordon-Byrne’s group has told the legislature that they believe health care safety is improved if biomeds “can have access to the essential information and materials necessary for complete, safe and effective repairs.” Consumers in Massachusetts tend to agree that they have a right to repair. In 2012, 86 percent voted in favor of the Automobile Owners’ Right to Repair Law. In principle, the ability for the purchaser to have the capability to repair what they have purchased, is a widely-
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held belief. This kind of freedom for consumers also extended to cellphones, prompting a change in the law that now allows cellphones to be “unlocked.” The issue includes medical devices but is a topic of dispute for vehicle owners, cellphone owners, in farming and consumer electronics, to name a few. “Manufacturers, in opposition to repair, have taken to conflating their requirement to provide safe products – with or without regulatory oversight – with use of the products. Such claims are made to confuse and frighten legislators – very few of whom know that the FDA requires reporting on adverse events so that unsafe designs can be corrected. Only the OEM can make this kind of adjustment or improvement,” GordonByrne says. “Users, meaning doctors, patients, HTM or others, cannot re-design products to make them safer; they can only use them safely. According to the FDA and CMS, the hospital administrator, supervising physician, or HTM/BMET/clinical engineer is responsible for safe use and also responsible for assuring that repaired equipment is returned to service in full working order,” Gordon-Byrne adds. She points out that purchase documentation includes much more than just purchase price and warranty terms. Contracts always include disclaimers and indemnifications of use, such as this very common sentence: “In no event shall [company] be liable for any direct, indirect, punitive, incidental, special consequential damages, to property or life, whatsoever arising out of or connected with the use or misuse of its products.”
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MAKING THE CASE Echoing many in the HTM community, Stephen L. Grimes, FACCE, FHIMSS, FAIMBE, managing partner and principal consultant with Strategic Healthcare Technology Associates LLC in Swampscott, Massachusetts says “manufacturers should provide service materials (i.e., troubleshooting advice, manuals, parts lists, software codes, etcetera) to medical equipment owner/ operators and third-party services at a reasonable cost.”
“ FOR MUCH OF THIS DECADE, SOME MAJOR MANUFACTURERS AND THEIR TRADE AND LOBBY GROUPS HAVE TAKEN STEPS ATTEMPTING TO FORCE THROUGH NEW REGULATIONS THAT REQUIRE IN-HOUSE AND THIRD-PARTY SERVICERS TO FOLLOW THE MAINTENANCE PROCEDURES AS RECOMMENDED BY THE MANUFACTURER.” STEPHEN L. GRIMES
“For much of this decade, some major manufacturers and their trade and lobby groups q have taken steps attempting to force through new regulations that require in-house and third-party servicers to follow the maintenance procedures as recommended by the manufacturer and to register with the FDA and implement the same quality management system and reporting requirements as the FDA requires of manufacturers,” Grimes says. Along with a lobbyist from the Repair Association, J. Scot Mackeil, CBET, a senior BMET at an academic medical center in Boston, as well as a colleague
from ACCE, attended a series of meetings at the Massachusetts State House, which included leaders of key legislative committees working in support of pending bills S.96 and H.143. As a result of that experience, Mackeil says that “the device manufacturers’ lobbyists are trying to neuter our pending right to repair legislation by getting an exemption for Class III medical devices — quite a bit of what biomeds work on falls in this category; defibs for example. I would assume MITA and MDMA have this request going on in other states that [the Repair Association] has similar bills in process,” Mackeil says. The Joint Commission’s new element of performance EP 3, that is slated to go into effect in January, provides: “The organization has a library of information regarding inspection, testing, and maintenance of its equipment and systems. Note: This library includes manuals, procedures provided by manufacturers, technical bulletins and other information.” The new EP gives the HTM community another arrow in its quiver in attempts to obtain information from OEMs. In addition to Gordon-Byrne’s organization, which attempts to aid consumers in many sectors, the establishment of a national HTM organization would provide a strong lobbying voice for the HTM community. “Biomeds, regional biomed societies and ISO groups should become politically active and partner with [the Repair Association] (www.repair.org) and support right to repair legislative initiatives in their states,” Mackeil says. “Our adversaries are well entrenched in the regulatory front. But, Right to Repair laws may be able to trump the OEM lobbyists, and if we can start to get these laws on the books in multiple states, HTM could win its own ‘Battle of Midway.’ The recent EP released by TJC, regarding service manuals and information, will prove to be a powerful new tool,” Mackeil adds. More will be known in the near future as the right to repair issue is considered by lawmakers in several states.
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EXPERT ADVICE
BY CINDY STEPHENS
CAREER CENTER
Maintaining Skills for a Successful Career
C
areer success is a long-term, continuing process. Maintaining your skills for a successful career is up to you. You must decide that your career is important enough to manage and maintain focus on your future to ensure success.
Your position in the biomedical equipment technology and/or healthcare technology management (HTM) career field is very important in today’s fastpaced and very competitive health care market. Yet, we find that many are at a loss as to why they are not hired or promoted to a higher-level position. Many employees and job seekers, at the technician and management levels, come to our firm for advice on how to be more successful in their career. They wish they could unlock the secret formula or combination of skills and values that will capture the attention of employers. Well, I don’t have any secret formula to share with you, but here are some tips that we believe will help you progress in your career or job search. An important key element in career success is to be sure you are in a career you enjoy – one in which you believe in and one in which you feel you belong; a career that you are excited about working in and committed to. Exhibiting a high level of interest and energy to your employer or prospective employer is often a critical factor in getting chosen over others to receive a promotion or job offer. To attain success in any career field,
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you must approach your job and daily responsibilities with enthusiasm, dedication and commitment. You should be prepared to do whatever it takes to get the job done. The most important factor in career advancement is often how a boss views an employee. The ability to view yourself and your performance through the eyes of your boss is a critical part of career development and success. In your career, perception is reality – and it is critical that you are recognized as a valuable employee and person. We know that every employer is looking for a specific set of technical skills from job-seekers and employees that match the skills necessary to perform a particular job. However, beyond the technical skills, certain characteristics or “soft” skills are also sought in new employees. The good news is that most employees and job seekers possess these soft skills to some extent, and weaknesses in these areas can be improved through professional and personal development. Most accomplished people have several quality characteristics in common. I believe that successful people have excellent communication skills and they display sincere enthusiasm. Honestly, those who can get the job done efficiently, communicate effectively, and do it with energy and enthusiasm are considered to be the most valuable employees. As a trained biomedical equipment technician and/or HTM professional, you have a solid, technical and professional background to support your career path.
Cindy Stephens Stephens International Recruiting, Inc.
You have a lot to offer your employer by virtue of your education and experience. There are many other equally important characteristics to consider and remember, too! One of the keys to looking like you belong in a certain career is to dress the part. Dressing for success is all about making good – and lasting – impressions. Always keep in mind that first impressions do count! In today’s fastpaced business world, impressions regarding your competence, intelligence and reliability are formed within minutes, even seconds, and are based on your professionalism, manners, attitude and appearance. Therefore, you want to project a professional image at all times,
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displaying confidence, competence and credibility! Be recognized as a leader and take on more responsibilities. Be the expert in your field; be known as more than the “guy in the basement who fixes the equipment.” Communication is very important – keep everyone informed of the status of repairs, work orders, etc. Make rounds in the hospital and be a promoter of your services. Remain professional, always. Follow up with your boss, supervisors, peers and department contacts. Ensure you provide quality service to your customers and in everything you do. Demonstrate your desire to excel and the willingness to work hard. Be the solution to problems. Go above and beyond what is expected and be the best you can be. To do this, you must have a heartfelt commitment to your career, knowing that it is more than just a job. Be proud of what you do and do it well. Your consistent, daily presence in every job is just as important as your first impressions in job interviews and during those first weeks on the job. Often, this is what makes a difference between you and other employees, the one thing that makes you stand above the rest. Be a team player and at the same time, take the initiative to work independently to accomplish your responsibilities. Do not wait to be told or asked to do something. Maintain a high degree of integrity. Be reliable and dependable. Be early for meetings and appointments. Be responsive and always return calls. Ensure all reports and documentation are completed in a timely manner, especially when it comes to safety, The Joint Commission and other regulatory requirements. Always maintain a positive attitude. Don’t speak negatively about anything or anyone. Don’t be a know-it-all; don’t be overly talkative; and don’t burn bridges. Invest in yourself with continuing education and certifications. Specialty training along with your experience will build your competence and your reputation! Keep abreast of technology by reading trade journals, magazines and manufacturer literature. Ensure you are maintaining your technical skills and utilizing your “soft” skills to attain and maintain success in your career! You can be a tremendous success if you are willing to work at it. Your career success is up to you.
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EXPERT ADVICE
BY DOUG KEENEN
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Because Quality Matters ISO 9001:2008 CERTIFIED
ULTRASOUND EXPERT Lock ups, lock ups, lock ups!!
N
ot a week goes by where we don’t hear the words, “my system is intermittently locking up,” or “freezing and I can’t do anything.” Nothing is more frustrating to an end user than when they have a patient on the table and the ultrasound machine locks up for no reason. Depending on the nature of the lock up, the sonographer may have to reboot the system. This is a huge inconvenience for not only the customer and the patient on the table, but also the line of patients waiting for their delayed appointment to be scanned.
This symptom is quite common and the root cause of the problem can originate from multiple areas within the ultrasound machine. It’s time to play detective. The key here is to interview the customer thoroughly to help lead you in the direction that will most likely resolve the problem.
KEY QUESTIONS TO ASK: Can you duplicate this problem for me or does it just happen sporadically?
1
2
How often is the lock up occurring? If it has only happened once or twice over the period of a few months, it could be a glitch. These are basically computers so that may happen occasionally.
3
Does the lock up occur at a specific time of day? Morning, later in the day? This may be a thermal problem.
4
Is there one particular probe or modality being used that is common to experiencing these lock ups? Sometimes when a probe is starting to
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fail, it can cause performance issues with the system. If the lock ups only occur when using color flow doppler, or PW doppler, then that is what needs your focus.
5
Does the system lock up when starting a new patient or saving patient images? The system then could possibly have patient data corruption, operation software corruption, or simply that the patient hard drive partition is too full. When the hard drive is too full, the system will have a hard time processing all the data and commands in a timely fashion. Deleting all patient files may resolve the problem. If this doesn’t work, reloading software may be necessary.
There are other factors to consider as well. This could be heat related. Check and clean all fan filters and filter trays. Check the back-end processors for dust build up on the microprocessor fans. Clean and reseat all the circuit boards in the back-end. It is also a good idea to open the front-end of the system and blow out
DOUG KEENEN Field Service Engineer for Conquest Imaging
the card cage with air and reseat the boards. This will insure that there is proper ventilation and secure connections in the card cages. As important as it is to ask the right questions, it’s even more important to listen and pay attention to what the customer is telling you.
For ultrasound tips and tricks and technical videos, visit www. conquestimaging.com or call Conquest Imaging 24/7/365 at 866-9009404 for free technical support.
Doug Keenen has over 27 years’ experience in the ultrasound industry in sales and service with 17 of those years in the multivendor ultrasound market. He is currently a field service engineer for Conquest Imaging and is responsible for ultrasound service and sales in the Mid-Atlantic region.
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653A
EXPERT ADVICE
BY DAVID SCOTT
BEYOND CERTIFICATION A
s the organizer of the Colorado Association of Biomedical Technicians’ (CABMET) Certification Study Group part of my job is to stay up to date with anything related to certification and ways to help techs prepare for the test or prepare for certification renewal. Which is partly what this column is about. The other part is regarding current events like my last column covering H.R.2118 and how it could effect everyone in HTM and how it might relate to certification.
I remember a little while back getting an email from AAMI to fill out a survey. The survey was related to certification. It asked questions about how much of your job involves each section of the certification test. I filled it out and didn’t think about it a lot after that. Now when reading the Certification Handbook, I see one line right after the schedule that says: “* There will be new exams for CBET, CLES, and CRES in 2018 based on the data found in a 2017 Job Task Analysis. Updated exam content outlines will be made available.” I have seen that in the 2017 Handbook since this spring prior to the May 2017 testing period. The only thing I thought when I saw that is that it somehow may be related to the survey from AAMI. I keep checking the AAMI site and handbook to see if there are any updates. So far, I have not seen anything. Then, I was looking at all the classes for the MD Expo in Orlando, Florida, on October 5-7. The schedule looks great, as usual, and I look forward to attending several classes. One class that
caught my eye was titled: “ACI Certification Update: Recertification Policy and BMET Exam Updates,” presented by, Sherrie Schulte, CAE, Senior Director of Certification, AAMI. This is the description of the class: “This session will present the updates and changes to the new recertification policy for CBET, CRES, CLES, and CHTM certifications through ACI. This session will also discuss updates to the BMET exam content outlines determined by a recent job task analysis. This update will inform certified individuals, as well as interested candidates, of the new developments to the exam as well as the overall scope of the designations.” We have already discussed the recertification process here and by now it should be old news to all the readers of the column. What interests me are the “new developments to the exam as well as the overall scope of the designations.” This may be the answer I have been looking for since seeing that one line note from the 2017 Handbook.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
DAVID SCOTT CABMET Study Group Organizer, Children’s Hospital Colorado
My guess is that the test will be changing. That is almost a given by the description. The survey asked questions about the same categories that are currently on the certification exam. I think the changes may relate to the percentages of questions asked in each category. So maybe less questions from the Fundamentals of Electricity & Electronics and maybe more from the Healthcare Information Technology category or another category? I think we will find out very soon! I will be attending this class along with several of the other interesting classes offered at the MD Expo Orlando. If you see me there take a minute and say “Hi.” I would like to hear from you.
OCTOBER 2017
TECHNATION
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EXPERT ADVICE
BY INHEL REKIK
TECH TIPS
Which Operating System For Which Medical Device, Why and How to Patch It?
R
ansomware such as WannaCry and Petya/Not Petya ransomware targeted vulnerabilities in the Windows operating system (OS) that many medical devices use. Thus, hardening our medical devices by applying security patches needs to be a priority for HTM departments. Also, medical device manufacturers need to limit the possibility of being impacted by malware.
Developers choose the operating system that a medical device runs based on the following criteria: • RELIABILITY AND AVAILABILITY: responds quickly to events and detects failure early • INTEROPERABILITY: ability to communicate with other devices or systems, either directly or through the network •C ONFIDENTIALITY AND DATA INTEGRITY: stores data safely and protected from unauthorized access •P OWER MANAGEMENT: very important for devices that need to run on batteries such as infusion pumps and ventilators Very few medical devices run on general purpose operating system (GPOS) since they are not capable of providing the reliability and real time availability that the majority of medical devices need. In addition, their performance can be unpredictable. The medical devices that have a GPOS tend to be a review station, a post exam processing station, serveror gateway, such as an infusion pump manager server or a diagnostic type of medical device such as an EEG system and metabolic cart. Patching of GPOS can be very straightforward and can be downloaded from the OS manufacturer website. However, it is usually a good idea to check
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with the device manufacturer before patching to avoid voiding a warranty or support contract. In reaction to WannaCry, some manufacturers gave the go ahead to healthcare delivery organizations to install available patches even though some had not been validated by them and offered support if a malfunction happened. In contrast, an embedded Real Time Operating System (RTOS) is designed to guarantee real-time availability and reliability. These operating systems behave in a predictable manner and always complete the tasks at hand. They are always available when needed. A big number of medical devices have a RTOS assuming that it supports the other functionalities of the device. Medical devices with RTOS (such as an infusion pump) run a compiled firmware that is stored in a flash memory or any other non-volatile memory in a read-only state, rather than software stored in a hard disk in a read/write state. This offers them protection against malware. Security fixes on these devices are a little more complicated since no patching or modification of the operating system can be done. Firmware needs to be updated and manually re-installed when vulnerabilities are discovered in a certain firmware version. This can delay the release of patches since medical device manufacturers need to verify that new firmware will not interfere with the
INHEL REKIK Clinical Engineering Manager
functionality of the device. Examples of RTOS are VxWorks, QNX and Windows Embedded Compact Edition (CE). Windows CE is chosen as an OS for medical devices because it can support sophisticated user interfaces which is always a big plus for the clinical staff. It is also real time capable, detects failure instantly and is very easy to program. Many medical devices use Microsoft Windows Embedded Standard which is a stripped down version of the standard Windows operating system that can be patched such as a hemodynamic system, some ultrasound systems and imaging systems. The patches for these systems are provided by the vendor to make sure they are validated to be used with their software. Microsoft Embedded Standard is selected for its power management capability and connectivity. This OS is a good compromise between GOPS and RTOS. Linux has gained popularity among medical devices because it is an open source and it is used in more computing
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platforms than any other OS which makes it very easy to program. In addition, it tends to be generally more secure. Very few medical devices have GPOS Linux, most medical devices have embedded Linux. There is a variety of medical devices using Linux: MRI, CT scanner, patient monitors and laboratory devices. Linux and Linux embedded are patchable. While Linux kernel is an open source, the various “distributions” such as RedHat, Ubuntu and openSUSE have proprietary attributes. Patches to address vulnerabilities are released by the companies that package and market the Linux distributions at various speeds. A few months after the WannaCry outbreak, HTM departments are still following up with some medical device manufacturers about security patches. Healthcare delivery organizations need to create an effective incident response program since malware outbreaks are becoming more PROOF APPROVED CHANGES NEEDED sophisticated. The health care industry needs to amp up its game when it comes SIGN–OFF: to medical device security or hacked medical devices will be CLIENT a part of many future headlines.
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71
EXPERT ADVICE
BY STEVEN J. YELTON
THE FUTURE
Diverse Backgrounds and Training for HTM Professionals
A
constant in my world is the shortage of adequately trained HTM technicians and availability of quality college level HTM training programs and how we are going to improve these issues.
The good news is that we have a hard-working group of professionals that comprise our field. I have been in this field for a long time, and I continue to be impressed by the people with whom I am in contact. I find we are all dedicated to the safe and effective use of medical systems and are willing to do everything that we can to improve it on a daily basis. This includes supporting college programs and helping to recruit new professionals into the field. I would like to take this opportunity to let you know of a few things that are currently in progress. I will also present an alternative way for hospital HTM departments to work with related departments within the organization. AAMI’s Healthcare Technology Accreditation Committee (HTAC) continues to make strides in promoting and improving HTM education. We have advanced in upgrading accreditation criteria for college programs, as well as providing guidance documents within AAMI’s (aami.org) and ABET’s (Accreditation Board for Engineering and Technology, www.abet.org) websites. We are moving forward in upgrading the HTM Program criteria for accrediting college programs through ABET’s process. An exciting new project is applying for an NSF-ATE (National Science
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Foundation – Advanced Technological Education) planning grant before the end of 2017. This planning grant would enable us to prepare for the NSF-ATE grant for a training center. This research is led by Barb Christe who is a founding member of AAMI’s HTAC. You are able to review some of these training centers at www.atecenters.org. The following is from the atecenters.org website: “The National Science Foundation’s Advanced Technological Education (ATE) program endeavors to strengthen the skills of technicians, whose work is vitally important to the nation’s prosperity and security. Throughout this site you will find evidence of the good work community colleges are leading to prepare the new American workforce.” We feel that our proposal fits perfectly into this philosophy. We are hoping to be granted funding to research the creation of a multimillion dollar HTM education center. We are in the early stages of this, but I thought that it would be important to mention it to you. If we are successful in securing the planning grant, we will be reaching out for information and data pertaining to this project. We must verify that we are an emerging technology that can benefit society and patients. We feel that if the planning grant enables us to secure an NSF-ATE grant for the HTM training center, then we
STEVEN J. YELTON, P.E., CHTM Senior Consultant for HTM
would be able to greatly advance the training opportunities for HTM professionals. This could support college programs as well as help everyone with the availability of qualified HTMs and provide greater access to training opportunities. On a topic related to HTM professionals with diverse backgrounds, I would like to share what I consider to be an innovative approach to a specific need. Within the health network where I work as a senior consultant, we have a number of specific positions within the HTM department which have a slightly different background requirement. The position that I would like to share is the Cardiovascular Clinical Support Specialist (CVIS). This position is somewhat unique within the HTM department largely because of the background of the CVIS technician. Our education, training and
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certification requirements are: “BS or an AAS in radiologic technology. Registered radiologic technologist with a minimum of 10 years clinical experience in invasive cardiac and peripheral imaging and/or an equivalent combination of education and experience in biomedical, imaging, engineering, or information technology with a masters preferred.” The majority of our positions have specific engineering or engineering technology requirements. The CVIS position is responsible for clinical applications training and the implementation and support of the cardiovascular information and hemodynamics systems. The clinical specialist coordinates activities that improve the overall proficiency level of imaging operations such as: defining training objectives, providing specialized training for clinical staff, the collection and analysis of quality control data, facilitating customization of hemodynamics nurse charting software and oversees the integration of acquisition modalities. In this role, the CVIS is expected to be a deep subject matter expert on the assigned information systems. The CVIS serves as the primary point of contact and acts as a liaison between the enterprise and the manufacturer, assists with image quality problems, as well as the resolution and escalation of technical or clinical issues, and ensures that preventive maintenance/repairs are performed in accordance with manufacturer guidelines and requirements for lab accreditation. We have found that this position greatly enhances the interaction between the HTM department and clinical departments within the hospital. We also employ this philosophy within the HTM department for other positions which may benefit from an alternative approach to training. Steven J. Yelton, PE, CHTM; is a senior consultant for HTM in Cincinnati, Ohio and a professor at Cincinnati State Technical and Community College where he teaches biomedical instrumentation courses. He is a member of AAMI’s Board of Directors-Executive Committee, AAMI’s Foundation Board of Directors, Chair of AAMI’s Technology Management Council, Chair of AAMI’s HTAC and is a member of the ABET Board of Delegates.
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EXPERT ADVICE
BY CHRIS DISSINGER
SODEXO INSIGHTS Does Your Healthcare Organization Have a Laser Safety Program?
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everal years ago when our health system was looking to set up a laser safety program, they looked to the biomedical department. Why us? If anyone would know which lasers were purchased for the health system and what departments were bringing in loaners and rentals, it would be us according our leadership’s thought process. Because the laser safety program was brought under the auspices of our department, my director encouraged me on the journey of being the laser safety officer for the health system. Whether or not the laser safety program falls under biomedical or some other department, why is one needed? I thought I’d share some lessons learned, or events we have had over the years, to give you some understanding of why.
CHRIS DISSINGER,
CBET, CMLSO, Technical Analyst and Laser Safety Officer at Cone Health
I had just finished going to medical laser safety officer training and was as green as you can get, when I received an urgent phone call from one of our day surgery centers. A patient was in flight from out of state for a cochlear implant procedure, and a vendor had just showed up at the center with a rental laser. The OR staff wasn’t exactly sure if the laser should be used, nor were they exactly comfortable with a laser being brought in at the last minute without notice. It wasn’t too long after this scenario, where again, I got a last-minute phone call from one of our hospitals. The physician had talked to a laser company’s sales representative at a conference weeks earlier. That sales rep had convinced the doctor their laser was the best for OB/GYN procedures using the daVinci robot. So the physician invited the sales rep to fly in from out of state with the laser to use for a scheduled case, of which none of the OR staff were aware of their arrival. Again, luckily the OR staff called me because they felt uncomfortable allowing this laser to be used on their patient. So, why were both of these cases canceled? In talking with medical staff services, the physicians didn’t have privileges to use these particular lasers because of the
EMPOWERING THE
medium (thulium) or for the type of procedure. Neither of the companies had submitted copies of their liability insurance to our contract administration to verify that they had enough coverage in case of patient injury. The sales rep for the one laser was placing the responsibility on the OR staff to operate the laser and reprocess the fibers. The staff had not had any training to perform these functions. To prevent last-minute events like this; protect patients and the health system from liability, my director and I embarked on working with leadership to have a laser safety policy that included a formal laser approval process. This process would require signatures from key stakeholders for any lasers brought into the system whether it is; purchased, rented, loaned or demo. Every facility is different. What works for us, may not work for you. The main point I want to make is that there is a lot at stake in regard to patient safety, liability and meeting regulatory requirements with lasers. If your system does not have a laser safety program in place, I highly encourage you to talk with your leadership to start one. Who knows, it may be a new adventure for you. So far, I have enjoyed the ride!
OCTOBER 2017
TECHNATION
75
EXPERT ADVICE
BY JEFF NIEDERHAUSEN
TECH KNOWLEDGE Internal/External Fine Line
I
f I was to come to your facility, what would your balance be between external labor and internal labor? Do you strive to do everything possible under the sun internally before reaching out to vendors for help and assistance? Or, do you simply look at something and say, “Yup, it’s broke. I will call so and so?” Over the years, I have seen both sides of the coin and where it has caused issues, not only financially, but personally with departments and staff within those departments.
I have seen and met with biomed department teams whose only goal was to make sure PMs are completed, and if anything breaks, it’s boxed up and shipped to a vendor service center. Or, they have vendor X on speed dial. While getting our PMs completed on time and accurately is very important, it is also important for techs to have the drive and initiative to want to fix things or learn from past mistakes. The more that can be done internally, the more we can control expenses and reap savings and financial benefits. For every dollar you save for your facility or company, it’s a dollar that we get to keep on our financials and not someone else’s. Training is a big part of this. For some things, it doesn’t take a rocket scientist to work on and diagnose/fix. For other equipment, it takes training. Good examples of these are, of course, radiology equipment like CTs or MRIs. The average tech is not going to tackle those, but with training and making your tech an expert, the savings start building. With this, departments start to get comfortable with “their tech” working on the equipment. Then, downtime hopefully becomes minimal with a tech only steps or minutes away. Of course, there are always ways to look at this and take one bite at a time. The dreaded contracts can be ramped down
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“Training is a big investment for many companies and facilities, but the return on the investment can be greater than the initial cost of the training.”
JEFF NIEDERHAUSEN Chief Finanacial Officer, Tech Knowledge
as techs are trained and different levels are achieved, which equates to savings to the financials. When our techs are trained, it should be the expectation of the directors of the biomed department and the department heads in the facility that the
tech is going to be our in-house expert on whatever modality they were trained on. Of course, there will be something over their head and they will need some help from vendor X at first. But, over time, vendor X will become a last resort as our tech becomes the true expert. Starting with first look contracts and reducing down to parts only would be a great game plan to control expenses, and to master that fine line between internal and external labor. Through the years, I have had colleagues who have discussed their expectations for properly trained techs. The majority agree that techs should be doing 80 to 85 percent of the work on the equipment they are trained on. The remaining balance is what is filled in by other sources, like vendors. Sometimes, it happens, where you have a device ripped apart and you are banging your head against the wall and just can’t figure it out.
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Before it gets worse, or before a department head screams in your ear saying, “This equipment makes this hospital money and the more it’s down, the more cash we are bleeding,” we should have an established relationship with the vendor as our backup. However, before making that call, you should run the situation by your director/ manager for their input. Not only does it put them in the know, but they may have experience to help the situation. I have heard stories of a tech trying to fix a piece of equipment, getting stumped, calling the vendor to remedy the problem, and the vendor responding on the phone to solve the problem before they even show up. It is important to instill pride in our techs and give them a belief in themselves that they can do what they have been called to do, fix equipment. Training is a big investment for many companies and facilities, but the return on the investment can be greater than the initial cost of the training. Having fleets of certain modalities or three or four big imaging instruments backed up with properly trained people can bring thousands of dollars in savings. I have also seen companies invest in staff only to continue the practice of looking at a piece of equipment and sending it to a vendor or calling them in. As leaders, we should be disgusted with wasting our facility/company’s money if that is the case. Nothing was accomplished except the tech had a little vacation on the company’s dime. That is not what we want! We want empowered techs being the best they can be, doing the best work they can provide on our equipment, which in return equals happier employees and better pricing and savings for our companies and/or facilities. With a little training and belief in our techs, we can conquer the world and have a world-class biomed program. With the attitude of “we do it all” or “go get them,” nothing is off limits. Techs who have a company or facility that invests in them and has faith in them to work on their multimillion dollar equipment is scary and exciting at the same time. I believe techs, when given the opportunities, will rise to the challenge and show the initiative needed to walk the fine line between do it myself, or call in help.
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OCTOBER 2017
TECHNATION
77
EXPERT ADVICE
BY ALAN MORETTI
THOUGHT LEADER It’s OK To Be a Dreamer – I Dare You
I
recently saw a social media post featuring images of the original “garage” storefronts of such companies as Amazon, Google and Apple. I believe many would agree that these companies have gone on from their “garage” birth homes to become some of the most successful businesses in modern times. These “garage” born dreamers, entrepreneurial pioneers in thought, resonate with myself and many others. Yes, I have been told over and over that I am the eternal optimist and am accused of setting lofty and unachievable goals. I am a dreamer inside and out!
ALAN MORETTI Healthcare Technology Management Advisor
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In Healthcare Technology Management (HTM) we have an assortment of personalities, mind-sets and age groups that have been a very positive influence in some aspects and a hindrance in others. Who and where are these HTM personalities to be found? Look at the HTM peers that you connect with and make your own assessments. Do you see some of these HTM dreamers? How many of your peers dare to dream and how many just choose to follow? I have reminisced many times about how our HTM service industry has advanced so much during my career. Think about the pre-owned medical equipment replacement parts market 30 years back. First and foremost, it didn’t exist. What did exist was a dysfunctional arrangement of mostly untested parts and questionable business practices exercised by some that were involved in that early period. As the dreamers of that early time period quickly recognized the growing HTM market’s need for a
formalized, qualified pre-owned replacement parts resource, what began to emerge were new conceptcreating companies in the HTM scene. This market sector, pre-owned medical equipment replacement parts as we know it today, is a formalized entity with numerous ISO and OEM businesses leading this industrychanging resource provision. Again, it’s the dreamers who visualized in their minds and dared to take that dream further when the odds of customer acceptance seemed to be a glimmer in the eye, pouring their energy and passion into successfully pioneering a much-needed product and service. So, please push yourself to always dream. Don’t worry about what those naysayers who, when your creative thoughts are shared, attempt to minimize them as far-off or lofty ideas! Maybe not all dreams can develop into something tangible, but many can and do!
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EXPERT ADVICE
BY MANNY ROMAN, CRES
ROMAN REVIEW The Truth About Lies
A
t the heart of the season finale of Game of Thrones was the lie. One character could not lie. Another could only lie. One liar received his deserved demise. All the turmoil, pain and anguish that the characters have endured was created and caused by a lie.
I was disturbed a little by how the character whose honor prevented him from lying was chastised by his entourage. The lie would have prevented a great deal of problems however his value system made it impossible for him to promise what he could not deliver. I began to think about lies. Research indicates that we all lie a couple of times a day. Who do we lie to and why? Are there instances where a lie is better than truth? Are some lies justifiable? We lie to strangers, coworkers, friends, loved ones, ourselves and anyone who sits still long enough. I believe that there are types of lies with varying intents and accompanying consequences. We must look at the intent of the lie to determine if we can accept it, once it is found out of course. The white lie is the subtle, inconsequential lie and is the least damaging. It is intended to preserve others’ feelings and possibly avoid an unproductive confrontation. “I’m on my way now.” “I’m not feeling up to it today” “My phone lost the reminder for the deadline for this column.” “No, your butt does not look big in those jeans.” People lie for many reasons: deceive, mislead, self-gain, guilt, shame,
aggrandizement, self-protection, protection of others, avoid rejection, self-deception, cause damage, habit, and probably many other reasons. Some lies cause more harm than others. The degree of damage is determined by the recipient as is the degree of absolution given as a result. This requires that the lie be discovered. There are some semi-reliable means of detecting a lie however mostly we cannot tell when others are lying, except some whose lips-in-motion is the indicator. Mostly we can only discern that someone is exhibiting signs of discomfort such as face touching, fidgeting, etc. In my communications presentations I speak on how the discomfort of lying may result in pacifying moves such as scratching an itch on the back of the head or an arm. The Pinocchio effect is where the discomfort of a lie causes the blood flow in the nose to increase. Which then causes an urge to touch or scratch the nose in a self-pacifying move. In a Ted.com talk titled “Can you really tell if a kid is lying?”, developmental researcher Dr. Kang Lee, presents very interesting findings on how and when we learn to lie. Children as young as two years old are already developing the ability to lie. Apparently, to be able to lie, we need the ability to know that the other person does not know what we know and we must have the self-control not to give up the lie with body language and intonations. His research also indicates that people who should be in the position to detect when a child tells a lie cannot
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MANNY ROMAN, CRES AMSP Business Operation Manager
tell. People like social workers, judges, other children’s parents, even the child’s own parents can’t reliably tell when their child is lying. However, he has developed a technique called Transdermal Optical Imaging that will detect a lie with 85 percent accuracy. Lying causes discomfort as we have stated. The emotions involved, such as fear, guilt, delight, cause the autonomic system to decrease blood flow to the cheeks and increase blood flow to the nose – the Pinocchio effect. His imaging technique will discover this even if we are successful at resisting the urge to scratch the nose. I will leave you to imagine all the useful applications of this technology. Wouldn’t it be great if your phone had it nicely hidden and no one else had it when you were talking? I heard somewhere that phone conversations carry the most lies and emails the least. One final comment: Just because you believe what you are saying does not make it true and that’s no lie.
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o you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your chance to prove it! Check out “The Vault” photo. Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will be entered to win a $25 Amazon gift card. To submit your answer, visit 1TechNation.com/ vault-october-2017. Good luck!
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CABMET SCRAPBOOK The second annual TechNation Tour included a stop at the 2017 CABMET Symposium, August 10-11. The 15th annual symposium was held at Children’s Hospital Colorado in Aurora and drew HTM professionals and leading companies from throughout the region. 1. D ustin Telford, Regional Certified Healthcare Technology Manager, visits with Pronk Technologies at CABMET 2017.
6. T he AUE booth provided great info to attendees.
9. HTM professionals network during the 2017 CABMET symposium. 10. CABMET members strike a pose during their annual event.
2. CABMET attendees enjoy delicious food at the annual event.
7. N etworking events like the poker tournament provided a relaxed environment for HTM professionals to share ideas.
3. T he Interstate Batteries booth is always a popular stop.
8. P roject C.U.R.E. shared information about their good works at CABMET.
4. B inseng Wang, Director, Quality & Regulatory Affairs at WRP32 Management Inc. presents to a large crowd. 5. TechNation Publisher John Krieg never misses a chance to network with HTM professionals! 4
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NCBA SCRAPBOOK The 2017 TechNation Tour continued with a stop at the 39th annual North Carolina Biomedical Association (NCBA) Symposium, August 23-25. TechNation held an event at Dugan’s Pub for all attendees and advertisers. The NCBA Symposium was once again a big success. 1. D ale Munson teaches a class on the Covidien Force FXC Electrosurgical Unit. 2. Ryan and Ethan of Injector Support & Service enjoy the TechNation Tour Stop at Dugan's Pub in Pinehurst. 3. NCBA board members support TechNation and the HTM industry during the annual TechNation Tour Stop. 4. RSTI President Dale Cover presents "Digital Mammo - QC & Medical Physics Checks" at the annual NCBA event. 5. John Noblitt holds a student convocation at Dugan's Pub with Jayme McKelvey. 6. One popular NCBA event was the roundtable forum on technology assessment and replacement planning. 7. After the first day of education and exhibit hours, NCBA members and local HTM professionals met for conversation and drinks at Dugan's Pub, thanks to TechNation.
8. TechNation is a great supporter of the NCBA and is one of the event's media partners and symposium sponsors. Glenn Scales visits Jayme McKelvey and Nicholle Endoso at the TechNation booth.
9. D avid Domanski with RSTI is followed his X-ray basics class with a follow-up class on X-ray safety. 10. Verithon taught classes on three different bladder scanners at the NCBA Symposium. These were certificate classes that qualified attendees the same as if they attended factory-certified classes.
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Ensure you KEEP receiving TechNation for another year by confirming your subscription information today! 2 Easy Ways to Renew your Complimentary Subscription! 1. Log onto www.1technation.com/subscribe OR 2. Complete the form below and fax to 770-632-9090 Please Print Clearly Name _______________________________________________ Title _______________________________ Hospital/Company ________________________________________________________________________ Address __________________________________________________________________________________ City _____________________________________________________________________________________ State ______________________ Zip _________________ Country ________________________________ Phone ___________________________________________________________________________________ Fax _____________________________________________________________________________________ Email ____________________________________________________________________________________ Website __________________________________________________________________________________ Signature ___________________________________________________ Date ________________________ 1. What is your primary job title?
(check only one) m Clinical, Biomedical or Radiology Engineer m Biomedical Equipment Technician m Service/Support Manager m IS/Network Manager m Purchasing Manager m Sales/Marketing Manager m Department Administrator/ Director or Manager m Other (please specify) _______________________________________ _________________
2. What is your company’s primary business? (check only one) m Hospital or Clinic m Medical Equipment m Computer/IT Equipment m Dealer or Distributor m Multivendor/Independent Service Organization m Depot Repair m Education/Training m Consulting m Other (please specify) ____________________________ ____________________________
3. Please check the statement that best describes your role in purchasing products/technolgy: (check only one) m Make final decision m Specify/recommend m No part in purchasing
4. Type of facility/business: (check only one) m ISO m OEM m Self Employed m Other (please specify) _________________________ _________________________
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C-Arm
A.M. Bickford 800-795-3062 • www.ambickford.com
6
ReMedPar 800-624-3994 • www.remedpar.com
24, 25
P P
Drager Medical Systems 215-721-5404 • www.draeger.com
41
Technical Prospects 877-604-6583 • www.technicalprospects.com
35
P
RepairMED 855-813-8100 • www.repairmed.net
53
Calibration
Soma Technolgoy, Inc 800-438-7662 • www.somatechnology.com
53
P
Rigel Medical, Seaward Group 813-886-2775 • www.seaward-groupusa.com
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
26
P P
Cardiology
P
Asset Management Shared Imaging LLC 800-606-0266 • www.sharedimaging.com
77
Auction/Liquidation J2S Medical 844-342-5527 • www.j2smedical.com
55
Batteries
P
3
ReMedPar 800-624-3994 • www.remedpar.com
24, 25
P P
Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/
16-17 99
P P
Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/
7
P P
Technical Prospects 877-604-6583 • www.technicalprospects.com
35
P
35
P
P
AllParts Medical 866-507-4793 • www.allpartsmedical.com
74
P
P
Cardiovascular
PartsSource 877-497-6412 • www.partssource.com/shop
61
Technical Prospects 877-604-6583 • www.technicalprospects.com
P
Biomedical
Computed Tomography
BC Group International, Inc 314-638-3800 • www.BCGroupStore.com
BC
Crothall Healthcare 800-447-4476 • www.crothall.com
88
P P
Dunlee 800-238-3780 • www.dunlee.com
44
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D.A. Surgical 800-261-9953 • www.da-surgical.com
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Injector Support and Service 888-667-1062 • www.injectorsupport.com
47
P
Health Tech Talent Management, Inc. 757-563-0448 • www.HealthTechTM.com
84
Intermational Medical Equipment and Service 704-739-3597 • www.IMESimaging.com
31
P P
iMed Biomedical 817-378-4613 • www.imedbiomedical.com
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JDIS Group 800-974-9729 • www.jdis.com
94
P P
Master Medical Equipment 866-468-9558 • masterfitmedical.com
47, 82
KEI Med Parts 512-477-1500 • www.keimedparts.com
71
P P
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
105
P P
Philips 800-229-6417 • www.philips.com/mvs
36, 73
P P
ReMedPar 800-624-3994 • www.remedpar.com
24, 25
P P
RSTI 800-229-7784 • www.rsti-training.com
Ins
P P P
RepairMED 855-813-8100 • www.repairmed.net
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RTI 800-222-7537 • www.rtigroup.com
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Sodexo CTM 888-Sodexo7 • www.sodexousa.com
63
Technical Prospects 877-604-6583 • www.technicalprospects.com
35
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The Intuitive Biomedical Solution Inc 866-499-3966 • www.tibscorp.com
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Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com
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Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
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P P P
Master Medical Equipment 866-468-9558 • masterfitmedical.com
47, 82
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AIV 888-656-0755 • aiv-inc.com
68
P P
FOBI 888-231-3624 • www.FOBI.us
80
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J2S Medical 844-342-5527 • www.j2smedical.com
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Maull Biomedical 440-724-7511 • www.maullbiomedical.com
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Diagnostic Imaging Advanced Ultrasound Electronics, Inc. 866-620-2831 • www.auetulsa.com
33
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Master Medical Equipment 866-468-9558 • masterfitmedical.com
47, 82
JDIS Group 800-974-9729 • www.jdis.com
94
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RepairMED 855-813-8100 • www.repairmed.net
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ReMedPar 800-624-3994 • www.remedpar.com
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Select BioMedical 866-559-3500 • www.selectpos.com
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Shared Imaging LLC 800-606-0266 • www.sharedimaging.com
77
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Soma Technolgoy, Inc 800-438-7662 • www.somatechnology.com
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USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
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Endoscopy
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Cadmet 800-543-7282 • www.cadmet.com
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Healthmark Industries 800-521-6224 • HMARK.COM
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J2S Medical 844-342-5527 • www.j2smedical.com
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Mammography
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
105
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Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
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ReMedPar 800-624-3994 • www.remedpar.com
24, 25
P P
RSTI 800-229-7784 • www.rsti-training.com
Ins
P P P
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Ozark Biomedical 800-457-7576 • www.ozarkbiomedical.com
Hand Switches inRayParts.com 417-597-4702 • www.inrayparts.com
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Monitors
Health Tech Talent Management, Inc. 757-563-0448 • www.HealthTechTM.com
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JDIS Group 800-974-9729 • www.jdis.com
94
P P
Infection Control Healthmark Industries 800-521-6224 • HMARK.COM
89
Infusion Pumps AIV 888-656-0755 • aiv-inc.com
Labratory
Drager Medical Systems 215-721-5404 • www.draeger.com
41
Select BioMedical 866-559-3500 • www.selectpos.com
67
Soma Technolgoy, Inc 800-438-7662 • www.somatechnology.com
53
Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com
79
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15
P P
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Monitors/CRTs 68
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SERVICE INDEX BMES 888-828-2637 • www.bmesco.com
IBC
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86
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AIV 888-656-0755 • aiv-inc.com
68
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Technical Prospects 877-604-6583 • www.technicalprospects.com
35
P
Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
P P
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
26
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BMES 888-828-2637 • www.bmesco.com
IBC
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Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com
14
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Integrity Biomedical Services 877-789-9903 • www.integritybiomed.com
86
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J2S Medical 844-342-5527 • www.j2smedical.com
55
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Patient Monitoring
MRI Bayer Healthcare - MVS 844-MVS-5100 • www.mvs.bayer.com
48
Cool Pair Plus 800-861-5956 • www.coolpair.com
84
Intermational Medical Equipment and Service 704-739-3597 • www.IMESimaging.com
31
P
Master Medical Equipment 866-468-9558 • masterfitmedical.com
47, 82
P P
JDIS Group 800-974-9729 • www.jdis.com
94
P P
PartsSource 877-497-6412 • www.partssource.com/shop
61
P
KEI Med Parts 512-477-1500 • www.keimedparts.com
71
P P
Philips 800-229-6417 • www.philips.com/mvs
36, 73
P P
PartsSource 877-497-6412 • www.partssource.com/shop
61
P P P
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
105
P P
Philips 800-229-6417 • www.philips.com/mvs
36, 73
P P
RepairMED 855-813-8100 • www.repairmed.net
53
P P
ReMedPar 800-624-3994 • www.remedpar.com
24, 25
P P
Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/
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Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/
7
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Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com
79
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USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
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inRayParts.com 417-597-4702 • www.inrayparts.com
96
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Technical Prospects 877-604-6583 • www.technicalprospects.com
35
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Ampronix, Inc. 800-400-7972 • www.ampronix.com
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RSTI 800-229-7784 • www.rsti-training.com
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Nuclear Medicine Global Medical Imaging 800-958-9986 • www.gmi3.com
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102
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Power System Components Interpower 800-662-2290 • www.interpower.com
Oxygen Blender
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Soma Technolgoy, Inc 800-438-7662 • www.somatechnology.com
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Technical Prospects 877-604-6583 • www.technicalprospects.com
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Healthmark Industries 800-521-6224 • HMARK.COM
89
The Intuitive Biomedical Solution Inc 866-499-3966 • www.tibscorp.com
65
P P
Prescotts 800-438-3937 • surgicalmicroscopes.com
82
P P
Recruiting
Telemetry
Aramark Healthcare Technologies www.aramark.com/careers
35
AIV 888-656-0755 • aiv-inc.com
68
P P
Health Tech Talent Management, Inc. 757-563-0448 • www.HealthTechTM.com
84
BMES 888-828-2637 • www.bmesco.com
IBC
P P
Sodexo CTM 888-Sodexo7 • www.sodexousa.com
63
Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com
14
P P
Stephens International Recruiting Inc. 870-431-5485 • www.bmets-usa.com/
71
Integrity Biomedical Services 877-789-9903 • www.integritybiomed.com
86
P P
J2S Medical 844-342-5527 • www.j2smedical.com
55
Master Medical Equipment 866-468-9558 • masterfitmedical.com
47, 82
Refurbish AIV 888-656-0755 • aiv-inc.com
68
Replacement Parts
P P
Pacific Medical 800-449-5328 • www.pacificmedicalsupply.com
8
P
Advanced Ultrasound Electronics, Inc. 866-620-2831 • www.auetulsa.com
33
P P P
RepairMED 855-813-8100 • www.repairmed.net
53
P P
Engineering Services, KCS Inc 888-364-7782x11 • www.eng-services.com
54
P
Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/
7
P P
Technical Prospects 877-604-6583 • www.technicalprospects.com
35
P
Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com
79
P P
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
26
P P
Respiratory A.M. Bickford 800-795-3062 • www.ambickford.com
6
P
Test Equipment
FOBI 888-231-3624 • www.FOBI.us
80
P P
A.M. Bickford 800-795-3062 • www.ambickford.com
J2S Medical 844-342-5527 • www.j2smedical.com
55
RTLS Versus 877-9VERSUS • versustech.com/nowait
TRAINING
SERVICE
PARTS
Company Info
AD PAGE
TRAINING
SERVICE
PARTS
AD PAGE
Company Info
49
Software
6
BC Group International, Inc 314-638-3800 • www.BCGroupStore.com
BC
medical 181-750-6699 • www.imtmedical.com
21
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
105
Pronk Technologies, Inc. 800-609-9802 • www.pronktech.com
5
Pheonix Data Systems 800-541-2467 • www.goaims.com
86
Radcal Corporation 800-423-7169 • www.radcal.com
32
Versus 877-9VERSUS • versustech.com/nowait
49
Rigel Medical, Seaward Group 813-886-2775 • www.seaward-groupusa.com
3
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
OCTOBER 2017
P P P P
TECHNATION
103
SERVICE INDEX
MW Imaging 877-889-8223 • www.mwimaging.com
27
P P
Philips 800-229-6417 • www.philips.com/mvs
36, 73
P P
ReMedPar 800-624-3994 • www.remedpar.com
24, 25
P P
Advanced Ultrasound Electronics, Inc. 866-620-2831 • www.auetulsa.com
33
P P P
ECRI Institute 610-825-6000. • www.ecri.org
104
P
Intermational Medical Equipment and Service 704-739-3597 • www.IMESimaging.com
31
Ventilators
RSTI 800-229-7784 • www.rsti-training.com
Ins
Drager Medical Systems 215-721-5404 • www.draeger.com
41
Technical Prospects 877-604-6583 • www.technicalprospects.com
35
P
AllParts Medical 866-507-4793 • www.allpartsmedical.com
74
Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
83
P
Bayer Healthcare - MVS 844-MVS-5100 • www.mvs.bayer.com
48
Dunlee 800-238-3780 • www.dunlee.com
44
P
Tubes/Bulbs
TRAINING
Training
SERVICE
P P
PARTS
16-17 99
Company Info
AD PAGE
Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/
TRAINING
62
SERVICE
RTI 800-222-7537 • www.rtigroup.com
PARTS
AD PAGE
Company Info
CONTINUED
Summit Imaging 866-586-3744 • www.mysummitimaging.com
4
P P P
Trisonics 877-876-6427 • www.trisonics.com
88
P P
P
P
Cadmet 800-543-7282 • www.cadmet.com
96
P
Engineering Services, KCS Inc 888-364-7782x11 • www.eng-services.com
54
P
Dunlee 800-238-3780 • www.dunlee.com
44
P
Philips 800-229-6417 • www.philips.com/mvs
36, 73
P P
PartsSource 877-497-6412 • www.partssource.com/shop
61
P P P
RSTI 800-229-7784 • www.rsti-training.com
Ins
P P P
ReMedPar 800-624-3994 • www.remedpar.com
24, 25
P P
RTI 800-222-7537 • www.rtigroup.com
62
Technical Prospects 877-604-6583 • www.technicalprospects.com
35
P
Technical Prospects 877-604-6583 • www.technicalprospects.com
35
P
Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
83
P P
Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
83
P P P
24, 25
P P
Ultrasound
X-Ray
Advanced Ultrasound Electronics, Inc. 866-620-2831 • www.auetulsa.com
33
P P P
AllParts Medical 866-507-4793 • www.allpartsmedical.com
74
P
Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
P P
Bayer Healthcare - MVS 844-MVS-5100 • www.mvs.bayer.com
48
Conquest Imaging 866-900-9404 • www.conquestimaging.com
11
P P P
Global Medical Imaging 800-958-9986 • www.gmi3.com
2
P P
J2S Medical 844-342-5527 • www.j2smedical.com
55
104
TECHNATION
P
OCTOBER 2017
ReMedPar 800-624-3994 • www.remedpar.com
P
WWW.1TECHNATION.COM
A national leader in the sale of new, used, and refurbished medical equipment.
Become More Profitable With PRN
ALPHABETICAL INDEX A.M. Bickford………………………………… 6
Master Medical Equipment…………… 47, 82
Advanced Ultrasound Electronics, Inc.……… 33
Maull Biomedical Training…………………… 62
AIV…………………………………………… 68
MW Imaging………………………………… 27
AllParts Medical……………………………… 74
Ozark Biomedical…………………………… 48
Ampronix, Inc.………………………………… 15
Pacific Medical ……………………………… 8
Aramark Healthcare Technologies………… 35
PartsSource………………………………… 61
esia • Beds/Stretchers • Cardiology • Endoscopy • Exam Room • Extremity Pump • Bayer Healthcare - MVS……………………… 48 Pump • General Medicine • IV Pump • Laboratory • Lymphedema Pump • Miscel• Monitor • Nutrition Pump • OB/GYN • Ophthalmology • OR/Surgery • Out the Door BC Group International, Inc……………… BC ic Respiratory • Supplies • Therapy • Ultrasound • Vascular • Gas Regulator • AnesBeds/Stretchers • Cardiology • Endoscopy • Exam Room • Extremity Pump • Feeding BMES……………………………………… IBC General Medicine • IV Pump • Laboratory • Lymphedema Pump • Miscellaneous • • Nutrition Pump • OB/GYN • Ophthalmology • OR/Surgery • Out Cadmet……………………………………… the Door • Pediatric 96 Our equipment ry • Supplies • Therapy • Ultrasound • Vascular • Gas Regulator • Anesthesia • Beds/ s • Cardiology • Endoscopy • Exam Room Extremity Pump • Feeding Pump • GenConquest Imaging…………………………… 11 is tested and •serviced cine • IV Pump • Laboratory • Lymphedema Pump in-house so that we• Miscellaneous • Monitor • Nutrip • OB/GYN • Ophthalmology • OR/Surgery • Out the Door • Pediatric Respiratory • Cool Pair Plus………………………………… 84 can guarantee its• Anesthesia • Beds/Stretchers • • Therapy • Ultrasound • Vascular • Gas Regulator integrity. Healthcare gy • Endoscopy • Exam Room • Extremity Pump • Feeding Pump Crothall • General Medicine Technology Solutions…… 88 mp • Laboratory • Lymphedema Pump • Miscellaneous • Monitor • Nutrition Pump • D.A. Surgical………………………………… 43 N • Ophthalmology • OR/Surgery • Out the Door • Pediatric Respiratory • Supplies •
Pheonix Data Systems……………………… 86
Drager Medical Systems……………………… 41
Rigel Medical, Seaward Group……………… 3
Dunlee………………………………………… 44
RSTI……………………………………… Insert
ECRI Institute………………………………… 92
RTI Electronics……………………………… 62
Elite Biomedical Solutions…………………… 14
Select BioMedical…………………………… 67
Engineering Services, KCS Inc……………… 54
Shared Imaging LLC………………………… 77
FOBI………………………………………… 80
Sodexo CTM………………………………… 63
Global Medical Imaging……………………… 2
Soma Technolgoy, Inc……………………… 53
Health Tech Talent Management, Inc.……… 84
Southeastern Biomedical, Inc……… 16-17, 99
Healthmark Industries……………………… 89
Southwestern Biomedical Electronics, Inc.…………………………… 7
Philips…………………………………… 36, 73 Prescotts……………………………………… 82 PRN/ Physician's Resource Network……… 105 Pronk Technologies, Inc. …………………… 5 Radcal Corporation…………………………… 32 ReMedPar……………………………… 24-25 RepairMED…………………………………… 53
sound • Vascular • Gas Regulator • Anesthesia • Beds/Stretchers • Cardiology • Endoscopy • Exam Room • Extremity Pump • Feeding Pump • General
Physician’s Resource Network
AUTHORIZED NORTHEAST DISTRIBUTER OF
iMed Biomedical……………………………… 88 imtmedical…………………………………… 21 Injector Support and Service………………… 47 inRayParts.com……………………………… 96 Integrity Biomedical Services………………… 86 Intermational Medical Equipment and Service…………………………31
1.800.284.0967 www.PRNwebsite.com
Stephens International Recruiting Inc.……… 71 Summit Imaging……………………………… 4 Technical Prospects………………………… 35 Tenacore Holdings, Inc……………………… 79 The Intuitive Biomedical Solution Inc……… 65 Tri-Imaging Solutions………………………… 83
Interpower…………………………………… 20
Trisonics……………………………………… 88
J2S Medical………………………………… 55
USOC Bio-Medical Services………………… 26
JDIS Group…………………………………… 94
Versus………………………………………… 49
KEI Med Parts………………………………… 71
Webinar Wednesday………………………… 93
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
OCTOBER 2017
TECHNATION
105
“He who wants a rose must respect the thorn.” – Persian Proverb
We Know Telemetry Inside and Out...
www.bmesco.com 888.828.2637
Introducing THE NEW IPA-3400 INFUSION PUMP ANALYZER
The High Accuracy, Easy-to-Use System with Full Touch Screen Control of All Processes
The IPA-3400 is the most compact, fully featured four channel analyzer on the market. The IPA-3400 has a dual syringe stepper motor driven system that offers continuous monitoring of the fluid flow, providing a more realistic flow path for the infusion device under test and more accurate readings. The independent stepper motor control of the custom designed, ceramic valving allows the system to run quietly and smoothly, with a bidirectional powered fluid flow for use in the built in cleaning cycle.
The Next Generation in Infusion Pump Analyzers is here!
Large 7” Color Touch Screen 1,2,3 and 4 Channel Models available (Field Upgradeable) User Swappable, Fully Self Contained Flow Modules Calibration in Flow Modules No need to be down for calibration or service! Smooth Dual Syringe System Eliminates Drain Cycle Inconsistencies Whisper Quiet Operation Auto Start Built-in Auto Test Sequences Built-in Data Collection Built-in Reports
Screenshots from the IPA-3400
Easy access to modules for expansion and calibration. Each module is calibrated with up to four channels in each IPA-3400. Stagger the calibration time for modules to prevent downtime. Users can also run specific test routines specified by various manufacturers using built in autosequences. Advanced features in the autosequences even allows the inclusion of pictures to aid with the setup and configuration of each step. IPA-3400 with Swappable Modules
Phone: 1-888-223-6763 Email: sales@bcgroupintl.com Website: www.bcgroupintl.com ISO 9001 & 13485 Certified ISO 17025 Accredited