TechNation - February 2018 by MD Publishing

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Vol. 8

ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

FEBRUARY 2018

MERGERS & ACQUISITIONS GENERATE CHALLENGES

ADAPTING TO CHANGE

12 Company Showcase

Avante Health Solutions

24 Company Showcase

BMES

38 Biomed 101

Getting the Most from Clinical Engineering

46 Roundtable

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CONTENTS

FEATURED

46 52 46

HE ROUNDTABLE: T ULTRASOUND PROBES

Healthcare technology management professionals discuss the latest innovations and share maintenance tips for ultrasound probes and transducers in this edition of the monthly TechNation roundtable.

Next month’s Roundtable article: IV Pumps

MERGER & ACQUISITIONS GENERATE CHALLENGES: HTM ADAPTS TO CHANGE

Many health care systems are merging with competitors or buying out other health care systems. These mergers and acquisitions can create new challenges for HTM employees and departments with a shift in the corporate culture, new rules, different budgets, possible layoffs and other personnel changes.

Next month’s Feature article: Balancing Act: How to navigate quality and expenses while managing service risks

TechNation (Vol. 9, Issue #2) February 2018 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FEBRUARY 2018

TECHNATION

CONTENTS

INSIDE

PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Jayme McKelvey Lisa Gosser Renee Tyler

ART DEPARTMENT

Jonathan Riley Karlee Gower

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas John Noblitt Todd Rogers Manny Roman David Scott Cindy Stephens Steven Yelton

DIGITAL SERVICES

Cindy Galindo Jena Mattison Travis Saylor Kathryn Keur

ACCOUNTING

Kim Callahan

CIRCULATION

Lisa Cover Melissa Brand

WEBINARS

Linda Hasluem

Departments P.12 SPOTLIGHT p.12 Company Showcase: Avante Health Solutions p.14 Professional of the Month: Nathan Burks, CBET, CRES p.18 Department Profile: CHI Health St. Francis Clinical Engineering Department p.20 Biomed Adventures: An Armor-clad Biomed p.24 Company Showcase: BMES P.28 p.28 p.32 p.35

INDUSTRY UPDATES News and Notes AAMI Update ECRI Institute Update

P.37 p.37 p.38 p.41 p.42

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

P.58 p.58 p.60 p.62 p.65 p.66 p.68

EXPERT ADVICE Career Center Tech Tips Ultrasound Expert The Future The Other Side Roman Review

EDITORIAL BOARD

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

P.70 BREAKROOM p.70 Did You Know? p.72 The Vault p.76 MedWrench: Where in the World is Ben C.? p.80 Service Index p.85 Alphabetical Index p.86 Parting Shot Like us on Facebook www.facebook.com/TechNationMag

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

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SPOTLIGHT

COMPANY SHOWCASE A

vante Health Solutions is a cost-saving, onesource medical equipment company emerging at a time when medical facility budgets are pinched and consolidation is quickly changing the health care landscape.

The new and rapidly growing company is a complete medical equipment provider, giving its customers access to new and refurbished capital equipment, installation, service, parts and support. Through organic growth and targeted acquisitions, Avante has amassed a breadth of services that compete as a cost-effective alternative to major equipment manufacturers. Over the past few years, Avante has brought together experienced equipment providers across a range of medical equipment specialties, including DRE Medical Group, Integrated Rental Services, Global Medical Imaging, Pacific Medical, Oncology Services International and Transtate Equipment Company. Moving into 2018, each company will become a division under the Avante name, allowing them to work more closely to offer customers a unified purchasing and service experience. “The new name brings our family of companies together under a common theme and message,” Avante Health Solutions President and Chief Operating 12

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FEBRUARY 2018

Avante Health Solutions President and Chief Operating Officer Steve Inacker

Officer Steve Inacker said. “At Avante, we are dedicated to helping our customers stay ahead of the curve in a challenging health care cost environment.” The company’s forward-thinking strategy upholds simplicity, convenience, affordability, trust and innovation as core values. ONE CONVENIENT SOURCE Avante is leveraging the expertise and capabilities of its companies to deliver a one-source health care equipment solution to facilities across the U.S. In addition to new and refurbished equipment sales, Avante offers support throughout the life cycle of today’s medical equipment market – from sourcing and installation to repairs, service and refurbishing.

By relying on Avante as a single point of contact for their health care equipment needs, medical facilities can focus on what they do best: delivering quality care to their patients. UNPARALLELED VALUE Beyond changing the way medical facilities purchase and maintain their capital equipment, Avante is also striving to offer its customers a true value in today’s medical equipment marketplace. “Our primary goal is to continue to be recognized by our customers and the market as a high-quality, low-cost alternative to OEMs for the product and service solutions that we offer,” Inacker said. BRAND AGNOSTIC APPROACH Avante utilizes an unbiased, brand indifferent strategy that allows the company to outfit its customers with the best equipment for their unique needs. This includes either factory new or professionally refurbished equipment options from leading manufacturers. COMPREHENSIVE SELECTION & SERVICE The conglomeration of the Avante family of companies provides customers with unprecedented access to a complete range of equipment options for any facility type, size or specialty. WWW.1TECHNATION.COM

SPECIAL ADVERTISING SECTION

Avante is currently comprised of six companies, which will soon be adopting the Avante name in order to further unify the brand: •

•

DRE Medical Group, Inc., Louisville, Kentucky | Avante Medical Surgical Integrated Rental Services, Inc., Louisville, Kentucky | Avante Rental Services Global Medical Imaging, Charlotte, North Carolina | Avante Ultrasound Pacific Medical, San Clemente, California | Avante Patient Monitoring Oncology Services International Inc., Montebello, New York | Avante Oncology Services Transtate Equipment Company, Concord, North Carolina | Avante Diagnostic Imaging

AVANTE MEDICAL SURGICAL DRE Medical has been a provider of operating room equipment for more than 30 years, offering new and refurbished lines of anesthesia machines, surgical tables, surgical lighting, procedure chairs, defibrillators, respiratory ventilators, exam and diagnostic equipment and more.

AVANTE RENTAL SERVICES Integrated Rental Services adds the critical rental component to the Avante service offering. The company will provide JCAHO compliant medical equipment rentals to hospitals, clinics, surgery centers, doctor’s offices and other medical facilities. AVANTE ULTRASOUND Founded in 2002 as a “brand indifferent” ultrasound solutions provider, GMI has grown into an authority on cost-effective diagnostic imaging solutions in both the private practice and hospital markets. AVANTE PATIENT MONITORING Pacific Medical is a proven source of outstanding customer service and patient monitor, patient module, telemetry transmitter, fetal monitor, transducer, infusion pump and syringe pump sourcing. The dual ISO-certified company boasts the largest patient monitoring inventory in the industry. AVANTE ONCOLOGY SERVICES As a partner to hospitals and cancer centers since 1985, Oncology Services International Inc. (OSI) is the leading alternative to OEM service for linear accelerators used in radiation therapy. In addition to being a refurbished equipment provider, OSI also boasts the largest selection of LINAC parts in the U.S.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

AVANTE DIAGNOSTIC IMAGING For nearly 20 years, Transtate has provided a range of high-quality cath lab, CT scanners and nuclear camera solutions. Its hyper-focused approach has fueled company growth, allowing Transtate to construct a full-service staging facility that houses thousands of replacement parts and a multispeciality team of experienced engineers offering onsite repair services. FORWARD THINKING Avante’s belief is that in today’s environment, doing more with less requires a progressive strategy and a new way of thinking: that better health care starts with seeing a better way forward. Avante strives to be a better partner, budget alternative and total solution. Uniting the Avante family of companies will bring together the best-of-the-best in the industry and allow the group to provide comprehensive quality care to its customers. Avante is focused on growing within its current markets, as well as expanding into new and complementary markets.

For more information, visit https://avantehs.com. FEBRUARY 2018

TECHNATION

SPOTLIGHT

PROFESSIONAL OF THE MONTH Nathan Burks, CBET, CRES BY K. RICHARD DOUGLAS

eading south from Detroit, or west from Cleveland, you enter the city of Toledo, Ohio. A major provider of health care services in the area is the University of Toledo Medical Center (UTMC). The medical center was established in 1964 as a teaching hospital.

Among the medical center’s HTM staff is Nathan Burks, CBET, CRES, who is biomed team leader in the biomedical engineering department. Burks has proven that if you set your sights on something, you can achieve it. “Prior to being a biomed, I repaired electronics and built custom guitar amps on the side. I went back to school to fill in my electronics knowledge and found that biomed was a practical and secure field to be in, so I enrolled in the program at Owens Community College. When I began my internship, I knew I made the right choice. The variety of work and knowledge necessary for the job was a perfect fit,” he says. Burks says that one of the best biomed training programs is right there in Toledo. “I attended Owens Community College from 2005 to 2007 and received an associate’s in biomed. Part of the degree is a nine-month unpaid internship. I was lucky to intern close to my home at the University of Toledo

TECHNATION

FEBRUARY 2018

Nathan Burks, CBET, CRES

Medical Center,” he says. “I began my career in Tiffin, Ohio as a BMET I with Aramark CTS. An opportunity opened closer to home at the University of Toledo Medical Center (the site of my internship), where I accepted a BMET I position. I have been promoted twice since being here; BMET II and biomed team lead,” he adds. Burks is manufacturer-trained in several modalities, including anesthesia, dialysis, nuclear medicine, interventional X-ray and radiation therapy. He holds CBET and CRES certifications. His areas of specialty include nuclear medicine, radiation therapy, medical device IT security, dialysis and anesthesia. When an older piece of equipment gets the job done, its up to the biomed

to know how to maintain it. Burks learned that patience and attention to detail would have to make up for the lack of a mentor on this particular job. “We have a nearly 30-year-old nuclear camera that our NucMed department loves for certain studies. Recently, a couple of photomultiplier tubes wouldn’t peak and needed to be replaced. I pulled one of the suspect tubes only to find that the coupling grease was deteriorated and all of the tubes needed to be recoupled with brand new grease,” Burks says. “I removed each tube, cleaned them, cleaned the crystal, and recoupled the tubes. This was the first time I had ever recoupled a tube, let alone many tubes. After identifying and replacing suspect tubes and repairing other mechanical connection issues, the camera tuning went smoothly and it is still working perfectly months later,” he explains. SERIOUS CYCLING In his off-time, Burks is all about staying fit and spending time on two wheels. “I used to weigh over 300 pounds,” he says. “At some point in 2008, I decided it was time to take my health seriously and this meant getting active and losing weight. I lost the first 50 pounds working out on an elliptical

WWW.1TECHNATION.COM

SPOTLIGHT FAVORITE BOOK “The Romance of Photogen and Nycteris” by George MacDonald FAVORITE MOVIE “Blazing Saddles” FAVORITE FOOD My wife’s Mulligatawny soup and pecan pie HIDDEN TALENT Problem solving/troubleshooting ability FAVORITE PART OF BEING A BIOMED “The satisfaction of completing a repair and knowing that a patient will receive the care they need. I also like working with our interns to make sure they begin their careers off right.” WHAT’S ON MY BENCH? Coffee, my favorite soldering iron, a book of 19th and 20th Century paintings from the Art Institute of Chicago, flash drives with equipment documentation and notes, my Day-

Timer to keep track of activities for documentation purposes

Above: When not working on medical equipment, Nathan Burks enjoys being outdoors. Above he is seen participating in the Lowell 50 Gravel Grinder.

Right: This Philips PET/CT device is just one of the pieces of medical equipment that Nathan Burks helps maintain at the University of Toledo Medical Center.

nearly every day. I hit a plateau and had to change my eating habits to lose the next 75 pounds. My weight still fluctuates plus or minus 10 pounds, but I’ve kept the weight off for about seven years now by staying active and watching what I eat.” Burks has had many hobbies over the years, which have included playing guitar, tinkering with computers, photography and others. “My current hobby is cycling and trying to stay fit in general. I started out road cycling and commuting the short distance I have to work. I picked up a fat bike to commute in the winter and started riding mountain bike trails as well,” he says. “This past year, I started cycling on gravel roads (gravel grinding). Gravel roads are great because they can take

you to places you would otherwise not visit and there are fewer cars to deal with. I’ve ridden in several races and challenges, including Iceman Cometh, Funk Bottoms Gravel Grinder, Michigan Mountain Mayhem, Lowell 50 Gravel Grinder, Little Miami Dirty Dozen, Pittsburgh Dirty Dozen, and many others,” Burks says. “Me and a few guys like to create routes and abuse ourselves whenever we have time free. We completed a 213 mile-in-a-day road adventure this past summer, as well as many self-supported gravel grinders on hilly roads near Loudonville, Ohio,” he adds. On the homefront, Burks spends time with his family and gets out in nature. “My wife and I have been married 18 years and we have a seven-year-old son. My wife is a runner and recently

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

completed her first half marathon. My son loves to play Minecraft and harass our cats. The Toledo Metroparks are awesome, so you will find us at one of them at least once a week,” Burks says. For his efforts on the job, he won the Shining Star, an award given to outstanding UTMC employees. There’s little doubt why Burks was nominated for the award and to be featured in TechNation; he proves that when you set your sights on something, you can achieve it.

FEBRUARY 2018

TECHNATION

SPOTLIGHT

DEPARTMENT OF THE MONTH

The CHI Health St. Francis Clinical Engineering Department BY K. RICHARD DOUGLAS

hen you think of America’s “breadbasket,” you are thinking of an area of the country west of the Mississippi River and east of the Rocky Mountains. There are few cities that qualify better as being in the country’s breadbasket than Grand Island, Nebraska. On a map, it is near the center of the country as well as the center of Nebraska.

This is real middle America and the good people of Grand Island are part of a total population of 83,000 throughout the entire Grand Island metropolitan area. Serving the health care needs of these Midwesterners is Catholic Health Initiatives (CHI) Health St. Francis. “CHI Health St. Francis is a 159-bed hospital with a full range of services that include a cancer treatment center, long-term care, women’s imaging services and a variety of specialty clinics,” says Scott Ostrand, CBET, CHTM, manager of clinical engineering. The four-member team includes Ostrand, Duane Buss, Brian Glause and Josh Jolibois. Buss works part-time and previously retired from St. Francis. He has 27-years of experience in HTM. Glause brings many years of electronics experience and converted to HTM three years ago. Jolibois is a graduate of Bates Technical College in Tacoma, Washington, where he was enrolled in the biomedical technology program. Ostrand manages 18

TECHNATION

FEBRUARY 2018

Joshua Jolibois prepares a scope for repair.

clinical engineering for St. Francis along with three other hospitals in Nebraska. Jolibois specializes in X-ray, Philips monitoring, contrast media injectors and capnography. Glause specializes in anesthesia, ultrasound, interpretive electrocardiograph and capnography. Buss specializes in legacy equipment, patient monitoring, perioperative areas, NICU (infant warmers), electrosurgical units and defibrillators. They share general HTM duties. Because CHI is a national organization, service contracts are managed at the national level with input from the local CE department. “All requests for contracts must be requested through our CMMS (TEAM). There is a multi-stage process for getting a contract. First is the data input

stage, where all pricing, terms of the contract, duration, type and asset info are entered. Second is the financial review. We are able to run asset history reports to determine historical costs. If the contract is a renewal we gather information from the OEM to determine what the time and materials cost would have been without the contract,” Ostrand says. “We then submit this information along with a summary/justification form that reviews multiple service methods and associated costs. Service methods evaluated are full service, third-party, time and materials, internal insurance program (FIIL), PM only, first call, etcetera. Individual CE managers make the recommendations which are approved at National CE in Erlanger Kentucky,” Ostrand adds. Data collection is accomplished through the use of multiple modules within their CMMS. “The primary ones are for asset management and work order tracking. We also have a financial module, a contract module and a capital module,” Ostrand says. “Data input for the work orders is placed into the CMMS by technicians,” he adds. “The asset information is entered at a central area and must be selectable by existing model, otherwise further work must be accomplished in order to get this onto the standardized list. The contract module is managed locally, but approved nationally.” He says that all contract proposals WWW.1TECHNATION.COM

SPOTLIGHT

The CHI Health St. Francis Clinical Engineering Department includes (from left) Brian Glause, Joshua Jolibois, Duane Buss and Scott Ostrand.

must be reviewed for efficiency and only approved with a rigorous justification review. The capital module is a collective effort of all the various stakeholders. All members of the capital group receive notices of intent to purchase. This starts the process of obtaining capital. RESOURCEFUL DETECTIVES The team has had its share of projects and challenges and rose to the occasion for both. One challenge was project management for a Philips patient monitoring installation. “We provided project management services for the newest monitoring and telemetry install. We coordinated Philips with the clinical staff and provided updates to the executive team. Detailed as-built drawings depicting server, switch and port locations were kept for future references,” Ostrand says. “All infrastructure coordination, and network design, was reviewed by CE and IT. After the project started, inventory was completed and all devices were entered into TEAM with all standard rankings in place as well as a

PM schedule assigned. Post install, we coordinated the redistribution of unused assets to other CHI facilities. We are truly a one-stop shop for services, planning and a steward of resources,” Ostrand adds. Often, CE is called upon to put on its collective detective hat. The CHI Health St. Francis team recently found itself doing just that. “The current nurse call system has the ability to send text pages to the nurse phones. Recently we noticed an unusual amount of work order requests for repairs on phones. Perception was that texts – preprogrammed notifications based on nurse call alarms – were not being received or occasionally sent to the wrong person,” Ostrand says. “After investigation, we found that phones were being issued without the proper programming entries in the SMS server. Complicating the issue, was the improper programming entries in the nurse call system that assigned patient room alarms to the responsible nurse. After resolving the issue, we put processes in place to ensure the phones were released with proper programming. We also held training sessions with nurse directors and key

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

staff. CE also distributed the programming guide to key nurse managers for future reference, should these problems recur,” he adds. Another challenge, begging for a solution, had to do with the nurse call system at skilled nursing (long-term care). “An increased number of service requests started our investigation to the problem reported. Many patient rooms would start alarming as if there was no nurse call pendant plugged in,” Ostrand explains. “Although true, we found a large number of plugs that held the patient pendant were loose. Also, we noted that many calls came in where the pendant was completely out of the socket. After repairing the loose sockets, the calls continued (although fewer). We discovered that many nurses were clipping the pendant to patient wheelchairs and patients were rolling away without unclipping them. We installed a retention system, that was stronger than the clip, so that if the patient forgot to unclip, it would pull loose off the chair and prevent damage to the sockets and pendant cables,” Ostrand says. The CE team members are all members in the Heartland Biomedical Association (Eastern Nebraska/Western Iowa). Scott Ostrand was the 2017 president of the HBA and currently serves on the executive board. The CHI Health St. Francis Clinical Engineering team may be small in size, but they are big on efficiency and resourcefulness. FEBRUARY 2018

TECHNATION

SPOTLIGHT

BIOMED ADVENTURES An Armor-clad Biomed BY K. RICHARD DOUGLAS

hen you grow up in a family where skills and hobbies are plentiful it just naturally wears off. Robin Faut, MSIT, CBET, Network +, CAHMS, is the kind of guy who doesn’t let grass grow under his feet and, just like other members of his family, he pursued skills beyond his vocation.

“My father – a Ph.D chemistry professor – did woodworking, gardening, remodeling, and played the clarinet. My mother was a seamstress, knitted, crocheted, did caning of chairs, watercolor painting and was a good cook. All four of us children were expected to help – we were kept very busy,” Faut says. Faut is an HTM professional at Olathe Medical Center in Olathe, Kansas. His interests have taken him to the realm of knights and armor. “My friends talked me into going to the Kansas City Renaissance Festival, in costume. There, I found a book ‘Modern Chainmail in the Current Middle Ages’ and was introduced to the Society for Creative Anachronisms (SCA). At the end of the day I went home, quickly read the book, purchased drop ceiling hanging wire and a metal dowel rod, and starting making a chainmail shirt (a hauberk),” Faut remembers. “About the time I finished the hauberk, about a month later, I found contacts to the local SCA chainmail group. I then went on to make a head cover (coif) and pants (chausses). This first suit was a footman’s suit. I then built a horseman’s suit. Each suit 20

TECHNATION

FEBRUARY 2018

“I use hickory because it is an entangled grain. Some woods have very straight grains that do not take to bending well, while other woods have very entangled grain that can take bending, compression and stretching well,” he adds. Faut has mastered the art of bowmaking and pays careful attention to several factors that can effect performance and accuracy.

Robin Faut makes chainmail and long bows.

weighed about half my weight at the time I built it. The SCA taught me several differing styles of links in the chainmail and had me research the history of chainmail armor. (The SCA is a teaching organization per its charter),” Faut adds. His participation in the Renaissance Festival also led to an interest in archery and bow construction. “While in the SCA, I became active in archery. I have advanced that interest into building my own long bows,” Faut says. “While I started making the chainmail after reading one book; with the bows I read four or five books and still was not sure how to get started. I ended up finding a couple weekend classes on bow making at the local WoodCraft store. The process is surprisingly simple. As I work with commercially harvested wood, it has to be backed to prevent splintering, so I glue a fairly thin piece of bamboo to the back of a two-inch by two-inch by six-foot piece of hickory,” Faut explains.

MAKING BEER, COMPUTERS AND PENS For many people, participating in renaissance festivals, constructing chainmail and building precision bows would be enough, but Faut comes from a family of doers and he finds mastering pastimes a challenge. In addition to his other pursuits, he also brews beer and builds computers. “I started brewing because I tasted mead at the renaissance festival and liked it. I tend to like sweet white wines. Mead was completely unavailable at that time in liquor stores, so I found a brewing supply store that had books and I read. My first batch was very good and I continue to make mead,” Faut says. “My roommates at that time wanted me to make beer, so I made a simple beer that looked like an American beer (American beer is based on a German pilsner lager recipe) called pale ale.” His roommates liked the results but said they wanted a dark beer. “I found that I liked the dark ales I made. Each batch of beer or mead is five-gallons, which amounts to about two cases. The funny thing is that I do not drink much; these batches last me months to years, so I end up bringing my WWW.1TECHNATION.COM

SPOTLIGHT

Robin Faut also enjoys hang gliding.

brewing to gatherings of friends to drink. It takes about two months to make a batch of beer and anywhere from four months to over a year for the mead, and despite the fact that it is cheaper to buy the beer and wine from the store, I still like making it,” Faut says. Besides brewing beer, Faut has a hobby that is more closely related to his vocation. He says that building your own computer is simple and most biomeds know more about the electronics of computers than computer people with an associate’s degree. Faut earned an associate’s degree in biomed in his thirties. He started building computers long before he got into biomed. He was in his early twenties and a roommate was working for a computer store at the time. He said some PC clones were just starting to become available. He would use parts from dead computers and cobble a system together. He started building computers before consumers began using the Internet. “Realize that this is the time of the 10MB hard drives and 64KB to 1MB RAM memory in the system; the days of DOS and command lines,” Faut says.

“Floppies were 180K single sided, single density and were five inches wide with the drive about three inches high. I would connect the old 20MB MFM or RLL hard drives and run media tests for a week before using the drive. The CPUs were eight to ten MHz 80286 Intel processors. The only competition with Intel was the WIS80 processor. There was no Internet; modems might be acoustically coupled to the phone and were between 300 baud (that is about 300 bits per second) to 2,400 baud. Hard drives were so unreliable that you had to do a weekly backup, and I often had to restore a drive,” he says. Today, building a computer has evolved and become more plausible for the layperson. “Nowadays, there are plenty of books and YouTube videos that show how to build your own computer. It is much easier than the ‘old days’ as you do not need to enter track and sector numbers, IrQ numbers for each card and IO device or do jumpers for CPU and bus speeds; all these are now auto detected. The biggest reason not to is that it is more expensive to build your own than to buy one (almost by twice as

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

much). You do, however, have full control to build the systems to what you like and want,” Faut says. Faut has even tried his hand at hang gliding. “I spent four days in the hang gliding school, three days in a ground school where we ‘launched’ off a hill on short flights,” he explains. He took two 2,500 foot flights after being towed up to the height by an ultra light airplane and then let go. Another of his hobbies is using a small lathe to make custom pens. “Oddly enough, the easiest wood to turn for pens are fruit woods, I have used apple and pear from local trees,” Faut says. “Most of the pens I have given away, the latest give away was a lever action pen with purple hard wood that I gave away on Veteran’s Day to any vet that said that they had earned a purple heart. I also made several such pens, with other woods, that I gave to any service man I ran across.” It seems like renaissance festivals are an appropriate place for Faut, because with all the things that keep him busy; this biomed is something of a renaissance man. FEBRUARY 2018

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BRINGING NEW LIFE INTO

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SPOTLIGHT

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COMPANY SHOWCASE Bio-Medical Equipment Service Company

MES was founded 28 years ago in Louisville, Kentucky by Jim Evans and Jerry King. Their vision was to listen to the needs of their customers while also understanding the needs of their employees. Achieving this balance resulted in the growth of BMES that continues today. The company’s growth includes personnel and facilities.

BMES President and CEO Ed Evans continues to honor the founding philosophy insuring that BMES provides a quality repair service at a competitive price, listens to its customers while adapting services to meet their needs while maintaining a work culture that insures an experience that is “Beyond The Expected.”

W hat are some advantages that your company has over the competition?

Evans: While BMES is a business, we realize and appreciate that there are people on both ends of every transaction. When you combine this philosophy with the quality service we provide, we are confident our solution is second to none. Our centrally located repair facility also provides a unique depot repair advantage in that shipping times are reduced greatly. At BMES, we are sensitive to the fact that equipment

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FEBRUARY 2018

BMES President and Chief Operating Officer Ed Evans

“ We tailor the service experience to meet what the customer defines as good service.” repairs could negatively impact patient services, which impacts revenue generation. Our physical location allows BMES to receive equipment in need of repair quicker without expedited delivery charges. Our close proximity to shipping hubs also means that we get our deliveries first thing each morning and that positively impacts workflow. The biggest BMES advantage, however, is that we tailor the service experience to meet what the customer

defines as good service. This includes options such as pick up and delivery, true account management support and any special reporting requirements. BMES wants to provide an experience that is wanted by the end user versus us determining what service should be.

C an you explain the company’s core competencies?

Evans: It is easy to see that BMES is a medical device repair facility that specializes in patient monitoring equipment. However, what we have the capability to do is not as limited as it may sound. At our core, we repair electronics. It is important to distinguish this as it takes away some of the tunnel vision that the market has concerning the scope of what BMES provides. When you really think about it, it does not matter if the electronic components are in a medical device or something outside of medical; the components perform the same function. How those components come together to create the end result is different but a resistor is a resistor. We also offer free evaluations and never charge a bench fee. Providing our customers with a risk-free evaluation is not only a great selling point, but offers BMES a chance to identify industry needs and pain points. It is a true win-win scenario.

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SPOTLIGHT

W hat is on the horizon for BMES?

Evans: 2018 is a going to be a really exciting year for BMES. We are rolling out a new systems platform that will allow our customers real-time access to their repairs and where that repair is in the workflow. Additionally, the system will provide a communication platform so that sales, service and the customer are all always on the same page. Overall, it will really simplify the customer interaction while enhancing the overall experience. BMES has also developed a director of operations position to insure we integrate innovation into our organization. Benny Cissell is leading this position and his experience, focus and relationships will bring a new look to the operations of BMES. This effort ensures that BMES will continue to provide the customer experience with high quality service and the personal touch that leads to our Beyond The Expected vision fulfillment.

C an you share some company success stories with our readers?

Evans: A great example of going Beyond The Expected involved one of our customers in Indianapolis. After doing some telemetry work for this

“ As we prepare for the years ahead my commitment is to remain focused on people, quality, and a Beyond The Expected solution for all of the customers that choose BMES.”

particular facility, the telemetry units would not work once connected to the system at the hospital. After reevaluating the units and not finding any issues, we sent one of our technicians to the hospital to see what was happening. It turned out that they were using a very unique version of software. Upon learning this, instead of saying we were unable to support their telemetry needs, we purchased the software necessary. The customer was extremely satisfied that we did not send them elsewhere but instead invested in what was necessary to solve their issues.

I s there anything else you want readers to know about your company?

Evans: Simply put, we are thankful. In today’s world there are not as many businesses still around after 28 years of service. It’s a great joy to lead a

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company and serve an industry as long as I have had the opportunity to here at BMES. I acknowledge that this business exists because of the customers we serve. Thank you to all of the longtime and new customers that have allowed us to be your provider of choice. It is our mission to not just say we are providing a Beyond The Expected experience but to live that out. As we prepare for the years ahead my commitment is to remain focused on people, quality, and a Beyond The Expected solution for all of the customers that choose BMES. If you haven’t experienced the BMES difference yet, we invite you to allow us the opportunity to show you firsthand what you have been missing. Thank you for 28 years! We look forward to many more. For more information,

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INDUSTRY UPDATES

STAFF REPORTS

NEWS & NOTES

Updates from the HTM Industry CENTRAL FLORIDA BIOMEDICAL SOCIETY REORGANIZED A group of BMETS from Orlando, Florida have worked to reorganize and energize the Central Florida Biomedical Society in the area. The Society is up and running with a new website at www.CFBIS.org. Any BMET from the Orlando/ Central Florida region can join online and attend local meetings. CFBIS is under the umbrella of the Florida Biomedical Society (FBS). So, CFBIS will be involved with the annual FBS Symposium in Orlando. The next

Symposium will be at Disney’s Yacht Club Resort, December 6-9, 2018. All members can attend to the symposium and educational opportunities for free! “It is with great pleasure and excitement that we announce the new Central Florida Biomedical Instrumentation Society (CFBIS) is up and running! Please take a moment to check us out at online and become a member today! We are excited about bringing a forum for discussion and education for those who provide

technology support to the health care community in the Orlando/Central Florida region,” an introductory email from new CFBIS President Luis Galarza stated. “Whether you are interested in strengthening your network of contacts, furthering your career, or just in need of a few more BMET friends, CFBIS can be a worthwhile option for you.” • Check www.CFBIS.org for future updates.

SURVEY: HEALTH CARE POWER SYSTEMS UNEQUIPPED FOR DIGITAL AGE According to a new study commissioned by Schneider Electric, health care facilities are missing out on opportunities to reduce energy use and costs, avoid outages and improve patient satisfaction because their power distribution and management systems are not equipped to take advantage of the Internet of Things (IoT) and other advanced technologies. The survey of 150 health care executives and facility managers underscores the importance of reliable power distribution and management in health care facilities and highlights the opportunity to integrate IoT-enabled power solutions to better meet health facility objectives. On average, more than one-third (36 percent) of respondents – who represent hospitals, health systems, doctors’ offices and clinics, and other health care facilities – indicated their power distribution and management systems are more than five years old. Among

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FEBRUARY 2018

respondents from hospitals, more than half (51 percent) report their power systems are at least five years old. Not surprisingly, those same facilities report greater concern with power availability and reliability and energy efficiency from their current power systems than larger organizations. “A five-year-old power infrastructure is not necessarily a safety problem, but we’re living in the digital age where safety and efficiency are table stakes,” said Mohamed Shishani, EcoStruxure Power implementation leader, Schneider Electric. “What’s increasingly important in health care facilities is the ability to accommodate IoT devices and dataintensive medical equipment transforming patient care. These older systems were implemented before the benefits and power requirements of advanced, connected technologies were apparent. Improving patient satisfaction, operational efficiency and financial health calls for modernization

of these systems.” IoT-enabled power solutions help address health care’s biggest challenges Health facility leaders recognize the critical role reliable power plays in delivering quality patient care and satisfaction. The survey found more than half (51 percent) of respondents plan to invest in power distribution and management in the next 12 months. Among the top objectives driving this investment is patient satisfaction, cited by 84 percent of respondents as being important or very important. Power availability and reliability, improved safety and financial performance were also among the top anticipated benefits to be derived through advanced power systems. • This survey was conducted by Morar Consulting in October 2017 among 154 U.S. health care executives and facility directors and managers. Results of any sample are subject to sampling variation.

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INDUSTRY UPDATES

BD ESTABLISHES PRODUCT SECURITY PARTNERSHIP PROGRAM BD (Becton, Dickinson and Company), a global medical technology company, has established a Product Security Partnership Program that emphasizes collaboration across the health care industry to enhance cybersecurity of medical technology and devices. The new program has three primary components: • Participation with government agencies, industry associations and security researchers and their efforts to enhance cybersecurity in health care; • Collaborating with UL to use the ANSI UL 2900 cybersecurity standard and participate in the UL Cybersecurity Cooperative Research and Development Agreement; and • A cybersecurity vendor certification program where BD verifies third-party security technologies that are compatible with its products and perform as indicated. “Intelligent and connected medical technologies have transformed how health care providers diagnose and treat patients,” said Rob Suarez, director of Product Security for BD. “As cyber-attacks become more sophisticated and attempt to find vulnerabilities through an interconnected health system, medical technology companies, health care providers and government agencies need to collaborate even more to protect patients.” As part of its participation with government agencies, BD is participating in the National Institute of Standards and Technology (NIST) Secure Wireless Infusion Pump Program and created a white paper for secure design and architecture. The company also contributed to the Health Care Industry Cybersecurity Task Force to produce recommendations on how to improve cybersecurity across the health care industry. For any potential vulnerabilities in BD products, the company has made a strong commitment to coordinate vulnerability disclosure through the U.S. Food and Drug Administration (FDA), and National Health Information Sharing and Analysis Center (NH-ISAC). This commitment also extends to the Department of Homeland Security National Cybersecurity and Communications

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Integration Center (NCCIC), which acts through the Industrial Control Systems Cyber Emergency Response Team (ICS-CERT) to provide expertise on control systemsrelated security incidents and mitigations. BD is using ANSI UL 2900 as part of its design and development process to minimize risks and help reduce exploitation, address known malware, enhance security controls and expand security awareness. UL has longstanding expertise in safety science, standards development, testing and certification and worked with industry to develop UL 2900 to help manufacturers address cybersecurity vulnerabilities. BD has also volunteered to participate in the UL Cybersecurity Cooperative Research and Development Agreement (CRADA), a program established to help improve the nation’s cybersecurity. The CRADA project will support improvement in patient safety and security through the use and verification of UL’s Cybersecurity Assurance Program (CAP). For third-party cybersecurity products to receive certification, BD employs a rigorous evaluation of the technology to ensure it is compatible with BD products and performs as indicated. The certifications specify which BD products were tested and passed the evaluation so biomedical technicians will have reassurance that the third-party software is compatible with the specified BD product and does not interfere with the operation of the device. In some situations, BD is taking a unique approach with security technology companies by tailoring their solutions to the specific needs of BD products in a health care setting. Inaugural members of the cybersecurity technology certification program include Attivo Networks and Cylance. BD has verified for certain BD products that the BOTsink Solution from Attivo Networks provides an effective method for distributed deception and decoy solution for early threat detection, and CylancePROTECT, uses next-generation machine learning and artificial intelligence to provide a powerful next-generation anti-malware technology. • For more information about BD’s product security efforts, visit http:// www.bd.com/ProductSecurity.

FEBRUARY 2018

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SIEMENS HEALTHINEERS ACQUIRES FAST TRACK DIAGNOSTICS Siemens Healthineers has signed an agreement to acquire Luxembourgbased Fast Track Diagnostics (FTD), a global supplier of diagnostics tests that, unlike a clinical examination alone, can distinguish between viral, bacterial, or other infections in one test. By introducing FTD products to its molecular diagnostics portfolio, Siemens Healthineers is further investing in precision medicine and better patient experience through solutions that eliminate the need for repeat diagnostic

testing, reducing time and improving patient outcomes. The acquisition of FTD increases the menu of the Siemens Healthineers VERSANT kPCR Molecular System by over 80 assays and syndromic panels, transforming care delivery for its customers with a comprehensive solution for molecular testing of infectious diseases. In addition, FTD’s platformagnostic menu allows Siemens Healthineers to effectively serve a broader customer base.

“By integrating the high-quality and cost-effective solutions of Fast Track Diagnostics into our own cutting-edge molecular diagnostics portfolio, Siemens Healthineers continues to strengthen and expand its presence in the field of molecular testing and precision medicine,” says Fernando Beils, head of molecular diagnostics, Siemens Healthineers. “We are excited to introduce both FTD’s products and world-class team to the Siemens Healthineers family.” •

MEDICAL DEVICE SECURITY WORKSHOP OFFERED HTM professionals are invited to join a series of free interactive forums hosted by the National Health Information Sharing and Analysis Center (NH-ISAC) and Intermountain Healthcare on April 24-25, 2018 at Park City, Utah. The two-day workshop includes exciting and thoughtful discussions with

other health care providers, medical device manufacturers, payers and regulatory agencies. The schedule includes a medical device security workshop, a cybersecurity tabletop exercise and a payer management workshop. •

Registration is available at https://nhisac.org/ events/nhisac-events/security-workshop-at-intermountain-park-city-ut/. For information, contact Jon Crosson (jcrosson@nhisac.org) or Priyanka Upendra (Priya. Upendra@imail.org).

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INDUSTRY UPDATES

SPBS OPENS NEW HEADQUARTERS Advances in medical technology are revolutionizing health care delivery, creating an increasing demand for SPBS to service and repair the equipment needed to safely diagnose and treat patients. The company’s recent move to the DallasFort Worth Metroplex, one of the epicenters of the medical industry, positions it to meet this demand in Texas and throughout the country. With a company that is forecast to quadruple in size in the next 10 to 15 years, SPBS President and CEO Jeff Daugherty explains, “Hospital leaders tell us that managing these new technologies is one of their biggest challenges. We shoulder this responsibility by keeping their equipment operating optimally so they can instead focus on what they do best – overseeing the safety and well-being of patients.” Field service offices across the state of Texas and in Oklahoma, New Mexico, Arizona, Colorado, Missouri, New Jersey, New York and Florida, allow the company to offer clients local service technicians, which drastically cuts down on response time. SPBS has been using the field service model

throughout the Southwest region since its launch nearly 40 years ago. Local technicians offer customer-centric service that is increasingly important as health care facilities decentralize and consolidate. “In addition to supplementing labor for hospitals, our technicians go to off-site surgery sites, imaging centers, stand-alone emergency departments, urgent care centers, and physician practices – wherever the equipment is located. That’s why the demand for SPBS’ services continues to increase,” says Danny Mobley, the director of sales and marketing. “The health care industry is growing rapidly, and the technology that supports it seems to advance at exponential rates. We know that this move to the heart of the country will position us to be even more responsive to the needs of our clients.” Daugherty concludes, “As long as we have human beings, there’s going to be a need to service and repair medical equipment.” •

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BY AAMI

AAMI UPDATE

Webinars, Podcasts And Winning Gold WEBINAR SERIES FOCUSES ON LEVERAGING CMMS DATA Practically every healthcare technology management (HTM) department has a computerized maintenance management system (CMMS), but only a few are using these systems to their full potential, according to two consultants who literally wrote the book on optimizing CMMS use. Too often, a department’s CMMS becomes a time-consuming repository of “arbitrary data entry rather than a source of useful, actionable information,” explained Matthew Baretich, president of Baretich Engineering Inc. and co-author of “Computerized Maintenance Management Systems for Healthcare Technology Management (third edition)”. To help HTM professionals turn their CMMS into a useful “management” and “technician assistance tool,” Baretich and co-author Ted Cohen, an HTM consultant and part-time project clinical engineer at UC Davis Health in California, developed a six-part webinar series that started in January. “Our goal is to have everyone in HTM use their CMMS as a tool to help make their jobs easier,” Cohen said. “By learning how to collect, analyze, share, and use data, HTM departments can operate more effectively, which ultimately improves patient safety.” Each webinar in the series addresses one specific aspect of CMMS use, such as benchmarking, medical device integration 32

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with the electronic medical record, or developing an alternative equipment maintenance plan. “All of the sessions will cover how HTM folks can address these topics with data collection and data analytics using their CMMS,” Baretich explained. “They all will focus on ‘how to,’ with additional practical applications.” Upcoming sessions include: • Feb. 14: How to Do Benchmarking for Financial Management • Feb. 28: How to Do Benchmarking for Quality and Performance Management • March 14: How to Manage Medical Device Integration, Cybersecurity, and Other HTM-IT Issues • March 28: How to Select and Implement a New CMMS Program More information about the interactive webinar series is available at www.aami.org/CMMSwebinars.

NEW PODCAST PROVIDES TIPS FOR DEVELOPING AN AEM PROGRAM What’s the optimal way to perform preventive maintenance? Although implementing an AEM program can save health care facilities time and money, the concept has caused confusion for many in the healthcare technology management (HTM) community. There’s even a lack of

consistency when it comes to the basic definition. The Centers for Medicare & Medicaid Services (CMS) defines AEM as “alternate equipment management,” whereas The Joint Commission uses “alternative equipment maintenance.” “Frankly, it’s difficult to parse out when CMS, Joint Commission, and the other accrediting organizations actually require, and so I think that HTM professionals have been reluctant to jump into it,” said Matthew Baretich, president of Baretich Engineering and author of AAMI’s “AEM Program Guide: Alternative PM for Patient Safety.” In the latest episode of the AAMI Podcast, Baretich seeks to cut through the confusion by offering practical, real-world guidance for implementing a well-crafted AEM program and remaining compliant with applicable standards and regulations. This AAMI Podcast episode, along with more than 20 others, is available at www.aami.org/ podcasts.

WINNING THE GOLD, AAMI FOUNDATION SCHOLARSHIP PROGRAM EXPANDS The AAMI Foundation raised more than $110,000 in 2017 for its scholarship program as part of the “Going for Gold” campaign to the celebrate AAMI’s 50th anniversary, surpassing its ambitious goal of $100,000. Because of this outpouring of support, the Foundation will be able to expand the program this year from five scholarships to seven. “We are so grateful to the WWW.1TECHNATION.COM

INDUSTRY UPDATES

corporations, both large and small, and individual AAMI members and supporters for their generous contributions,” said AAMI COO Steve Campbell. “On more than one occasion this year, I’ve told a donor ‘You made my day,’ and I meant it. These donations go directly to the students who need the financial help.” Some of the most generous supporters in 2017 included Crothall Healthcare, Healthmark Industries, Medtronic, Becton Dickinson & Co, Alpha Source, UL, TriMedx, Sodexo, and DOTmed. Since the program’s inception, the AAMI Foundation has awarded scholarships to 21 students with diverse backgrounds and career aspirations, many of whom are now enjoying thriving careers in healthcare technology. “Make no mistake, these scholarships can shape a student’s career and life,” Campbell said. “For some, this support is the boost they need to continue their education and begin a rewarding career. It also means a lot to the healthcare technology management field to help fill vacancies resulting from a growing number of retirees and help groom future leaders.”

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BY ECRI

ECRI UPDATE In honor of ECRI Institute’s 50th anniversary, we are spotlighting the employees who made us who we are today. Here is a story from Mark E. Bruley, CCE, Vice President, Accident and Forensic Investigation; an employee of ECRI since 1975. After more than 42 years, I am honored to have worked for, and had my name associated with ECRI Institute. To have improved patient safety and medical device effectiveness has left me with a worthwhile career. It was the fall of 1974, my senior year at college, when I first heard about ECRI. My biomedical engineering professor at Temple University, Dr. Victor Schutz, said “There is a wonderful, unique institute in Philadelphia, The Emergency Care Research Institute, that does marvelous work researching and evaluating medical devices. We will visit them next semester.” Over Christmas break, when I was home in Baltimore, The Baltimore Sun published an article about a biomedical engineer and his research at Johns Hopkins University. I phoned him and asked to visit to discuss careers in the biomedical engineering field. He kindly accepted. After talking about his work, he recommended that for applied research I should consider ECRI. He introduced me to the head of the clinical engineering department at Johns Hopkins Hospital, who spoke very highly about ECRI, as did the other clinical engineers in Baltimore to whom he had referred me. They all had Health Devices Journal, ECRI’s flagship publication, in their offices. A few weeks later, I applied for a position at ECRI as a Project Engineer and had two days of interviews in early January 1975. Between the two interviews, I toured ECRI with one of my biomedical engineering classes. On the day after the second interview, I was offered the job. I bicycled to the lab, EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

Mark E. Bruley, CCE, EIT Vice President, Accident and Forensic Investigation, ECRI Institute

reviewed and signed the employment contract, and started work in June 1975. In the early years, we were a small, tight-knit group of dedicated professionals of 28 employees. We produced a single journal while simultaneously developing a shared clinical engineering services business for medical equipment inspection and preventive maintenance, performing equipment planning consulting, investigating accidents, and, oh yes, building our new facility in Plymouth Meeting, Pennsylvania. We spent many long days of regular work time at our downtown Philadelphia location, plus working in the new office during weekends constructing the new 40,000 square-foot building. My wife, Sue, contributed hundreds of hours of work during that construction as well. So here I am, 42 years later, proud to have developed ECRI’s Accident and Forensic Investigation Program. Throughout my career I’m honored to have published evaluations and hazard

reports; drafted an FDA standard on cryosurgical devices; lectured worldwide; pioneered research into the causes and prevention of skin injury and burns during surgery; become an expert in the insidious hazards of gas embolism; and led ECRI to be the world expert on surgical fires. All this has been possible because of the collaboration of my long-time ECRI colleagues. The opportunity to have been a member of the ECRI Executive Committee for more than 20 years is also something I valued. I watched its members and the members of our board of trustees in their evolving pursuit of our institutional mission and goals. We continued and expanded upon the 1969 vision of Dr. Joel Nobel, the dedicated and energetic physician who founded ECRI. Our unbiased, impartial, and independent medical technology analysis, laboratory testing, expert judgment, consulting, and advice are unique. These are the foundation of our identity, the foundation of our reputation, and the foundation of our revenue generation. In this respect, no other single organization does what we do for the public. The staff at ECRI are at the core of what the health care community most needs; passion. And so it has come to this. In this world, I’m one of the lucky people. I found a niche worthy of my wits, memory, and engineering and scientific skills. It’s been quite a ride. Sincerely, Mark E. Bruley, CCE, EIT Vice President, Accident and Forensic Investigation, ECRI Institute For more information about ECRI Institute, visit www.ecri.org, contact communications@ecri. org, or call 610-825-6000, ext. 5889. FEBRUARY 2018

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SHOPTALK

Conversations from the TechNation Listserv Q:

My STERIS-Amsco Century V116 unit is taking nearly double the time since the last visit of the service team. Our facility has since decided to cancel that contract and keep the money in house. It is now mine to troubleshoot. I have looked at all seals and valves and the steam trap, and have not been able to come up with why the cycles are taking so long. I checked the printout, and it appears that it is reaching pressure and temperature but it is taking quite a while to do so. I checked service inputs, steam it at 60 psi, 287 degrees Fahrenheit, vapor quality is unknown. Water is at 60 psi, 70 degrees Fahrenheit. I am pretty new to the biomed world, any help would be greatly appreciated.

Sounds like the boiler is not producing enough steam. First, I would check that the elements are all working. A boiler can produce the necessary pressure and temperature but slow to get to that point, I recently had a similar situation and troubleshooting revealed that only one element out of three was working. Replacement of the elements cured that. Another problem is that depending on your water quality,

boilers have a tendency to build up a lot of sediment and mineral deposits, which decrease the useable volume of steam in the vessel. The only way to correct this is to remove the elements and scrape out the sediment in the boiler and replace all the elements at the same time. It’s a good idea to replace the contactors too while you’re at it. This will make the unit more efficient.

Heat exchanger and check valves, drain valve and trap of chamber should help.

I assume when you say you’ve checked the steam trap, you mean the trap that is part of the manifold under the chamber? Not the stand-alone jacket trap. Also, for Steris gauges, you need to know an accurate chamber and jacket pressure to determine correct function. Always keep a couple good gauges on hand. Could be as simple as a steam regulator adjustment.

each valve is clean? Or does the pressure drop below 40 PSI during conditioning? If the pressure drops that low, you either have a bad heating element or lost power to one of the elements. Test the voltage at the input of the elements’ contactor and measure the continuity of the elements “with power off.” Heating elements should be ~ 22-28 Ohms.

Follow Up I figured it out, the steam trap was plugged, and the pressure regulator was adjusted down farther than it should have been. After cleaning the steam trap, and proper adjustment of the pressure regulator, the unit ran an average of 7 seconds over projected cycle times. 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.

If your steam trap is plugged with debris you might want to check if there is a screen in the chamber drain.

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BY JOHN SCHAFER

BIOMED 101

Getting the Most from Clinical Engineering BY JOHN SCHAFER

his article is written for hospital leadership throughout the health care industry, specifically administrators and CFOs. I have been in clinical engineering since 1983, and I have seen a lot of variation with in-house operations throughout this industry.

Ownership of medical equipment is not free. It will need to be repaired, upgraded, and don’t forget the consumables. For example, consider the Genius II thermometer. Last time I looked those little probe covers cost 2.8 cents each in bulk. Once you have applied some basic math you will see that taking one million temperatures will cost you $28,000! In a children’s hospital or large inpatient facility it will not take long to accomplish that very thing. Many of the services available through your clinical engineering shop include: sourcing collaboration, equipment standardization, preventing the hospital from buying junk, installation planning, pre-purchase clinical evaluation, and maximizing the warranty. In general, these are all excellent ways to cut future expenses. Things you can miss out on during an initial purchase include installation, service manuals, user manuals, software necessary to make everything work, test apparatus, CE tech training (under a service contract or serviced in house), user application training, and technical support; all of which could be an additional cost if procured separately after the initial purchase. There is also the loss of establishing an economy of scale by treating each department as its own entity and discounting the entire 38

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hospital’s medical equipment inventory as a fleet of equipment to be managed as a large unit. PRE-PURCHASE PLANNING Many times departments are in a hurry to purchase medical equipment and do so without any planning because: “We have money for that in the budget.” In fact, at some facilities the lack of pre-purchase collaboration results in clinical engineering discovering new equipment when it shows up for delivery at the back dock. Do you already have some equipment that does the same function? Having multiple patient wings, all having different brands of monitoring is a great example. The nursing staff has to be trained for all different brands. There will be several types of consumables, and the ability to view all monitored patients from a single nursing station is going to be a challenge. Without pre-purchase planning, interoperability becomes very difficult or impossible. In addition, your hospital’s operation will not be anywhere near as good as it could be; and you will most likely end up spending more money to boot. NEW EQUIPMENT COMPARISON BY TOTAL COST OF OWNERSHIP Clinical engineering is an integral part of determining what the total cost of ownership will be for proposed new equipment acquisitions. What will be the cost of service (in-house vs. contract)? What will be the cost of consumables? What is the expected life span of your new acquisition? Can this be supported past the planned end of life date through using an alternate source for parts and service? The

answers to all of these questions will help determine the correct path to maximize the return on investment (ROI) on these new purchases. Warranty maximization is a huge opportunity for dollar savings. There are many warranty options available other than “one year, parts and labor.” Some other options will include training, parts, tech support and plastic components. At Intermountain Healthcare we recently changed the entire health system to the Carefusion 8000 series “Brain and Channel” style IV pumps. Rather than the standard one-year warranty, we looked into other options to maximize our benefit. And besides, all you need to do is ask what your options are. The worst thing an OEM can do is to say “No.” MANAGING THE EQUIPMENT FROM INSTALL TO DISPOSAL Since you probably can’t increase your top line revenue (you have already done that as much as you can), you can increase what’s left over on the bottom line by cutting expenses that you will incur. To maintain an ongoing reduction of expenses, engage your clinical engineering department to operate as an equipment life cycle management program, rather than just fixing what breaks. No one in the entire facility has the firsthand knowledge of the condition of the equipment and the ability to support it like the CE department does. They will have information on what equipment has an end of life date. Can that equipment be supported past the end of life date due to the availability of alternate sources? What equipment is not going to make it to the end of its WWW.1TECHNATION.COM

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Biomedical Equipment Technician recommended service life and will need to be replaced early? If you are a hospital administrator or CFO and you need to replace $25 million dollars worth of equipment and you only have $18 million dollars to work with (does that sound familiar), that type of information is worth its weight in gold. Clinical engineering can also provide a valuable service by reviewing service contacts to find instances where you are paying more than you need to for service. Does that X-ray unit in your outpatient clinic that operates from 8 a.m. to 5 p.m. really need a premium 24x7 service contract? No, it can be supported nicely by an 8-5, Monday through Friday contract for a much lower price. Or do you have contracts that could be eliminated all together by training your in-house CE staff? Contact me on LinkedIn, I can tell you all about it. EQUIPMENT DISPOSAL Your clinical engineering department can assist with equipment sales to maximize your equipment sales revenue. Companies that want to buy used medical equipment bombard us and we can pass that information along. Used equipment that is in operational condition is worth more money upon resale. Your CE department can work with OEMs and other suppliers to make sure hard drives are purged of patient data but still have operating systems in place. CONCLUSION I really see this, not as a trend, but as the future of clinical engineering in health care as a way to gain out-of-thebox savings. In order to provide the highest quality and most affordable health care possible, we must engage

internal resources in new ways where they can add value, cut costs and improve service. And that’s just what we have been doing with Intermountain Healthcare’s clinical engineering program. In my career, I have had discussions with more than one hospital administrator or CFO that “a flat top line with an increased bottom line due to cost cutting is not exactly how I had envisioned the year, but I love the result.” The only problem with this is it is almost always immediately followed by “What else you got?” Talk with your clinical engineering department. I guarantee you they will be interested in working with whoever will be buying equipment. After all, it is in their best interest on helping make the best deal: they will be supporting it for the next 8 to 10 years or more. Working with you on pre-purchase planning is how they can make their lives easier. As administrators, you are looking for ways to do it better for less money and resources. The good news is that these resources are already in the building. Your clinical engineering department would most likely jump at the chance to work with other departments to structure the best purchase deals on new equipment as it will make their life a lot easier when it is time to service that new equipment. Ask them when you are out practicing “management by walking around.” You will be surprised what resources are already available to you. If you think any of the suggestions in this article will benefit your facility, share it with your leadership. John Schafer, MBA, A.C.H.E., is Program Manager, Clinical Engineering, Intermountain Support Services/Supply Chain.

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FREE EDUCATION CONTINUES IN 2018 U

MRi sponsored the last Webinar Wednesday presentation of 2017. The presentation featured James McGee, founder of NuclearCardiologyReports.com and Wayne Webster, principal at Proactics Consulting.

The duo discussed and provided useful information for those conducting nuclear cardiology perfusion examinations and requiring IAC (formerly ICANL) certification. Attendees learned about the new IAC standard for production of reports as well as the IAC certification process and how poorly implemented reporting can scuttle attempts to achieve certification. The webinar also discussed the impact on clinical operations and revenue generation during lapses in IAC certification. They also addressed how an automated preformatted report program can and should be added to the daily reporting of patient test results. The webinar received positive reviews via post-webinar surveys. “I enjoyed the webinar format for this subject ... the presenters were extremely knowledgeable about their subject and offered additional information when answering questions,” said A. Bannister, CNMT. “This was a very informative and educational webinar. I realize now where we could use Nuclear Cardiology Reports to become compliant with Medicare. I am excited to share this information with my 42

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leadership and staff,” Nuclear Medicine Technologist T. Jordan said. Another 2017 webinar “Techniques To Validate Medical Device Suppliers Claims in the Medical Device Industry” was sponsored by Summit Imaging and shared important advice on how to maintain quality in an imaging program. Summit Imaging CEO and CTO Larry Nguyen and Training Manager Kyle Grozelle shared some of the key factors health care facilities are validating to identify quality medical device suppliers that can support the rapidly changing industry. The webinar addressed understanding quality management system standards and investigating traceability. Nguyen and Grozelle also discussed certifications that reinforce quality. HTM professionals from around the world attended the live webinar session and provided reviews in a post-webinar survey. “Thank you so much for showing us what to look out for. With patient safety, so much is at stake that it is essential we take all reasonable measures to ensure the safety and quality of the equipment we use that comes in direct contact with our patients,” HTM Director G. Scarlatis said. “I thought this webinar was very informative! It definitely helps boost my knowledge about the medical device industry,” said Biomed E. Huynh. The recent Nuvolo-sponsored webinar “Kill Your Spreadsheets: How Top HTM

Teams Optimize Reporting” was a hit with HTM professionals. In the webinar Ben Person, senior director for solution consulting at Nuvolo, discussed how leading HTM teams enable data-driven decision-making and improve compliance with real-time reporting. He also touched on how HTM professionals are doing it with modern, cloud-based CMMS alternatives. Person shared how to provide technicians with an easy-to-use mobile experience to ensure accurate data capture during clinical rounds and at the point of service. He also spoke to how top HTM teams eliminate spreadsheets, manual data uploads and number crunching with real-time reporting and analytics. He unveiled the top reports that every HTM team needs to improve patient care, cut costs and boost compliance – and how to make them in minutes, not hours or days. “The Nuvolo Webinar was very informative and easy to follow. Exceeded my expectations and look forward to future webinars. This system seems to eliminate countless hours spent on work orders and trying to remember what you worked on during rounds, and puts it all in your hand with mobile capabilities whether online or not. This in turn frees up more time to get other necessary work done,” Biomed J. McCormick said. “This webinar was perfectly timed to meet my biomedical department exactly in the middle of our CMMS research project. I learned enough to make the WWW.1TECHNATION.COM

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“ These webinars provide a forum for BMETs to keep their skills and knowledge about the clinical engineering field up-to-date. It is great that so many professionals are logged on at one time, attending the courses and sharing questions that I would have never thought of asking.” E. Huynh, Biomed

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decision easier and hope to learn more in the following walkthrough,” Biomed W. Polcin said. The 2017 Webinar Wednesday series was hugely successful in 2017 with more than 10,000 registrations. Also, approximately 4,500 CE certificates were sent out throughout the year. The Webinar Wednesday series was also praised by attendees after every presentation, including the most recent ones. “These webinars provide a forum for BMETs to keep their skills and knowledge about the clinical engineering field up-to-date. It is great that so many professionals are logged on at one time, attending the courses and sharing questions that I would have never thought of asking,” Biomed E. Huynh said. “I always enjoy Webinar Wednesdays as they provide me with information that is helpful at my job,” said Senior Biomed S. Gardner said. “Webinar Wednesdays – the best way to stay current in the biomedical maintenance business,” added B. Black, BMET. “I use the webinars to help me with the newer AAMI regulation to keep my CBET current. I wish I would have known about this program earlier, however. These really do help and I learn things too. A win/win situation in my book,” said M. Tassler, BMET.

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ROUNDTABLE Ultrasound Probes

TechNation contacted healthcare technology management professionals to quiz them regarding the latest innovations and maintenance tips for ultrasound probes and transducers. Members of the roundtable panel sharing their insights are Conquest Imaging Senior Director Probe Repair and Operations Bob Broschart, Hitachi Healthcare Americas Inc. Ultrasound Marketing Manager for Radiology/Womenâ&#x20AC;&#x2122;s Health Matthew Ernst, SummitÂ Imaging CEO and CTO Larry Nguyen and Trisonics Senior Territory Manager Hobie Sears. Q: WHAT ARE SOME OF THE NEWEST ULTRASOUND PROBE/ TRANSDUCER TECHNOLOGIES HEALTH CARE FACILITIES SHOULD CONSIDER WHEN MAKING PURCHASING DECISIONS? Broschart: There are several new technologies and probe models on the market right now. Wireless probes are the newest innovation and are being developed by all the major

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manufacturers. They have seen some market acceptance, however they currently are not compatible with existing systems. (They require a new system platform). The best new probe technology in my opinion is the single crystal array probes on the market. Single crystal arrays provide better 2D image quality, (better penetration, resolution, etc.) This technology has really advanced where and when ultrasound can be used. Ernst: The Matrix CMUT - Capacitive Micro Machined Ultrasound Transducer. This Matrix linear transducer 4G CMUT uses capacitive cells fabricated using techniques first developed in the semi-conductor industry rather than traditional piezoelectric materials. The ultra-wide bandwidth of these cells enables a single probe to do the job of many, supporting not only scanning of superficial structures, but also deep-seated organs and blood vessels.

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Larry Nguyen, Summit Imaging Nguyen: Two of the newest ultrasound transducer technologies health care facilities should consider when making purchasing decisions are high frequency and wireless transducers. The benefits are obvious, however vulnerability to accidental damage from drops can significantly increase total cost of ownership. Sears: Health care facilities should focus on transducers that fit their clinical needs. This might include the newer transducer technologies such as Single Crystal, Matrix or even the latest breakthrough with a CMUT transducer now available in the ultrasound market. However, the main consideration is getting the transducer that allows sonographers and physicians to get the best results needed for their patients. This is key because the new technologies are most certainly going to cost more over the life of the transducer. Any added cost needs to return a benefit back to the facility in some way, in better outcomes for the patient or faster scanning or some other measurable way.

Q: HOW IS THE INCREASING USE OF ULTRASOUND IMPACTING THE MAINTENANCE OF ULTRASOUND PROBES AND TRANSDUCERS? Broschart: The wider use of ultrasound has placed more pressure on probes. It seems more labs are using their probes almost constantly during the day. The increased patient load does mean that ultrasound probes are under power far longer than in the past. Regular, routine checks of your probes has become a must rather than an afterthought. Sonographers understand the importance of their probes. However, as more non-traditional users of ultrasound appear, (oncology, podiatry, etc.), these users are not as familiar with things like basic probe care. Training and education will be the key to helping these users keep their probes in good condition. Ernst: Ultrasound transducers are now becoming more and more specialized depending on application. In doing so, there is an increase in the number of transducers sold but also many more unique designs and components which make maintenance such as repairs more challenging. Nguyen: The growing user base of ultrasound is by nontraditional users (doctors and nurses) who have limited knowledge of the construction and function of the transducer beyond providing a diagnostic image. They often lack the education or knowledge to protect ultrasound transducers

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

which can result in increased accidental damage of the equipment. For example, an anesthesiologist may toss a TEE transducer into a metal sink after surgery causing catastrophic damage and resulting in total loss of the transducer. Sears: The number of transducers in most facilities is increasing, sometimes dramatically. One of the greatest factors in transducer maintenance is managing a proper inventory, knowing what you have will allow you to plan for replacements, loaners, etc. Everyone involved with ultrasound is required to play a role in transducer maintenance and care; this includes the engineer and the sonographer. As most units are PMed only once (or maybe twice) per year the sonographer is often the first person to notice a problem. When repair is to be considered as an option, finding issues when they are small will generally allow for the best outcome from a repair standpoint. Communicating with the ultrasound departments and making sure they are reporting the little issues makes a big difference when it comes to reparability. Last, all clinically used transducers need to be evaluated on a regular basis, for example, during a PM; this should include phantom imaging, visual inspections and electrical leakage testing.

Q: WHAT ARE THE PROS AND CONS OF BUYING BRAND NEW VERSUS BUYING REFURBISHED PROBES/TRANSDUCERS? Bob Broschart, Conquest Imaging Broschart: First, I think it is imperative to understand one thing. Even the OEMs provide used/refurbished probes as replacements for the most part. It is rare that you will receive a new probe when you request a replacement. However, as pros and cons go, new versus used is always debated. Even new probes can have dead elements in them from the manufacturer. There is an acceptable tolerance that each OEM has to use for new product. Regrading refurbished/used probes, as this seems to be more the norm in the industry, to me the key is making sure they are fully tested and performance is verified. Minimal acceptance testing would include both a good element test and live testing in my opinion. Ernst: Purchasing new comes with a peace of mind and backing from the OEM in terms of quality, reliability and warranty. Of course this comes at an increased cost to the end-user. On the other hand, purchasing re-furbished can come with some risk with respect to the same quality, reliability and warranty. However there is typically a significant cost savings in doing so.

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Nguyen: The pro of purchasing a new transducer is that it is unused and there are no layers of asset ownership that could cause questions or concerns if the equipment has gone through quality control. The con is that it is expensive. The pro to purchasing refurbished transducers is it significantly lowers total cost of ownership for health care facilities. The con is that health care facilities must carefully select suppliers that have certified quality management systems governing the transducer repair process with validated methods that preserve the performance and safety of the equipment. Unfortunately, the market is flooded with counterfeit parts inside the devices that end users never see, but can have negative impacts on patient care and total cost of ownership.

Hobie Sears, Trisonics Sears: The difference between purchasing a new transducer compared to a refurbished transducer is usually a monetary decision. The pro is simple, buying a refurbished transducer will save money for the facility. The con is the sonographer believes they are getting an inferior product. It is necessary that the sonographer feel comfortable in the quality of the transducer; they need the assurance that if the refurbished transducer does not seem right that the issue will get rectified quickly. Your vendor needs to be completely supportive of this and willing to provide warranties or replacements without any argument. Since I didn’t mention it prior, that refurbished transducer needs to function just as if it were new, not a pro or con but a fact. The con of purchasing a new transducer is usually the considerably higher price tag. Depending on the manufacturer you may not receive an extended warranty on a new transducer, compared to a refurbished one from another vendor. Therefore, the only pro that a new transducer should have would be in quality, but this is not really the case. Refurbished transducers should function just like new, this decreases the new transducers value. In an active day-to-day practice, I don’t see any greater DOA rate with refurbished transducers than I do with new.

Q: WHAT CRITERIA SHOULD BE USED TO COMPARE AND SELECT A PROBE/TRANSDUCER REPAIR PROVIDER WHETHER IN-HOUSE, ISO OR OEM? Broschart: A starting point is to determine if the provider has a good quality system in place (ISO:9001, 13485). This is a must in today’s health care environment. I also recommend a site visit. The probe is too important to trust a repair to 48

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STAFF REPORT

someone not qualified. How are they trained? What type of testing do they do? Do they clean and disinfect their probes? And lastly, make sure they actually “repair” their probes and are not a broker. Ernst: When selecting a repair vendor, customers should ensure they meet all of the necessary regulatory requirements as required by the FDA. They should also consider how long a repair vendor has been in business, volume of repairs and references/ratings from other customers. Nguyen: It would be important to know how an ultrasound equipment repair company tests the transducer during evaluation and repair. ISO 13485:2003 QMS certification should be a requirement for repair companies such that health care facilities can thoroughly investigate and validate suppliers. Absent this certification, excess risk will likely result from unsubstantiated claims with no accountability or requirement to operate to a procedure to best protect the safety and performance of the equipment for patients. For ultrasound transducers, live Doppler testing by a formally trained ultrasound repair technician should be a requirement. It is critical to validate an ultrasound equipment repair organization’s training of their technicians from certified experts in image quality, otherwise the quality control testing is systematically flawed as user expectations are never properly tested prior to delivering the transducer. Sears: Your ultrasound service/parts/transducer provider should be acting as a partner in the management of transducer maintenance. Transducer repair is much like any other repair, although often more complicated; it still comes down to quality and trust. Many will speak to certifications such ISO:9001 (or 13485) that their companies have achieved. Those certifications are good and Trisonics has achieved some and is currently working toward a higher level as well, but they are more of a baseline. What happens beyond that is what matters. Can your provider verify issues with a transducer if needed or step in when they see an issue that appears to be systemic and could cause greater failure rates? You need a provider that can engage with the hospital engineer and the ultrasound staff in a holistic manner.

Q: CAN YOU EXPLAIN THE IMPORTANCE OF HOLDING AN INSERVICE OR STAFF TRAINING ON HOW TO PROPERLY HANDLE ULTRASOUND PROBES AND TRANSDUCERS? Broschart: On-site training is incredibly important in my opinion. I have done it several times, all to great effect. I have found that most sonographers once they are trained WWW.1TECHNATION.COM

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on how their probe works and what they themselves can do to prevent problems, they really become an ally. Training them on probe technology, proper handling (i.e. use of the probe holder on the system, watching where the cables lie, etc.), cleaning and disinfection are the most critical areas I have found, especially TEE and vaginal/ prostate probes. Some people really do not follow the OEM’s guidelines for disinfection; although they are well-written by the OEMs. Reading and following the guidelines for the disinfecting solution itself is also key, as well as making sure to wipe the probe off after each use – cleaning the gel off prevents it from liquidizing and getting under the lens. Do not use pure alcohol to wipe down a probe. Use only approved wipes or solutions for ultrasound probes.

Matthew Ernst, Hitachi Healthcare Americas Inc. Ernst: With the sheer number of ultrasound companies providing different and sometimes unique solutions it is imperative that staff are trained sufficiently. Ensuring equipment is operating correctly and maintained properly will ultimately provide the best patient care which is the responsibility of both vendors and users. Nguyen: The high cost of transducers makes it important for users to know how to best care for them. The loss of a transducer due to unnecessary damage results in a higher total cost, loss of productivity and delayed patient care. It is also important that users understand what contributes to image degradation and how that can impact the diagnostic quality of the exam. Users also need to understand how components can be damaged, such as pin connectors and cables as well as the array itself. Sears: I can’t overstate just how important this is for any facility! Trisonics will provide this in-service to ultrasound departments (including central sterile) free of charge. Proper transducer care and handling are of primary importance and the first line of defense in all transducer maintenance. These in-service sessions always result in lowering the number of damage and repair incidents a facility has for the following year. Also, all hospital engineers that work in ultrasound should be well versed in transducer care and handling.

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Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING ULTRASOUND PROBES/TRANSDUCERS? Broschart: I think it is so important now with the pending FDA legislation of our industry, that probe suppliers and repair suppliers are better vetted by users. There are too many brokers out there who, in turn, do not properly vet out their suppliers. The probe is the only piece of the ultrasound device in contact with the patient. The probe provides all the data to the system as to the patient’s condition. It is vital that probe and probe repair suppliers also understand this importance. They should be organized and trained to provide this highly critical task that is so important to patient care. Ernst: If done properly there is no right or wrong decision when it comes to purchasing new, re-furbished or repaired transducers. Customers need to make the best choice for their specific needs and to ensure that whatever choice is made that product and patient safety are the highest priority. Nguyen: HTM professionals need to understand the current regulations and requirements of the FDA and use those standards to validate a repair company. It is alarming that many organizations do not know or understand current regulations and perform repairs that negatively impact equipment safety and performance in order to enhance their bottom lines. The equipment being repaired should preserve the safety and performance to best serve health care facility customers and patients. It is the only approach that improves patient care and lowers total cost of ownership. Sears: Being engaged in the modality of ultrasound is important for all those who are providing service and support. This includes having a working relationship with sonographers and managers in those departments. This type of engagement will translate into the best understanding of the needs for any ultrasound department during a new purchase or a service event. Then, develop a relationship with your vendor and verify the quality that they say they will deliver. While not specific to transducers, this is the best advice I can give anyone who supports the modality of ultrasound.

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MERGERS & ACQUISITIONS GENERATE CHALLENGES

ADAPTING TO CHANGE

BY K. RICHARD DOUGLAS

the American health care model has evolved with changes that have challenged health care systems. More regulation and more “hoops” have meant more costs, while in many cases, setting a higher bar for patient care. In order to survive and prosper in this environment, many health care systems have considered merging with former competitors or buying out other hospitals or health care systems. While these mergers and acquisitions (M&A) can help solve some financial challenges, they can also create new challenges for employees and departments with new corporate cultures, new rules and budgets, possible layoffs and personnel changes. The year 2016 was the third best on record for M&A deals with 4,951 mergers. After the financial crisis, many companies began to hold onto cash. Large companies, listed on the Standard and Poor’s 500 Index, held more than $1.5 trillion as of the end of the third quarter of 2016. For the M&A activity to continue, the cost of borrowing money has to remain fairly low. This will be determined by how quickly the Federal Reserve raises interest rates. The debt financing rate is connected to the Federal Reserve’s Federal Funds short-term rate. Another factor is the current administration. A pro-growth, probusiness agenda will help with successful M&A activity, just as it will help the equity markets and steady growth in the gross domestic product (GDP). This is an environment ripe for M&A. For companies looking for buyers, it is like preparing a house for sale. Curb appeal must be maximized and in the M&A game, companies must make their valuations look attractive, operate efficiently, have top-notch employees and diversify revenues. STRETCHING EVERY DOLLAR In health care, the impetus for either mergers or acquisitions comes out of the need to improve efficiency or lower costs

or both. One hurdle is to get the blessings of the Federal Trade Commission (FTC), which needs to review any antitrust concerns. These concerns can impact consumers as well, just as a consolidated airline industry has led to more fees. In 2014, there were 95 hospital mergers, which was considered a record number at the time. A Medicare Payment Advisory Commission (MedPAC) blog post stated that hospitals “can cut costs when they are under competitive and fiscal pressures.” Conversely, concerns about the impact on patients caused Connecticut Governor Dannel Malloy to place a moratorium on hospital and health care system mergers in 2016. For many health networks and individual hospitals, dwindling reimbursement rates from inadequate federal payments or commercial payers is one factor that drives the need to scale up. Mergers provide health systems with economies of scale that allow them to leverage increased resources and buying power. For 2018, there is talk that Ascension Health and Providence St. Joseph could merge, according to Fortune Magazine. If true, the resulting health care hospital network would be the largest in the country. Mergers that have surpassed the talking stage include Advocate Health Care’s planned merger with Aurora Health Care and Dignity Health and Catholic Health Initiatives (CHI). A 2016 joint press release from CHI and Dignity Health said: “The organizations complement one another in many other important ways. CHI brings a diverse geographic footprint with proven clinical service lines and

home-health capabilities, as well as successful partnerships in research and education. Dignity Health has a proven operating model that has successfully scaled enterprise-wide initiatives to ensure consistent practices across the system, and is well known for its work with innovative, diversified care-delivery partnerships.” HEALTH CARE SQUEEZED Health care systems are being forced to consider mergers and acquisitions in order to survive and prosper in a marketplace that has been transformed through changes in the health care model. Many hospitals depend on reimbursements from CMS for Medicare and Medicaid patients. In 2013, Medicare penalized nearly 1,500 hospitals under their quality incentive program. Hospital stays are shrinking also. Some hospitals are losing market share. Many hospitals are joining together to become systems or networks in order to survive. For hospitals in rural areas, there are fewer large employers who provide employer-sponsored health insurance, so there are larger populations who depend on Medicaid and Medicare. Some of these rural hospitals are even termed “Medicare-dependent hospitals” (MDHs) because such a large portion of their patients depend on Medicare. If one of these facilities closes, it is a blow to the health care needs of the local population. A merger or acquisition may be the only hope. In places that have had cuts to Medicaid, the public hospitals have had to step in and provide more care without reimbursement. Also, under the Affordable Care Act, health care systems must expand their service coverage to a

MERGERS & ACQUISITIONS GENERATE CHALLENGES “ Make sure your database is clean, accurate and always up to date, when you merge with someone else your data will be merged with their system and you can save a lot of time and embarrassment by ensuring you have a solid database.” – Jim Fedele larger geographic area. Hospitals are also losing some sources of profit as in the example of CMS’s consideration of allowing knee replacement surgeries to be performed in outpatient settings with reimbursement. Hip replacement surgeries could follow. Traditionally, these patients have been operated on in an inpatient surgical unit in a hospital and then spend several days in the hospital. A shift to outpatient surgery centers could account for more than $7 billion in lost reimbursements for hospitals. More than a third of all M&A deals in the past year have been in the longterm care category. Managed care accounts for about a quarter of all deals. “Regulatory pressures are causing hospitals to improve the care they provide to patients and not keep patients in the hospitals unless there is a medical need (i.e. ED, surgery or ICU stay). CMS reimbursements to hospitals are shrinking. All this change is causing loss of market share, forcing health care organizations to expand their market share to ensure patient retention and profit margins are not reduced,” says Salim Kai, MSPSL, CBET, manager of biomedical engineering at Kettering Health Network in Dayton, Ohio. “The HTM workforce is being affected by this rapid change since we manage technology and technology follows the patient journey from any point of entry into the health care ecosystem (emergency department,

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FEBRUARY 2018

surgery, labor and delivery, routine outpatient visits),” he adds. IMPACT ON HTM DEPARTMENT? For those in the HTM department, the prospect of being a part of a merger or acquisition includes many factors; both good and bad. In some cases, it can mean additional resources or personnel that are a welcome addition. It can mean upgraded technology or a different CMMS system that are an improvement. On the flip side, it may mean that some middle managers are eliminated. It may require adopting a culture that seems intrusive or foreign. If the entity purchased was used to newer technology, and the larger purchaser has more antiquated technology, it may mean taking a step back in time. As is the case in any work environment, when there is a substantial event, the mood is one of apprehension; what changes might be on the horizon? Some of this is justified and some is needless speculation. “Within my career I have been involved in three mergers/acquisitions, one in the late ’90s; we combined three local hospitals to form a health system. In 2015 the health system decided to actively search for a larger partner to merge with to get ahead of the financial impact and pick our own partner while our performance was strong. In October of 2016, we merged with UPMC. Then in October of 2017, we added two more local hospitals to our system,” says Jim

Fedele, CBET, director of biomedical engineering for Susquehanna Health at the Williamsport Regional Medical Center in Williamsport, Pennsylvania. “So I am living this on a daily basis and the future looks like more of the same,” he adds. While there have been many biomeds with good experiences after an M&A has occurred, some others describe something more unsettling. This Ohio biomed, who preferred to remain anonymous, had a negative experience. “What happened to me was not pleasant. The large multi-state hospital group that I was working for sold off all of the facilities it had in this state. The new group came in and was very nice at the start. They brought in their own CMMS software so the first thing they wanted to do was convert our data into their system. My supervisor and I helped them complete this big project. All was good. Next they brought in one of their technicians. This was good because we needed more help. Another good thing. Next they told us we were going to share some resources with another one of their group hospitals. Another good thing,” he states. “Next, they hired us another new technician. Still good. Soon after, when we had taught these new technicians all about our operation, they let my supervisor go and made their technician, that they had brought to the operation, the one in charge. Right about here, I knew my job was not secure, and it was not long after that I was let go,” he adds. Fedele, on the other hand, says that in his case, there were no big changes. “The impact will be who is signing your check, the fundamentals of the job won’t change but who is paying you will most likely change. For me I was paid by Aramark to manage the program and when the latest merger happened they put in their program so now I get paid by them. Of course we are learning how to use a new CMMS system and how to order parts and items like that, but we

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are still performing PMs and fixing broken equipment and taking care of customers,” he says. “Also, it is going to affect your relationships with salespeople; if your hospital is being purchased, you most likely will be using their preferred vendors and they may not be the ones you have been using. Even equipment manufacturers, that you have used in the past, could be changed as new equipment is purchased,” Fedele adds. How does HTM address this probability, prepare for it, or respond to the C-suite? “My advice is the following,” Fedele says. “Make sure your database is clean, accurate and always up to date, when you merge with someone else your data will be merged with their system and you can save a lot of time and embarrassment by ensuring you have a solid database.” “Be sure you are an asset to your organization and are exceeding customer expectations, because if you aren’t, a merger may be a good time you get cut loose,” he adds. As a final note on the topic, Fedele gives probably the best advice. “Most importantly embrace the change, help your customers navigate new equipment vendors and assist them anyway you can,” he says. VIEW FROM THE ACQUIRER Within the acquisition component of M&As, there are two parties; the entity being acquired and the entity that is making the purchase. While there are often changes that the HTM department, which is part of the entity being acquired experience, there are also changes experienced by those working for the purchaser. “Our system has recently brought in several new hospitals and our biomed department has taken ownership of the local hospital department and employees. So I am coming from the occupying facilities point of view,” says Steven Kelley, manager of diagnostic

imaging repair, biomedical engineering at Piedmont Healthcare in Atlanta. “We have standard operating procedures and a system wide database. We merge the local biomed team into this system ASAP. This allows us to have access to their data and helps with management. We work closely with the local hospital, understanding that each facility has different needs. However, we need to operate on a standard set of rules across our system,” he says. “My concern is to make sure the local hospital biomeds are treated in a way to help them to realize that we are there to back them up, provide training and tools that are needed and to make their job better. That we are open to listen to their needs and the hospital’s needs and make adjustments to our standards to meet those needs,” Kelley adds.

over, the big concern is that the C-suite makes decisions that affect biomed without their input. If they are contracting biomed out to a vendor, without the input from the local biomed leadership, then things could be missed that would actually cost the facility more,” he says. “I feel that there needs to be more business-minded leadership in the biomed ranks. I am not talking about an MBA with no biomed experience running biomed. I am suggesting more biomeds learn the business side of things and bring that to the department as leaders. Strong business-minded leadership in a biomed department cannot be beat. And when that is missing, it is more probable that the department will be outsourced to a vendor,” Kelley says.

“My concern is to make sure the local hospital biomeds are treated in a way to help them to realize that we are there to back them up, provide training and tools that are needed and to make their job better.” – Steven Kelley

Kelley says that in his experience, he believes that they were able to provide a positive impact. “Elevating the biomed department in house and providing guidance and support to the team that was not there before. Becoming part of a much larger system gives the biomed group greater impact in dealing with vendors and lowering costs,” he says. Kelley says that in order for the HTM contingent to have the best experience resulting from a merger or acquisition, the biomeds must think more like business people. “For the group that is being taken

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“So, to be prepared for a merger, you should be actively involved with your C-suite making them aware of your concerns. Offering to be part of the transition team and showing concern for the outcome to the hospital, not just to yourself,” he adds. There are some inevitabilities in health care today. One is that mergers and acquisitions make good business sense and health care is a business. If you have not experienced one of these events yet, there is a good chance you will. Be prepared, make the best of it and remember that a fiscally well-off employer is a good thing.

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FEBRUARY 2018

TECHNATION

EXPERT ADVICE

BY TODD H. ROGERS

CAREER CENTER Recruiters Need Specifics BY TODD H. ROGERS

ear Hiring Manager: I’ve put together a brief set of items I will need from you in order to successfully fill the open position you have on your team. Hopefully you will read these carefully, as carefully as I’ve written them as these are some of the barebones pieces of information I need. I assure you, I could assemble an incredibly long list of things I will need but at the outset, here are the fundamentals.

So you want me to locate someone who can work on medical equipment. You’re in luck: that’s exactly the type of worker I specialize in finding. But, you probably already know that people who work on this sort of equipment come in many varieties. Let’s start with what equipment you have that you hope this person can work on when he or she shows up on the first day. Is it equipment that takes pictures? Is it stuff that makes contact with the patient? Is it a machine that is used to test samples that were taken from the patient? Maybe something else? I need to know. And, since I’ve never worked on any medical equipment personally, I will need you to explain to me if the skills are unique to a specific brand or even a specific model. You see, I’ve come to learn that if you can work on one type of equipment that usually means you can work on other kinds of similar equipment. But that rule doesn’t always apply. So, I’m going to need you to give me a crash-course on this. After all, a lot of people use a resume to tell other people about the work they can do. I will be reading those resumes and I need to know a little bit about what I am reading. This brings me to the next thing that I will need from you. 58

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How will I know that I’m looking at the right resumes? Recruiters need guidance from hiring managers on what to look for. Key words are an example. But that isn’t enough. Sometimes key words mean different things. For example, in hospitals, consider the word “tech” in a job title. Radiology Tech, Rad Tech, X-ray Tech all generally mean “technologist,” which is the person who takes the image of your broken arm. Alternatively, a technician is the person who fixes it when it’s broken. Technologists rarely fix equipment and technicians don’t generally operate equipment. But, they’re both “techs” and as a hiring manager, you can contribute to a successful outcome by explaining the subtle differences in terminology. The more details like this the more likely I will send you resumes of people that are relevant. Did you know that key word searching plays heavily in how I go about finding people on job boards, networking group sites, and sundry social media sites? Pretty soon I’m going to send you an email with a resume attached. I might have to send you a couple of resumes before I start sending you the right resume. I need you to do me a favor. Read those resumes and whether the resume has potential or not, take a moment, press reply, and tell me whether or not I’m on to something. If I’m not sending you the right resume, write a couple of sentences explaining where I’m missing. This will help me focus. If you don’t give me this sort of feedback, I’m going to keep sending you the wrong resumes because I don’t know any better. When you get resumes from me, I’m

TODD H. ROGERS Talent Acquisition Specialist for TriMedx

looking for one of three possible responses: 1) Yes, I like it; 2) No, I don’t like it; 3) Maybe, I’m not ready to say yes or no. The first two options are completely OK. That third option is the one that concerns me. Generally, I interpret that to be #2, which is very OK. Just know that people applying to jobs are a little impatient and they will become unavailable pretty quickly. Now, suppose I send you a resume and my interview notes and you decide you want to move forward. I’m going to need to know in advance who the people are that MUST interview this candidate. I also need to know the people who you’d like to interview this person but that’s something different. Putting it bluntly, I need to know exactly who, at a bare minimum, must this person meet in order to get a job with us. Did you know that candidates interviewing for jobs really appreciate it when we tell them in advance how the process is going to play out? And, when the process plays out how we told them it was going to, they come away feeling pretty good. So, I really need to know. WWW.1TECHNATION.COM

EXPERT ADVICE

Watch your

Since we’re talking about interviewers, I politely want to make you aware of something. Having multiple people interview your candidate seems like a good idea. But it’s got some downfalls, too. First, the more interviewers you include, the longer the process takes. People aren’t always easily available to schedule interviews and we really want to make a good showing. So, pick your interviewers carefully and let them know in advance that they’ll be getting meeting requests for interviews; they need to respond to those requests promptly and they need to know that we really can’t reschedule an interview because you had to bump it for something else. Please do everything in your power to keep that interview from getting over-booked. From the moment the candidate enters our building until he or she is finished, it’s our job to make sure that the entire process goes smoothly and without interruption. Rescheduling even one person in that sequence makes an unfavorable impression. You see, Hiring Manager, we want to fill your team with good people. And good people aren’t always easy to find. When we are fortunate to have an ambitious and talented person agree to interview with us, please help us help you. I will need to know the jargon. I will need to know what to look for; resumes can be cryptic. I need you to act! The best people tend to be slightly impatient when it comes to job searching. Delays will always hurt us. And finally, just think of it as a show. I get the actors on the stage. I get the audience seated and in the right frame of mind. What I need from you and your team is to show up in character and break a leg.

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TECHNATION

EXPERT ADVICE

BY INHEL REKIK & JOHN RASMUSSEN

TECH TIPS

Demystifying Medical Device Security, Part II BY INHEL REKIK, CLINICAL ENGINEERING MANAGER, MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL AND JOHN RASMUSSEN, MEDSTAR VICE PRESIDENT & CISO EDITOR’S NOTE: PART 1 OF THIS ARTICLE RAN IN THE JANUARY ISSUE OF TECHNATION AND ONLINE AT 1TECHNATION.COM

pplication of security controls should be done as a partnership between clinical engineering, IT and the medical device vendor. This will ensure that there are layers of defense to prevent infection.

OPERATIONAL SECURITY CONSIDERATIONS The security program mentioned in Part I of this article should include a myriad of tools to ensure multiple layers of defense to counter the different threats to the confidentiality, integrity and availability of biomedical devices. The tools can be broken down into three categories: • Physical security • Network security • Application/Operating system security Physical security protects the device from unauthorized access or alteration. A device containing PHI needs to be protected from unauthorized access. This can be done through locking screensavers if it’s a desktop type of medical device, or by placing the device in a secure area where the public does not have access. Another way to secure these devices is to use a cable lock or physically bolt them in place. If a device has USB ports, these can be utilized to install malware or can be used as key loggers, the USB ports should be secured. There are ways to disable the USB ports from the operating system or they can be physically blocked using USB port locks. However, this needs to be done with medical device manufacturer approval. 60

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Physical security controls should extend to the end of life of a product and must include controls for surplus of the devices. A device should never be sent to surplus if it contains patient information. That data must be removed from the device before it is accidentally disclosed to someone who is not authorized to view or access it. Drives should be removed and physically destroyed or degaussed. This should be clearly stated in the medical device disposal policy. Administrative safeguards are your policies and procedure around medical device security. HTM partnership with IT security helps to establish this governance. IT security professionals are here to guarantee that our patients’ data is protected and that our medical devices are operating in a safe and secure manner. It’s important to build a solid collaboration in order to have an effective medical device security program which includes policies, standards and guidelines for securing medical devices. Technical safeguards include many types of technologies that create multiple layers of protection and include border defenses like firewalls, email gateways, web filters, internal network segmentation, intrusion detection systems, advanced endpoint protection, network access control, antivirus (AV) and patching. Virtual private networks (VPNs) between vendors and hospitals can act as a conduit for infection. If a vendor network contains malware it may try to propagate over the VPN connection to the hospital network. Unless absolutely necessary, alternative remote connection technologies should be utilized to keep

exposure to a minimum. Network segmentation is utilized to isolate or restrict access to certain kinds of devices on the network. A medical device should not be located on the same network as a regular workstation that routinely accesses the Internet in order to prevent propagation of a worm. Network access control can be utilized on some networks to prevent unauthorized devices from connecting to the network. This could prevent an accidental or malicious device from gaining access to vital network resources. For application/operating system security controls the most important control is to patch the operating system. Very few medical devices use general purpose operating systems. Most devices use a stripped down operating system to guarantee real time availability, connectivity and processing power, data integrity and security. Microsoft operating systems have been the most targeted with cyberattacks and thus need to be patched regularly. If the medical device uses a standard Microsoft operating system, patches can be applied with or without manufacturer’s approval simply by downloading them from an operating system manufacturer’s website. Be sure you understand your support contract before patching the device as you may invalidate support. Many medical devices use Microsoft Windows Embedded standard which is a stripped down version of standard Windows operating system that can be patched such as contrast injector, hemodynamic system and many imaging systems. The patches for these WWW.1TECHNATION.COM

EXPERT ADVICE

INHEL REKIK

JOHN RASMUSSEN

Clinical Engineering Manager

MedStar Vice President & CISO

systems are provided by the vendor. Medical devices with Real Time Operating Systems (RTOS) devices run a compiled firmware, no patching or modification of the software can be done. This offers them protection against malware. Firmware needs to be re-installed when vulnerabilities are discovered in a certain firmware version. Windows CE is the Microsoft version of RTOS. With medical device patching, the main challenge remains that when vulnerability is known, medical device manufacturers don’t have their patch ready on time and when a patch is released for a certain operating system, oftentimes it’s not validated to be used with the software version running on the medical device. This was clearly shown during the WannaCry outbreak. Antivirus can also act as good defense on these devices. If the vendor does not support or allow antivirus on the system you will need to look at other options on the network level to keep the devices secure. If antivirus is not supported ask the vendor why it can’t be used. Sometimes a vendor will allow it to be installed if it is configured to exclude certain folders or files on the device. This is better than running with no antivirus and should be considered as a hardening option. A device should arrive in a hardened state but sometimes the device is configured to run a lot of services. Work with your vendor to identify services that could be shut down or if

application firewalls can be used to limit inbound and outbound traffic. An additional area of vulnerability for these devices is password management. Devices may arrive with default passwords from the vendor and these devices may be common among an entire class of device. The use of common passwords can place an entire collection of devices at risk of compromise. Utilize best practices for privileged account management when managing these passwords and create a policy around password management. One of the most important aspects of the program is incident response planning. When something goes wrong, and it will eventually go wrong, you should have a written incident response plan in place that has been tested. A response plan should be written in conjunction with providers, clinical engineering and IT to ensure that all operational aspects are considered. The plan should identify incident leads, contact information, and downtime procedures. The plan should be tested annually in a tabletop exercise to identify weaknesses, update the plan and, most importantly, to ensure everyone is prepared. RESIDUAL RISK Biomedical devices typically have a long life span, much longer than the average computer lifespan of 4 years. While an operating system may be supported for a decade or more, biomedical device manufacturers may not develop a product running on the OS until halfway through its lifecycle and may

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continue to sell devices on this OS until the date it is no longer supported by the OS vendor. This can create residual problems for unsupported devices or devices that are resold after their useful life at a hospital has passed. This should be taken into consideration if a hospital resells equipment. Additionally, the contract between a vendor and a hospital may not permit the transfer of a software license between the hospital and a third party. If a hospital is reselling old equipment it should review its contracts to ensure it is not in violation of the contract agreement. Fundamentally, a hospital should also consider who it resells used equipment to. If items are being sold to community physicians or providers in underserved communities, do those providers have the means to protect their patients, networks, and data that is stored on these devices that are past their support periods? Proper disposal of the device should include removal of any non-volatile memory and physical destruction of the data on that memory (degaussing or shredding). SUMMARY Until the medical device industry catches up with cybersecurity there are steps that hospitals can take to minimize medical device cybersecurity risks. An effective program with defining medical device governance is a good place to start. Operationally, medical device security starts with the procurement process and proper asset management. HTM departments need to know the “big picture” and understand where they sit in a network full of integrated devices and think in terms of “medical systems” as opposed to individual devices. In a system full of connected devices, security is only as strong as its weakest link.

FEBRUARY 2018

TECHNATION

EXPERT ADVICE

BY MICHAEL DAVIS

ULTRASOUND EXPERT Keeping Current Backups BY MICHAEL DAVIS

any customers have contacted me after having lost all of the settings and presets on their ultrasound system. The ultrasound technician/sonographer cannot perform a study using their usual methods when the system doesn’t work like it used to. This can happen when any biomed or clinical engineer performs a simple software reinstall. My first question when I get the call as a technical support specialist is did they perform a backup? The answer is usually no.

MICHAEL DAVIS Technical Support Specialist

TECHNATION

FEBRUARY 2018

Performing a system backup is one of the most critical parts of performing a preventative maintenance (PM). The backup will keep most of the settings that are needed to insure the system runs correctly. As we have stated in the past and reinforce during all our classes – document, document, document. You can never have too many backups and printouts. Backups normally do not take a long time to complete so there is no reason to skip performing them. Along with the backups, it is mandatory to print out the settings and option keys. While most of these items are on the backup, there is no assurance. Having a hard copy of the network and options keys will insure that you can get the system functional. Specific systems will require additional backup as well. An example is the GE Logiq E9, this system does not back up the TCP/IP settings, so a printout is needed. Another is the Philips IU22/IE33 where the options key requires a separate backup. The question is, why are these backups so important?

Many times, a system will become slow and unresponsive, give a boot error or the back-end processor fails. Any of these failures will require that you load software. At this point, you may not have access to the information on the drive. All you can do is perform a clean install. If you do not have the necessary information, you cannot complete the install. Imagine not having the options key and having to contact the OEM to retrieve it. Not only does this take time, it may cost an additional fee as well. Or the DICOM settings are missing and they cannot pull up the Worklist or send to PACs. It then becomes necessary to call IT and wait for them to get the information. The delay does not make you look efficient or effective. Is it necessary to have a current backup? The short and long answer is, “Yes.” Settings may have changed since the last PM or the software may have been upgraded. A newer version of software may not be able to load from an older backup. It is always the best action to have a current backup. Remember the entire reason for having these backups and printouts is to insure that downtime is kept to a minimum. Backups help make simple installs run smoothly. Be the hero and get the system back up as quickly and successfully as you can by always having a current backup and printout. 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.

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TECHNATION

FEBRUARY 2018

WWW.1TECHNATION.COM

EXPERT ADVICE

BY ROGER A. BOWLES

THE FUTURE

The Future is in Good Hands ROGER A. BOWLES, MS, EDD, CBET

ver 20 years and probably over 1,000 students, I’ve realized that everyone who comes through the Biomedical Equipment Technology program at Texas State Technical College Waco has their own story. Many things lead them here and the overwhelming majority of them become successful technicians and managers. Many of them stop by or call me from time to time to catch up or to hire graduates. Some I remember very well for various reasons and some I don’t remember so well. Maybe it is because they were quiet students or maybe it is just because I am getting old.

One particular young man, who will be graduating in April of 2018, has a remarkable story and was featured on the local news. There is no doubt that he will make tremendous contributions to Healthcare Technology Management. Talgat Pate came to the United States about 13 years ago, at the age of 8, from Almaty, Kazakhstan, a former Soviet Union Republic. He and his brother were adopted from the same orphanage and his first language was Russian. His mother homeschooled him the first year in the United States and today his English is almost perfect. Talgat has 10 siblings in all, 5 sisters from Bogota, Columbia, another sister from foster care, and 2 brothers. His parents had three biological children and adopted 8 children. His father and his uncle started CardioQuip in 2003 in the Bryan/ College Station area of Texas. Today the company manufactures equipment

used in open-heart surgery. Talgat worked there during high school, going on field service trips with his father. This led to his decision to pursue HTM as a career field. When asked what inspires him, Talgat says, “I get to work with great people all over the world. I’m excited to travel and provide great customer care. I believe having great customer care is the number one thing in this field.” Currently, he is doing an internship with CardioQuip and happy to be the face of the company to its customers. When asked what he likes best about the HTM field, Talgat says he enjoys not only using his hands but also getting to meet so many different people. And he enjoys the fact that learning is a constant in this career field and, in order to improve, biomeds are required to keep learning. Talgat speaks very highly of his parents, who adopted him from the orphanage. “They were the first people to love me for me,” he says. He states that there was no compassion at the orphanage and he is grateful for the opportunities he has been given. Although I didn’t know Talgat’s story until recently, it was obvious to me from the start that he was going to be a successful student. His level of optimism and enthusiasm about learning new things is not seen in every student. Plus, I’ve never seen him without a smile on his face and that attitude will serve him well. He may not want to me to relay this incident, but it does show his dedication. In one particular lab, the students were operating a blood gas

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

ROGER A. BOWLES MS, EdD, CBET, Texas State Technical College

analyzer and doing a very basic PM. One of the things they do is a simple touchscreen calibration. It is a fairly fast test, and for whatever reason, Talgat did not touch the buttons on the screen at the appropriate place and time. At the conclusion of the test, the touchscreen was completely out of whack and nothing in the manuals was helpful. I was not happy and simply told him and his lab partner to “handle it.” And handle it they did. They researched, made several phone calls, and came back with the solution (which I didn’t know myself). Problem solved. This is the kind of ownership of problems that will make him successful. Those of you who would like to see the local interview with Talgat by Ann Harder of KXXV can go to her Facebook page (Ann Harder KXXV) and look for a post made on December 5.

FEBRUARY 2018

TECHNATION

EXPERT ADVICE

BY JIM FEDELE

THE OTHER SIDE

AEM-OEM Decision Does it Really Affect Patient Care? BY JIM FEDELE, CBET

ne major aspect of managing a biomed program today is deciding on OEM or AEM preventative maintenance. By now we are all well aware of the CMS requirement that identifies what we must do; 100 percent PM completion on all medical equipment. I know many programs are defaulting to the OEM, however, given the technological advances of modern day medical equipment and the varied environments the equipment must operate in, are we sure the OEM knows best?

I feel like I need to first establish that for the purpose of this discussion I am referring to scheduled performance inspections (SPI). These checks differ from preventative maintenance (PM) because SPI does not require replacing parts that wear out. As managers, one of our tasks is to manage the expenses of our departments. We do this in many ways including managing our human resources. If you work for a prospering and growing organization, you are adding new equipment to your inventory almost daily. The inventory growth seems to outpace the removal of equipment from the inventory which ultimately increases work load for the technician. Since it is very difficult to add new staff, we have to find ways to optimize our human resources to maintain equipment that benefits from our intervention. For the past two decades, up until the CMS changes, we used a risk ranking model to decide what equipment would be included in a SPI/PM program. I remember when we first started implementing these programs many people were skeptical. They claimed we were jeopardizing patients and that equipment would become unreliable. To my knowledge, that did not happen. We removed many small items from our inspection list and traded that time for rounding with nursing to help them understand how to operate their 66

TECHNATION

FEBRUARY 2018

equipment. One example of a pitfall of selecting OEM recommendations for SPI or PMs is that you must strictly follow those recommendations. This means you cannot add steps to the PM. For example, ultrasound machines, which are mandated to be on an OEM program, may be operated in an environment that requires a filter change more frequently than what the OEM recommends. Even though it is the right thing to do for the machine, technically you are not adhering to the manufacturer recommendations. A very common piece of equipment in hospitals is thermometers. When I polled a group of biomeds, about half of them had thermometers on a SPI. In my opinion, they are the perfect candidate for the AEM program. There are many of them in a hospital and they are hard to find. That makes achieving 100 percent completion almost impossible. Walking through a risk analysis reveals thermometers should be on an AEM program. The thermometers we use do a self-diagnosis every time they are turned on and also when the probe is removed. The self-test checks all the major systems and the probe to ensure everything is working correctly. If it is not, the thermometer gives an error code that will not permit the unit to be used until the error is corrected. When a thermometer gives a “questionable reading “the user

JIM FEDELE, CBET

will recheck the patient and try another thermometer to ensure the reading is correct. The user manual states that the only maintenance needed is to check the batteries, check the physical condition and to keep the unit clean. These tasks certainly do not need to be conducted by a biomedical technician. The service manual recommends cleaning and a visual inspection (which should be done by the user) and a calibration “check” annually. So if you are following OEM for thermometers you need to purchase the calibration well needed to check the thermometer, find every thermometer and do a calibration verification. None of these steps extend the life of the unit. So why are we still chasing down thermometers? I know some of my colleagues worry about litigation but a common excuse when a patient incident occurs close to the time of the last “performance check” the tech usually explains that the check is only accurate the minute the equipment is checked. After that anything can happen to affect the safety and performance of the equipment. If all we are doing is a WWW.1TECHNATION.COM

EXPERT ADVICE

performance verification and not performing steps that actually prevent failure, like replacing seals, cables, and filters, then we aren’t preventing anything. What should we be doing? If we want to be effective at improving patient safety and equipment availability, we should be focusing on outcomes not tasks. Looking at a list of recommended PM or SPI tasks is only half of the equation. What are the outcomes from the steps we are performing? Are we making equipment more reliable or less reliable? Is equipment available for our nurses when they need it? What environmental factors should be considered when performing a PM or SPI on the equipment? Deciding on a strictly OEM only program may be the easiest to manage, but I do not feel it is the right thing to do for your customers or for your departments efficiency and efficacy. JIM FEDELE, CBET, is the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments via email at info@ mdpublishing.com.

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FEBRUARY 2018

TECHNATION

EXPERT ADVICE

BY MANNY ROMAN

ROMAN REVIEW Science Proves You Wrong BY MANNY ROMAN, CRES

couple of months ago I conducted three days of soft skills presentations at a major university in Texas. I spoke on relationships skills, communication and other topics to over 50 university employees.

A major focus of the presentation was on the various types of personalities we encounter on a daily basis. I described the wants, needs and behavior patterns of four basic personality types and how to identify them. This is important so that we can treat others as they wish to be treated. Especially considering that our own personality will be diametrically opposed to approximately 25 percent of the people we come into contact with on a daily basis. Individual members of my audience agreed to determine which personality type they each were and all was well. There was a little resistance from the analytical personalities, which is expected because that is the personality type that needs to perform much research. I moved on to my next topic. The presentation is titled the “7 Triggers to Yes – The Magic of Influence” and is based on the Russell Granger book “The 7 Triggers to YES, The New Science Behind Influencing People’s Decisions.” In this presentation, I state, “If you have been using logic and reason to persuade and influence others, I’m afraid that science proves you wrong.” I then proceed to show the comparison between the belief that logic and reason are prime drivers of decisions and what science has demonstrated to be true. 68

TECHNATION

FEBRUARY 2018

I show that the logic and reason drivers for decisions that have been believed for over 2,500 years since Aristotle have been dispelled by research in neuroscience. Dr. Antonio Damasio, states, “We are not thinking machines that feel; rather we are feeling machines that think.” The first response to anything is always emotional. This means that emotion is a necessary item to make decisions. Without emotions, the brain can manipulate data and apply reason and logic yet cannot make a decision. People whose emotional base, the amygdala, is damaged just cannot make decisions. So why am I telling you this? Because of the response to the above from a very analytical individual in attendance at the presentations I conducted at the university. I also cover nonverbal communication. I noticed his body language and saw a great deal of discomfort when I said that decisions are mostly an emotional response. He prided himself in his logical and reasoned decision-making process following a period of due analysis. I was telling him that his analysis was a process of rationalization for the decision that had already been emotionally made. I destroyed his vision of himself as a rational and logical human being. Well, I did not destroy it, science did. We proceeded to fulfill his need for further analysis, an emotional response, of course. He defended his position with emotional rational responses. I kept pointing out the emotion in everything he said. It was a fun discussion.

MANNY ROMAN, CRES AMSP Business Operation Manager

After some fun, I finally admitted that I myself had a great deal of difficulty accepting this scientific evidence at first. I also believed myself to be a logical being. I also performed a great deal of analysis before making decisions. I always agonized at the thought that I might not have gathered all the relevant information and performed the correct analysis. And then anxiously waited for the outcome to see if I had made the correct decision. Then, with the scientific evidence in hand, I realized that I did in fact make emotional decisions and the analysis was a means of justifying them. As I performed the analysis, I always had a feeling of awareness regarding what the decision would be. It’s like flipping a coin to make a decision and as it is in the air you already know what you hope it will be, generally whatever you said heads would decide. So, the first response is always emotional. Without emotions you cannot make a decision. The process of analysis is a rationalization for the decision already emotionally made. We are not cool, calm and collected, self-controlled beings who go nuts now and then. We are nuts who occasionally act rationally. My analytical friend and I made the highly emotional decision to further analyze the science over a few cold ones. Neither of us recalls our subsequent decision. WWW.1TECHNATION.COM

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TECHNATION

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DID YOU KNOW? Science Matters

‘Power pose’ proves to have weak effect Pop psychology advises those who want to influence other people to spread their bodies wide and lean forward – but eleven new studies all found that the “power pose” gives you no advantage.

‘Powerful’ body language

Does this man look headed for success?

Leaning forward onto a desk

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1 People tested held

2 Test subjects held

They did no better than test subjects who did not pose

They performed no better than people who had not posed

a power pose, then engaged in a negotiation with another person

Where idea came from 2012 TED lecture that popularized “power posing”: https://www.ted.com/talks/amy_ cuddy_your_body_language_ shapes_who_you_are? language=en

a power pose, then were interviewed for a hypothetical job

A former advocate of power posing reexamined the evidence for it and now says, “I do not believe that ‘power pose’ effects are real” Source: Joseph Cesario of Michigan State University; Comprehensive Results in Social Psychology (journal); Dana Carney of University of California Berkeley Graphic: Helen Lee McComas, Tribune News Service

TECHNATION

FEBRUARY 2018

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FEBRUARY 2018

TECHNATION

BREAKROOM

THE VAULT

you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your o 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-february-2018. Good luck!

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FEBRUARY 2018

TECHNATION

INDEX

SERVICE INDEX Gopher Medical 844-246-7437 • gophermedical.com

USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com

P P P P P

The Intuitive Biomedical Solution Inc 1-866-499-3966 • www.tibscorp.com

Tri-Imaging Solutions 855-401-4888 • www.triimaging.com

TRAINING

SERVICE

A.M. Bickford 800-795-3062 • www.ambickford.com

RSTI 800-229-7784 • www.rsti-training.com

PARTS

Anesthesia

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

AD PAGE

Company Info

P P P P P P P P

Contrast Media Injectors

Association

Injector Support and Service 888-667-1062 • www.injectorsupport.com

AAMI 703-525-4890 • www.aami.org

Maull Biomedical Training 440-724-7511 • maullbiomedicaltraining.com

P P P P P

Biomedical

Diagnostic Imaging

ALCO 800-323-4282 • www.alcosales.com

62, 85

Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com

BC Group International, Inc 314-638-3800 • www.BCGroupStore.com

Avante Health Solutions avantehs.com

Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com

Crothall Healthcare Technology Solutions (800) 447-4476 • www.crothall.com

D.A. Surgical 800-261-9953 • www.da-surgical.com

iMed Biomedical 817-378-4613 • www.imedbiomedical.com

Master Medical Equipment 866-468-9558 • masterfitmedical.com

PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com

ReNew Biomedical 844-425-0987 • www.ReNewBiomedical.com

P P P P P P P P P

Rigel Medical, Seaward Group 813-886-2775 • www.seaward-groupusa.com

InterMed Group 386-462-5220 • www.intermed1.com

Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/

Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/

P P P P P P P

Minnesota State College southeastmn.edu/bio18

Endoscopy Healthmark Industries 800-521-6224 • HMARK.COM

PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com

P P

Gas Monitors

64, 85

Hand Switches inRayParts.com 417-597-4702 • www.inrayparts.com

P P

Infection Control Healthmark Industries 800-521-6224 • HMARK.COM

Infusion Pumps

Computed Tomography Injector Support and Service 888-667-1062 • www.injectorsupport.com

International X-Ray Brokers internationalxraybrokers.com/

FEBRUARY 2018

Education

ALCO 800-323-4282 • www.alcosales.com

Gopher Medical 844-246-7437 • gophermedical.com

12-13 40

General

Cardiology

TECHNATION

International X-Ray Brokers internationalxraybrokers.com/

Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com

Calibration

P P

AIV 888-656-0755 • aiv-inc.com

Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com

P P P P

WWW.1TECHNATION.COM

INDEX

AIV 888-656-0755 • aiv-inc.com

Webinar Wednesday 800-906-3373 • webinarwednesday.live

FOBI 888-231-3624 • www.FOBI.us

Master Medical Equipment 866-468-9558 • masterfitmedical.com

Select BioMedical 866-559-3500 • www.selectpos.com

USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com

P P

Mammography Ampronix, Inc. 800-400-7972 • www.ampronix.com

International X-Ray Brokers internationalxraybrokers.com/

RSTI 800-229-7784 • www.rsti-training.com

P P P P P

Oxygen Blender FOBI 888-231-3624 • www.FOBI.us

Select BioMedical 866-559-3500 • www.selectpos.com

RSTI 800-229-7784 • www.rsti-training.com

AIV 888-656-0755 • aiv-inc.com

Ampronix, Inc. 800-400-7972 • www.ampronix.com

Avante Health Solutions avantehs.com

12-13 40

BETA Biomed Services 800-315-7551 • www.betabiomed.com/

Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com

Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com

24-25 87

Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com

Gopher Medical 844-246-7437 • gophermedical.com

Master Medical Equipment 866-468-9558 • masterfitmedical.com

Pacific Medical 800-449-5328 • pacificmedicalsupply.com

50, 73

PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com

ReNew Biomedical 844-425-0987 • www.ReNewBiomedical.com

MRI

Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/

Innovatus Imaging 1-844-MVS-5100 • www.mvs.bayer.com

Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/

Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com

USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com

P P P

Monitors/CRTs

USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com

P P

PACS

BMES 888-828-2637 • www.bmesco.com

Monitors

BMES 888-828-2637 • www.bmesco.com

P P

Patient Monitoring

Laboratory

Ampronix, Inc. 800-400-7972 • www.ampronix.com

TRAINING

Minnesota State College southeastmn.edu/bio18

Ozark Biomedical 800-457-7576 • www.ozarkbiomedical.com

SERVICE

Online Resource

Infusion Therapy

P P P P P P P P P

PARTS

P P

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

Master Medical Equipment 866-468-9558 • masterfitmedical.com

AD PAGE

Company Info

4 24-25 87

P P P P P

Nuclear Medicine Global Medical Imaging 800-958-9986 • www.gmi3.com

InterMed Group 386-462-5220 • www.intermed1.com

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

P P P P

FEBRUARY 2018

P P P P P P P P P P P P P P P

P P P P P P P P P P P P P P P P

TECHNATION

INDEX

SERVICE INDEX TRAINING

P P

Power System Components Interpower 800-662-2290 • www.interpower.com

Radiology Ampronix, Inc. 800-400-7972 • www.ampronix.com

RSTI 800-229-7784 • www.rsti-training.com

The Intuitive Biomedical Solution Inc 1-866-499-3966 • www.tibscorp.com

P P P P P P P

Recruiting Stephens International Recruiting Inc. 870-431-5485 • www.bmets-usa.com/

Refurbish AIV 888-656-0755 • aiv-inc.com

Rental/Leasing

AIV 888-656-0755 • aiv-inc.com

Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com

BMES 888-828-2637 • www.bmesco.com

24-25 87

Elite Biomedical Solutions 855-291-6701 • elitebiomedicalsolutions.com

Gopher Medical 844-246-7437 • gophermedical.com

Master Medical Equipment 866-468-9558 • masterfitmedical.com

Pacific Medical 800-449-5328 • pacificmedicalsupply.com

50, 73

ReNew Biomedical 844-425-0987 • www.ReNewBiomedical.com

Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/

Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com

USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com

P P P P P P

P P P P P P P P P P P P P P

Test Equipment

Avante Health Solutions avantehs.com

12-13 40

Repair ALCO 800-323-4282 • www.alcosales.com

64, 85

Replacement Parts Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com

Engineering Services, KCS Inc 888-364-7782x11 • www.eng-services.com

P P P P

Respiratory A.M. Bickford 800-795-3062 • www.ambickford.com

FOBI 888-231-3624 • www.FOBI.us

RTLS Versus 1-877-9VERSUS • versustech.com/nowait

Surgical Healthmark Industries 800-521-6224 • HMARK.COM

TECHNATION

SERVICE

Telemetry

inRayParts.com 417-597-4702 • www.inrayparts.com

PARTS

Portable X-ray

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

AD PAGE

Company Info

FEBRUARY 2018

P P P

A.M. Bickford 800-795-3062 • www.ambickford.com

BC Group International, Inc 314-638-3800 • www.BCGroupStore.com

PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com

Pronk Technologies, Inc. 800-609-9802 • www.pronktech.com

Radcal Corporation 800-423-7169 • www.radcal.com

Rigel Medical, Seaward Group 813-886-2775 • www.seaward-groupusa.com

Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/

P P

Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com

ECRI Institute 1-610-825-6000. • www.ecri.org

RSTI 800-229-7784 • www.rsti-training.com

Tri-Imaging Solutions 855-401-4888 • www.triimaging.com

P P P P P P

P P P P

Training

WWW.1TECHNATION.COM

INDEX

We ONLY use OEM Parts!

TRAINING

SERVICE

PARTS

AD PAGE

Company Info Tubes/Bulbs Tri-Imaging Solutions 855-401-4888 • www.triimaging.com

P P

Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com

Ampronix, Inc. 800-400-7972 • www.ampronix.com

P P P P P

ATS Laboratories atslaboratories@yahoo-com • www. atslaboratories-phantoms.com/

Ultrasound

Avante Health Solutions avantehs.com

12-13 40

P P P

Conquest Imaging 866-900-9404 • www.conquestimaging. com

P P P

Global Medical Imaging 800-958-9986 • www.gmi3.com

P P P

Innovatus Imaging 1-844-MVS-5100 • www.mvs.bayer.com

MW Imaging 877-889-8223 • www.mwimaging.com

Summit Imaging 866-586-3744 • mysummitimaging.com

Trisonics 877-876-6427 • www.trisonics.com

P P P P P P P

X-Ray Engineering Services, KCS Inc 888-364-7782x11 • www.eng-services.com

Innovatus Imaging 1-844-MVS-5100 • www.mvs.bayer.com

InterMed Group 386-462-5220 • www.intermed1.com

International X-Ray Brokers internationalxraybrokers.com/

RSTI 800-229-7784 • www.rsti-training.com

Tri-Imaging Solutions 855-401-4888 • www.triimaging.com

P P P P P P P P

Providing support services and quality rebuilt equipment for over 17 years! BIOMED DEPARTMENTS… • Our technicians repair circuit boards, pump mechanisms and LCD screens at the component level. • Look to Select for BEST IN CLASS Pricing, Quality and Turnaround Time.

EQUIPMENT PURCHASERS… • We sell and rent the highest quality refurbished infusion pumps available. • We work with you to provide tailored solutions specific to your equipment needs. • Our IOT experience ensures we can help with your M2M connectivity issues.

Contact us today! www.selectbiomedical.com | 866.559.3500 Information@selectpos.com Select also buys equipment. Call us if you have surplus pumps or monitors to sell. We offer top dollar!

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FEBRUARY 2018

TECHNATION

Vis it Ce Tri-I nte ma r in gin NA g’s SH Ed VI uca LL E, tion TN

NEW TO IMAGING OR WANT TO BE? Our BMET to Imaging courses have been specifically designed as an Education

Roadmap to help biomeds move to imaging much more efficiently and effectively.

73 CEUs from AAMI

Completion of our BMET to Imaging 1 course* now offers 73 CEUs from the AAMI Credentials Institute for use in maintaining HTM certifications. *Equivalent to Phase I and II

CALL TODAY OR VISIT US ONLINE FOR MORE INFORMATION WWW.TRIIMAGING.COM • 855.401.4888 • ISO 9001:2015 CERTIFIED

Quality Parts

Support Services

Hi-Intensity Tri-Imaging Training

SOLUTIONS

Training • Imaging Parts • Tech Support • Service* Support • Equipment (install, deinstall, sales)

INDEX

TRIM 2.25”

Bed & Stretcher Parts Wheelchair Parts • Casters

ALPHABETICAL INDEX International X-Ray Brokers……… 59

AAMI……………………………… 63

Interpower………………………… 23

Advanced Ultrasound Electronics, Inc.………………… 67

Master Medical Equipment……… 64

AIV………………………………… 33

Minnesota State College…………… 39

ALCO…………………………… 64, 85

MW Imaging……………………… 22

Ampronix, Inc.………………………… 4

Ozark Biomedical………………… 79

ATS Laboratories…………………… 33

Pacific Medical………………… 50, 73

Avante Health Solutions…… 12-13, 40 BC Group International, Inc……… 88

PRN/ Physician’s Resource Network……………… 59

BETA Biomed Services…………… 31

Pronk Technologies, Inc.…………… 5

Biomedical Repair & Consulting Services, Inc.……… 34

Radcal Corporation………………… 30

BMES……………………… 24-25, 87

Maull Biomedical Training………… 71

MEDICAL DEALER TECHNATION Rigel Medical, Seaward Group……… 3 BUYERS GUIDE OTHER27 RSTI…………………………………

Crothall Healthcare Technology Solutions…………… 71

SelectMONTH BioMedical………………… 83

ECRI Institute……………………… 74 Elite Biomedical Solutions………… 16 Engineering Services, KCS Inc…… 17

800.323.4282 www.alcosales.com

ReNew Biomedical ……………… 64 PUBLICATION

Conquest Imaging…………………… 8

D.A. Surgical……………………… 67

TRIM 4.5”

A.M. Bickford……………………… 78

NEW • RECONDITIONED• REPAIR

ShroudGuard……………………… 69 J F M A M J J A Southeastern Biomedical, Inc…… 79 DESIGNER: JR Southwestern Biomedical Electronics, Inc.………………… 26

FOBI……………………………… 67

Stephens International Recruiting Inc.………………… 57

Global Medical Imaging……………… 2

Summit Imaging…………………… 51

Gopher Medical…………………… 11

Tenacore Holdings, Inc…………… 44

Healthmark Industries……………… 6 iMed Biomedical…………………… 85

The Intuitive Biomedical Solution Inc………… 43

Injector Support and Service……… 69

Tri-Imaging Solutions……………… 84

Innovatus Imaging………………… 45

Trisonics…………………………… 57

inRayParts.com…………………… 50

USOC Bio-Medical Services………… 7

InterMed Group…………………… 36

Versus……………………………… 56 Webinar Wednesday……………… 75

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

AD SIZE 1/6 Page Vertical

Leading the Industry in Biomedical Solutions

ORTODAY

Blender Repair O N D Service

NOTES

No QR code, SPV

Blender repairs are one of iMed’s most proficient specialty services. The iMed blender overhaul includes full replacement of OEM specified parts and ultrasonic cleaning. Our blender practice provides quick turn-around time while assuring quality with inspection from multiple certified BMETs. All blender repairs are backed by a 1 year warranty.

FEBRUARY 2018

TECHNATION

BREAKROOM

“ One man’s ‘magic’ is another man’s engineering. ‘Supernatural’ is a null word.”– Robert A. Heinlein

TECHNATION

FEBRUARY 2018

WWW.1TECHNATION.COM

bmesdecember.pdf

12/27/17

10:40 AM

Because EVERY PIECE COUNTS.

CMY

Beyond the expected www.bmesco.com 888.828.2637

Introducing THE NEW IPA-3400 INFUSION PUMP ANALYZER

The High Accuracy, Easy-to-Use System with Full Touch Screen Control of All Processes

The IPA-3400 is the most compact, fully featured four channel analyzer on the market. The IPA-3400 has a dual syringe stepper motor driven system that offers continuous monitoring of the fluid flow, providing a more realistic flow path for the infusion device under test and more accurate readings. The independent stepper motor control of the custom designed, ceramic valving allows the system to run quietly and smoothly, with a bidirectional powered fluid flow for use in the built in cleaning cycle.

The Next Generation in Infusion Pump Analyzers is here!          

Large 7” Color Touch Screen 1,2,3 and 4 Channel Models available (Field Upgradeable) User Swappable, Fully Self Contained Flow Modules Calibration in Flow Modules No need to be down for calibration or service! Smooth Dual Syringe System Eliminates Drain Cycle Inconsistencies Whisper Quiet Operation Auto Start Built-in Auto Test Sequences Built-in Data Collection Built-in Reports

Screenshots from the IPA-3400

Easy access to modules for expansion and calibration. Each module is calibrated with up to four channels in each IPA-3400. Stagger the calibration time for modules to prevent downtime. Users can also run specific test routines specified by various manufacturers using built in autosequences. Advanced features in the autosequences even allows the inclusion of pictures to aid with the setup and configuration of each step. IPA-3400 with Swappable Modules

Phone: 1-888-223-6763 Email: sales@bcgroupintl.com Website: www.bcgroupintl.com ISO 9001 & 13485 Certified ISO 17025 Accredited