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VOL. 8
EMPOWERING THE BIOMEDICAL / HTM PROFESSIONAL
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CYB3RSECUR1TY WHAT EVERY HTM PRO SHOULD KNOW
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Company Showcase Versus
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News and Notes Industry Updates
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Roundtable Digital Radiography
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CONTENTS
FEATURED
CYB3RSECUR1TY WHAT EVERY HTM PRO SHOULD KNOW
46 52
TECHNATION: CYBERSECURITY / WHAT EVERY HTM PRO SHOULD KNOW
46
THE ROUNDTABLE: DIGITAL RADIOGRAPHY TechNation interviewed a variety if professionals from the HTM industry to find out the latest on DR including the latest advances in this imaging technology and how facilities can meet their needs while also staying within budget.
Next month’s Roundtable article: Test Equipment
52
CYBERSECURITY Cybersecurity news has featured headlines about hackers who have found their way into company networks, or government computers, but the threat of stealing proprietary information seems trivial compared to someone controlling another person’s very heartbeat. And how might these cyber bad guys wreak havoc on patients in a hospital via access to that hospital’s network?
Next month’s Feature article: Test Equipment Makeover: Do you have the test equipment you need?
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TechNation (Vol. 8, Issue #11) November 2017 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.
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EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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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
Departments P.12 SPOTLIGHT p.12 Department Profile: Wexner Medical Center p.16 Professional of the Month: Patrick Shepherd, CBET p.20 Biomed Adventures: Touring on Two Wheels p.22 Company Showcase: Versus P.26 INDUSTRY UPDATES p.26 News and Notes: Updates from the HTM Industry p.31 AAMI Update p.32 ECRI Institute Update P.36 p.36 p.38 p.41 p.42
THE BENCH Shop Talk Biomed 101 Tools of the Trade Webinar Wednesday
P.60 p.60 p.62 p.64 p.66 p.68 p.70 p.72
EXPERT ADVICE Career Center Ultrasound Tech Expert The Future Tech Tips Thought Leader Sodexo Insights Roman Review
P.75 p.75 p.77 p.78
BREAKROOM Did You Know? The Vault MedWrench Bulletin Board
p.80 Service Index p.85 Alphabetical Index
Izabella Gieras, MS, MBA, CCE, Director of Clinical Technology, Huntington Memorial Hospital Inhel Rekik, Biomedical Engineer, MS, Clinical Engineer
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SPOTLIGHT
DEPARTMENT PROFILE
The Ohio State University Wexner Medical Center’s Clinical Engineering Services Department BY K. RICHARD DOUGLAS
W
hen you think of Ohio State University, you might think first about Buckeye football, Woody Hayes, Archie Griffin or the fact that the university is one of the top-20 public universities in the country. The university has a storied past, along with impressive academic credentials.
The university is based in Columbus, Ohio with satellite campuses in six other locations across the state. The main campus provides academic programs to more than 59,000 students. On the medical side, the university has some impressive credentials as well. The Ohio State University College of Medicine is among the top 40 medical schools in the U.S. The Ohio State Wexner Medical Center offers major programs in critical care, heart, neurosciences, cancer, transplantation and imaging. Between the hospital, and its affiliated network of care centers, more than a million patients a year are served. University Hospital is the flagship patient care facility within the group. It takes an elite team of HTM professionals to live up to the reputation and demands within this prestigious environment. The Department of Clinical Engineering Services at Ohio State Wexner is made up of 56 team members and oversees the medical equipment maintenance program for seven hospitals — cancer hospital, heart hospital, brain and spine hospital, med/ surg general hospitals, community and mental health — and 60 plus ambulatory sites. Within these facilities, there are 1,368 total in-patient beds.
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Leadership within the department includes Anthony McCabe, associate director of biomed and radiation therapy service; Richard Eldridge, associate director of imaging service; Richard Roettger, service manager of biomed; and Susan Brokus, office manager. Team leads include QA Coordinator Polly Oberman, QA Coordinator David Criss, Senior Clinical Engineering Biomed Specialist Robert Passwaters, Senior Clinical Engineering Imaging Specialist Warren Olds, Senior Clinical Engineering Lab Specialist Fadi Alawad and Linear Accelerator Engineer Trey Divelbiss.
and implementation, burn patient equipment design and implementation, and development and maintenance of a laser safety program,” McCabe says, summing up an enormous list. The linear accelerator vault design project offered some unique challenges. “We worked closely with the architects, vendors, clinicians, and physicists on the design of the vault for patient flow and practicality with all of the new technologies,” McCabe says. “Our organization took the department from four Linac vaults in the basement, and designed/built their new department on the second floor of a
With a 56-member team, big projects can be tackled, even when the demands of a large health system beckon daily. The CE team at Wexner has had their fair share of successful projects.
“Other that the practical design and workflows of patient care areas in both inpatient and outpatient settings, we’ve been heavily involved with linear Accelerator vault designs for second-floor mass installations including a trio suite of Linac, MRI and Brachy suite; Hybrid ORs, alarm fatigue initiatives, IHIS integrations of equipment, training and simulation labs for critical care up to linear accelerators, deep brain stimulation research, cardiovascular research, MRI safe equipment design
21-story building. This presented a lot of new and unique problems with design as now we had to worry about all six sides of the rooms for radiation, but also how to get into the rooms for cable runs, both temporary and permanent, and try to future proof the design as much as possible as new technologies come out that could be added,” McCabe explains. He says that this also allowed the department to assist with research opportunities into new technologies. “We also were heavily involved with
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SPOTLIGHT
THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER'S CLINICAL ENGINEERING SERVICES DEPARTMENT MAINTAINS A HUGE INVENTORY OF DEVICES.
the complexities around having a configuration of a linac vault, CT Sim room used for Brachytherapy procedures with an MRI room in-between to accommodate workflows from either with all safety precautions in place,” McCabe adds. Like many health systems, the modern operating room is a location in the hospital that demands the skills of technologically savvy biomeds. “We just went live with another hybrid OR project where we took the leadership role of facilitation and worked to make sure everything in the room had integration to meet the needs of our clinicians. Working with multiple vendors and making sure that everything is coordinated to get the best output with best technology available,” McCabe says. As mentioned earlier, the issue of alarm fatigue is another area of focus for the group. “We sit on the Clinical Alarm Steering Committee, and are helping identify and standardize on alarms across the organization for all medical devices that produce alarms and have adjustability,” McCabe says.
“We bring the vendors to the table to provide their recommendations and capabilities, and then the task force that reports to the steering committee does the leg work and studies to get data to set new standards to personalize to our patient population,” he adds. The team has always been involved with the laser safety program; with it actually being a part of clinical engineering’s role for laser operators and laser safety officers completely at one point. Now they share the responsibility for the laser safety program oversight with a more diverse team in Hospital Safety, having one of two of the laser safety officer deputies in the department and they work on improvement initiatives and standardization with clinicians. Away from the hospital, two of the team’s management staff serve on the HTMA-OH board, and some members of the staff are part of the organization. McCabe is on the board for the Radiotherapy Service Engineers’ Association (RSEA). As Ohio State continues its tradition of excellence, the CE team is holding up their end and maintaining the good reputation on the medical side as well.
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SPOTLIGHT
PROFESSIONAL OF THE MONTH Patrick Shepherd, CBET Michigan HTM Pro BY K. RICHARD DOUGLAS
G
rowing up in Michigan, Patrick Shepherd, CBET, was one of those kids who wanted to know what made anything electronic work. “I can remember, many times [when] I received a new toy, I found myself disassembling it after only a couple weeks; I just had to know what was inside of that walkie-talkie and how it worked,” he recalls.
“This wasn’t limited to just my toys either; if one of my mother’s kitchen appliances stopped working, you better believe I was right there with a screwdriver. My great uncle was a radio operator/electrician for the army in World War II; he was the one who fi rst introduced me to electronics. From that point on I was hooked. In grade school, I don’t think I completed one science project that did not involve an electrical experiment,” Shepherd says. “In my junior and senior years of high school I attended a residential and industrial electrical vocational program,” he adds. That early interest in all things electronic set the stage for things to come. A friend told Shepherd about the biomed profession. He discovered that Schoolcraft College in Livonia, Michigan offered a biomed program and he enrolled for the fall semester. “In 2009, I received an associate in applied science, biomedical engineering technology,” Shepherd says. “My initial plan was to complete the two-year biomed program and then transfer to a four-year biomedical engineering program at a university.” “That initial goal changed when
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completing an internship at a local hospital, I was offered a full time position as a biomed,” Shepherd adds. That position was in the clinical engineering department at McLaren Flint; a 378-bed teaching facility located in Flint, Michigan. “While I was in school, I had been working full time at a minimum-wage job and the full-time biomed position sounded very enticing, so much in fact, that I decided to forgo the four-year degree and accepted the position. I have often looked back and wondered if I should have continued on to be an engineer, designing the very things that I work on every day now, but ultimately I am happy I selected the career path that I did,” he says. Starting out in his new position as a BMET, Shepherd says that his job duties were similar to most entry level BMETs, involving the PM and repair of general medical equipment such as IV pumps, SCDs, suction units, beds and PT exercise equipment. His main job was hospital bed repair. REDUCING COSTS Shepherd specializes in diagnostic ultrasound and enjoys working on the
systems. He loves the technology behind how they work. Related to this is an effort he has made to control costs. “One of the greatest challenges I have encountered associated to the ultrasound world is attempting to eliminate the high costs associated with TEE transducers. This is a particularly difficult endeavor because these devices change many hands throughout a day, they are extremely fragile, the staff using them tends to have a higher turnover rate making education difficult and there is little to no accountability for broken transducers,” Shepherd says. He says that he has been able to make some good progress the past year or so. “I have been able to reduce much of the needed repairs by working closely with the department heads where the TEE probes are being used. We have implemented a sign-out and inspection process that follows each probe through its transitions from storage, to procedure, to disinfection and back to storage,” Shepherd adds.
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SPOTLIGHT
PATRICK SHEPHERD PLANS TO GET A PILOT'S LICENSE.
“We have mandated the use of bite guards for every procedure and reeducated the staff on proper handling practices. I have even gone as far as attaching impact indicating labels on the connectors of the transducers that will turn red if the probe is mishandled or dropped,” he adds. Recently, Shepherd has also been involved in the implementation of new IV pumps hospital-wide. Since the administration wanted to use a newly installed RTLS system to track the new infusion pumps, a challenge arose because the IR/RF tracking badges would not fit anywhere on the pumps. “The badges required a flat surface to mount to and furthermore the pumps had to be able to stack on top of each other and be able to slide into a charging station,” Shepherd explains. “I designed a mounting bracket that was made of strong plastic (PETG) that could conform to the rounded edges of the pump with a little heat, yet it still provided a flat surface to mount the RTLS tag and was thin enough that the pump could still be inserted into a charging station,” he adds. OUTDOORS ACTIVITIES It’s not all work for Shepherd though. His free time fi nds him outdoors enjoying all that Michigan has to offer. “In my free time I am an adrenaline junkie and a true outdoorsman. In the summers I enjoy roller coasters, riding motorcycles on and off road, going to the sand dunes along Lake Michigan and probably anything else you can
think of that involves speed. I even set a goal for myself to get my pilots license this summer and am planning on completing that goal this fall,” Shepherd says. The fall also brings with it one of his other passions. “I am an avid hunter, whether it is waterfowl, upland game or deer,” he adds. “One day, I would like to travel out west for a mule deer or elk hunt, but for now I stay in Michigan. I am also an avid fi sherman and I was recently introduced to fly fi shing, which is fast becoming my favorite method of casting a line. This fall, I am really looking forward to the salmon season,” Shepherd says. Shepherd says that during the winter months, he can be still be found outside. “I enjoy skiing and snowboarding, ice fi shing and snowmobiling. I also travel quite a bit and like a good adventure whether it be camping in northern Michigan or riding a scooter through the back roads of Jamaica. I try to visit another new country every year, next year my girlfriend and I have a backpacking trip across southern Europe planned,” he adds. On the job, Shepherd says that the part about being in the biomed profession that he enjoys the most is that he is able to help people in need every day. “It is that sense of making someone’s day better that drives me to come to work every day and it is why this job is so rewarding,” he says.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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PATRICK AND HIS GIRLFRIEND ARE PLANNING A TRIP TO EUROPE.
PATRICK SHEPHERD LOVES BEING OUTDOORS IN HIS FREE TIME.
FAVORITE MOVIE: “The Matrix”
FAVORITE FOOD: Fish
FAVORITE PART OF BEING A BIOMED:
“My favorite part of being a biomed is the diversity of equipment we get to work on; you’re always doing something different.”
WHAT’S ON MY BENCH • • • • •
Coffee cup Pocket combination screwdriver DMM Ultrasound phantom Liquid solder flux
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SPOTLIGHT
BIOMED ADVENTURE Touring on Two Wheels BY K. RICHARD DOUGLAS
and wound up buying one from the Pittsburgh area,” Swim adds. On a business trip to Pittsburgh, a couple of years later, Swim visited with the former owner. He says that there is a tight community of BMW motorcycle owners who share technical and travel tips.
T
here’s just something about moving down a rural highway, on two wheels, with nothing separating you from the scenery except for possibly a face shield. Movies have been made about the carefree, exhilarating feeling of the open road on the back of a motorcycle. Many motorcycles are made just for that purpose; long distance touring.
Richard Swim, CLES, MCSE, team leader of clinical technology in the Healthcare Technology Management Department at Baylor Scott and White in Dallas, Texas can speak in volumes about the experience. Swim has logged many a mile on the back of a couple of touring motorcycles over the past 11 years. Yet, for Swim, it all started many years before. “I started riding off-road motorcycles when I was 14 years old in Abilene, Texas. While in high school and college, motorcycles were a primary mode of transportation. I’ve owned Hodaka and Bultaco dual sport
and trials bikes,” Swim says. “On the street, I put many miles on a Honda CL450 and a Kawasaki KZ750. Those last two got me through my college days and my start of work in the industry. After I started my full-time job in biomedical engineering — now HTM — I always wanted to tour the mountains and ride long distance. But work, finances and personal commitments never allowed those long road rides,” Swim recalls. Swim took a brief hiatus from his hobby, saying that he and his wife had two “wonderful children” and he put motorcycling aside until around 2006. “My son was going into college, and I had more expendable time. That’s when I started working on my desire to tour long distance,” he says. “When I was in high school, BMW motorcycles always caught my attention as reliable and well-designed machines for distance touring. Back then, there was no way I could afford one. And in 2006, I still could not afford a new BMW, but I was stuck on the idea of finding a K75RS. I could not find a K75RS in the Texas area
Racking up the Miles
Since returning to the open road in 2006, Swim has visited 35 states and Canada. He has made these trips with fellow riders and on solo treks; always stopping to take pictures along the way. “I rode 41,000 miles on my first BMW and have logged another 89,000 miles on my K1200RS, that I acquired in 2010. A lot of these miles were with trips organized by my local riding club. Motorcycling is a very social sport, both on the bike with radio communications, and off the bike, sharing ride stories,” Swim says. He is a member of the Lone Star BMW Riders. Back in 2006, Swim discovered the club and learned that they were “devoted touring motorcyclists that were friendly to all riders of any make of bike.” He found the club members to be friendly and willing to share knowledge and their experiences. “I think that I rode roughly 50 organized events with the Lone Star BMW Riders. Some were solo and on other trips my wife joined with me and other couples,” Swim says. “These organized rides were a mix of day trips and week-long journeys through twisty mountain roads and
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SPOTLIGHT wide-open plains. Through these organized events, with other more experienced riders, I too gained my own experience and self-confidence to venture out on my own.” Swim says that traveling on two wheels brings a certain dynamic into travel that might be unique to motorcycle touring. “There have been so many good trips being organized club rides, solo rides and trips that my wife and I took to north New Mexico and Colorado. I love the wide-open American West and have met travelers from all around the world. Motorcycling breaks down socioeconomic barriers,” Swim says. “When I stop for fuel, it is common for other travelers or locals to approach me to see where I have been or where I’m going.” After seeing so much of the country, the backroads and rural highways, it is hard to single out just one experience as being the most scenic or exhilarating. One trip does stand out though. “One of the most interesting trips I have done was a 14-day, 6,500-mile ride into Canada and down the Pacific Northwest. This may have also been my start of long-distance riding,” Swim says. “My local club left two days earlier than me, and I joined them in Banff, Alberta after riding 2,000 miles over several days. We rode together through the ice fields of the Canadian Rockies seeing elk and grizzly bears on the sides of the roads,” Swim says. Swim split from the group to ride back into the states where his wife, Debbie, joined him in Seattle. “Deb and I rode back up into Canada to Vancouver and took the ferry to Victoria. We rejoined my riding club in Washington, and journeyed Highway 101 to Coos Bay, Oregon. We split from the club and rode to Lake Tahoe were another of my riding partners, Tom, joined to ride with us. Tom and I continued on to Texas after I dropped Debbie at the Reno airport so she could get on back to home and work,” Swim adds.
Follow Along
If it seems like it would be nice to join Swim on some of these adventures, it is possible to do so in a virtual sense. Swim also has writing and photography skills and he puts those to use on a blog that documents his two-wheeled adventures. “The blog was started as a personal journal of my trips. Over the years, I realized that many people follow the blog for various reasons,” he says. “They may not be able to do the rides I am able to, or they may be fellow riders that just enjoy the stories from the road. I do love photography, and the motorcycle gives the perfect method for ‘seeing’ that is so important in photography.” Swim gives credit to another touring biker who has documented his adventures in a blog for inspiration. “I have to attribute Bo Griffin [to] introducing me to long-distance motorcycling. I followed Bo’s ride reports while he traveled from Dallas through Central and South America to the southernmost point of Tierra del Fuego. Bo was a member of the Iron Butt Association and he competed in the 11-day 11,000-mile Iron Butt Rally held every two years,” Swim says.
On the Job
It’s not all travel adventures for Swim, he has to work to have funds for his trips . On the job, Swim works with his team and enjoys the daily challenges. “What I do to support my motorcycling addiction is clinical system implementation project management. My team gets involved with construction of new nursing areas and hospitals where connect-
RICHAR D SWIN AND HIS WIFE EN JOYING TH E OPE N R OAD
ed medical devices will be deployed. Examples are patient monitoring systems, infusion pump management applications and other connected devices where patient vitals are being transmitted over the network to patient electronic health records,” Swim says. “I’ve been working with Baylor Scott and White since 1979- then Baylor University Medical Center. I have seen all aspects of medical device management from first-hand service on clinical laboratory analyzers to management of biomed teams to where I am now leading a system-level clinical engineering team,” he says. “About the time I thought about leaving the biomed field, something changed in the industry where I felt I could leverage my experience in networking and clinical systems. It has very rarely been a uninteresting job,” Swim adds. To follow along on Swims upcoming rides, or read more in depth about some of his past adventures, you can find his blog at http:// NTMoto.net
THE WIND EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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SPOTLIGHT
SPECIAL ADVERTISING SECTION
MCLAREN FLINT SAVES $1 MILLION WITH VERSUS RTLS ASSET MANAGEMENT
I
infrastructure and software.
TRACKING AND MANAGING IV PUMP AVAILABILITY HOSPITAL-WIDE Each of McLaren Flint’s 600 new pumps is affixed with a Versus Asset Tag that relays real-time location information to the Advantages Asset Management software. The number of IV pumps on each unit is continuously monitored, which helps to manage inventory through a process called PAR (periodic automatic replenishment). Each unit, floor or department determines its PAR level, or how many pumps they need to meet average patient demand. If the number of pumps on the unit nears that PAR level, the software triggers an alert. The Transportation team then replenishes the unit from others with excess inventory. “I want a nurse or clinician to have a pump available to them whenever they need it,” says Wheeler. “A pump should always be ready for the next patient that comes in.”
there was push-back. But this radical shift came with a well-defi ned plan to increase the availability of IV pumps using RTLS. To foster buy-in from all involved, McLaren created a multi-disciplinary team that included Biomedical Engineering, front-line Nursing, IT, Transportation, and Management from both the local and corporate levels. Together, the team landed on a target purchase quantity of 600 IV pumps, 400 less than the requested purchase of 1,000. Evidence from the utilization studies and a clear promise that when clinicians needed pumps, pumps would be available convinced the clinical staff.
METRICS VALIDATE ASSET UTILIZATION AND ROI The effective management of pumps made possible by Versus has made a significant impact. “We’ve taken our utilization rate from 30 or 40 percent to about 80 percent,” says Wheeler. In addition to improving utilization by 133 percent, decreasing pump acquisition from 1,000 to 600 allowed McLaren to save more than $1 million, even after purchasing the RTLS infrastructure and software. The system also saves valuable time, which enhances patient safety and care. In one example, Biomed performed a software upgrade on pumps within three days – a process that previously took several weeks.
n 2016, McLaren Flint set out to replace an aging fleet of IV pumps. As an essential piece of equipment that always seemed to be in short supply, clinical staff asked for more pumps. At the same time, operations measured existing pump utilization to determine if the capital expenditure could be reasonably reduced.
“Although initial desire was to purchase 1,000+ new pumps,” explains Brent Wheeler, Vice President of Operations, “the studies confirmed that our existing 900 pumps had a 30% pump-in-use rate. Compared to industry standards of utilization rates at 30-40 percent, we weren’t completely surprised.” Clearly there was room for improvement, enabling an evidence-based decision to invest in a real-time locating system (RTLS), technology that has been shown to improve the utilization rates of mobile equipment. McLaren ultimately selected Versus Advantages™ Asset Management, which utilizes RTLS to effectively track and manage IV pump inventory hospital-wide. Using Versus to increase pump utilization allowed a 33 percent decrease in pump inventory, which enabled McLaren to save $1 million in capital expense. At the same time, the hospital saved biomedical and nursing teams valuable time while gaining an RTLS infrastructure that can be leveraged further to improve patient flow and staff safety. PURCHASING LESS WHEN THEY WANT MORE: GAINING STAKEHOLDER CONSENSUS It’s a familiar refrain: clinical staff say they don’t have enough IV pumps. Nurses hide them, units fight over them, and hospitals typically over-purchase. When McLaren Flint’s operations group proposed a 33% decrease in inventory,
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In addition to improving utilization by 133 percent, decreasing pump acquisition from 1,000 to 600 allowed McLaren to save more than $1 million, even after purchasing the RTLS
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SPOTLIGHT
Photo Courtesy McLaren Flint McLaren Flint is a 378-bed tertiary teaching facility located in Flint, Michigan. The hospital is affiliated with the Michigan State University College of Human Medicine in its medical residency programs, including family practice,
INTEGRATION INNOVATION ELEVATES VISIBILITY TO PUMP STATUS McLaren is also the first hospital to launch an RTLS-smart pump interface between Versus and B. Braun based on IHE® Patient Care Device (PCD) open standards. “While Versus shows us the location of a pump and helps us manage inventory, we also wanted to see the status of a pump,” explains Wheeler. Now the IV pump dosing software feeds pump status to Versus, which is displayed alongside the pump location. “The transportation team can see at-a-glance which pumps are ready for retrieval and re-distribution. There’s no need to disturb the patient to manually check the status of the device,” Wheeler adds. VERSUS SCALABILITY SUPPORTS FUTURE PERFORMANCE IMPROVEMENT Although Versus saved McLaren $1 million through effective asset management, the health system has a larger vision for RTLS at McLaren Flint and beyond. As Wheeler explains, “Although we started with pumps, we now have the Versus infrastructure to explore patient flow, staff assistance and process improvement. We’re also looking at future standardization of the technology across our other hospitals.”
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internal medicine, general surgery, orthopedic surgery and radiology. McLaren Flint also maintains vascular surgery and health psychology fellowship programs in partnership with MSU.
Photo Courtesy McLaren Flint Versus Asset Tags, affixed to IV pumps, allow the real-time location of McLaren’s fleet to be displayed in both list format and on floor plans of the hospital, as shown above. Thanks to an interface with B. Braun IV pumps, Versus also indicates which pumps are available (green icons) or in use (red icons).
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INDUSTRY UPDATES
STAFF REPORTS
NEWS & NOTES
Updates from the HTM Industry GEORGE MILLS LEAVING THE JOINT COMMISSION After nearly 13 years as the director of engineering at The Joint Commission (TJC), George Mills, a familiar and widely respected figure in the healthcare technology management (HTM) community, will be leaving the accreditation organization on Oct. 6 to join JLL, a professional services firm. “I fought some good fights, wrote some good papers, did some good presentations, and was privileged to work with the industry’s leaders,” Mills told AAMI. “I feel satisfied with a lot of the things I’ve accomplished, and I feel like it’s the right time for me to make a career change.” As director of healthcare technical operations, Mills will oversee teams focused on quality and compliance, plant operations and facility management, safety, supply chain management, healthcare project and development services, and energy and sustainability. “This is an exciting opportunity to
get out and work hands-on with the field,” Mills said. “JLL is a solid company with a lot of resources behind them, and being in charge of operations, it’s up to me to figure out how to best orchestrate them. They have a lot of the pieces, and they’ve asked me to help bring the program to the next level.” Throughout his 32-year career in the health care industry, Mills has worked to make patient environments safer and healthier. His presentations at the AAMI Annual Conference & Expo have routinely drawn standing-room-only crowds, and his “Ask George” column in AAMI’s journal BI&T was a popular feature. “I’ve been teaching the intent of The Joint Commission standards for 12 years, and by managing facilities and HTM contracts and staff, I get a chance to put the tires on the car and drive it down the street,” he said. “This is an opportunity to really show the industry
GEORGE MILLS
that we can be compliant with the expectations of The Joint Commission, and when we are, patient safety and the patient care environment improve.” Mills will continue to serve as a member of AAMI’s Board of Directors.
RIGEL MEDICAL INTRODUCES NEW ELECTRICAL SAFETY ANALYZER WITH PATIENT LEAD TESTING Rigel Medical has launched its latest electrical safety analyzer in the USA, which is ideal for the testing of medical and laboratory equipment. The SafeTest 99 offers accurate, high-current, low-energy ground continuity testing to provide users with fast and precise readings, with tests carried out in accordance with NFPA 99
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guidelines. Correct results are always achieved due to an automatic warning of secondary ground paths, eliminating the opportunity for invalid readings. The SafeTest 99 is compact, portable and easy to use, with an intuitive layout and a fast selection of test routines. Testing is simple and quick to do, while full manual control allows the user to select specific required tests. “The SafeTest 99 further expands the ever-popular SafeTest product line with an economical solution to electrical safety testing,” Jack Barrett, National Business Development Manager at Rigel Medical (soon to be Seaward Medical), said. The device performs electrical safety
tests including point-to-point testing, load current measurement, ground leakage, chassis (also known as touch) leakage, patient lead leakage and ground continuity. “We’ve developed a medical safety analyzer that can be used both for medical and laboratory equipment, at line voltages ranging from 90 to 264vac with patient lead testing,” Andrew Upton, Managing Director at Seaward Group, Rigel Medical’s parent company, said. “We want to make sure patients receive the highest level of care and Rigel Medical is pleased to play an integral role in keeping medical equipment safe.” Register now for a free online product demonstration of the SafeTest 99 at www. rigelmedical.com/safetest99
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INDUSTRY UPDATES
FDA RECOGNIZES WIRELESS COEXISTENCE TIR, FOUR AAMI STANDARDS
Because Quality Matters ISO 9001:2008 CERTIFIED
CONQUEST IMAGING ANNOUNCES IMPROVEMENTS Conquest Imaging has announced the latest addition to its ultrasound probe repair program, SIMPLIFY. New customers will receive their first probe repair at 50 percent off and lowered transparent pricing on probe repair and exchanges. The SIMPLIFY program, launched in July of this year was created to offer health care delivery systems, an alternative to costly, complicated transducer repair services. By providing a noobligation, free probe evaluation for standard and specialty probes, Conquest could save a facility $150 per evaluation. Additionally, the program can reduce the decision process by days and even weeks by employing a transparent pricing model where a customer can request a price sheet for repair and exchange based on their specific probe inventory. Conquest’s transparent pricing allows a health care facility to project their spend based on their probe failure history and SIMPLIFY’s current pricing. Conquest Imaging lowered pricing recently on 19 of the 20 or so probes listed on its website at www.proberepairs.com. “We’ve been successfully managing probe repair for several years for our customers. We quote lower-level as well as higher-level repairs and find that most probes are repairable, about 78 percent,” Conquest Imaging President and CoFounder Mark Conrad said. “With a six-month warranty on standard probes and a failure rate of less than 2 percent, our probe repair customers come back again and again. I am proud to offer this alternative. We believe by lowering prices, offering 50 percent off and charging no evaluation fee that hospitals will give our probe repair a try and find out how simple and cost-effective probe repair can be.”
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The Food and Drug Administration (FDA) has recognized four AAMI standards and one technical information report – TIR69, which helps provide a reliable method to assess how well wireless medical device systems are able to operate in an increasingly congested wireless environment. TIR69, Risk management of radio-frequency wireless coexistence for medical devices and systems, was released in April and applies to medical devices and systems that incorporate radio frequency wireless technology to perform or control a medical function or to communicate medical data. The report provides manufacturers and users with a consensus process to help determine and manage the risks associated with the coexistence of wireless medical devices and systems with other wireless products that can operate in the same location or vicinity. “More and more untethered devices are coming online every day, needing more and more bandwidth,” said Wil Vargas, director of standards at AAMI. “Health care facilities needed a way to test their devices and manage the associated risks in a way that helps ensure these devices are able to connect to the wireless network and deliver the expected care. Once the risks and test results are understood, the facilities can actively take steps to improve device connection reliability and availability.” Most medical device manufacturers rely on consensus standards while developing and testing their products, and the FDA allows manufacturers to submit a “declaration of conformity” to those standards to help facilitate the review process. The other AAMI standards recognized in the Aug. 21 Federal Register notice include: • ANSI/AAMI/ISO 15223-1:2016, Medical devices – Symbols to be used with medical device labels, and information to be supplied - Part 1: General requirements • ANSI/AAMI/ISO 14160:2011/(R)2016, Sterilization of health care products – Liquid chemical sterilizing agents for single-use medical devices utilizing animal tissues and their derivatives - Requirements for characterization, development, validation and routine control of a sterilization process for medical devices • ANSI/AAMI CI86:2017, Cochlear implant systems: Requirements for safety, functional verification, labeling and reliability reporting • ANSI/AAMI/ISO 80369-5:2016, Small-bore connectors for liquids and gases in healthcare applications - Part 5: Connectors for limb cuff inflation applications.
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INDUSTRY UPDATES
BY AAMI
AAMI UPDATE
AAMI Releases Service-Level Agreement Template
A
AMI’s Supportability Task Force has released a tool designed to help healthcare delivery organizations (HDOs) work more effectively with original equipment manufacturers (OEMs) when considering a medical device for purchase.
The Service-Level Agreement Template helps set mutual expectations for HDOs and OEMs – groups that don’t always see eye-to-eye – to improve their working relationship. Using the template, HDOs can create a custom contract to specify responsibilities for training, parts availability, service manual access, and more. The template is modular so HDOs can select what they need to craft a contract that is most relevant to them. “The template is meant to be tailored to your specific needs – you can take the bits and pieces that are applicable to your HDO, department, or device,” said Patrick Bernat, director of healthcare technology management at AAMI. The free template is available at www.aami.org/SLAT. AAMI FOUNDATION TO AWARD $80,000 IN RESEARCH GRANTS The AAMI Foundation is accepting applications for a fresh round of grants and will award up to $80,000 to support research and initiatives 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 AAMI’s former president and CEO, is to encourage and fund studies that promote positive patient and healthcare 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
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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 health-care 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. For more information, please visit www.aami.org/TheFoundation. VIDEO OUTLINES HEALTHCARE CYBERSECURITY’S ‘FEARSOME FOUR’ A new video from AAMI, developed in collaboration with Accompany Partners, offers a creative take on the “Fearsome Four” weaknesses in hospitals, as described by cybersecurity expert Kevin Fu during his presentation at the AAMI 2017 Conference & Expo in Austin, Texas. “Are we secure? The answer is ‘no.’ What’s your next question?” said Fu, who is chief scientist of Virta Labs, Inc. and director of the Archimedes Center for Medical Device Security and the Security and Privacy Research Group at the University of Michigan. That question, according to Fu, should either be how quickly could a hospital recover from a cyberattack or how well the system will tolerate threats. Stakeholders, he stressed at the conference, should “focus on availability of care” when it comes to evaluating the importance of any given cyberthreat. The video is available at www.aami.org/FearsomeFour.
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BY ECRI
ECRI UPDATE
Recognizing Exceptional Technology Management Part 2: Bringing Value to the Enterprise
L
ast month, we described the app-development platform that earned Penn Medicine’s Center for Health Care Innovation the 11th Health Devices Achievement Award, announced in May by ECRI Institute. That project was not the only one to gain recognition, however. Three additional organizations were honored as finalists for the 2017 Award.
The projects from these organizations – described below in alphabetical order – show how health technology management professionals can bring value to the enterprise by thinking strategically, completing service tasks more reliably, and managing product safety information more effectively. NORTON HEALTHCARE Norton Healthcare in Louisville, Kentucky was named a fi nalist for its use of strategic planning principles to set the direction for its clinical engineering group. The group developed, and later refreshed, a multi-year strategic plan to establish guiding principles and tactical goals so that the group could better meet the evolving needs of the organization.
A key component of this project was the refresh effort that took place in 2016. During a department-wide workshop, teams were challenged to identify tactics that the group should employ to better meet its goals. The recommendations from each group were then incorporated into a road map that listed: • The tactics to be employed, and how each one related to the group’s defi ned goals • An “owner” for each tactic • A target date for completion and, if possible, an associated measure of success
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These efforts were pivotal in setting the direction for the clinical engineering department and in identifying measures to support the broader organizational goals. The refresh effort, in particular, provided an opportunity to take a fresh look at the group’s activities and to adjust and refi ne its tactics, in light of ever-changing circumstances, to better meet the organization’s goals. Involving the entire team in these processes helped staff understand the trajectory of the group’s efforts and fostered a greater sense of ownership in helping to meet the group’s goals. SERVICE NEW BRUNSWICK Service New Brunswick in Fredericton, New Brunswick, Canada earned recognition as a fi nalist for the simple but effective approach it used to improve completion rates for medical device inspection and preventive maintenance (IPM) procedures throughout the Canadian province. Several years ago, the eight clinical engineering groups serving the health care facilities in New Brunswick, Canada, were consolidated into a single group. One challenge associated with this consolidation was completing IPM procedures in a timely manner across the organization. Any IPMs that were not completed during one month would spill over into the next, compounding the problem. The organization needed a way to provide technologists with better guidance to help them prioritize the equipment on their lists. Their solution was to forget about “due dates” and instead to embrace a concept called the “critical percentage.” The critical percentage for any piece of equipment is determined by dividing the number of days since the equipment’s last inspection by the recommended frequency of inspection (in days). That figure is then multiplied by 100 to obtain a percentage. Whereas the due date communicates only when an inspection is due for a piece of equipment, the critical percentage expresses the due date in relation to the recommended IPM frequency for that piece of equipment. In this way, it helps technologists prioritize their work by identifying the most urgent IPMs to complete at any given time.
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Plus, the critical percentage is expressed as a single value. This makes it easy to see at a glance which equipment should be given priority (higher numbers are a higher priority than lower ones). It also simplifies generating reports so that technologists, managers and administrators can track progress toward meeting the organization’s IPM goals for each facility in the system. Since instituting this change, the organization achieved marked improvement in its IPM completion rates and has consistently maintained that level of performance.
•
Exploiting the capabilities of an existing communications system to improve notifications about, and responses to, situations that require immediate action
•
Using the Alerts Tracker Automatch feature to identify whether supplies in inventory at the health systems’ various facilities are the subject of a recall or other alert
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Developing enhanced reporting tools, such as a dashboard to communicate compliance trends and resolution times
ST. LUKE’S HEALTH SYSTEM St. Luke’s Health System in Boise, Idaho was named a fi nalist for the process it used to transition its recall management program from a disconnected, paperbased process to a centralized, automated system. The new system allows better tracking of reports, enhanced and reliable communications, documentation of actions taken, and real-time reporting. The team at St. Luke’s recognized that successful implementation of such a far-reaching system required more than just redefi ning processes and purchasing new technology. It would require a well-conceived strategy for achieving effective and lasting change. Thus, the team set in motion a process of optimizing technology, systematizing processes, and mobilizing people. Technology solutions included: • Implementing an online recall management system, ECRI Institute’s Alerts Tracker
As the program matured, the St. Luke’s team systematized its processes by, for example, producing a systemwide recall policy, creating standard operating procedures based on best practices and measures for avoiding pain points, and standardizing the employee training system. To mobilize people – that is, to engage both leadership and staff in the process – the organization developed a clear shared vision, communicated that vision throughout all departments, and empowered people to act on that vision. The success of the team’s approach can be seen in the significant reductions in unresolved alerts that were achieved in the fi rst six months. The baseline of unresolved alerts – that is, the total number of alerts that remained unresolved from week to week – was reduced tenfold, from approximately 2,000 alerts to about 200 to 300 alerts. Likewise, average resolution times for alerts were reduced dramatically.
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ALSO DESERVING RECOGNITION . . . Next year, the winner could be you. ECRI Institute presents its annual Health Devices Achievement Award to
the member health care institution that has carried out the most exceptional initiative to improve patient safety, reduce costs or otherwise facilitate better strategic management of health technology. 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 accepting submissions for next year’s Award through January. For additional information, visit https://www. ecri.org/Pages/Health-Devices-Award-Rules. aspx. This article was excerpted from ECRI Institute’s membership website. The full article features additional details about the projects outlined above. To learn more, visit www.ecri. org/HDAwardwinner; call (610) 825-6000; or e-mail communications@ecri.org.
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SHOPTALK
Conversations from the TechNation Listserv Q: A: Looking for advice on purchasing new syringe pumps. What do you like and why?
A:
We have Smiths Medical Medfusion 3500 units and they work great. Never had a complaint about clinical performance. Only work orders are derived from them being drop-tested from the top of the anesthesia machine.
A:
We have 34 of these pumps and have reached the point where we usually have one out for depot repair because of a “Supercap Post” error. This mandates replacement of the main board and costs about $400. The oldest of these are about six years old. The problem is that these are about the best stand-alone syringe pumps out there. I miss the InfusOR pumps; they were just about bulletproof.
A:
Mainly, we use the Alaris syringe pump. Our NICU uses some of the Medfusion 3500 and our critical transport crews use the BBraun Perfusor Space pumps. All of them work well for us.
A:
I agree about the InfusOR pump. But we are needing to replace ours for integration into the EMR.
A:
If they have InfusOR pumps that are broken, we can still repair them. Sadly there is no direct replacement for the pump. We do carry the Baxter AS50 pump and do plan on supporting it for many years to come. We have a complete supply of parts for this
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pump and we offer a full one-year warranty with the purchase of the pump. I have been repairing the Baxter syringe pump line for over 25 years.
A:
Probably have to go with Alaris then, but beware that some of their 8100s will go end of life very soon.
A:
I thought it was the 8015 PCs that were going end of life in 2019. I was under the impression that the LVPs, Syringe, ETCO2s and PCAs were still good.
A:
We have been using the Alaris system for the last 10 years plus. Cost of ownership might be a little high because the units have multiple connection points that can be broken easily. They do use a laptop style battery which is expensive, but the staff loves these units. It is really hard to over medicate a patient because of the guard rails drug software. (I think that’s the name.) The pharmacy can push a new drug chart through the wireless connection. You can take one brain and connect 4 different modules to it in any combination that is required such as IV, Syringe, IV and an enclosed syringe style unit for pain management. In the long run, I believe it is the best option out there. They have been here a long time so if someone knows of a latest and greatest thing coming out I sure would like to hear about it.
Q:
Can anyone validate the 8015 end of life in 2019?
I should have been more specific, for that I apologize. There is a next generation 8015 that is coming out that has a bigger screen and the card will now be internal. I am trying to find the notice we received to let us know the units we purchased in 2009 would be end of life in 2019, but I am not having any luck finding them. I also have not found anything on the Internet as of yet, when I do I will post it. Sorry for any confusion.
A:
The Alaris PC Unit model 8015 4.7-inch LCD will go end of support Jan 1, 2019.
A:
I received an EOL software announcement from BD (08.01.2017) that posted an end of support for the 8015 as of Jan 1, 2019. It was followed by an announcement of an upcoming major software version change (v9.33). It would be my guess that a new hardware option is also coming soon.
Q:
I am looking for a service manual or any information you can give me on a 5415R centrifuge made by Eppendorf. I think I need to change the motor, but I am struggling to get inside the device. Any advice?
A:
I’d give Ozark Biomedical a call. They know just about everything about just about every centrifuge out there. I am not affiliated with Ozark – just like to give credit where credit is due.
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A:
I concur. Ozark Biomedical has helped several TechNation Listserv users over the years. I always hear good things about them.
A:
I also concur with the Ozark Biomedical suggestion. Here is a link to a service manual to a Eppendorf 5415D centrifuge if it helps: http://photos.labwrench.com/ equipmentManuals/2416-8571.pdf TRIM 4.5”
A:
Ozark guys are the best in the business for centrifuges.
THE SHOP TALK article is compiled from TechNation’s ListServ and MedWrench. com. Go to www.1TechNation.com/Listserv or www.MedWrench.com/?community. threads to find out how you can join and be part of the discussion.
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STAFF REPORTS
THE BENCH
BIOMED 101 MedWrench
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t is true – MedWrench could be the best tool in your toolbox! Multiple users have been quoted making that claim and it is no surprise to the thousands of HTM professionals who visit MedWrench.com on a regular basis.
But, you might ask, what is MedWrench? MedWrench is a comprehensive database of knowledge for medical equipment. “Our goal is to provide the most complete and efficient professional networking experience, serving as the central meeting point for all conversations around current and late model products in the health care industry,” says Marketing and Sales Manager Kaylee McCaffrey. The 2017 MedWrench Media Guide provides even more details about the site. “MedWrench is a product focused support network where medical professionals, purchasing administrators, manufacturers, dealers and industry experts can provide opinions, share ideas, and gather relevant information on medical technology and equipment,” according to the media guide. “MedWrench fosters guided dialogue with a targeted audience around critical medical equipment issues and provides the quickest way to find medical technology and equipment information – from solving problems to purchasing – all in one place.” In other words, it is a community where professionals from throughout the industry can come together to share ideas, solutions and troubleshoot problems for the benefit of everyone. Perhaps the best part for HTM professionals is that MedWrench is free to join and can be customized to provide tailored updates and information about one’s area of work. For example, biomeds who work on anesthesia machines can
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limit emails and notices to anesthesia issues. “When browsing MedWrench you may see the ‘Add to My Bench’ buttons,” McCaffrey says. “Clicking these buttons will bookmark whichever equipment, category or manufacturer you choose. This allows you to receive updates on articles and news feeds and allows you to join any related discussions.” MedWrench users also benefit from the online Bulletin Board feature. This is a resource where medical service professionals can find all the information needed to help them be more successful. Some of the features of the Bulletin Board are the weekly MedWrench blog, continuing education information, upcoming expos and events and a career section where users can review and submit applications to open jobs. If this all sounds great to you, know that you are not alone. MedWrench users always have great things to say about the website. “MedWrench is my prime source for assistance in troubleshooting many devices. They have a wealth of information and their website is very easy to use,” HTM educator Jewel C. Newell says. “As all of us biomeds are aware that you never know what resource we might have to use next to find a solution to a problem. I have found MedWrench to be a great resource at many different levels from
tracking recalls, talking amongst other technicians, and finding information on various pieces of equipment. MedWrench is just a good all-around resource for what we do,” says Adam Colvin, Rockingham Memorial Hospital. So, keep reading to find out how to sign up and put MedWrench to work for you!
STEP 1: VISIT MEDWRENCH.COM AND SIGN-IN Sign-in to MedWrench or Register if you are a new user. Manage your account and profi le settings anytime by clicking on "About Me" (from the person icon) then "Edit Public Profi le". From here you can include a description about yourself, update your display name and add a forum signature. STEP 2: SEARCH Find the product you are looking for by using the search bar. Once you have found the product you are interested in you can read description, features, and specifications. Other resources to be found on product pages are the ability to request a quote or buy now. You can sometimes fi nd equipment manuals and videos located on the product page. The "add to my bench" option subscribes you to the product and will give you instant access to discussions, news and additional resources surrounding the equipment page.
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THE BENCH A national leader in the sale of new, used, and refurbished medical equipment.
Become More Profitable With PRN STEP 3: USE A SOCIAL FORUM Each product on MedWrench has a social forum area where you'll sections to: • Ask a Question: if you have a question regarding a piece of equipment you currently use, or maybe about a product you plan on purchasing post it on MedWrench to get answers from colleagues, industry experts, manufacturers, etc. MedWrench administrators will assist in getting answers from industry experts. • Answer a Question: If you know the answer to a question, chime in and share your knowledge with the community. Each answer will position yourself or your business as a leader and expert in your field. • Read News: Catch up on product specific press releases and recent news post. • Share Preventative Maintenance: Preventative Maintenance tips and tricks with other users are posted. • Watch Videos: A video pertaining to a specific piece of equipment. STEP 4: ADD TO MY BENCH/MANAGE MY BENCH Now that you have checked out products that you are interested in, or currently use, you may have noticed each product has a “Add to Bench” button. Clicking this button will bookmark that piece of equipment which will send an updated feed to your “My Bench” page where you can view the most recent activity (rather than
Anesthesia having to re-search for a product) you• Beds/Stretchers • Cardiology • Endoscopy • Exam Room • Extremity Pump • Feeding Pump • General Medicine • IV Pump • Laboratory • Lymphedema Pump • Miscelcan also choose to be emailed when laneous • Monitor • Nutrition Pump • OB/GYN • Ophthalmology • OR/Surgery • Out the Door • Pediatric Respiratory • Supplies • Therapy • Ultrasound • Vascular • Gas Regulator • Anesupdates occur, such as a new video post, thesia • Beds/Stretchers • Cardiology • Endoscopy • Exam Room • Extremity Pump • Feeding or maybe an answer has been provided Pump • General Medicine • IV Pump • Laboratory • Lymphedema Pump • Miscellaneous • to a question you asked. Monitor • Nutrition Pump • OB/GYN • Ophthalmology • OR/Surgery • Out the Door • Pediatric Our equipment • Supplies • Therapy • Ultrasound • Vascular • Gas Regulator • Anesthesia • Beds/ When you first sign in toRespiratory MedWrench, Stretchers • Cardiology • Endoscopy • Exam Room Extremity Pump • Feeding Pump • Genis tested and •serviced you will have access to youreral ‘My Bench’ Medicine • IV Pump • Laboratory • Lymphedema Pump in-house so that we• Miscellaneous • Monitor • Nutriactivity page and you can also tionaccess Pump it • OB/GYN • Ophthalmology • OR/Surgery • Out the Door • Pediatric Respiratory • can guarantee its Therapy • Ultrasound • Vascular • Gas Regulator • Anesthesia • Beds/Stretchers • anytime by clicking on “MySupplies Bench”•from integrity. Cardiology • Endoscopy • Exam Room • Extremity Pump • Feeding Pump • General Medicine the person icon (top right). In• this area• Laboratory • Lymphedema Pump • Miscellaneous • Monitor • Nutrition Pump • IV Pump OB/GYN you will see a list of items you have • Ophthalmology • OR/Surgery • Out the Door • Pediatric Respiratory • Supplies • Therapy • Ultrasound • Vascular • Gas Regulator • Anesthesia • Beds/Stretchers • Cardiology • Endoscopy • Exam Room • Extremity Pump • Feeding Pump • General bookmarked from the site. Your bench page will have a “subscriptions gear icon” where you can search from only the items on your bench, turn email notifications Physician’s Resource Network on/off, and easily manage the equipment you are interested in.
STEP 5: ACCESS THE BULLETIN BOARD The Bulletin Board is a growing resource on MedWrench where you can find our weekly blog, expos and events, continuing education, and career opportunities. STEP 6: BUY NOW. BUY NOW IS A NEW RESOURCE ON MEDWRENCH You now have access to purchase parts and equipment from reputable vendors. You can easily search through the listings, read the description and shipping information, and instantly add to your cart. All funds are securely transferred via PayPal between buyer and seller. For more information or questions about using the MedWrench website, call 866-989-7057 or send an email to support@medwrench.com.
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he TSI Certifier FA Plus, available from BC Group International, can test most models of ventilators: adult, pediatric, anesthesia, neonatal and high-frequency. It can also test a variety of other medical equipment such as anesthesia gas delivery machines, insufflators and oxygen concentrators. The Certifier FA Plus’s compact size makes this ideal for use in field service, biomedical shops and manufacturing. With fast response and bi-directional sensors, it’s capable of testing all types of ventilators including neonatal and high frequency. This ventilator tester is designed to measure air, oxygen and nitrous oxide flow and pressure in institutional, home care, field service, laboratory and production applications.
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WEBINAR WEDNESDAY Taboo Topic
T
he recent TechNation Webinar Wednesday presentation sponsored by Summit Imaging left a lasting impression on members of the HTM profession.
“This was an eye-opening webinar disclosing some of the undesirable actions being taken in the industry in the repair of medical equipment. I appreciate the tips on what to look out for and how to vet potential suppliers of repair services,” Biomedical Engineer George S. wrote in his post-webinar survey. More than 300 people registered for the insightful and “eye-opening” webinar “How Low-Quality Remanufactured Parts Inside Medical Devices Increase Total Cost of Ownership” presented by Larry Nguyen, CEO & CTO at Summit Imaging and Kyle Grozelle, Manager of Global Education and Training. Participation in the presentation was eligible for 1 CE credit from the ACI. Nguyen and Grozelle discussed how low-quality repaired ultrasound replacement parts and transducers impact health care facilities’ total cost of ownership. The webinar informed health care professionals how to reduce unnecessary risk and potential resulting liabilities as well as equipment downtime, by learning how low-quality remanufactured components can significantly impact the performance and safety of medical devices. These low-quality medical devices are rarely disclosed to health care facilities and
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negatively impact clinical engineering budgets and patient care. Attendees shared their thoughts on the webinar in a survey and expressed gratitude for the information and insights. “Thank you to the Summit team for discussing a taboo topic that is not so well know to the entire industry,” Biomedical Engineer Jesse H. wrote. “As an engineer at a company that provides replacement and re-certified parts, I feel proud that our company is able to defend our products through validation and verification testing and our QMS through ISO13485 certification,” Quality Engineer Jackie R. said. “The Webinar Wednesday series makes me more confident in my biomed profession,” wrote Biomed Technician Pavel G. “I think these are great tools for service engineers who do not have access to training due to location or for those on a tight budget and want to continually update their knowledge in the field,” Pacific Biomed Services President Stan B. said. “It is my first time attending this webinar site and at the end, I was fascinated with this new type of method. I am from México and I was able to obtain valuable information from my desk,” Biomed Jesus L. shared.
“ As an engineer at a company that provides replacement and re-certified parts, I feel proud that our company is able to defend our products through validation and verification testing and our QMS through ISO13485 certification.” - Jackie R.
To find out more about the TechNation Webinar Wednesday series, including a calendar of upcoming webinars and an archive of previous presentations, visit 1TechNation. com/webinars.
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ROUNDTABLE
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ROUNDTABLE ROUNDTABLE
ROUNDTABLE Digital Radiography
T
echNation contacted several people within the HTM industry to find out the latest advances in digital radiography, the most important things to look for in a DR service provider and more.
The panel of those able to participate in the roundtable article include The InterMed Group Vice President of Business Development Dave Bauerle, Radiologic Service Training Institute (RSTI) President Dale Cover, Carestream Regional Business Manager for X-ray Solutions Cheryl McCarron and Cal-Ray, Inc. President John Snyder. Q:WHAT ARE THE LATEST ADVANCES IN DIGITAL RADIOGRAPHY? Dave Bauerle, The InterMed Group Bauerle: The most important advancements in DR regarding patient care include the introduction of true direct readout radiography, and the advancements in postprocessing software. In the beginning, “digital” referred to CR, and required the X-ray techs to run the phosphorus plates through a CR processor before the image was ready to be read. By going to CCD, Gaddox, and most recently Cesium, the images are available to be read by the radiologist in 3-5 seconds. This saves the patient and facility a huge amount of time. Over the last 10 years, the biggest advancement in patient care would arguably have been the enhancements to post processing software. Today’s acquisition suites have come a long way since their introduction in the early 1990s. Using advanced algorithms, techs are able to use less radiation to obtain the same image detail and quality. In my opinion, lowering the doses is one of the most valuable things we can do for our customers.
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Cover: Digital radiography has many forms; the fi xed installation detector, wired and wireless movable panels that require interfacing to the individual X-ray systems they are used in and the latest configuration, the wireless panel can detect when they are being exposed. This functionality is referred to as Automatic Exposure Detection (AED). The ability to detect when the exposure begins and ends frees the panel from the need to be interfaced to the X-ray system. This freedom allows the panel to be used with any X-ray system in the hospital. It is convenient that this advancement would come along just as regulatory pressure is being applied to the other free use digital medium (CR) in an effort to phase it out. Other advances in digital include new image stitching techniques that combine multiple images into on continuous image, dual energy imaging that can help with specific tissue image enhancement and tomosynthesis that creates images that can be viewed in 3 dimensional decks and reduce superimposition. McCarron: The introduction of wireless DR detectors revolutionized X-ray imaging. Some of the latest detectors offer advanced image quality, greater reliability and faster capture speeds. The ability to register all DRX detectors with all DRX portable and room-based systems delivers exceptional flexibility and redundancy. The latest innovations in DR include advanced applications such as tomosynthesis and dual energy. I think you will see more of these kinds of applications being developed in the future. Snyder: As it relates to DR, I would have to say tomosynthesis is beginning to be recognized as a valuable and cost-effective study in orthopedics. Several OEMs are now offering this feature with general radiographic suites, and on remote RF systems. This functionality can provide improved detail visibility, over CT. Standing and weight-bearing studies can also be done with tomosynthesis.
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ROUNDTABLE
Q: HOW CAN A FACILITY WITH A LIMITED BUDGET MEET ITS DIGITAL RADIOGRAPHY NEEDS? Bauerle: Digital pricing has dropped substantially in the last five years making it much more attainable to the facilities working with a limited budget. A few tips to limit the cost to the facility: • Many consumers think they need a complete RAD room overhaul when upgrading to DR. While this can be true, much of the time they are able to use their existing RAD equipment, and only replace the CR/wet fi lm processor with a new digital detector. • If shopping for a digital portable, consider a retrofitted AMX4+. Almost all of the digital manufactures offer a retrofit kit, and can provide a portable DR solution at a fraction of the cost of a new DR portable. Of course this would not be a straight comparison, but for a site looking for a lower cost option this could be a great solution. Cover: The type of DR solution that would be most suitable for any facility would be determined by how they operate and how many systems they have. The small private practice facility would be well served with one of the interfaced DR panels of which there is no shortage of options to choose from. Competition at this market has driven cost down recently. For the larger facility trying to move away from CR, the wireless panels with AED would be very effective at maintaining the way the department operates. Cost effectiveness in any case would lean toward adding new digital panels to existing standard X-ray rooms rather than buying a whole room designed from the ground up to be digital. Cheryl McCarron, Carestrea McCarron: Retrofitting mobile units and rooms with DR detectors allows facilities to extend the life of X-ray systems while achieving rapid access to high-quality images. In addition, Carestream DRX detectors can be registered for use on any DRX system, enabling detector sharing for more effi cient utilization and a lower investment. As an example, health care providers can use a detector in a portable system for early morning rounds and then transfer it to a DR room for use during the day. Snyder: We are seeing smaller hospital groups, affi liating with or being acquired by larger medical systems. The days of the small independent medical facilities is nearing the end. Those that remain can join GPOs like Vizient and HealthTrust and fi nd savings when buying equipment.
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Q: WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A DIGITAL RADIOGRAPHY SERVICE PROVIDER? Bauerle: Today, most manufacturers are offering very similar products with very similar price tags. When choosing the right product for your facility, please take into account the following options: • Fixed, tethered or wireless panels? This is all buyer preference and has no effect on the quality of the image. Talk to your RAD team, and discuss the best option for your site with a knowledgeable DR advisor. • What kind of detector – CCD, Gaddox (GAD) or Cesium Panels? These are currently the three different types of digital detectors. CCD detectors are no longer in high volume production, with all DR panels moving to GAD or CSL. Gaddox is the lower cost standard, with Cesium being the higher quality. Cover: I think this would be little different from having your car serviced. You would look for a reputable company with trained and qualified techs that has been in business for a number of years that gets good reviews from past customers. Now if you drive a Bugatti Veyron you may be inclined to go with dealer service. McCarron: Health care facilities need a provider that continuously upgrades its DR portfolio with new imaging systems, new detectors and expanded functionality. It’s also important to work with a provider that offers a comprehensive family of DR systems and detectors that can address a wide range of imaging needs and volumes. Virtually every imaging services provider is now able to purchase a DR system that meets their needs. It’s important for biomed professionals to work with a supplier that has a service partnership program with varying levels of support. At Carestream, we enroll biomeds in the same training courses as our service engineers, so biomeds are fully equipped to service and support DR detectors and systems at their facility. And biomeds – along with other users – provide feedback that we use to design new imaging products.
John Snyder, Cal-Ray Inc. Snyder: Digital X-ray products can be found today from many dealers and OEMs. The equipment providers that have experienced engineers, that understand networks, PACS, in addition to knowledge in X-ray physics and hardware will be successful. Secondly, applications support, that ensure the operators are fully trained on the use of the technology and skilled in proper dose control. Applications specialist also know how to adjust the image quality to the acceptance of the reading radiologist.
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ROUNDTABLE ROUNDTABLE
Q: IS IT POSSIBLE TO KEEP UP WITH THE LATEST DIGITAL RADIOGRAPHY TECHNOLOGY WITHOUT BUYING BRAND NEW? Bauerle: Possible, but not recommended. Because of the lack of service options if a system gets damaged, I always recommend going for a new DR included with a real warranty. Now that DR has been around for a while, we are seeing more used systems hit the market. A lot of the time these are great systems but if it breaks, be ready for a hefty bill to replace. Dale Cover, Radiologic Service Training Institute (RSTI) Cover: As far as replacing panels goes, you could maintain the same imaging system and upgrade to the new panel. Technologies like tomosynthesis and dual energy would require that the entire system be replaced. There won’t be a strong preowned market for some time. Heck, some systems are still awaiting FDA approval. McCarron: Retrofitting existing imaging systems with DR detectors is an excellent way to achieve enhanced image quality from existing X-ray systems. Snyder: Today’s marketplace is being flooded with old CR and tethered DR panels. Most of the older DR solutions on the used market are running windows XP which is no longer supported. Knowing which used DR panels on market can be used with Windows 7 and 10 operating systems would be helpful for those looking for low-cost entry into digital imaging technologies. Several older Canon DR panels, for example, can run on Windows 7 and the latest Canon software. Q: WHAT ARE THE BIGGEST CHALLENGES HEALTH CARE FACILITIES MUST OVERCOME IN REGARDS TO SERVICING DIGITAL RADIOGRAPHY DEVICES? Bauerle: The biggest challenges faced by health care facilities is that there is very little able to be done if a panel gets damaged. A great deal of care should go hand-in-hand with the use of these detectors. Outside of that, if it breaks, it will need to be replaced in most situations. Facilities are able to purchase additional warranties and drop coverage, depending on their needs and expected level of use. These options should definitely be considered at time of purchase. Cover: The challenges for digital radiography systems are similar to other high-tech imaging systems. Black box technology leads to expensive replacement parts. New technology leads to training and service support needs. Many of these new technologies require specialized test fixtures and equipment. Sufficient documentation could be another road block to efficient in-house service.
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McCarron: One of the biggest challenges has been preventing damage to a detector due to mishandling or accidents. The detector is carried around by health care personnel from one setting to another. It is in and out of protection bags and buckys. Drops, dings and spills happen. Most vendors have accident protection plans to help defray the cost of replacements, but education is important to ensure that radiologic technologists handle the equipment carefully. Snyder: I believe one of the biggest challenges is getting drop protection for their detectors. No one likes to replace broken panels damaged by an accidental drop. Protection plans are coming down and many new panels today come with one-year drop protection included. Additional protection plans are available for older working panels as well from insurance and OEMs. Q:WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING DIGITAL RADIOGRAPHY? Bauerle: The different options and configurations can be overwhelming, even to a seasoned radiology director. Working with a knowledgeable, vendor-neutral digital radiology provider ensures that you buy the right product for your needs. Cover: As new technology comes to the market there will be some lag but parts, training and support services will eventually be developed. At RSTI, we always have our eye on emerging technology to determine where we can most effectively help our students with the tools they need to succeed in today’s high-tech imaging department. McCarron: The future promises new technologies and new software. Carestream offers advanced applications including grid software that applies to the chest and abdomen. We are also designing a new portable DR system that uses carbon nanotube technology to create a compact, lighter weight system to expedite bedside imaging in crowded critical care areas. We continually look to our customers, including biomeds, to provide feedback and ideas on new imaging solutions. The continued development of advanced applications and technologies creates an even greater need for well-trained biomeds with expertise in electronics and IT technologies. Snyder: Negotiating training for biomeds at the point of sale would be beneficial for those buyers with in-house biomed and clinical engineering departments. Being wise to the differences between DR panels on the market and understanding that cheaper isn’t better in most cases. The investment must encompass thoughtful consideration to OEM longevity in the industry, durability, IPX ratings, weight of panels, image quality and drop protection.
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STAFF REPORTS
CYB3RSECUR1TY
CYB3RSECUR1TY WHAT EVERY HTM PRO SHOULD KNOW
IL OV
EY OU
MI
CH
AE
L
BY K. RICHARD DOUGLAS
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COVER STORY
Imagine you have an implanted pacemaker for a heart condition and a hacker takes control of the pacemaker and sets it to do whatever they want? Sound farfetched? It’s not. It’s just one example of the seriousness of cybersecurity as it could potentially impact medical devices. Cybersecurity news has featured headlines about hackers who have found their way into company networks, or government computers, but the threat of stealing proprietary information seems trivial compared to someone controlling another person’s very heartbeat. And how might these cyber bad guys wreak havoc on patients in a hospital via access to that hospital’s network? It’s one thing when ransomware requires a hospital to pay a large sum to cyber criminals, but it is quite another for these virtual thugs to injure or end the life of a vulnerable patient. Hospitals in England can attest to the threat that incursions into a network can have. Many fell victim to a ransomware attack that arose from malware called WannaCry in May of this year.
ARTICLE CONTRIBUTORS
BOB CHAPUT,
CEO OF CLEARWATER COMPLIANCE LLC
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INHEL REKIK,
MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL
JUUSO LEINONEN, PROJECT OFFICER AT ECRI INSTITUTE
SCOT COPELAND, MEDICAL DEVICE IT SPECIALIST
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COVER STORY CYB3RSECUR1TY
HEALTH CARE EXPOSURE When targeting health care providers, hackers can create more serious problems than might be experienced by corporations or retail outlets. As already mentioned, the hackers can compromise the actual health and well-being of patients, in very perilous ways, in addition to infl icting monetary injury. This requires fi rewalls to keep these digital pathogens out, identify those cyber risks that may have gained access to their systems, neutralize any incursions and identify the fallout. “At present, we believe that the most pressing concern for health care facilities is a potential interruption to health care operations due to loss of access to data or systems,” says Juuso Leinonen, project officer in the Health Devices Group at ECRI Institute. “This past year, we have seen several hospitals that were significantly impacted by ransomware or other malware. While some medical devices have a potential to be impacted, ECRI Institute has not received direct reports of patient harm due to ransomware in medical devices,” Leinonen adds. Bob Chaput, CISSP, HCISPP, CRISC, CIPP/US, CEO of Clearwater Compliance LLC in Nashville, Tennessee suggests that guarding against cyber threats requires inter-department cooperation. “Team up,” Chaput suggests. “Ensure that your organization treats this matter as an enterprise-wide, business and patient risk management issue that should involve, but not be limited to, legal, risk management, fi nance, compliance, IT, clinical engineering, security, quality, operations,” he says. He suggests that all those concerned should “adopt a risk- and asset-based risk management approach.” “Remember cyber risk management is about your ‘assets’ and their exposures to a compromise of confidentiality, integrity or availability. It’s not
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about someone else’s controls checklist. The largest breaches in health care and retail, for example, have occurred at organizations that adopted such approaches,” Chaput says. He adds that it is best to leverage three critical building blocks – organizations most successful at cyber risk management adopt an overarching framework (we recommend the NIST Cybersecurity Framework), implement a rigorous process (once again, we recommend the NIST information risk management approach documented in a series of NIST Special Publications, starting with NIST SP800-39) and adopt a “Deming/Continuous Process Improvement” mindset.
“At present, we believe that the most pressing concern for health care facilities is a potential interruption to health care operations due to loss of access to data or systems.” Leinonen HIMSS lists three major areas of concern on its website; spear phishing and SQL injection, data breach and ransomware. According to the HIMSS Cybersecurity Survey for 2017, and articulated in an article on their website (5 Takeaways from the 2017 HIMSS Cybersecurity Survey, Aug. 28, 2017) by Lee Kim, JD, CISSP, CIPP/US, FHIMSS, HIMSS North America director of privacy and security, there are five takeaways. Among what was distilled from the survey results was that “Penetration testing is a good way to test one’s cybersecurity defenses, incident
response plans, awareness training, policies and procedures.” Penetration test reports can hold significant value, as it will explain what gaps or deficiencies may exist and how to remedy them, according to Kim. HIMSS also reports that “information security professionals at acute care providers are concerned about cloud security.” Their fi ndings also centered upon the connections created through other wireless technologies. “Many acute providers have life-sustaining or life-saving medical devices. Considering that many of these are Bluetooth-enabled connected devices, medical device security and patient safety are very much intertwined – so much so that a potential compromise on a medical device may lead to an adverse event,” Kim says. The HIMSS survey also pointed out the importance of cyber security considerations prior to the procurement of new medical technology. “Eighty-eight percent of health care organizations with chief information security officers or other IT security leaders and 57 percent of health care organizations without such leaders are ensuring that cybersecurity due diligence is done during the pre-acquisition stage – i.e., prior to the implementation of the technology product and/or service at the organization,” Kim adds. HTM’S ROLE With the technology convergence of biomed and IT on many fronts, the role of the HTM professional in contributing toward cybersecurity defense is an important one. “HTM should partner with IT and as much as possible to bring the medical device fleet into the enterprise security management plan. HTM can bring to the table specialty risk and operational information that can inform the IT network security plan,” says Scot Copeland, a medical device
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IT specialist in California. He says that on their own, HTM can gain knowledge and training in IT networking and security and begin to gather the networking, vulnerability and privacy risk attributes associated with medical devices and maintain them in the CMMS. To create that inventory of susceptible devices, Copeland says to seek out the cooperation of other departments. “Begin with the medical device inventory in the CMMS and identify networked medical devices or standalone devices that contain or manage ePHI. Reach out and partner with other departments that may have been managing their own medical devices and begin to incorporate them into the CMMS (think pharmacy, lab, point of care testing, specialty imaging/radiation therapy or on-site contracted services). Reach out to departments that may have been developing and managing their own networks and document them in the CMMS,” he says. “Network discovery tools, used by the IT department, may be useful in flushing out network devices that are part of medical device system but use caution when running discovery tools on a medical device network. Some medical devices are sensitive to scanning protocols and may react adversely,” Copeland adds. The importance of having an accurate inventory, that is frequently updated, is echoed by Inhel Rekik, clinical engineering manager at Medstar Georgetown University Hospital in Washington, D.C. “In addition, some additional data needs to be collected in the asset management system such as whether the medical device has a wireless or wired network connection in addition to the wireless protocol used such 802.11 a, b, g and n,” Rekik says. “Open ports and communications protocols could be added as well if data is available. Some additional network information such as device network ID, fi rmware version, software version, MAC address and
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underlying operating system need to be collected as well.” She says that this data allows health care organizations to quickly identify affected devices when a vulnerability is known. For the HTM department, Copeland suggests that scrutinizing each medical device or system and assessing its risk profi le is a good fi rst step. “HTM should begin with a security/ privacy risk assessment of their networked medical devices and their standalone medical devices that contain or manage ePHI,” Copeland says. “The health care delivery organization (HDO) should already have risk assessment methods and standards in place for security and privacy of IT network resources to address regulatory requirements. The HDO can consider applying those standards to the medical device/ systems on the network or that contain ePHI, identify gaps and develop remediation plans, and/or modify the standards to include medical devices.” There are tools that will allow a health system to bolster resources in combating cybersecurity. Copeland suggests a couple. He says that there is a cottage industry developing in the market that in most cases combines network monitoring and discovery capabilities with vulnerability, threat and, in some cases, clinical risk information in an attempt to provide real-time risk analysis of the medical device fleet. [Note: HTM professionals can check out Verta Labs Blueflow, Asilimy and Zingbox IoT Guardian] “Sometimes overlooked, the HDO’s enterprise IT security management tools can be applicable and effective in managing medical device security including vulnerability and discovery scanners, intrusion detection/prevention, fi rewalls, VLANs, SIEM, and behavior monitoring,” Copeland says.
“Remember cyber risk management is about your ‘assets’ and their exposures to a compromise of confidentiality, integrity or availability. It’s not about someone else’s controls checklist.” Chaput
HAZARDS AND VENDOR QUESTIONS There is a degree of due diligence that is
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COVER STORY CYB3RSECUR1TY
required prior to purchase. Copeland says vendors should be asked if they provide the HIMSS MDS2. Also, do they provide implementation guidance to ensure the most secure implementation in the HDO network? “Are they aware of IEC 80001-2-6 guidance on vendor responsibility agreements and can they provide documentation useful in creating a security solution during installation? Do they have a Software Bill of Materials that outlines all of the computer off-the-shelf software, .dlls and libraries that make up the medical device software system?” Copeland asks. “Risk assessment and risk management is an integral part of procurement and of the device lifecycle management. As the environment of the medical device changes, risks should be periodically re-evaluated,” says Rekik. “HTM departments need to add the cyber risk classification to the basic risk classification as high risk and non-high risk detailed in EC.02.04.01.” John Rasmussen, MA, MBA, vice president and chief information security officer at MedStar Health in Columbia, Maryland says that a risk assessment includes evaluating the product upon procurement to determine if administrative, technical, or physical safeguards need to be put in place to mitigate the risks. “Risk assessments will look at the technology being used, and its current vulnerabilities, as well as the type of data and operational use of the equipment. A risk assessment will ask about patching, password management, local data storage, Internet connectivity, device interoperability, remote support, etcetera,” Rasmussen says. Rasmussen agrees that an important part of the risk assessment will be the Manufacturer’s Disclosure Statement of Medical Device Security (MDS2), “which should be provided to Clinical Engineering prior to procurement,” he
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says. “The Medical Device Innovation, Safety and Security Consortium can provide health care organizations with a good starting point of the medical device cyber risk and answers the MDS2 form questions.” “The risk assessment should also include scanning the device for vulnerabilities and open ports prior to deploying the medical device. Vulnerability scanning should be done periodically within the environment to assess new risks; however, care should be taken to ensure vulnerability scanning is not done when the device is being actively used for care,” Rasmussen adds.
“HTM should begin with a security/privacy risk assessment of their networked medical devices and their standalone medical devices that contain or manage ePHI.” Copeland Simple and common storage technologies have introduced other means for cyber threats to be introduced into the health care network or a device. Thumb drives are a prime example. HTM can help do their part in mitigating this risk. “Ensure the HDO has a policy for use of removable media and propagate it down to the medical device fleet if possible. Policies not able to be enforced or managed via group policies (i.e. Active Directory) may be enforced via workflow policies. USB port
blocking plugs can be used as a backup physical control,” Copeland says. BEST PRACTICES Copeland suggests a few sources to determine best practices. “ANSI/AAMI/IEC 80001-2 Application of risk management for IT networks incorporating medical devices covers wireless, distributed alarms systems, security controls, vendor responsibility agreements and more,” he says. “Medical devices share some of the same vulnerabilities and constraints with regards to network security as Industrial Control Systems (ICS). Some insight may be gained from NIST SP 800-82 Guide to ICS Security.” Also, AAMI TIR 57 Principles for Medical Device Security-Risk Management is an informative tool. He also suggests the online resource: The Healthcare Sector Cybersecurity Framework Implementation Guide available at https://goo.gl/kdc3X7. As mentioned earlier, there are partnerships that must be formed within health care systems to combat cyberthreats. The skills of many different departments will be required as new threats become more sophisticated and take more circuitous routes. “In order to effectively deal with emerging cybersecurity threats, a collaboration between HTM, IT and Information Security departments is highly recommended. This collaboration should address security concerns during any future medical device purchases, incident response, and with ongoing risk management efforts,” Leinonen says. With the insights provided by experts and established frameworks, along with a thorough updated inventory and cross-collaboration with other stakeholders, the HTM department can do its part to protect patients and their employer’s brand. As long as there are resourceful criminals, the challenge to protect entrusted information will be ongoing.
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EXPERT ADVICE
BY TODD H. ROGERS
CAREER CENTER I
f you’ve ever gone through an interview process that involved a recruiter, you might believe recruiters don’t seem to do a very good job when it comes to follow-up phone calls. You’ve probably been left in limbo at least once and the feeling of being disregarded is awful.
I visit social media sites on a daily basis. Over at LinkedIn you don’t have to search very far to find a rant or article written about some lazy recruiter who said he would follow up but never did. And, beneath that piece in the comments section is the ever-present battle between frustrated job-seekers and recruiters trying to explain how this game works. Let me, herein, provide a few of the common reasons that you might not hear back from a recruiter and some possible implications for the radio silence. First, let me go on the record and say that I fully realize how frustrating – if not downright aggravating – it can be to spend 15 to 30 minutes on the phone with a recruiter who asks all sorts of personal questions and then makes follow-up promises, only to have those promises evaporate. I also want to make it known to the reader that you likely have the feeling that if recruiters would just do a little better of a job following up, people might be more receptive to us when we call. I know that a lot of people that I deal with think people in my career field border on being scum-of-the-earth. What I want the reader to try and appreciate is that the work that we do as recruiters straddles the demarcation line between a person’s profession and their means to put food on the table. At once we deal with things that are exclusively work-related and also
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“When you want to make a change in the place where you trade your time for money, the exchange frequently involves a broker and that broker is the recruiter.” things that are incredibly private and personal. You go to work and trade your time for money, which you then use to take care of things that are personally important to you. When you want to make a change in the place where you trade your time for money, the exchange frequently involves a broker and that broker is the recruiter. Try and hold that thought as you read this. I try to never make it personal. I assure you that I’ve been shafted by plenty of candidates. Some of the less than scrupulous ones have gone onto forums and blogs and
TODD H. ROGERS Talent Acquisition Specialist for TriMedx
said nasty things about me, by name. As disappointing as that is, I just keep quiet and take the high road. But, when the process seems to be going well and the suddenly you get recruiter radio silence, here’s a list of what may be going on: • Volume of people, volume of open jobs. This is the most likely reason that you’re not hearing back. I’ve got a lot of open jobs I’m working on and that means I’m speaking with a lot of people. I speak with candidates, hiring managers, decision-influencers, my boss, my boss’s boss, her boss’s boss, VPs, their administrative assistants, travel agents, vendors, and the list goes on. I also spend lots of time reading through resumes and cover letters, processing newly hired people, and I generally have about two or three projects that have nothing to do with filling the jobs that I presently have open. “But it’s just one phone call to give me an update,” you say. Yes, it is. It’s also one more phone call that gets added onto the list of the dozens that I make each
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EXPERIENCE MATTERS day. There has to come a point where a recruiter turns it off and goes home. • You’re the likely runner-up. I call 100 percent of runner-up candidates to give them the bad news. But, while one process is coming to a close, two or three other processes are beginning and between other calls, I’ll admit it, I call the active candidates first. It’s just business. • You’re an excessively needy candidate. This one might sting for some people. But, the fact of the matter is, some candidates are just very needy and can’t stand to let the sun go down and not have contact with the recruiter. If you’re on the needy side and you succumb to the temptation to call the recruiter five or six times before lunch, please know that we live in the era of caller I.D. Your recruiter is sitting at his or her desk each and every day and your calls and emails are most certainly being received. And bear in mind that for each step in the interview process, there are multiple related processes that are outside of the recruiter’s control. So, we must wait. Now, here’s something important to consider: if you’re needy during the interview process, it’s a safe bet that you’re likely to be a needy employee. I’ve never had a hiring manager tell me, “What we are really looking for is someone who’s needy, someone who seeks a lot of validation or confirmation.” So, the take-away from this is, if you’re demonstrating excessive neediness, it’s probably affecting your perception of the recruiter’s follow-up tempo. It’s probably also affecting your success at landing the next awesome job. • You simply don’t deserve a call. We receive dozens to several hundred applications each day. Many of those people applying have very little to no chance of moving through our process. With the speed of the Internet, you can apply to dozens of companies before
getting out of bed. That makes for saturation. On the recruiter’s end, that means we must screen out dozens of resumes each day. Please accept my apology in advance. The quantity of inbound applications makes it impossible to contact everyone. At times, I get an irate voicemail from someone who applied and is of the belief that because he or she applied, a phone call is expected. That’s wrong. • Your resume is so poorly written that I simply decide it’s not worth my time. This one saddens me. All you need to do is search the Internet for resume writing, make a draft copy, and circulate it among people you trust. Microsoft Word also has all sorts of spell-check and grammar-check tools that mean that you really don’t need to do much work. It’s about making a good impression and a poorly written resume signals that you don’t care enough and that is plenty of reason to move on to the next resume. • You’ve upset enough people or established a pattern of poor performance or bad behavior. Bad decisions are part of life and everyone makes them. Along the way, it’s a near certainty that you’re going to make an enemy or two. At some point, the stars will align and karma will show up. A nugget of dirt might point directly at your character and if it fi nds its way to the recruiter, you probably won’t get called back. As an anecdote, I get a monthly voicemail from a guy that has twice walked off the job; he just stopped showing up. I don’t call him back and I really believe that he has no idea why. It would be nice if someone sat him down and explained the fundamentals about showing up for your job, even if you don’t like your job. I can say for sure that I will not be that guy. Because in order to do so, I would actually have to call him back.
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EXPERT ADVICE
BY MIKE DAVIS
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Because Quality Matters ISO 9001:2008 CERTIFIED
ULTRASOUND EXPERT Pictures, Documenting and Wiring
I
recently received a call from a technician whose ultrasound machine had no video display. After running a few tests, we discovered the graphics card was defective so I ordered a replacement card – A few days later, during my follow up call with the technician, she informed me the system was still having the same issues and shared with me that she had a different technician install the card because she was out of town when it arrived. First, I had her check to ensure that the card was installed correctly and that all the cables were attached. After all the possible hardware failures were ruled out, I had her check the cabling again. It turned out that the technician who originally swapped out the cards had plugged the output of the card into the incorrect port. Because neither technician had taken pictures before servicing the system, they did not know that the cabling was wrong. I simply had her wire the cables up correctly and the system booted.
Since I am building a knowledgebase for ultrasound troubleshooting I asked two vital questions:
1 2
Why was this not detected earlier in the diagnostics? How can such a simple mistake have been made?
To answer these questions, I looked at another call that had similar issues. A technician had been sent to replace a defective board. While this board had nothing to do with the video, after replacing the board a working system suddenly had no video. When the technician was replacing the board, he needed to remove all the cabling from the back of the system. When the cables were re-installed two of the wires were crossed. Instead of going to the monitor, the main display was going to the touch panels. This happened because the technician did not take
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MIKE DAVIS Tech Support Specialist at Conquest Imaging
pictures of the system before he removed the cables, a decision that cost the technician unnecessary frustration. Not just video card ports, but hard drive cabling, power cabling and USB cabling can cause you all sorts of issues. Everything looks correct and nothing is loose so why does it not work? “My
control panel does not function.” “My CD is not reading.” “My printer does not print.” Ultrasound machines require that every cable and every plug be in a specific place to work correctly. As an example, Universal Serial Bus's are no longer universal. You cannot assume that it’s all wired correctly, you need to verify. The best verification method is to take a quick pic with your mobile device before changing anything. Save yourself time and frustration – take pictures before starting, while you are servicing, and slow down. This method has saved many hours of frustration and made me the hero of many service calls.
For more ultrasound technical tips and tricks, or to view technical support videos visit www.conquestimaging.com. Conquest Imaging Technical Support is available 24/7/365 at 866-900-9404. – Mike Davis is a tech support specialist at Conquest Imaging.
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BY ROGER A. BOWLES
THE FUTURE The Professional BMET
F
irst, the good news. After a couple of years of declining enrollment, our department has seen a pretty good uptick in enrollment with the fall semester. With an incoming class of nearly 60 BMET students and an overall enrollment of over 130 students, we are very hopeful for the future.
Right as the semester began in late August, the BET club officers asked me if I would present at a club meeting about “professionalism.” A little hesitant at first due to the broad nature of the topic, I decided to dig in the best I could. I also invited other faculty members to join me for sort of a panel discussion. Usually these club meetings have about 20 to 30 members present (probably because they offer lunch) so my plan was to go around the room and ask for input on what professionalism for a Biomedical Equipment Technician might look like, discuss what it meant to me and the other faculty members present and then put it all together. Sounded like a good plan until we had over 50 people show up. I’m glad I had a plan “B.”
“professional.” I thought I knew what it meant to me and I could point to people and examples and say “he or she is a professional.” But when it came down to defi ning it, exact words and meaning escaped me. So I went looking for answers … starting at the place where most old people go for answers … that storage depository for antique documents, the library. From there, I searched periodicals and the Internet for articles relating to professionalism. The Merriam Webster defi nition for Professionalism is: the conduct, aims, or qualities that characterize or mark a profession or a professional person; or the following of a profession (such as athletics) for gain or livelihood. For
"Keeping calm, cool and collected when dealing with irate customers under tense conditions, separates the professional from the amateur." During my education, I had plenty of opportunities to research leadership and I have read and analyzed many books and articles on leadership and leadership styles, the difference between leadership and management, types of leadership (i.e. Servant Leadership), etc. But I can’t remember doing much on what it meant to be a
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me, that was rather vague. Looking around a bit more, I found an excellent article/post on LinkedIn by Daniel W. Porcupile, a retired Marine and management consultant, which broke down professionalism into 7 components. Since he wrote that article in 2015, it has had over 50,000 views. I believe it is a good start for
ROGER A. BOWLES MS, EdD, CBET, Texas State Technical College
our BMET students. So for the meeting, I took his main points and customized them to fit the Biomedical Equipment Technician profession. I have shortened the presentation somewhat for this article because of space limitations. The fi rst component of professionalism, according to Porcupile, is Specialized Knowledge. Think about it, HTM professionals have a very unique knowledge and skill set. Very few people even think about how medical devices operate or what they do, much less analyze, troubleshoot and repair them. Students pick up the fi rst small part of their specialized knowledge by earning that degree. They must continue to build upon that specialized knowledge for the rest of their careers in order to remain successful and relevant. The second component Porcupile lists is Competency. BMETs must be able to do what is expected of them and do it well, without making excuses. They fi nd solutions to problems and
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have the ability to use resources to complete the job. They continue to build expertise in their own areas of responsibility as well as expand their horizons into other areas. Honesty and Integrity are Porcupile’s third component of professionalism. BMETs do the right thing. They treat medical equipment as if they or their family members will be the next people to use it. They do not take shortcuts when doing PMs or repairs, even if it means taking a little longer to do it right and return the device to the customer in a more pristine condition than when they received it. They do not show up late for work or leave early. And if they do not have the expertise necessary to do a job, they ask for help. They keep their word and their commitments sacred. Porcupile’s fourth component of professionalism is Respect. BMETs treat everyone in the health care facility with respect. This means saying hello to the janitorial staff with the same enthusiasm and respect shown to doctors and administrators. This means being polite to everyone. The fifth component, according to Porcupile, is Accountability. Own your mistakes and learn from them. Do not blame others for your shortcomings or make excuses when your performance doesn’t match your intentions. A very important part of professionalism for BMETs is Self-Regulation. The ability to retain your composure under pressure is critical. Keeping calm, cool and collected when dealing with irate customers under tense conditions, separates the professional from the amateur. And last but not least, Porcupile includes Image. Image plays a big part in how the BMET is perceived in the workplace. This has been harped on for years in our community and it is still key for our success. The tech with the wrinkled, disheveled look and a mustard stain on his shirt isn’t going to fare well in our business. As my colleague, Victor Fowler, tells our students, that first impression is key and you don’t often get a second chance to change it. We encourage our students to watch their body language, their speech, their manners and their dress. While all of these are important all of the time, they are critical when a technician is brand new to the work place. This is a shortened version and I’m sure it is not complete. Many of you probably have several other components of professionalism that I missed but I thank Daniel W. Porcupile for coming up with an excellent list of teaching points that we can use with our students.
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BY GEORGE HAMPTON
TECH TIPS Work Life Balance
I
have been in the clinical technology field for over 30 years. Most of my friends are also health care professionals. It became apparent to me early on that health care people are a special breed. My experience is that we frequently have a different view of working hours and off hours. Many of us carry pagers or cellphones that connect us to work basically 24/7. Many of us understand that we have a career much more so than a job. Our individual contributions are mission critical, and this mission is very important. We contribute directly to the healing ministries of our workplaces by ensuring the important technology they use is safe and in correct working order.
This is why I have a great feeling of satisfaction when I consider my career. I love being a part of such a noble industry. But with this great sense of responsibility can come the challenge to balance our connection to work with our need for personal time. It is tempting to do a value comparison between what we accomplish and contribute in our professional life to what our home life requires. And that is precisely what goes sideways for us when we attempt to divide our time. Here is what I believe: Living holistically at home and leisure is as important to our career as our daily work requirements. Beyond the obvious, as human beings and adults, we need to take care of our loved ones and seek to be good citizens. We must also consider our own mental health. Burnout in the health care setting is particularly destructive. Most typically, our shops are staffed very lean; we have specific areas of specialized skills that are not duplicated within our work group, and
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we have very little supervision. These are great motivators and satisfiers in our industry, but with the wrong mental state, they become damaging, if not dangerous. As a manager of a shop, and over the years in leadership, I have seen the onset of burnout in the best of us. Techs lose focus, and PM performance falls off. Normal shop banter turns sour and people retreat into their own heads. Our shops are typically so much like a family, and that family can become dysfunctional. Conversely, if we don’t focus on our personal time as well, we can see difficulties at home. Our spouses and children might not understand our level of connection to our job. I know I never got into the habit of discussing my workday with my spouse or children; I never felt it was necessary. That was most likely a mistake on my part, and now with lots of business travel, I am a bit of a ghost at times. I have to resist the temptation to try to fi x all the things I wasn’t a part of while I was gone, or
GEORGE HAMPTON President of Tech Knowledge Associates
critique their survival methods in my absence. Who knew life would be so difficult? I will admit, I draw more wisdom from observing others than I have gained on my own behalf. I have been exposed to people who do a great job with work life balance. So, how do we combat all these potential pitfalls and learn how to create work life balance?
1
Don’t pretend you are two different people divided by a time clock. You can use your technical skills for hobbies, missions, or volunteer work. It’s always good to go with your strengths.
2
Look for ways to knit your family relationships into these activities. You can’t have real balance without including important personal relationships.
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Consider your own health. Hobbies that are physical in nature can give you a double win. As we grow older, we need to make a greater effort to maintain our health. Good health opens up the door to much more activities to feed our need for fun and adventure. Just don’t get too carried away like I do. My mountain bike helmet has the scuffs and dents to prove my fool hardy sense of adventure can get out of hand.
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Encourage your co-workers. As I mentioned, my co-workers are my primary source of friendship. I have had the opportunity to do many new and fun things because my buddies at work have hobbies and skills that I didn’t have. Of course, everyone has their own likes and dislikes. My likes tend to run toward outdoor activities. Spending most of your life in a building in the basement can cause a great craving for open skies.
You will be the only judge of what is best for you. If you truly are stuck in a rut and have poor work life balance, you need to make a giant leap and become purposefully intentional. That means sitting down with a calendar and scheduling personal time, and be detailed, “This Saturday I will go …”. If your job is forcing an imbalance in your life, sit down with your boss and discuss the factors causing the issue. A good supervisor will want to work with you to ensure you take the time you need outside of work to be the best you can be at work! Good luck and have a blast!
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EXPERT ADVICE
BY ALAN MORETTI
THOUGHT LEADER Hurricanes Provide Wake-Up Calls
Y
ou don’t have to live in the hurricane belt to be prepared for extreme emergency scenarios and have a plan in place to overcome them. Disasters come in many forms – natural and man-made – and can strike with little or no notice quickly affecting the HTM landscape. Tornadoes, heavy rains and flash floods are just a few of the many disaster events that can impact entire geographic populated areas including places of business and public service locations such as hospitals and other health care provider locations that the general population relies upon as a safe haven.
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immense in not only effort but also cost. Medical equipment that was not properly shut down during the natural disaster is susceptible to power brown-out and other electrical disturbances that tend to be one of many harmful side effects of a natural disaster. Damaged power supplies and critical electronics of the medical equipment are usually causalities of these adverse conditions. Liquid cooling supply systems, such as chillers associated with many advanced imaging medical equipment, can become affected by natural disaster flooding or their heat-exchanger jackets may have contaminated cooling water introduced in the system causing both short and long-term flow and bacteria issues. It can take weeks, if not months, from the post-disaster recovery period for many of the immediate diagnosed medical equipment failures to be rectified and add even more challenges. Some
ALAN MORETTI Healthcare Technology Management Advisor
symptoms leading to equipment failure may not show themselves clearly for six-months or more. Lessons learned from natural disaster experiences such as the most recent hurricanes provide a wealth of knowledge regarding the value of preparedness and readiness. These lessons need to be thoroughly learned from and put into immediate disaster planning initiatives. They should be incorporated into your organization’s MEMP. A saying many of us may be familiar with is that hindsight is 20/20. Take advantage of this very valuable rear view vision!
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MS16626
Natural disasters such a Hurricane Harvey and Hurricane Irma remind us how important it is to have an up-todate disaster plan in place that’s ready to be implemented at a moment’s notice. HTM professionals train to be reactive to service events, but how do we prepare to be proactive and prepared for service events caused by a natural or man-made disaster? Perhaps your hospital’s Medical Equipment Management Plan (MEMP) speaks to this type of readiness? Here is a challenge for HTM service professionals, pull-out your organization’s MEMP and see if it speaks to how your organization is to be prepared at all times for natural and man-made disasters. It is highly likely that it does not speak to it in detail or maybe not all! The medical equipment clean-up which always follows natural disasters such as Harvey and Irma can be
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EXPERT ADVICE
BY ABDUL ALSAADI
SODEXO INSIGHTS Clinical Engineering Enhances Delivery of Services
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C
linical engineering is responsible for the application of technology in enhancing delivery of services. Technology-driven medical companies have been focusing on developing technological tools that foster cheaper, faster and efficient service delivery. The health care industry has witnessed a fast increase in the application of sophisticated medical diagnostic and therapeutic tools.
Health care observers such as the Cleveland Clinic agreed that application of technology in the medical system has resulted into reduced overall medical costs and increased safety and survival rates. According to a National Institute of Advanced Industrial Science and Technology study, advancement in clinical engineering technology will be a mainstream endeavor in the future of medicine and clinical practice. This does not dismiss the already available application as seen and used in many hospitals across the nation, and the long way the technology has come and evolved through different civilizations. However, with the practical approach of biomedical research, more sophisticated therapeutic and diagnostic equipment is made available and applied in the health industry. Despite the rising concerns as to whether or not patient safety is appropriately addressed, technological
development in this field has been focusing on measuring physical and chemical variables and signals emitted by human beings. This has enabled doctors to detect diseases early enough and efficiently manage treatment. Necessities such replacement equipment planning, compliance requirements, effective acquisition processes, risk assessment and mitigation, device integration and alarms management in medical facilities and patients’ homes are key areas emphasized by clinical engineers so as to ensure effective use of equipment and patient safety. Clinical engineering technology has been applied widely in many hospitals, but its full potential has not been realized because of the peripheral roles of the clinical engineers. Much of the clinical engineers’ work involves regular equipment testing and preventive maintenance which is less important today. Their efforts should be redirected to
“Clinical engineering technology has been applied widely in many hospitals, but its full potential has not been realized because of the peripheral roles of the clinical engineers."
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ABDUL ALSAADI BSBE, MSBE, PH.D.
more critical needs that are currently going unchecked to enable safe and effective use of medical technology in health care. Carrying out strategic capital planning that ensures the acquisition of adequate information concerning particular hospitals guarantees new system deployments and/or prioritizing of any replacement plans. Performing risk and vulnerability assessments to identify systems with critical risks and vulnerabilities is particularly important to ensure planning of timely mitigation to any identified risks. According to one white paper, the alignment of clinical engineering services to the needs of a specific hospital is vital to the effectiveness and efficiency of services provided. This is determined by
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establishing whether the clinical engineers routinely participate in all medical systems evaluations, manage and document all medical equipment services, collaborate with IT experts on medical device integration and comply with the various standards and requirements such as those by the Joint commission, CMS, ONC and the AAMM. Clinical engineering is without a doubt a critical feature in the health industry and will continue to heavily impact health care providers’ ability to prevent, diagnose, treat and cure various diseases.
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BY MANNY ROMAN, CRES
ROMAN REVIEW Blame the Event Boundary
I
t is really tough being a young man in an old man’s body. Mentally, I am somewhere around 22 and physically I am around 122. I am not complaining. I am just coming to a realization, an acceptance of reality actually.
The TV volume continues to creep down on me even as Ruth’s hearing continues to improve. I don’t read quickly enough to understand the captioning and still see the show or movie. I am exhibiting the head nod and smile of incomprehension when others speak to me. Since mostly the conversation proceeds as though the speaker did not notice, I assume that most conversations don’t contain items of importance. I walk into rooms wondering why I entered them with very little chance of recalling the reason. Wait! I recall some research regarding this effect. I think I wrote about it before. Let me find it. OK, here goes. Back in 2011, a University of Notre Dame psychology research team identified what is called an “Event Boundary.” When I wrote about it
MANNY ROMAN, CRES AMSP Business Operation Manager
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“When I wrote about it [event boundaries] a long time ago, I was somewhat surprised that scientists did not study this effect sooner. ”
a long time ago, I was somewhat surprised that scientists did not study this effect sooner. Although I did not know what the scientific community would call the effect, I knew of its existence for most of my life as a trainer. My own, unscientific research established its existence way back over 40 years ago. The effect continues to be proven over and over. As an instructor, I discussed a topic in the classroom, queried the students for understanding and even gave written quizzes to verify the knowledge. The students got it. There was no doubt that they understood and internalized the topic. I did a great job transferring the information. Then, we would go to perform the laboratory exercises. In the labs, the students had forgotten everything we discussed. If it were not a serious situation, it would be amusing to see a bunch of zombies wandering around aimlessly. I would even ask them to turn to their notes and the information would be there, in their own handwriting. They just took the notes five minutes before.
I got to the point of telling the class, while still in the classroom, that we had installed an erase mechanism in the doorway. The mechanism would erase their memory of all that we discussed in the class. Some of you would recall me telling you this but the mechanism did its job here also. The Notre Dame research verifies the erase effect. The researcher said, “Entering or exiting through a doorway serves as an ‘event boundary’ in the mind, which separates episodes of activity and files them away.” Yep, I knew this. It files it away apparently in write-only memory, never to be seen again. The article says, “…the doorway or “event boundary” impedes one’s ability to retrieve thoughts or decisions made in a different room.” You encounter this effect when you leave one room to do something in another room. How often do you forget why you went there? You then have to go back to the original room, to the exact spot where you were when you made the decision. The memory then floods back and you feel a
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little stupid for having forgotten such a simple task. Now that I remember that the effect has a scientific name, I will use this to my advantage. When I forget things now I shall blame the event boundary rather than old age. It makes perfect sense that the vast majority of what I learned happened in some room a huge distance away from the one in which I find myself at any point in time. I surely navigated many, many doorways since the information entered my brain. Therefore, what we call old age, spacing out, brain flatulence, etc., is actually a natural effect of having walked through so many doorways over a lifetime. It makes sense that the older you are, the more doors you walk through, therefore the more you forget. So how can we prevent and even erase this effect? We walk through doors facing the exit from the room. The event boundary effect occurs when we do this. Logic dictates that the event boundary effect could be eliminated by backing through doorways. The mind is a wonderful thing. It can be fooled. When the mind perceives us as not leaving but entering the same room where we made the decision, it will not forget what we wanted to do. My own experiments verify this. Try it. It works. Walk backwards through the doorway when leaving a room. It will improve your memory and generate new conversations when people see you do it. Additional scientific research by trained professionals may be required before everyone is convinced to exit backwards through doorways. I vaguely remember sending a letter outlining my discovery to Notre Dame, however the expected research grant never appeared. Bottom line, walk backwards my friend.
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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-november-2017. Good luck!
SUBMIT A PHOTO Send a photo of an old medical device to editor@mdpublishing. com and you could win a $25 Amazon gift card courtesy of TechNation!
OCTOBER PHOTO Late 90s Test Lung submitted by Carol L. Wyatt, MPA, CHTM, CBET, Director, Northern Region Healthcare Technology Management
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BULLETIN BOARD
A
n online resource where medical equipment professionals can find all the information needed to help them be more successful! The easy to navigate Bulletin Board gives you access to informative blogs, expos and events, continuing education opportunities, and a job board. Visit www.MedWrench.com/BulletinBoard to find out more about this resource.
Career Opportunities
The Importance of Training and Education- A Q&A with Ken Hable of Technical Prospects Ken Hable of Technical Prospects shares his insights on the importance of training and continuing education in the medical imaging field during a Q&A with MedWrench.
Q: Please explain the importance of continuing education as it relates to this field.
Because Quality Matters.
Conquest Imaging is Hiring a Technical Trainer Conquest Imaging is always looking for good talent. Do you thrive as part of a committed team? Do you love to find creative solutions to old challenges? Do you want to make an impact and help your company and your career advance together? Are you passionate about helping ultrasound healthcare providers deliver better diagnostic patient care? If you answered yes to any of these questions, consider a career at Conquest Imaging.
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A: As professionals, Imaging Engineers need to be exposed to new technology and experience how the OEMs are implementing that technology in their new imaging systems. Continuing education is an excellent example of the “Evolve or Else� effect; if an engineer does not stay current with their training and experience they will eventually lose their ability to be effective.
What we have seen firsthand is that an engineer is only as valuable as their ability to work on current and evolving technology. New technology is always built upon older, established tenens within the industry but the speed at which technology evolves continues to become a shorter and shorter cycle. This reduced development and implantation timeframe equates to a higher demand for current knowledge and experience.
Read more here: www.medwrench.com/bulletin-board/
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INDEX
SERVICE INDEX TRAINING
SERVICE
PARTS
Company Info
AD PAGE
TRAINING
SERVICE
PARTS
AD PAGE
Company Info
Cardiovascular
Anesthesia A.M. Bickford 800-795-3062 • www.ambickford.com
85
Technical Prospects 877-604-6583 • www.technicalprospects.com/
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
24
Computed Tomography
Auction/Liquidation J2S Medical 844-342-5527 • www.j2smedical.com
29
Batteries PartsSource 877-497-6412 • www.partssource.com/shop
14
Biomedical
34
AllParts Medical 866-507-4793 • www.allpartsmedical.com
40
Exclusive Medical Solutions 866.676.3671 • emedicalsol.com
61
Injector Support and Service 888-667-1062 • www.injectorsupport.com
28
JDIS Group 800-974-9729 • www.jdis.com
18
KEI Med Parts 512-477-1500 • www.keimedparts.com
85
Philips 800-229-6417 • www.philips.com/mvs
3
BC Group International, Inc 314-638-3800 • www.BCGroupStore.com
BC
Crothall Healthcare Technology Solutions (800) 447-4476 • www.crothall.com
63
RSTI 800-229-7784 • www.rsti-training.com
50
D.A. Surgical 800-261-9953 • www.da-surgical.com
30
RTI Electronics 800-222-7537 • www.rtigroup.com
34
iMed Biomedical 817-378-4613 • www.imedbiomedical.com
71
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
Master Medical Equipment 866-468-9558 • masterfitmedical.com
45, 71
The Intuitive Biomedical Solution Inc 1-866-499-3966 • www.tibscorp.com
73
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
39
Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
58
Sodexo CTM 1-888-Sodexo7 • www.sodexousa.com
57
Injector Support and Service 888-667-1062 • www.injectorsupport.com
28
Maull Biomedical Training 440-724-7511 • maullbiomedicaltraining.com
63
Contrast Media Injectors
C-Arm Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
Diagnostic Imaging
Cardiology Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/
37
Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com
65
Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/
7
JDIS Group 800-974-9729 • www.jdis.com
18
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
Endoscopy 28
Cadmet 800-543-7282 • www.cadmet.com
80
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INDEX
Healthmark Industries 800-521-6224 • HMARK.COM
6
J2S Medical 844-342-5527 • www.j2smedical.com
29
Select BioMedical 866-559-3500 • www.selectpos.com
4
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
39
Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com
59
Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
BMES 888-828-2637 • www.bmesco.com
IBC
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
24
Monitors
Hand Switches inRayParts.com 417-597-4702 • www.minxrad.com
Monitors/CRTs 30
Imaging JDIS Group 800-974-9729 • www.jdis.com
TRAINING
SERVICE
PARTS
Company Info
AD PAGE
TRAINING
SERVICE
PARTS
AD PAGE
Company Info
18
Infection Control Healthmark Industries 800-521-6224 • HMARK.COM
6
Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com
35
Bayer Healthcare - MVS 1-844-MVS-5100 • www.mvs.bayer.com
43
Master Medical Equipment 866-468-9558 • masterfitmedical.com
45, 71
Exclusive Medical Solutions 866.676.3671 • emedicalsol.com
61
JDIS Group 800-974-9729 • www.jdis.com
18
MRI
Infusion Therapy FOBI 888-231-3624 • www.FOBI.us
25
KEI Med Parts 512-477-1500 • www.keimedparts.com
85
J2S Medical 844-342-5527 • www.j2smedical.com
29
PartsSource 877-497-6412 • www.partssource.com/shop
14
Master Medical Equipment 866-468-9558 • masterfitmedical.com
45, 71
Philips 800-229-6417 • www.philips.com/mvs
3
2
Select BioMedical 866-559-3500 • www.selectpos.com
4
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
24
Mammography
Nuclear Medicine Global Medical Imaging 800-958-9986 • www.gmi3.com
Online Resource
Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
Exclusive Medical Solutions 866.676.3671 • emedicalsol.com
61
RSTI 800-229-7784 • www.rsti-training.com
50
J2S Medical 844-342-5527 • www.j2smedical.com
29
MedWrench 866-989-7057 • www.MedWrench.com
67
Webinar Wednesday 800-906-3373 • 1technation.com/webinars
44
Oxygen Blender FOBI 888-231-3624 • www.FOBI.us EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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INDEX
SERVICE INDEX
50
Recruiting Sodexo CTM 1-888-Sodexo7 • www.sodexousa.com
Patient Monitoring
TRAINING
RSTI 800-229-7784 • www.rsti-training.com
73
SERVICE
The Intuitive Biomedical Solution Inc 1-866-499-3966 • www.tibscorp.com
PACS
PARTS
Company Info
AD PAGE
TRAINING
SERVICE
PARTS
AD PAGE
Company Info
CONTINUED
57
Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
Replacement Parts
BETA Biomed Services 800-315-7551 • www.betabiomed.com/
37
Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com
65
BMES 888-828-2637 • www.bmesco.com
IBC
Engineering Services, KCS Inc 888-364-7782x11 • www.eng-services.com
51
Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com
35
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
J2S Medical 844-342-5527 • www.j2smedical.com
29
Respiratory
Master Medical Equipment 866-468-9558 • masterfitmedical.com
45, 71
A.M. Bickford 800-795-3062 • www.ambickford.com
85
Pacific Medical 800-449-5328 • www.pacificmedicalsupply.com
8
FOBI 888-231-3624 • www.FOBI.us
25
PartsSource 877-497-6412 • www.partssource.com/shop
14
J2S Medical 844-342-5527 • www.j2smedical.com
29
Philips 800-229-6417 • www.philips.com/mvs
3
RTLS
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
39
Versus 1-877-9VERSUS • versustech.com/nowait
Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/
37
Software
Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/
7
Pheonix Data Systems 800-541-2467 • www.goaims.com
45
Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com
59
Versus 1-877-9VERSUS • versustech.com/nowait
2223
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
24
Surgical Healthmark Industries 800-521-6224 • HMARK.COM
X inRayParts.com 417-597-4702 • www.minxrad.com
30
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
2223
6
Telemetry
Radiology
BMES 888-828-2637 • www.bmesco.com
IBC
Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com
35
Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
J2S Medical 844-342-5527 • www.j2smedical.com
29
RSTI 800-229-7784 • www.rsti-training.com
50
Master Medical Equipment 866-468-9558 • masterfitmedical.com
45, 71
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
Pacific Medical 800-449-5328 • www.pacificmedicalsupply.com
82
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INDEX
TRAINING
SERVICE
PARTS
Company Info
AD PAGE
TRAINING
SERVICE
PARTS
AD PAGE
Company Info Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/
7
AllParts Medical 866-507-4793 • www.allpartsmedical.com
40
Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com
59
Ampronix, Inc. 800-400-7972 • www.ampronix.com
15
USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
24
Bayer Healthcare - MVS 1-844-MVS-5100 • www.mvs.bayer.com
43
Conquest Imaging 866-900-9404 • www.conquestimaging.com
11
Exclusive Medical Solutions 866.676.3671 • emedicalsol.com
61
Global Medical Imaging 800-958-9986 • www.gmi3.com
2
J2S Medical 844-342-5527 • www.j2smedical.com
29
Philips 800-229-6417 • www.philips.com/mvs
3
Test Equipment
A.M. Bickford 800-795-3062 • www.ambickford.com
85
BC Group International, Inc 314-638-3800 • www.BCGroupStore.com
BC
IMT Medical 181-750-6699 • www.imtmedical.com
19
PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
39
Pronk Technologies, Inc. 800-609-9802 • www.pronktech.com
5
X-Ray
RTI Electronics 800-222-7537 • www.rtigroup.com
34
AllParts Medical 866-507-4793 • www.allpartsmedical.com
40
Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/
37
Bayer Healthcare - MVS 1-844-MVS-5100 • www.mvs.bayer.com
43
Engineering Services, KCS Inc 888-364-7782x11 • www.eng-services.com
51
Exclusive Medical Solutions 866.676.3671 • emedicalsol.com
61
Philips 800-229-6417 • www.philips.com/mvs
3
RSTI 800-229-7784 • www.rsti-training.com
50
Training
Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com
65
ECRI Institute 1-610-825-6000. • www.ecri.org
69
RSTI 800-229-7784 • www.rsti-training.com
50
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
RTI Electronics 800-222-7537 • www.rtigroup.com
34
Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
58
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
58
Tubes/Bulbs Cadmet 800-543-7282 • www.cadmet.com
28
PartsSource 877-497-6412 • www.partssource.com/shop
14
Technical Prospects 877-604-6583 • www.technicalprospects.com/
34
Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
58
65
Ultrasound Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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(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) _______________________________________ _________________
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INDEX
Looking for Parts? Call KEI Med PARTS!
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Med
ALPHABETICAL INDEX A.M. Bickford ………………………
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85
JDIS Group …………………………
18
Advanced Ultrasound Electronics, Inc. 65
KEI Med Parts ………………………
85
AllParts Medical ……………………
40
Master Medical Equipment …… 45, 71
Ampronix, Inc.………………………
15
Maull Biomedical Training …………
63
Bayer Healthcare - MVS ……………
43
MedWrench ………………………
67
BC Group International, Inc ……… BC
Pacific Medical ……………………… 8
BETA Biomed Services ……………
PartsSource
37
………………………
14
BMES ……………………………… IBC
Pheonix Data Systems ……………
45
Cadmet ……………………………
28
Philips ………………………………… 3
Conquest Imaging …………………
11
PRN/ Physician's Resource Network
Crothall Healthcare
Calibrate, then Celebrate.
Riken FI-8000P Portable Gas Indicator
01 SIMPLE TO USE 02 RAPID ANALYSIS 03 NO CONVERSION FACTORS To order, or to request a price quote, call 800-795-3062 or email timk@ambickford.com.
39
Pronk Technologies, Inc. …………… 5
Technology Solutions ……………
63
D.A. Surgical ………………………
30
ECRI Institute ………………………
69
Elite Biomedical Solutions …………
35
Engineering Services, KCS Inc ……
51
Exclusive Medical Solutions ………
61
FOBI ………………………………
25
RSTI …………………………………
50
RTI Electronics ……………………
34
Select BioMedical …………………… 4 Sodexo CTM ………………………
57
Southeastern Biomedical, Inc ……
37
Southwestern Biomedical Electronics, Inc. …………………… 7
Global Medical Imaging ……………… 2
Technical Prospects ………………
34
Healthmark Industries ……………… 6
Tenacore Holdings, Inc ……………
59
iMed Biomedical ……………………
71
The Intuitive Biomedical Solution Inc 73
IMT Medical ………………………
19
Tri-Imaging Solutions ………………
58
Injector Support and Service ………
28
USOC Bio-Medical Services ………
24
inRayParts.com ……………………
30
Versus …………………………… 22-23
J2S Medical…………………………
29
Webinar Wednesday ………………
44
800-795-3062 | ambickford.com
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bmestelemetryad.pdf
BREAKROOM
“Technology is nothing. What’s important is that you have a faith in people, that they’re basically good and smart,
C
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and if you give them tools,
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they’ll do wonderful things with them.”
– Steve Jobs, co-founder of Apple Inc. 86
TECHNATION
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bmestelemetryad.pdf
1
7/28/17
12:09 PM
We Know Telemetry Inside and Out...
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CMY
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www.bmesco.com 888.828.2637
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WHY BUY AN ESU-2400? THERE ARE MANY GREAT REASONS TO PURCHASE AN ESU-2400:
ESU-2400H
AUTO-SEQUENCES
EASE OF USE
WAVEFORM GRAPHING
PDF REPORTS
TOUCH SCREEN
UPGRADEABLE
USB CONNECTIVITY
PROVEN RELIABILITY
CALIBRATE AND PM TO FACTORY REQUIREMENTS
HERE ARE A FEW REASONS YOU MIGHT NEED AN ESU-2400: The ONLY all-in-one analyzer validated to Covidien ForceTriadTM factory requirements and PM ± Meet the Spec: The ESU-2400’s DFA Measurement Technology makes it the only all-in- one device that meets the specifications for testing the Covidien ForceTriadTM • 1% Accuracy – Twice the accuracy of competitive devices • Crest Factor of 500 – 25 times the capability of competitive devices • Don’t take our word for it – See the ForceTriadTM Service Manual section 6-11 ± Save Time: Automated PM Procedure for the ForceTriadTM and Covidien Valleylab FT10 cuts time to perform the PM in half • Watch the video: esu.bcgroupintl.com ± Measurement Range up to 5500 mA needed to calibrate the ForceTriadTM ± Tissue Response testing available to measure and graph the current delivered during the tissue sealing process using the optional TRL-2420 ± Only Analyzer that can communicate with the DUT ± Uses factory stipulated Current Measurement Method
The ONLY all-in-one testing of Pulsed Output Generators
NEW VIDEO
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± Measures pulsed mode ESU generator output ± Provides Duty Cycle and Pulse vs RMS measurements ± Upgradable to the ESU-2400H, future-proofing for next gen pulse generators
The BEST all-in-one ESU Analyzer in the world ± Generates PDF test reports - Saves to internal memory, flash drive or network drive ± Waveform graphing for debugging and output analysis - No Oscilloscope Required ± Remote control capability for display function and SCPI command protocol is standard ± 3 USB Ports allow for the connection of a barcode scanner, keyboard, mouse or storage device Any of the trademarks, service marks or similar rights that are mentioned, used or cited within are the property of their respective owners. Their use here does not imply endorsement or affiliation with any of the holders of any such rights. Copyright © 2014 Covidien. All rights reserved. Reprinted with the permission of the Surgical Solutions business unit of Covidien. Copyright © 2014 Conmed. All rights reserved. Copyright © 2016 Olympus. All rights reserved.
Conmed System 5000TM
Olympus ESG-400TM (Plus numerous other models and manufacturers.) Phone: 1-888-223-6763 Email: sales@bcgroupintl.com Website: www.bcgroupintl.com ISO 9001 & 13485 Certified ISO 17025 Accredited
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