TechNation - March 2018

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ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

MARCH 2018

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Vol. 9

18 Biomed Adventures

Riding and Routing

21 Industry Updates

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News & Notes

38 Roundtable

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CONTENTS

FEATURED

T C A g n i c Balan

38 42 38

42

OUNDTABLE: R IV PUMPS

BALANCING ACT: MANAGING QUALITY, EXPENSES AND RISKS

We contacted IV pump gurus and asked them to provide insights regarding the latest advances in IV pumps as well as tips and advice that they think will benefit our readers.

We follow up with industry experts to garner tips on how to navigate quality and expenses while managing service risks in an ever-chaning health care environment. For any organization to run efficiently, it takes planning, a set of internal policies, a roadmap for the future and an effort to make employees the best at what they do. TechNation shares advice on how to achieve these goals.

Next month’s Roundtable article: Endoscopes

Next month’s Feature article: Construction Excitement and Pitfalls

TechNation (Vol. 9, Issue #3) March 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

MARCH 2018

TECHNATION

9

CONTENTS

INSIDE

PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Jayme McKelvey Lisa Gosser

ART DEPARTMENT

Jonathan Riley Karlee Gower Kathryn Keur

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

ACCOUNTING

Kim Callahan

CIRCULATION

Lisa Cover Melissa Brand

WEBINARS

Linda Hasluem

Departments P.12 SPOTLIGHT p.12 Professional of the Month: Mitch Hoffman, CBET p.14 Department Profile: The David Grant Medical Center Medical Equipment Repair Center p.18 Biomed Adventures: Riding and Routing P.21 p.21 p.27 p.28

INDUSTRY UPDATES News & Notes AAMI Update ECRI Institute Update

P.31 p.31 p.32 p.35

THE BENCH Shop Talk Biomed 101 Tools of the Trade

P.51 p.51 p.52 p.55 p.56 p.58

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

P.60 BREAKROOM p.60 Did You Know? p.62 The Vault p.64 MedWrench Bulletin Board

EDITORIAL BOARD

Eddie Acosta, Business Development Manager, Colin Construction Company Manny Roman, Business Operation Manager, AMSP

p.66 Service Index p.70 Alphabetical Index

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

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

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SPOTLIGHT

PROFESSIONAL OF THE MONTH Mitch Hoffman, CBET Keeping the Faith

BY K. RICHARD DOUGLAS

S

erving the health needs of the residents of Northwest Ohio and Northeast Indiana is Parkview Health with more than 10,000 employees. One of those employees, in the biomed department, has been with the health system for 38 years.

Mitch Hoffman, CBET, has enjoyed a long career as an HTM professional.

“What got me interested in HTM or biomedical engineering was the curiosity of electronic equipment in the early ’80s,” Hoffman remembers.

“At this time, I was working in facilities right out of high school. [I] actually started college studying to be an accountant. But, when I saw the hospital start this new department, where the techs would work on Physio Control Lifepak 4 defibs, that were huge and heavy and had a capacitor the size of a toaster, and heart monitors that were also huge, the department caught my eye. So, I switched my major to digital electronics in college,” Hoffman says.

“My supervisor, who was over biomed and facilities, saw that I had switched majors to electronics. I was working third shift and was home in bed when I received a call from him asking if I would like to transfer to biomed,” he adds. “He said one of the guys, who was working in the newly started shop, was leaving. I said yes, of course; so I was attending college and working in the field. It was great.”

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In addition to working as a biomed for 34 years, Hoffman worked in facilities for about two years and also worked as a facilities biomed supervisor for about two years. He didn’t care for the supervisor position and went back to being a biomed.

RIGHT UNDER YOUR NOSE “Parkview Health System is the largest employer in northeast Indiana employing over 10,000 employees. To get that big, you have to keep expanding and adding/ updating hospitals to the overall system.

In the 2008 time-frame, Parkview began building, at a new location, a hospital to replace the current one that was built in the ’50s that I was assigned to,” Hoffman says.

“So, I was maintaining the current old building [and] attending pre-construction meetings. I recall an early meeting I attended, when looking at the blueprints, and not seeing a biomed shop. I asked the architect; ‘Where is the biomed shop?’ The architect replied ‘What is biomed?’ After I explained, it was added to the next drawings,” Hoffman remembers.

“Also, at the time, I was maintaining the medical equipment at another location in the same health system, 20 minutes away. Fortunately, I did have the help of another biomed tech at the new facility being built, during the construction process. [It] took some of the stress off me for sure. While taking care of the old hospital, the hospital 20 minutes away, the

other tech and I managed receiving over 1,000 pieces of new medical equipment that was arriving in batches to the new hospital,” Hoffman adds.

Hoffman says they had a receiving area where all the equipment was sent where they would unbox, test, tag, inventory and enter the equipment into the management software system. The day of the switch over from the old facility to new facility, more techs arrived to help with the staging process of bringing the equipment from the old facility that was going to be reused at the new facility.

“It was basically controlled chaos,” Hoffman recalls.

ALWAYS HELPING Hoffman has also helped out a general surgeon who provides medical services to people in Haiti. Hoffman met Dr. Chamberlain when he removed Hoffman’s gallbladder and appendix. During the surgery, the heart monitor quit functioning.

“They knew I was OK,” Hoffman says. “So, the anesthesia doctor said ‘page biomed.’ The nurse said ‘we can’t, he is on the table.’ (I was the only biomed at the hospital. This was before we were a health system, so I had no backup). They went to another room and got another monitor and everything was fine. They told me about this after my surgery,” Hoffman adds.

Today, the surgeon is semi-retired

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SPOTLIGHT

FAVORITE BOOK “The Book of God” FAVORITE MOVIE “Braveheart” FAVORITE FOOD Anything with horseradish HIDDEN TALENT Underwater basket weaving FAVORITE PART OF BEING A BIOMED Fellowship with other biomed technicians I work with. Sharing information with each other to get a job done. Lifting a co-worker up when they are down. Being kind and humble to co-workers.

Sharing Jesus Christ by setting an example of Him. WHAT’S ON MY BENCH? Fluke 5000C, Pronk SimCube, Riken FI-21 Gas Indicator, Fluke VT305 gas flow analyzer, Fluke Impulse 7000DP, Fluke QA-ES II ESU analyzer.

Mitch Hoffman, CBET, loves his job at Parkview Health.

from Parkview Health System, according to Hoffman.

“I have known Dr. C. for over 20 years. He saw me working on medical equipment in the OR. When he would go on his mission trips he would hook up with me and ask if I had any in-hospital medical equipment that the hospital was not using anymore that he could take on his trips. The hospital was able to supply him equipment from time to time. I would verify that the equipment was functional and off it would go,” Hoffman shares.

Hoffman says that Chamberlain recently shared how a Valleylab electrosurgical unit was being used on patients and just keeps working in all kinds of temperatures and humidity.

“How many lives were saved would be too many to count,” he says. “He told me of a story of a SPO2 monitor, that I provided from the hospital, that was being used on a patient during surgery and he and the anesthesia doctor noticed the patient’s blood saturation dropping and realized the patient needed oxygen. They were able to bring the patient back because of the monitor we donated. From time to time, the surgeon will bring back

equipment for me to repair, if possible.

One of the most recent pieces was the multiparameter monitor that I submitted to ‘The Vault’ section and was used in December 2017 edition of TechNation,” Hoffman says.

AN ENRICHING PASTIME Hoffman has found special meaning in his faith. It has been personally transforming and has been another way to provide healing besides working to help patients on the job.

“Hobbies would be riding my bicycle throughout the year weather permitting.

I’m very active in my church. I lead the men’s ministry and am faithful to Jesus Christ. I have three children, three grandchildren, a wife of 24 years. I love to read the Bible, watch sports and play a little golf,” Hoffman says.

“About five years ago, I started attending a local church knowing that there was more to this life than I was experiencing. God got ahold of me and I haven’t looked back. My relationship with my family has improved drastically because of my devotion to my Father and the intimate relationship I have with

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

Him,” Hoffman adds.

“One result of God’s love and change, He made in my life, was witnessed a few Christmases ago. My relationship with my oldest daughter had been strained due to my arrogant and selfish attitude. God called me out on it and I prayed for humility. God worked with me on that along with going to people in my life that I have wronged by lies, etcetera and asking for forgiveness including my daughter. The relationship with her became so much better because of Him. That Christmas morning while opening presents, she handed me a letter and asked me to read it alone later. It was incredible. True evidence of what God can do when you let Him work through you,” Hoffman says.

At his current church, Hoffman is leading the men’s group “by teaching them how to be better men for Him and our wives and families,” he says. “It has been a teaching experience not just for them; but for me. Teachers have to be taught.”

This biomed has been a part of healing patients and a lot more.

MARCH 2018

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SPOTLIGHT

DEPARTMENT OF THE MONTH

The David Grant Medical Center Medical Equipment Repair Center

BY K. RICHARD DOUGLAS

F

ifty miles northeast of San Francisco, and seven miles east of Fairfield, in northern California, sits Travis Air Force Base. It leads the country in the amount of passenger and cargo traffic compared with any other military air terminal. It is home to several units in addition to the 60th Air Mobility Wing. It is also home to the David Grant USAF Medical Center. The facility, operated by the 60th Medical Group, sees 400,000 patients annually.

“David Grant Medical Center (DGMC) is the Air Force Medical Service’s flagship medical treatment facility in the United States,” says U.S. Air Force Senior Master Sgt. Bruce Haskin, 60th Medical Support Squadron section chief of clinical engineering.

The HTM professionals managing the medical equipment at Travis are part of the Medical Equipment Repair Center (MERC).

Leadership in the MERC includes Paula Binns, chief of clinical engineering; Kevin Hoellein, CBET, chief of the Medical Equipment Repair Center; Master Sgt. Aubrey Durkin, NCO in charge, Medical Equipment Repair Center; and Haskin.

The MERC also includes 31 technicians, who service an inventory of 10,187 pieces of equipment.

The group has wide-ranging responsibility for multiple facilities.

“At David Grant Medical Center, we service multiple clinics, and have a joint venture with the Veterans Administration where we service equipment items to serve VA patients,” says Haskin. “As a MERC, we support 34 Department of Defense 14

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MARCH 2018

Military Treatment Facilities in eight states in the Western Region of the United States.”

Haskin adds that each site is visited annually for routine maintenance.

“We also support the facilities with technician support for installations of various equipment including PCRI on new radiology equipment before patient use.

Additionally, we work hand-in-hand with physicists during initial inspections/ acceptances of new radiology equipment,” he says. “MERC technicians also provide quality control oversight for supported bases during annual visits.”

Both service contracts and database management are handled by unique, dedicated entities that are a part of the military biomed infrastructure.

“An in-house contract services department, a subsidiary of medical logistics, oversees annual service contracts and manages one-time repairs and services,” Haskin says.

“All equipment inspections, preventative maintenance, calibrations, other services, repairs, and modifications are recorded into the Defense Medical Logistics Standard Support database system,” Haskin adds.

Haskin says this includes documenting the amount of time the technician(s) spent on the equipment, and the specific services done to the equipment. The system provides historical information, cost of services (including contract costs), historical cost, life expectancy, maintenance timelines and other pertinent data to determine when the equipment should be replaced.

Training is also unique to the military.

Active duty HTM professionals are trained through the same school that many current civilian biomeds graduated from.

“Active duty technicians are trained through the DoD Biomedical Equipment Maintenance program at the Medical Education and Training Campus (METC) at Fort Sam Houston, in San Antonio, Texas,” says Haskin.

“Additionally, before deployment, technicians attend DoD advanced courses including the Advanced Field Medical Systems course, and a manufacturer CT school to prepare them for down-range support of a field CT system with little to no outside support,” he adds.

Part of the reason the team is well trained is that METC training is so comprehensive. Haskin points out that team members may have also taken some advanced courses through the DoD school.

WIDE-RANGING UNIQUE CUSTOMERS The MERC team at Travis Air Force Base, California, has a worldwide reach. They have also loaned personnel to important humanitarian missions.

“This facility has a high operations tempo for deployments throughout the world,” says Haskin. “Our technicians have served in many countries in Europe, Africa and the Middle East.”

“Two members of the DGMC team were recently ‘deployed’ to San Antonio, Texas, to support humanitarian relief efforts after multiple hurricanes struck the United States and nearby countries,” says Haskin.

“Tech. Sgt. Ryan Schaffer and Senior Airman Nathan Howard inspected and reconstituted $4 million of equipment and WWW.1TECHNATION.COM

SPOTLIGHT

Senior Airman Nathan Howard and Technical Sergeant Ryan Schaffer recently helped hurricane victims.

supplies to redeploy equipment.”

“They made a couple of outstanding accomplishments during their time. They serviced 367 equipment items and restored 29 aircraft pallets of equipment and supplies. This directly impacted operations and led to the evacuation of 211 patients,” he says.

“They also helped establish a loaner repair and return center to support other installations’ medical equipment needs, which will allow customers to request loaner equipment and have it shipped at a moment’s notice,” Haskin explains.

One thing that further distinguishes the MERC team from its civilian counterparts are the types of services it provides.

Haskin says that the team provides unique services to DoD and VA customers.

“We provide regional support for 32 bases in the Western U.S.,” says Haskins.

“This includes some calibration, training and quality control review of anesthesia, audiometers, ventilators, X-ray and acceptance testing of some radiology systems.”

“We perform technology management and life cycle management for all medical equipment used at DGMC. This includes pre-acquisition review and research,

Senior Airman Abdeljawad and Senior Airman Cook replace a broken display on an anesthesia unit.

standardization, installation, acceptance testing, scheduled maintenance, repairs and disposition,” he adds.

Team members complete approximately 9,500 scheduled work orders a year, approximately 700 acceptance inspections per year and up to 1,500 repairs per year.

They also review approximately 600 alerts and recalls per year.

MEETING CHALLENGES The team has shown that employing some ingenuity can solve some vexing challenges when multiple sign-offs must be tracked.

“One challenge the facility had was a smooth review of new equipment requests with assurance that all of the appropriate parties had reviewed a request before acquisition. Our Technology Management Office revamped all of the associated forms and the entire submission and review process,” Hoellein says. “We established a SharePoint site as a repository for all equipment requests that included tracking mechanisms for the review and acquisition processes. The site was developed to have reviews by specific offices when necessary. They include systems, facility management, medical physics, bioenvironmental engineering,

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

hospital safety and others as required.”

Hoellein says this resulted in better tracking of all packages, expedited reviews and assurance of compliance and special considerations before acquisitions.

“It reduced the overall amount of time from submission to receipt, and it resolved many of the post-acquisition issues and complaints that existed before the new process,” he says.

Another challenge the facility faced was the growing complexity of cardiac cath equipment while still utilizing a legacy PACS system.

Hoellein says the equipment and PACS were integrated poorly, if at all, making workflow and documentation difficult for the providers.

“Technology Management worked with the U.S. Air Force Medical Operations Agency in Ft. Detrick, Maryland, to define requirements, review existing technologies and procure a new cardiology PACS as well as a way forward regarding upgrade paths of additional cardiac equipment,” Hoellein says.

Patients and clinicians at DGMC and many other locations can rest assured knowing that an innovative HTM team has their backs.

MARCH 2018

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SPOTLIGHT

BIOMED ADVENTURES Riding and Routing

BY K. RICHARD DOUGLAS

T

he image of the motorcyclist for many, old enough to remember the movie “Easy Rider,” is captured in the lyrics sung by Steppenwolf’s lead singer John Kay; “Get your motor runnin’, Head out on the highway, Lookin’ for adventure, And whatever comes our way,” from the iconic 1969 song “Born to be Wild.”

It is the image of running on two wheels, freedom, a counter-culture worldview and disdain for boxier transportation. While the experience of traversing the interstates and backroads on two wheels does provide an extra degree of freedom, the average motorcyclist just likes the experience of being on the back of a bike. It is just a different way of getting around.

Chris Jones Sr. is a biomedical CT specialist and lead imaging services technician in the clinical engineering department at Johns Hopkins Bayview Medical Center in Baltimore. Jones has a bachelor’s in health care administration and is a certified PACS associate. He is also a Microsoft certified professional.

Jones is one of those motorcycle enthusiasts who take the two-wheel approach whenever it is practical.

Jones’ enjoyment of motorcycling goes back to his teens, although his parents were not fans.

“I would say that my interest really

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started watching the ‘Wild World of Sports’ and seeing a super motocross race from Germany in the late ’60s, early ’70s,” he says.

He remembers when he had his first experience with a bike.

“I guess when I was around 14 or 15, a friend of my brother and I had an old 50cc Honda dirt bike we would ride around on. It was fun and we enjoyed the life on two wheels. Unfortunately, our parents – dad a physician, [and] mom just didn’t like them.”

The enthusiasm for motorcycling grew later on thanks to his brother.

“When I got out of the military in 1984 – from active duty – I was living in Albuquerque, New Mexico – he loaned me his Kawasaki 650 LTD and I fell in love with the two wheel life once again.

I moved to Virginia Beach, Virginia and my roommate had a Harley-Davidson 1200 Custom that he let me ride when he was out to sea,” Jones says.

Today, Jones’ ride is a 2004 Yamaha 1100 Custom that goes by the name of Veronica.

“Well, Veronica and I do a daily run to work and home – weather permitting – cold, snow, and rain are a no-no for us. I have just started to do some MotoVlogging on my rides, maintenance and other aspects of motorcycles. I also have joined a Motorcycle Amino – for meetups, chats and other motorcycle related interests,” Jones says.

(The Amino app brings together communities of people with similar interests) Besides his local commuting, Jones has also taken his bikes for longer rides.

When he lived in Virginia, it was mostly local, but that wasn’t the case in New Mexico or today.

“When I was in New Mexico, I rode to Colorado, Utah, and Wyoming for some trips,” he says.

“Veronica and I have travelled to Pennsylvania, West Virginia and the Eastern Shore several times. I am looking forward this year to making an extended trip in to upper Pennsylvania, Connecticut (to see my sister and brother-in-law), make a trip to Virginia Beach to ride with my brother – he owns a BMW R1150 RT,” Jones says.

CRAFTING FROM WOOD Enjoying trips on two-wheels is not Jones’ only pastime. He also engages in a hobby that requires concentration that is more fixed on the material and power tool at hand. He has enjoyed woodworking for several years.

When he was a First Class Scout with Troop 182 in Wellesley, Massachusetts, he earned the Woodworking Merit Badge. That was enough to capture his interest and it never ended. To pursue his craft, it meant accumulating many hand tools and power tools.

WWW.1TECHNATION.COM

SPOTLIGHT

Chris Jones Sr. (left) and his 2004 Yamaha 1100 custom motorcycle nicknamed “Veronica” (right) enjoy hitting the open road.

“Well, I have used many, almost too many to list, but some include a half-inch router, jigsaw, coping saw, wood chisels, old hand planes, table saw with straight and dado blades, etcetera,” Jones says.

And what projects have taken shape from all of these tools and experience?

“Well, over time, five custom wood clocks from fallen or freshly cut trees, bookshelf, repaired wooden chairs, refurbished a wood coffee table [which] had cribbage and chess board built in, and just recently completed my first shadow box for a friend’s grandson for a Christmas present,” Jones says.

The impetus for these woodworking projects can come from anywhere, but most come from his wife.

“She asks and I can work it up, but mainly from inspiration from my friends – they see some of the work I have done.

My best friend (gave him a clock for his birthday several years ago) saw one of

the clocks and that is when I built him one. The bookshelf – the wife requested – she loves to read,” he says.

Of course, piloting a motorcycle and fabricating a project from wood are only pastimes. On the job, Jones works at one of the nation’s most respected health systems; Johns Hopkins Medicine.

“My job or job title is ‘Biomedical CT Specialist,’ but the job, like most of us in the field, is not limited to just my title,” Jones says.

“Mainly, I work on keeping the CMMS database on somewhat of a working order, build PM plans, job plans, insert equipment, check for pricing and other database management stuff. I am also the lead imaging services technician – yea I get all the fun calls and I also have mentored a couple of biomeds who have since gotten training in imaging equipment,” he adds.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

“I started after my graduation from the 35 G Basic Biomedical Equipment Maintenance Technician School (Fitzsimmon Army Medical Center, Denver, Colorado.) in August 1977 – so a little over 40 years I have been either a biomed, imager or HTM professional,” Jones says.

He is also happy that he may be passing the baton to his son and continuing the HTM profession in the family.

“Our 17-year old high school senior told me a couple of weeks ago that he plans on following in my foot steps and has applied to a local college that has a biomed technician curriculum,” Jones says.

“Life is good,” he adds.

The freedom of two wheels, the enjoyment of woodworking and passing along an important vocation like HTM; you can’t ask for more.

MARCH 2018

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INDUSTRY UPDATES

STAFF REPORTS

NEWS & NOTES

Updates from the HTM Industry

JOINT COMMISSION PROMOTES FROM WITHIN TO REPLACE MILLS Filling one of the most high-profile positions in the world of healthcare technology management, The Joint Commission (TJC) has named its successor to George Mills.

Kenneth Monroe was appointed senior associate director of the commission’s Standards Interpretation Group’s Department of Engineering in late December.

Monroe replaces Mills, who held the position for nearly 13 years before leaving for a position with a professional services firm.

Starting at TJC in April 2016,

Monroe previously served as an associate project director in TJC’s Department of Standards and Survey Methods, where he was responsible for maintenance, updates and improvements to life safety and environment of care standards, as well as assisting with emergency management standards, which included workplace safety issues.

Monroe has more than 25 years of health care experience, having also worked as a health care facilities professional. During this time, he directed numerous projects, from

planning and design to construction and operations. Monroe has implemented a facility master plan for a 305-bed hospital, and he has been a facility director at a 1.3-millionsquare-foot health care facility.

Monroe, who has taught project management at the graduate school level, earned his bachelor’s degree in mechanical engineering from Northwestern University and an MBA degree from the Kellogg School of Management at Northwestern University. •

SAGE SERVICES GROUP RECEIVES DUAL ISO ACCREDITATION Sage Services Group, a provider of medical patient monitoring services, parts and accessories; recently announced dual certification to ISO 9001 and ISO 13485 standards.

ISO 9001 is the world´s most recognized quality standard, awarded to Sage for its Quality Management System (QMS). ISO 13485 specifies requirements for an organizations ability to consistently meet customer and regulatory requirements applicable to medical devices and related services.

“The achievement proves Sage’s ability and commitment to providing the highest

quality products and services to its customers and further establishes Sage as a leader in the medical equipment/services marketplace,” according to a news release.

Sage has been ISO 9001 certified since 2014 and was proactive in getting certified to the Medical Device Standard of ISO 13485.

Company President and Founder Joe Harper said that he believes the achievement of dual certifications is “a great accomplishment by our team and further demonstrates our commitment to delivering the highest levels of quality as well as regulatory

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

compliance to our clients.”

“Sage has now elevated itself for further expansion in the patient monitoring marketplace,” he added.

“We’re excited about our growth and the level of confidence this provides our current and future customers.” • For more information about Sage Services Group, call 877-281-7243 or visit www.SageServicesGroup.com.

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STAFF REPORTS

A NEW HOME FOR B.R.I.T. TECHNICAL INSTITUTE B.R.I.T. Technical Institute has a new home and “we wanted to let you all know,” according to an email from President and Co-founder Jewel C. Newell, MBA. “This facility is beautiful on the inside and out, and we cannot wait to give you all a tour! Just be a bit patient with us, as we will be doing some minor reconstruction to make our new home stand out as the place that everyone wants to be,” Newell added.

The new facility is the next step in a desire to provide quality education opportunities to the next generation of HTM professionals.

“Thank you to everyone who supported our vision for this

institute, and just know that we will do our very best to grow, develop, and cultivate a strong passion, work ethic and customer-focused energy into each student we educate,” Newell wrote.

The address of the new B.R.I.T. Technical Institute is 221 Bedford Road, Bedford, Texas 76021.

“If you would like to help us do more, please use this link to donate PayPal.Me/redwelled! As a newly formed nonprofit, grants do not come easy, so we are looking to our community for support! We also need tools, testing equipment, medical devices, electronic components and computers,” Newell added in her email. •

AAMI CONFERENCE PROMOTES MEDICAL DEVICE INDUSTRY SUCCESS To help clarify recent and upcoming changes to U.S. and international standards and regulations for medical devices and other healthcare technologies, AAMI is hosting a two-day conference in collaboration with BSI and the Food and Drug Administration (FDA).

The International Conference on Medical Device Standards and Regulations, which will be held March 22-23 at the Crystal City Marriott in Arlington, Virginia, will bring together regulators and standards leaders from around the world to report on major upcoming regulatory shifts and discuss how medical device manufacturers can prepare for these changes. Understanding the evolving landscape is crucial for device manufacturers who want to enjoy continued compliance and global market access.

“The healthcare technology industry is facing a number of significant regulatory shifts in many parts of the world, and there are a number of areas where we anticipate international standards or their implementation to change.

This includes the areas of risk management, quality systems and postmarket surveillance,” said Joe Lewelling, vice president of emerging technologies and health IT standards at AAMI. “This conference will address the ‘current state’ and recent and imminent changes to standards and regulations, as well as preview additional changes that may be on the horizon.”

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Topics under discussion will include: • Recent regulatory changes, including the 21st Century Cures Act and the FDA Reauthorization Act of 2017 • Restructuring of the FDA’s Center for Devices and Radiological Health to incorporate a total product life cycle model • Medical device single audit program • New European Medical Device Regulations • Development of national and international cybersecurity standards • Current and planned guidance for additive manufacturing • E ducational, regulatory, and standards needs related to artificial intelligence and medical algorithms “This is the premiere event to get information and discuss the emerging issues in standards and regulations, and a unique opportunity to network with regulators, notified bodies, and industry representatives involved in preparing these standards,” said Eamonn Hoxey, an international consultant for quality and regulatory compliance matters who will be presenting at the event.

Seating is limited and AAMI encourages early registration. • For more information, including the full conference agenda, visit www.aami.org/isc.

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INDUSTRY UPDATES

OUTLOOK FOR HEALTH CARE M&A REACHES NEW HIGH IN 2018 Capital One’s annual survey of health care leaders found that industry executives are doubling down on their alreadypositive outlook for merger and acquisition activity. The survey of more than 300 senior executives found that exactly half of industry leaders identify mergers and acquisitions (M&A) as their primary growth strategy for the year ahead.

In addition, 99 percent of those surveyed expect their company’s financial performance to match or exceed 2017 performance.

The percentage of executives citing M&A as their top growth strategy rose substantially from last year’s survey, from 38 percent to 50 percent today. Twenty-one percent expect growth to be driven by new segments or lines of business, down from 31 percent last year. Twenty percent anticipate growth through revitalizing and updating their existing offerings.

“All signs point to an increase in acquisitions in 2018, even following a strong year for M&A in 2017,” said Al Aria, senior managing director, Capital One Healthcare.

“As liquidity in the market remains high, we’re seeing a continued demand for capital. Barring a significant crisis, we expect another year of strong investment activity in the health care industry.”

Capital One’s survey also found that regulation and reimbursement challenges pose the greatest concern to the industry. Fifty-two percent pegged this as their top worry for 2018, and an additional 20 percent specified that changes to the Affordable Care Act were their chief concern. The continued transition to value-based care was cited by only 13 percent. •

BIOMEDICAL TRAINING INSTRUCTOR LAUNCHES NEW BUSINESS Quality training is essential for the biomedical profession, but it’s often hard to find. BC Group is proud to endorse and recommend a new and innovative option for our industry, according to a news release from the company.

Dale Munson, a popular training instructor in the biomedical community, has launched his own business; Biomed Support Services. Biomed Support Services strives to build technical competence in biomedical technicians and clinical engineers. Biomed Support Services include creating simple-as-possible training materials, presenting customized courses, recommending process improvements and performing a variety of technical support functions (calibrations, output verifications, PMs, etc.).

Biomed Support Services has more than 40 years of designing and developing technical training materials. The primary objective at Biomed Support Services is to improve job performance so hospitals can keep their medical

equipment reliable, safe and available for use. By maximizing equipment up time, hospitals can extend the useful life of their equipment and reduce the total cost of equipment ownership.

Biomed Support Services training curriculum includes: • Principles of Electrosurgery • LigaSure Vessel Sealing Generator • Force FX-C Electrosurgical Generator C • Force EZ Electrosurgical Generator • ForceTriad Energy Platform • Valleylab FT10 FT Series Energy Platform • Getting the Most From Your BC Group ESU-2400 • For more information visit www.biomedsupportservices.com. You can also reach Biomed Support Services at 303-525-3393, or by email at dale@biomedsupportservices.com.

RELINK MEDICAL ACHIEVES ISO 9001:2015 CERTIFICATION reLink Medical has successfully achieved ISO 9001:2015 certification for its medical equipment disposition processes.

ISO 9001:2015 is the latest version of the internationally recognized ISO 9001 standard that specifies the requirements for a Quality Management System. To achieve certification a company must build a Quality Management System and processes that meets the requirements of the ISO 9001:2015 standard and then pass an audit by an accreditation firm.

“We are extremely excited about achieving our ISO 9001:2015 certification.” said President and COO Jeff Dalton. “Like our

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

quality policy states, we are committed to providing world class disposition solutions that meet and exceed the expectations of our customer and partners. The ISO 9001:2015 certification validates our commitment to provide quality and transparency through scalable, repeatable and proven processes.” •

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STAFF REPORTS

ZOLL RECEIVES PREMARKET APPROVAL ON ITS FULL PORTFOLIO OF DEFIBRILLATORS ZOLL Medical Corporation, a manufacturer of medical devices and related software solutions, is the first company to achieve premarket approval (PMA) by the U.S. Food and Drug Administration (FDA) to continue to market and distribute its full line of defibrillators in the U.S. The list of defibrillators which received PMA approval include the R Series and X Series monitor/ defibrillators and the AED Pro and AED

Plus automated external defibrillators.

All of these devices are equipped with ZOLL’s proprietary rectilinear biphasic waveform to deliver maximum current to high-impedance patients and Real CPR Help technology that helps rescuers perform high-quality CPR. “ZOLL is very pleased to have received PMA approval for our entire portfolio of defibrillators,” said A. Ernest Whiton, president of ZOLL’s resuscitation division. “This is the most

stringent level of regulatory approval for safety and efficacy of a medical device, and represents ZOLL’s long-standing commitment to product quality, safety, and efficacy.” •

CANADIAN MEDICAL AND BIOLOGICAL ENGINEERING CONFERENCE (CMBEC41) The CMBES organizes annual medical and biological engineering conferences in various cities across Canada. This upcoming event will be a joint conference with the Atlantic Canada Clinical Engineering Society (ACCES).

In addition, the CMBES

conference sponsors seminars, which include peer-reviews, technical paper presentations, exhibits of current medical devices, a continuing education program, workshops, symposia and networking opportunities.

CMBEC41 will take place in

Charlottetown, PEI on May 8-11, 2018. • For more information visit www.cmbes.ca or http://accesociety.org/about-acces.

DIGIRAD SALES MDSS SERVICE CONTRACTS TO PHILIPS NORTH AMERICA Digirad Corporation has entered into a definitive purchase agreement with Philips North America to sell its Medical Device Sales and Service (MDSS) business unit service contracts.

The total consideration under the agreement is $8 million.

Digirad President and CEO Matt Molchan said, “Over the last few months we have been evaluating our opportunity to run this service business outside our prior Philips relationship,

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and we determined that the best value for the business would be in the hands of Philips. We are very pleased with the economics and outcome of this agreement, and this transaction will better position Digirad to focus on its core business – providing convenient mobile diagnostic health care solutions.”

The MDSS business unit provided post warranty contract maintenance services for large diagnostic imaging

equipment, primarily in the upper mid-west region of the United States, for Philips products.

As part of the agreement, Digirad and Philips agreed to extend its prior consolidated service agreement to continue to provide installation and warranty services sold in the same upper mid-west region through January 31, 2018.

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INDUSTRY UPDATES

BY AAMI

AAMI UPDATE

Join Your Colleagues at the AAMI Annual Conference

D

uring the AAMI 2018 Conference & Expo, set to run June 1-4, thousands of members of the healthcare technology management (HTM) community will gather in Long Beach, California, to learn about the latest innovations and advances in healthcare technology, get solutions to some of their toughest challenges on the job and connect with their peers.

“HTM professionals are constantly learning and adapting to changes in health care delivery and accreditation requirements, as well as changes to the technology and systems themselves,” said Sherrie Schulte, AAMI’s senior director of certification and the annual conference. “Attending continuing education programs, such as the AAMI Annual Conference, helps HTM professionals stay on top of these changes, giving them a leg up in their careers.”

Throughout the conference, industry experts and leaders will share valuable insights on the biggest trends and challenges in the healthcare technology sector and provide practical tips and guidance.

In addition to education, networking and professional advancement

activities, the conference offers an expo hall that will feature the latest technology from more than 200 medical equipment manufacturers.

More than 90 percent of the biomedical and clinical engineers, healthcare IT specialists, clinicians and other HTM professionals who attended last year’s conference agreed that the event was a good place to gain insight on how their organization could improve clinical outcomes. The conference also provided a good perspective on the state of the HTM field, they said.

When asked what they gained from their conference experience, nearly all attendees said they acquired new business contacts, learned about new products and technologies, were exposed to new ideas applicable in their jobs and returned home with new skills and best practices.

Early-bird discounts are available until March 16. For more information about the conference and to register, visit www.aami.org/ac.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FIND CONTENT BY TOPIC ON THE AAMI WEBSITE The AAMI website has a new “Browse Topics” feature that allows visitors to find multiple resources related to a specific topic of interest, such as cybersecurity.

Resources listed under any given topic might include standards, news articles, videos or manuals. The new functionality is part of a broader effort to better showcase the many resources that AAMI has developed for the healthcare technology community and improve access to them.

“As AAMI develops more content and tools to help healthcare technology professionals, we know that we must make this material easier to find,” said Sean Loughlin, AAMI’s vice president of communications and marketing. “This is an ongoing effort, and we’ll be listening to our members and website visitors to guide us on further improvements.”

For more information, go to www.aami.org/BrowseTopics.

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BY ECRI

ECRI UPDATE

A Top Hazard – Ransomware and Other Cybersecurity Threats

F

or any industry, a ransomware attack can be an IT nightmare. But in the health care environment, an attack brings additional concern: it can trigger a patient safety crisis.

Ransomware and other types of malicious software programs (malware) infiltrate an organization’s network and propagate through connected devices and systems. Once these programs gain entry to the network, they encrypt data to disable user access, software and IT assets. For a hospital or health system, the attack could disrupt health care delivery operations, placing patients at risk.

The significant and broad implications to patient care associated with ransomware and related cybersecurity threats prompted ECRI Institute to designate this topic as the Number 1 concern in its report detailing the “Top 10 Health Technology Hazards for 2018.”

THE NATURE OF AN ATTACK Multiple ransomware and other malware variants have infected health care organizations, as well as other private and public organizations, throughout the world. This form of malware uses encryption to essentially disable software-based devices and systems.

Encryption is a way of making data available only to parties that hold an appropriate “secret” or key. Encrypting data for storage (“at rest”) and transmission (“in transit”) are accepted best practices across industries. What

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ransomware programs do is forcibly encrypt data without the owner’s consent.

This makes the data inaccessible to normal users. In the case of ransomware, hackers request payment, often in Bitcoin (a virtual currency that is difficult to trace), in exchange for a decryption key that will allow victims to regain access to their data.

In reality, though, paying a ransom does not guarantee that functionality or data will be restored. In at least some attacks that have been characterized as ransomware, systems have instead been infected with a wiper virus that destroys, rather than encrypts, the victim’s files.

Also, some advanced ransomware reportedly has rendered certain devices useless, requiring device or hard disk replacement. (It is recommended that organizations faced with a ransom demand contact their local Federal Bureau of Investigation office for guidance.)

THE EFFECTS ON PATIENT CARE In a health care environment, a malware attack can significantly impact patient care on multiple fronts.

Most notably, malware can render health IT systems unusable. This includes electronic medical records and other clinical systems, as well as administrative, email, ordering, inventory and materials management, financial information and scheduling systems.

Similarly, an attack can prevent access to patient data and records, in some cases even affecting access to online backups.

Malicious software likewise can affect the functionality of hospital workstations and networked medical devices.

Less obviously, malware can affect

building and infrastructure systems (e.g., heating, ventilating, and air-conditioning).

Also, it can disable third-party services – such as dictation services or other web-based services – that have been affected by the attack. Or it could disrupt the supply chain for drugs, supplies or devices.

Consequences for health care facilities can include being forced to alter workflows (e.g., reverting to the use paper records), cancel procedures or even close entire care units. Additionally, equipment and systems can be damaged and sensitive data can be exposed. All such outcomes can have significant financial implications.

Ultimately, the disruptions can compromise or delay patient care, leading to patient harm.

TIPS FOR BEING PROACTIVE ECRI Institute’s full report, published in November, details 39 distinct steps to help health care facilities address the threats associated with ransomware and other malicious software programs.

Chief among the recommendations, according to Juuso Leinonen, a senior project engineer in ECRI Institute’s Health Devices Group, are three actions for senior leadership:

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INDUSTRY UPDATES

•

Define high-level security goals for the organization, and institute a practical plan for achieving those goals.

• Allocate appropriate resources – in terms of people and budget – to the ongoing management of cybersecurity efforts within your organization.

• Facilitate collaboration across departments.

Cybersecurity threats are not just an IT problem, particularly in health care organizations.

In fact, staff at all levels of the organization have a role to play. Clinical engineering and IT staff, for instance should work together to: • Identify and address medical device vulnerabilities.

• Maintain accurate medical device software and network connectivity information, including details about which devices and systems include protected health information (PHI).

• Frequently back-up data from IT assets and test recovery system functionality.

• Apply validated software updates to medical device systems, when practicable.

Additionally, all personnel should follow security best practices, as outlined by the organization’s IT department.

For example, staff and other personnel should be instructed: • Not to click on links or attachments in suspicious emails.

• Not to use computer-like medical devices for email or web browsing. (Medical devices should not be used to access the Internet except as part of a normal workflow.)

• To follow organizational policies regarding the use of USB drives (e.g., thumb drives).

• To report any identified issues with networked devices (e.g., computers, workstations) to the IT or clinical engineering help desk.

In addition to the discussion in its “Top 10 Health Technology Hazards” report, ECRI Institute has published a free public resource – Ransomware Attacks: How to Protect Your Medical Device Systems – to aid health care facilities in tackling ransomware with medical devices.

Stay tuned for the next issue of TechNation, where more hazards from the list are uncovered.

This article supplements ECRI Institute’s Top 10 Health Technology Hazards for 2018. An executive brief of the report can be downloaded from ECRI Institute as a free public service. The full report, which includes detailed problem descriptions and recommendations for addressing the hazards, requires membership in certain ECRI Institute programs or separate purchase. For more information, visit www.ecri.org/2018hazards, or contact ECRI Institute by telephone at 610-825-6000, ext. 5891, or by email at clientservices@ecri.org.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

MARCH 2018

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THE BENCH

STAFF REPORTS

SHOPTALK

Conversations from the TechNation Listserv Q:

A:

A:

A:

Are you required to get a flu shot by your employer? Do you think it is a good idea to get a flu shot?

Yes I am. Yes I do. I’d like to keep my job. Seriously, even though it’s not as effective as it should be, anything that promotes patient safety is a good thing.

A:

We either have to get a flu shot or sign a declination form. If the declination option is selected staff is required to wear a mask when around patients and visitors. I think that vaccinations are a fantastic idea. I did a year of graduate work in virology and I have yet to see an argument against that was scientifically supported. It is not only for your own safety. I work in a hospital and am around people in compromised state of health. I would consider it harmful to increase their exposure to harmful pathogens.

A:

You are a technician. Investigate flu shots. It is not an evidencebased practice. Hand washing is many times more effective in stopping the transferal of the virus – that is evidencebased.

A:

Yes I am required. I have no reservations about it. But I think the significant question is … how effective is the flu shot?

My flu shot was so effective that I was sick for two weeks following, including a hacking cough that went on nonstop night and day.

Yes, and yes. Although the flu shot is the result of a “best guess” of what we’ll have, it’s better than nothing!

A:

Not when it is ineffective.

A:

Couldn’t agree more. People really need to investigate. Why is it that a cook/chef needs to know all the ingredients of what they’re preparing because of allergies; yet the doctor/nurse who gives you a flu shot doesn’t even question the contents? Besides, it’s 2018, and people still cough into their hands! Those are the types of issues we should really be dealing with.

A:

Q:

A:

A: A: A:

Flu shots can help and they are required by my employer. I’ve also read that vitamin D is helpful against the flu. And, I agree, a good defense is hand washing.

Scientifically speaking, there is a very small chance of contracting Guillain-Barré from the flu shot. This is easily overlooked because of the adage “the good outweighing the bad” of not getting the flu shot. Until, it is your family member that experiences this horrific side affect and never recovers. I understand the intent behind requiring flu shots but I do not agree with it based on my personal experience.

A:

Guillain-Barré can also be caused by exposure to the influenza virus itself. If you were susceptible to exposure via the killed virus in the vaccine you are equally susceptible from exposure to the virus itself.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

What is the best gift to get a biomed?

Leatherman multi-tool.

LED pocket flashlight.

A recruiters name and number.

THE SHOPTALK 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.

MARCH 2018

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THE BENCH

BY DOUG BROWN

BIOMED 101

HTM Analytics and Performance Measurements for Hospitals in 2018

BY DOUG BROWN

I

t is common for healthcare technology management (HTM) departments to fret over the condition of their CMMS database and the poor quality of the data it contains.

Inaccurate databases, caused by years of uncontrolled input and poor data management, have left hospitals with a reduced ability to effectively measure their performance compared to external standards. Without this ability to compare internally and externally, there is no practical way to know how HTM departments are performing, leaving them vulnerable to the C-Suite as well as ISOs. Accurate information is helpful to HTM departments at the 5,800 acute care hospitals throughout the U.S. The question is how does one get it? After years of inaccurate input, the output is typically corrupted to a point that it is not only diminished in value, but can be detrimental in properly measuring performance. We have all heard the expression “GIGO” (garbage in – garbage out) and never has it been more accurate than in the typical HTM department. In fact, over 78 percent of hospitals recently surveyed said they would not use their data to make sound decisions.

Just as executive management uses data to analyze surgical outcomes, occupancy levels, staffing, length of patient stays, financial performance and hundreds of other measurements, accurate CMMS data can reveal low-performing equipment as well as low-performing personnel. The ability

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to clearly measure how PMs impact mean time between failures (MTBF), they don’t, or provide actual “cost of ownership” on expensive-to-repair or maintain equipment can help management make better decisions in running their departments, as well as provide the necessary input to other departments tasked with equipment acquisition. Positive outcomes such as higher performing technicians as well as reduced PM costs and implementation of compliant AEM programs are potential outcomes of proper performance measurement.

Never has the need been greater and the stakes higher for information than in the coming year. Reduced hospital reimbursements and smaller budgets mean HTM departments aren’t filling open positions and – in some cases – are reducing staff. Unfortunately, many of these departments need to increase, not decrease their staff, but they lack the tools to make defensible arguments to C-suite managers who don’t see the justification in increasing the costs of these departments, even when it may be the best financial option. A properly run department is a cost saver, not a bottomless pit of expense as many C-suiters see it.

Through the use of analytics and benchmarks, you can use valuable CMMS information to justify your department like never before.

Superior Analytics, a division of Phoenix Data Systems, has created a process to get the information needed and restore a CMMS system to the required accuracy.

The first step to accurate performance measurement is ensuring

that the data is correct. If you can’t correct the decades of inaccurate data input, you will get out exactly what you put into it. We have software that is capable of “reading” a CMMS, regardless of vendor. It compares the data to the proprietary MDX2 database, which contains over 3 million pieces of equipment, corrected to the level of manufacturer, model name and number. By comparing data, it can correct – or “normalize” – the equipment to ensure it has the appropriate information.

It then creates data spreadsheets which quickly identify areas where HTM departments can improve departmental performance such as PM completion, CM hours, labor efficiency, MTBF … over 100 metrics in all. By quickly identifying the “low-hanging fruit” HTM can begin to manage the department using analytics to find the highest need and quickest ROI. It will help identify unused equipment, instantly highlight anomalies in staff costs and better prepare HTM for Joint Commission reviews by quickly pointing out problem areas.

Once data is cleansed, major problem areas are identified and the wheels are set in motion to correct overall performance. Now HTM can compare its performance to other hospitals. The system readily allows HTM to see its overall performance compared to the mean as well as the “best in class.” This can be done at the highest level (overall departmental performance) or by modality, equipment type, manufacturer or even specific hospital locations and/ or personnel. By applying the average labor rate (including overhead) a

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department can quickly identify where its performance is lacking or where it exceeds the mean level or “best in class”, projecting potential savings.

Imagine being able to show C-suite managers how an HTM department is exceeding the “norms” and saving the organization money.

What is the real cost of delaying the implementation of a normalization and/ or benchmarking solution? Here are some questions to ask yourself.

• Do you have a full-time analyst who can do the work?

• Is he/she stymied by the sheer volume of devices to be “cleansed” or normalized?

• Do you have accurate data available to you when you need it?

• Is the data problem getting worse as time goes on?

In most hospitals, the answers to these questions will lead you to the appropriate decision, even when talking to the C-suite. Having accurate data on which to make decisions is no longer a luxury, it is imperative in today’s hospital. Imagine the chaos if doctors didn’t analyze the results of the medical procedures they perform? Should the analysis of the equipment they use be any less stringent?

By clearly outlining the information you need to know, you can make an informed decision on the project.

• W hat (positive) changes can you make and what data is required to support those changes?

• Can this knowledge improve

decision-making and increase credibility in management meetings?

• Will you be able to save the hospital money due to better management, more effective labor application, better training and fewer service contracts?

• Can you support better acquisition efforts by supplying repair and maintenance costs to purchasing or materials management?

• How much effort will it take from you or your staff? Will the results justify the time?

• Can an outside vendor provide the solution you need?

The average hospital reviewed in 2017 saw a potential opportunity to save more than $250,000 annually, simply by achieving the overall mean performance level of Superior Analytics users. Reaching “best in class” distinction would allow for another potential $250,000 to $400,000 in savings. This is an average. HTM savings may be more or less depending on size, condition of the database and level of performance. Generally, bigger organizations save even more, especially when trying to combine CMMS databases after an acquisition.

Doug Brown is vice president of sales for Superior Analytics, Phoenix Data Systems Inc. He may be reached via email at DBrown@ GOAIMS.com

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

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ROUNDTABLE IV Pumps

TechNation contacted IV pump gurus for this installment of the monthly Roundtable article. We asked experienced professionals to provide their insights regarding the latest advances in IV pumps as well as tips and advice that they think will benefit our readers.

The roundtable panel for IV pumps is made up of Select Biomedical CEO Tom Fischer, Elite Biomedical Solutions Co-Owner/Vice President Nate Smith and Soma Technology Biomedical Engineer Majed Zaitoun.

Q: WHAT ARE THE LATEST ADVANCES IN IV PUMPS IN THE PAST YEAR? Fischer: From our perspective, the biggest advances we have seen have been in areas of integration and M2M connectivity. The Internet of Things is finally seeing great strides in the medical device industry – especially in the infusion pump world.

Connectivity and security will again be hot topics for biomeds in 2018.

Smith: Not a ton has really changed since the term “Smart Pump” was introduced about 10 years ago, which incorporates an extensive drug library, pump history, etc. Hospitals have began incorporating barcoding, which basically marries the pump to the patient as well as better traceability of what is going on at the nurse call stations.

Zaitoun: There are a few advances in infusion pumps within the last year. The latest infusion pumps help prevent medication errors by alerting you to a pump setting that doesn’t match the administering of a drug.

Wireless connectivity streamlines the patient information system and central systems. Barcode scanning for drug entering (auto ID), drug library editing software, diagnostic and maintenance software are also new features.

Q: WHAT FACTORS SHOULD HTM CONSIDER TO DETERMINE COST OF OWNERSHIP? Fischer: Total cost of ownership should, and in most cases, include training, parts, software, connectivity, reporting, etc. However, we are also seeing a shift to include opportunity costs becoming part of HTM

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decision-making. As resources continue to be stretched, low-revenue producing fleets/equipment are being scrutinized as to how best to incorporate a longer view of cost of ownership.

Smith: Software, disposables, training and most importantly maintenance of the device. The maintenance of the device can get overlooked but can be very expensive over the course of 7-10 years of owning the device. Make sure you have a reputable third-party that can save you money and time, but still deliver the quality product/service that’s needed.

Zaitoun: HTMs should consider the cost of equipment, technological features, operational features (capable of upgrades), cost of accessories and consumables.

Installation requirements like integrating software and hardware, manpower training and time consumption should also be taken into account. Annual maintenance costs (labor/comprehensive), running cost and insurance cost are a few factors which need to be considered while purchasing equipment.

Q: WHAT ARE THE PROS AND CONS OF BUYING BRAND NEW VERSUS BUYING REFURBISHED UNITS? Fischer: In almost all cases where a facility is looking to change OEMs, we recommend going directly with the new OEM to make sure installation, security and training come from the OEM. The pros and cons of buying to supplant existing equipment depend greatly from where you are buying the equipment. In all cases of buying refurbished equipment, a facility needs to make sure the product has a longer warranty than OEM, the dealer understands machine-to-machine connectivity, and the quality of the equipment meets or exceeds OEM specs (no non-OEM parts). If these rules are not followed, buying refurb will be all cons!

Smith: Expense, is really the driver behind this.

Recertified is a great way to go due to how quality of parts and service have greatly improved over the last 5 years. You can get recertified units now that look pretty close to brand new. When selling recertified devices we change out cosmetic parts with new, replace sensors and ensure all boards are working properly.

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ROUNDTABLE

Zaitoun: The only limitation to refurbished equipment is that the technology is older, but most of the medical staff was trained to use this equipment, and already know how to work with it. The perks are that refurbished medical equipment costs less than new, and has lower maintenance and running costs. While new equipment has newer features, it will be harder for the medical staff to learn how to use the equipment. Since new medical equipment is twice as expensive as refurbished, it will quickly deplete a hospital’s budget.

Q: WHAT CYBERSECURITY MEASURES SHOULD BE TAKEN WHEN IT COMES TO IV PUMPS? Fischer: We have seen a large increase in our interaction with IT departments working with biomeds to insure connectivity and security. In most cases, we are acting as interpreters for IT to make sure pumps are secured correctly. Our biggest recommendation is deeper training for HTM professionals.

Nate Smith, Elite Biomedical Solutions Smith: The FDA has been working hard at investigating which devices may have the chance to be affected by a cyber hack, so continue to monitor their website for further information.

Zaitoun: The connections from your networks to the Internet, and other partner networks, expose your systems to hackers. By creating and implementing some simple policies, appropriate architectural and technical responses; you can reduce the chances of these attacks succeeding (or causing harm to your organization). Rather than focusing purely on connections, think also about where your data is stored and processed, and where an attacker would have the opportunity to interfere with it. You can manage the network perimeter by use of firewalls, antivirus software, intrusion detection software, all to prevent malice. You can protect your internal network through secure wireless access, enabling secure administration, configuring the exception handling processes and monitoring the network.

Q: CAN YOU EXPLAIN THE IMPORTANCE OF HOLDING AN IN-SERVICE OR CLINICIAN TRAINING ON HOW TO PROPERLY USE THE DEVICES? Fischer: From our perspective, training is a mandatory step in making sure the setup is complete on all pump purchases. We also provide training on best ways to clean pumps – incorrect handling/cleaning of pumps causes more damage to fleets than any other cause.

do have safeguards to prevent issues from occurring, but it needs to always start with the nurse.

Zaitoun: Clinical training will help us to obtain the knowledge of operating instructions. Daily maintenance, storing and using the accessories, handling, sanitizing and sterilizing equipment are all pertinent information. Periodic training can help us to improve patient care, patient safety and avoid human error.

Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING IV PUMPS DEVICES? Tom Fischer, Select Biomedical Fischer: At Select Biomedical, we understand there are alternatives when it comes to pump sales, rentals and service. If we can offer any advice – while price will always be an important factor – we highly recommend also valuing experience in the field and connectivity, warranty/quality, customer service – and finally, how easy are they to do business with. Again resources are tight, needing to make a dozen calls to make something right, will cost you 3 to 4 times the original cost of a repair or pump sale!

Smith: The OEM isn’t the only option when it comes to purchasing and servicing IV devices. The quality of the thirdparty market has grown significantly over the last couple of years.

Work with a company that has their ISO certifications, is FDA registered, with a responsive sales/customer service team and a company that will get issues resolved same day so you can move on to taking care of the patients.

Majed Zaitoun, Soma Technology Zaitoun: Purchasing requires much attention to detail. We need to think about the future technical requirements, safety recalls, accessories costs and maintenance costs. Always buy in large or cumulative quantity and use third-party inspection and certification of the equipment. Consider the service locations, turn-around time, technical training, maintenance of software and hardware, and to verify with tech support.

Previous TechNation Roundtable articles are available online at https://goo.gl/79fqNj.

Smith: If a nurse doesn’t know how to properly use a device then there could be major complications to the patient. Infusion devices

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or any organization to run efficiently, it takes planning, a set of internal policies, a roadmap for the future and an effort to make employees the best at what they do. Finding a way to achieve these goals will help ensure that the organization realizes success while meeting any metrics it has challenged itself with achieving.

Making a plan, and following it, also provides direction for employees. It provides an environment where costs are contained, employees obtain proper training and customers are served.

Achieving all of these goals can sometimes be a challenge in CE/biomed departments where budget and resources must coexist with needs, compliance and existing inventory. Cost savings have become an expectation while there is no room for compromise. An evolving health care model, with inherent disruptions, further requires that a solid plan be in place.

At the AAMI 2017 conference, Mike Busdicker, MBA, CHTM, system director of clinical engineering at Intermountain Healthcare and Aaron Goryl, general manager, in-house and on-demand services with GE Healthcare, brought this topic into focus in a panel discussion presentation titled “Balancing Cost and Quality: Managing Risk in Your Service Program.” Other panelists were Steve Vanderzee, AA/BAS, CBET, Advocate Health Care and Erin Schipper, BSBME, Thedacare Regional Medical Center.

The presentation touched on six primary areas: 1) Human Capital Optimization, 2) Asset Availability, 3) Flexibility for Evolving Needs, 4) Hidden Administrative Costs, 5) Program Compliance and 6) Sustainable Verses Short-Term Savings.

Busdicker says that the human capitalization element

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requires an organization to get its ducks in a row. He says that considerations should include technical training, specialization, geographic coverage, and enabling service tools and technology factors when evaluating financial impact.

“With this category, it becomes very important to build an implementation and business plan around the equipment a department is looking to service, or equipment they might currently be servicing,” he says. “This includes measuring staff competency and skill knowledge sets, requirements for the servicing of the equipment, availability of all service tools (manuals, test equipment and keys), parts availability and resources outside of the organization.”

“The organization really needs to look at the geographic area being serviced and what it is going to take to provide the coverage level expected by stakeholders,” he adds. “Other things to consider in this area include the availability of backup equipment, history of the equipment, costs (vehicles, on-call, specialized test equipment, call dispatching and communication devices) to support the identified equipment.”

Busdicker says that these internal variables need to be evaluated for cost effectiveness and efficiency when compared to “service partnerships with authorized service providers.”

“The end result should be the development of a program that optimizes internal and external staff to support equipment in an efficient manner,” he says.

GE Healthcare’s Todd Hall stresses the importance of “optimizing your human capital” in the white paper “Balancing Cost and Quality: Managing Risk in Your Service Program.”

“Considering the cost of imaging assets, the mission critical importance to care delivery, and publicized

Balancing ACT concerns about the potential effects of over utilization, technical service labor may be the most important issue you need to get right in your new model,” Hall says.

“Starting with how many resources are needed to support your organization.

What is the optimal mix of in-house versus outsourced resources? How will you scale and optimally deploy these resources to meet the needs of your organization as it grows and changes?”

“For example, advanced service diagnostics and tools from OEMs are important to support the engineers. Will your team have access to these items?

Usage of diagnostic tools can help support productivity. To provide an estimate of the value of an OEM diagnostic tool, an engineer could multiply the number of hours saved when using each diagnostic tool by the hourly cost of downtime, and then replicate that analysis for each modality,” Hall adds.

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directly with the service providers on outstanding items,” Busdicker explains.

Hall suggests that remote diagnostics and support can be a valuable tool.

“The key to achieving a guaranteed performance metric is the response process.

How will you be confident that guarantee will be realized? One important variable is access to remote diagnostics and support, especially if you have facilities in remote geographic locations and/or without equipment redundancies,” Hall says. “The value can grow if any of those facilities are mission-critical based on patient volumes and/or clinical capabilities. When effectively designed, remote diagnostic services can dramatically help reduce the time needed to identify and fix an issue, and may enable the proactive repair of issues prior to a decline in system performance.”

In addition to tracking PMs by providers, Busdicker says that equipment downtime should be tracked.

“The service coordination center gathers information utilized to support the Intermountain goal of zero harm to our patients,” he says. “Therefore, they capture data around patient care like if the equipment is hard down or soft down, if there was a patient on the table when the equipment went down, or if patients are having to be rescheduled. This information is used for trending analysis, patient incidents and impact on revenue.”

Another component of the approach that Busdicker advocates is to utilize an automated on-call process. He suggests the establishment of an automated after-hours process that will put stakeholders in direct contact with the on-call service technician.

This eliminates the need for multiple calls and allows stakeholders to place one call and focus on patient care and treatment.

He also suggests an executive level escalation process – each with an RCA for continuous improvement.

“The department has established a continuous improvement process that includes the performance of a root-cause analysis be performed on equipment with extended downtimes as determined by department and organizational leadership,” Busdicker says.

“This process includes the potential

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BLUEPRINT FOR SUCCESS To continue to hone that roadmap, Busdicker suggests that certain levels of expectation should be well defined and that communications with customers, providing clear instructions, is part of constructing an efficient level of understanding with all stakeholders.

Regarding asset availability, Busdicker says that biomed departments should “identify specific commitments on response time and equipment uptime, as well as remedies for noncompliance.”

“Here at Intermountain Healthcare, we have developed and distributed an equipment brochure to departments throughout the organization,” he says.

“This brochure includes: key definitions – ‘urgent and routine service request;’ this explains how we define a request for service from the stakeholder.”

“For example, the urgent request would be for equipment that goes down and creates a loss of the facility’s primary function, safety hazard or interruption of immediate patient care,” Busdicker says.

“The routine request includes service that might not be needed right away, can be performed at the first opportunity, or does not significantly impact the primary

function of the department/facility.”

He says another element is service level agreements; both in-house and ASP. “Here we identify the service level agreements established with our service providers during contract negotiations and the service level agreements of our in-house staff established with internal stakeholders,” Busdicker says.

The brochure distributed to customers also outlines how to obtain service referencing stickers, call number and tag number.

“The brochure identifies the process for requesting service through our service coordination center. It includes the call in number, how to locate the equipment asset tag, information required for the request, hours of operation and the afterhours call process,” Busdicker adds.

Another step Busdicker’s team took was to establish a service coordination center at Intermountain Healthcare and all calls for on-site service are generated through this function. He says that it doesn’t make a difference if the equipment is under contract, first look or full in-house service.

“Once a call is dispatched, all service technicians are required to acknowledge and respond to the call through the coordination center,” he says. “This provides quality documentation for both the outside and internal service providers.”

The metrics of the response time are tracked; call time, acknowledged, customer contact, on-site.

“The identified response times are tracked by the service coordination center and documented in a report shared with department and organizational leadership.

It provides data and information around the quality of the internal and external service providers with potential identified opportunities for improvement,” Busdicker says.

There should also be an effort to track all work performed by providers outside the in-house team.

“The service coordination center tracks all authorized service provider events to include scheduled PM work orders. The department receives and uploads all field service reports into the asset history record and tracks PM completion percentage. They work

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The end result should be the development of a

program that optimizes internal and external staff to support equipment in an efficient manner.

authorized service provider focuses only on costs and increasing revenue the potential exists that this cost will be passed on to the patient,” Busdicker says. “In the end it does not benefit health care as a whole, so everyone involved in the process needs to see the bigger picture.”

Mike Busdicker, MBA, CHTM, System director of clinical engineering at Intermountain Healthcare

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ADDRESSING THE COST SIDE One of the cornerstone elements of the successful service program blueprint is controlling costs. Busdicker breaks this element into nine areas of focus.

Hidden Administrative Costs – Understand sources of hidden cost and know which expenses are simply transferred from contract to process cost.

Contract Verses In-house Cost Comparison – Organizations need to continually monitor, track and trend their equipment service. Each year we perform an assessment of our equipment costs and contract costs comparisons. Some of this review is performed in conjunction with our service providers and they provide input on suggested equipment transitions to reduce costs or improve quality.

Damaged/Abused Items – This is an item we keep track of for all equipment whether it is on contract or supported in-house. This information is used in trending reports and annual reports to organizational and department leaders. We work with individual departments to provide training and processes to reduce this hidden cost of equipment service.

Central Parts Stocking Program – We have done a lot of work with our departments, service technicians, and service providers to evaluate the inventory of on-hand parts. We stock high usage critical parts in a central location and reduced the

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involvement of our authorized service providers, stakeholders and service technicians. The department has developed an approved form for documentation that includes cause, resolution, suggested changes and lessons learned,” he adds.

Another component is “Flexibility for Evolving Needs.” On this topic, Busdicker says to look for usage-based coverage, pooling options, conversion flexibility during agreement term and tighter performance commitment.

“Here we were looking at the need for organizations to be flexible as needs, technology, staffing and volumes shift,” he explains. “This includes flexibility from the health care facility/system standpoint and from the authorized service provider’s position. Everyone needs to work together in order to maintain a fiscally responsible operation without negatively impacting the quality of the program.” “If the facility strictly focuses on the cost aspect it could impact cost for other organizations. If the

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parts with a minimal turnover rate. This has really reduced our on-hand inventory dollar amounts and positively impacted the repair process. We have implemented a complete process that includes parts replenishment, parts tracking, W/O uploading, overall downtime tracking of equipment, and savings around parts ordering and shipping.

Invoice Review Process – The HTM department here at Intermountain has implemented a comprehensive invoice review process for service contracts, parts purchasing and service events. This includes all of the following areas: FSR/Invoice Matching – All field service reports are matched with the invoice for the particular service event.

This is done to ensure we are not being charged for repeat events, labor hours match, parts usage is correct, travel time is accurate and whether overtime has been charged correctly.

Parts and Labor Discounts – Invoices are matched with any service agreements that might be in place to ensure all discounts for labor, parts and all other negotiated items are included on the invoice.

Contract Reviews – Adds and Deletes – Our contract invoice process includes no more than quarterly billing with a preference on monthly for higher level agreements. This allows our department to review each contract invoice for correct billing, matching of equipment adds and deletes with amendments and potential incorrect invoice amounts.

Warranty Expirations and Budget Building – Organizations need to ensure they are capturing all warranty information for new equipment and repaired equipment. We have implemented a comprehensive process to record the warranty information for equipment and parts. This process has prevented expense on items that were still under warranty from suppliers or from the manufacturer.

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ACHIEVING AND SURPASSING TARGETS Part of assuring a quality program is the compliance component. Busdicker says that this means it is a program that

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monitors changing environment, implements adequate policies and measures results.

The tracking of regulatory service includes in-house and ASP compliance (RepTrax, competency, downtime and documentation). This topic covers

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agreements, special interest items, equipment downtimes, and targets for the next quarter. Most of these reviews are done in conjunction with the in-house and authorized service providers,” he says.

Besides bringing in service providers, a HTM department should look internally.

THE Key to achieving a guaranteed performance metric is the response process. –Todd Hall

Todd Hall General Manager of Service Sales, GE Healthcare

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numerous areas that include adherence to organizational requirements for entrance into the facility, compliance to state and federal regulatory requirements and observance of organizational standards related to the installation and ongoing maintenance of medical equipment in the facility.

Busdicker says that another element of quality and compliance is to sit down with stakeholders and discuss it regularly.

“We schedule quarterly business reviews with all major service providers and our in-house teams to provide data and information around program performance. These reviews include information around regulatory compliance, performance against service level

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“The HTM department here at Intermountain has developed and implemented an internal audit process for our program. This audit evaluates regulatory compliance, policies/procedures, implementation of organizational requirements and overall HTM program implementation,” Busdicker explains.

“We complete a final audit report for each facility within the system and develop an action plan to be implemented and completed the following year.

This includes a formal report to executive leadership.”

Finally, keeping the lines of communication open within the department through daily and weekly huddles can achieve several goals.

“These huddles are not problem-solving forums, but provide an opportunity for staff and leaders to share important information centered on patient care and treatment. The huddles ae limited in time and provide an opportunity for a safety minute, recognition of caregivers, performance in relation to metrics, any compliance concerns, and any other organizational issues that might need to be shared with leadership,” Busdicker says.

To make cost savings more sustainable instead of just temporary, Busdicker suggests using an analytics-driven approach to control service spend, increase utilization and reduce expenditures.

“It is very important to use analytics and reports to ensure the program is driving sustainable savings over the long

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term instead of just focusing on the short term,” he says.

“If short-term savings are the only goal, the long-term result will be an increased cost for the organization and for health care as a whole. Therefore, it is very important for the organization to develop analytics and reports to demonstrate consistent results that can be benchmarked and used as performance metrics. These analytics, benchmarks and metrics need to be monitored on a routine basis in order to continue controlling cost and maintaining or improving quality,” Busdicker adds.

With this roadmap in mind, the HTM department can be a model for all departments in achieving levels of efficiency, self-monitoring and cost savings to benefit the whole organization.

Hall points out that every health care facility has unique needs.

“There are many different approaches to medical maintenance, and there is no single solution that works for all health care providers. And the advantages and trade-offs of each must be considered across a variety of factors.

Some models may achieve a reduction in operating expenses through brute force limitations that pare equipment service back to a near break-fix mentality and leave large gaps that can increase costs, potentially imperiling patient care delivery and staff productivity,” Hall says. “Some may have hidden costs resulting from administrative paperwork or a lack of access to training and advanced tools. Others may inherently have more risk and can have downstream operational impact that can offset cost savings.”

“There are many approaches to cutting costs, but the approach you choose should not come at the expense of equipment performance, continuity and timeliness of patient care, staff satisfaction and productivity, or the ability to capture and utilize data to improve and guide decision making,” he adds.

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• By starting with an action verb and keeping the statement to one line, your message will be powerful, and to the point.

1

NEVER HAVE MORE THAN TWO PAGES • The two-page rule applies only if your past experience and background relates to the position for which you are applying, if not, then one page!

• Although you might think your credentials warrant an autobiography, the majority of technical hiring managers don’t have the time to read more!

• Avoid the tendency to put critical information on the second, where it might not be read at all.

2

BEWARE OF FANCY FONTS • Using fancy fonts in your resume might demonstrate your graphic arts talent, but will rarely get you an interview. Neither will your photo unfortunately.

• Your resume will be emailed or maybe even faxed 90 percent of the time, and fancy fonts are often difficult to read.

• Employers may think there’s an underlying reason for sprucing up your resume – not enough related background, perhaps?

• Enlarging and bolding your headings with adequate spacing between topic areas will make your resume more powerful and easier to read.

4

LOSE THE FLUFF • When you describe yourself or your past experience in your summary or work history section avoid using “fluffy” phrases. These do not hold any weight with employers as they are deciding whether or not to interview you.

These may be noteworthy attributes, but employers will not believe them until they actually witness them on the job.

Examples of such phrases are: I’m a people person, I’m dedicated, I’m hard working, I’m loyal Instead, fill you resume with facts.

5

3

USE BULLETS, NOT PARAGRAPHS • Keep the text short and easy to read.

• In describing your experience and positions, always start with an action

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

BEEF IT UP; NEVER MAKE IT UP • The candidate who fictionalizes a university degree may be in trouble if the hiring authority has a relative who actually graduated from the school.

• The candidate who claims to have experience with certain equipment or software may be embarrassed if a prospective employer asks for a mini-demo at the interview.

• There are many ways to make a resume more impressive without making anything up: • Summarize or highlight years of experience, sales percentages, or cost savings at the beginning of the resume, in bulleted format.

• List your degree(s) and related

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training courses.

• List all certifications completed.

For example: CBET, CRES, ACCE, A+,CNA, CNE, etc.

• List awards or commendations if they are industry-recognized or unique (not one that all receive).

• List organizations and affiliations that are recognized by your industry and profession.

•T he only personal comments on a resume should pertain to your ability to speak other languages or willingness to relocate or travel.

OVERALL COMMENTS AND SUGGESTIONS Check your final draft for spelling and grammatical errors and inconsistencies.

The last place you would like to see your resume go is into the “round file” (trash).

There are many resume formats available via the Internet but be careful to choose a format that allows you the flexibility to present your credentials to your best advantage.

If you can’t find a suitable and adaptable format, create your own. It might not be easy, but you will be more likely to obtain your objective – an interview!

MARCH 2018

TECHNATION

51

EXPERT ADVICE

BY MICHAEL DAVIS

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BY MICHAEL DAVIS

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lack and white printers, color printers, monitors and large screen TVs. These are just a few of the peripherals that can be connected to an ultrasound system. I have received many “how to” connection calls from biomeds and end users as well as many troubleshooting calls to get the peripherals working correctly.

Here are tricks to make sure everything goes smoothly.

POWER When connecting any powered device to an ultrasound system, you will want to ensure you have it powered correctly. You do not want to simply plug the AC cord into any outlet. The outlet needs to be isolated with the ultrasound system. Many systems have their own power outlets. Philips normally has extra outlets that you can plug into. GE systems normally have ports to plug special adapters into, while other systems will have power strips.

Ultrasound systems have isolation transformers and are designed to prevent ground loops. Connecting your peripherals to the ultrasound and not the wall will keep the system safe.

Sometimes this is not possible because a TV may be mounted to a wall. The best solution here is to install an isolation transformer and connect all the devices to it. Also ensure that the peripherals have either a ground plug or directional plug.

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TECHNATION

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SET UP After making sure that all the cables are connected correctly, the hardware still may need to be configured.

External monitors will normally work without having to do more than changing what is viewed. TVs on the other hand may need to be configured. Some systems do not have a standard TV output. Changes will need to be performed in the system settings. You may need a signal converter or you may need to change the output resolution.

Printers can prove to be an even bigger challenge. Some printers use a video source and simply connect to an RCA or BNC port on the back of the system. Pressing the print button on the printer will produce whatever is on the screen. Some can even be controlled by a remote cable connection. Using the remote cable will require you to configure the print buttons on the ultrasound.

Most printers are going to connect using a USB cable. These printers will require that the ultrasound system has the drivers installed. Because it can be difficult to add drivers to the system, the printer manufacturer has configured the printers to be able to use older drivers or run in emulation mode. All you need to do is change the settings in the printer.

As an example, the Sony is configured through its menu feature.

Press the “Menu” button on the front. It is usually the scroll wheel.

Press it in and this will bring up the

MICHAEL DAVIS Technical Support Specialist

menu. Scroll down until you find COMD. Press the button in and scroll from D897 to D895. Then press the button again to lock in the choice.

Power cycle the printer. It is now set to use the Sony UP-D895 drivers already loaded in an older system.

Make any of the necessary adjustments to the ultrasound settings and begin using the system.

Ensuring that the peripherals are connected and configured correctly the first time will end up saving you frustration down the road.

For more ultrasound technical tips and tricks, or to view technical support videos visit www.conquestimaging.com. Conquest Imaging Technical Support is available 24/7/365 at 866-900-9404.

Mike Davis is a Technical Support Specialist at Conquest Imaging.

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EXPERT ADVICE

BY JIM FEDELE

THE OTHER SIDE Available Equipment?

BY JIM FEDELE

W

e have recently started to focus on measuring and tracking available equipment. I have always tracked the completion of PM and repairs but did not really consider measuring the availability of equipment. I have discovered after working with nursing on a couple of projects that this is very important to our nurses. It is possible that by measuring and improving equipment availability we can positively affect nursing satisfaction and improve patient throughput.

I have had the opportunity to work for many different organizations, (while staying in the same location) and have been trained, coerced and exposed to many initiatives to improve patient satisfaction and nurse satisfaction.

These programs and the money spent on implementing them illustrate how important nurse and patient satisfaction is in our industry. It has always been a struggle to apply what we do daily as a support department to these initiatives and programs. I often felt like we were driving a square peg through a round hole in trying to move these initiatives forward.

I am not sure what it is like at other facilities lately, but our hospitals are busy and running near and sometimes over capacity. During one of our management staff meetings, we were all challenged to improve our patient throughput. In an effort to support this challenge I met with our nurse manager and asked what they needed from biomedical engineering. Their comments were around ensuring they had their basic equipment available like thermometers, pulse oximeters and blood pressure monitors. I was told that at times a patient can’t be discharged until their vitals are confirmed to be good and if they can’t find the equipment it can delay the discharge.

We have started measuring available equipment to help improve this situation. We divide the number of “cannot locate” +“out of service” devices by the total number of devices in the inventory. Our goal is to improve this number by 10 percent. By going through the exercise of analyzing and measuring it helps me understand what departments need help finding equipment and if we need to increase the amount of equipment in a department.

We are still in the early stages of monitoring this so I am not sure how our improvement efforts will bear fruit, but I feel confident that we should be able to make a difference. Already I am noticing that equipment that is handled by our equipment distribution program seems to be less likely to be lost. This is not surprising to me as nurses aren’t always focused on managing their equipment. The distribution program delivers, picks up, cleans and stores equipment, this is very helpful as it keeps the stock in one area and it can be deployed where the need is instead of being located in a department where there isn’t a present need for it.

For the past couple of years, our industry narrative has been focused on maintenance requirements and what should or can be on an AEM program.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

JIM FEDELE, CBET

But maybe our focus should be on available equipment? I don’t want to imply that preventative maintenance isn’t important, especially on equipment that actually has procedures that help prevent failures. But the majority of what we do is a performance check, which does little to prevent failures. I believe ensuring our nurses have what they need when they need it has just as much, or even more, benefit for our patients than performance checks. Monitoring and managing equipment availability is certainly a worthwhile activity.

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.

MARCH 2018

TECHNATION

55

EXPERT ADVICE

BY JOHN NOBLITT

THE FUTURE

Don’t Let Change Stress You Out

BY JOHN NOBLITT

E

veryone working in health care today knows that tremendous change is just the normal way of getting through another day in the workplace. Change is taking place at every level of health care, from training physicians in medical school to using newer technologies to diagnose and treat patients. One example of how physician training is changing is how some medical schools are changing who gets in and who does not get in. In the past it has been all about academics, such as your MCAT or medical college admissions test score, your GPA, how advanced your organic chemistry classes were, so heavy emphasis was on IQ or intelligence quotient.

Today many schools are looking at other areas such as EQ or emotional quotient. Yes, a good IQ is still heavily valued but health care providers today must also have high EQ scores. The reason for this are the changes in health care. Today, physicians must work in a team concept delivering excellent health care via creative partnerships that solve complex problems. Higher EQs work best in team environments. I read an article not long ago that said 80 percent of health care dollars are spent on the sick while 20 percent are spent on prevention. This is a big area of change in health care as we move from paying physicians for their volume of work to the value of the work they perform. This change states that we are moving from a reimbursement-based model to a more evidence-based model of health care delivery or a change from reactive medicine to a proactive approach.

Technologies are creating other areas of rapid change in health care. Patient powered health care is on the rise with advances in telemedicine. Today patients can access their health data and even create their own health data with technologies

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such as Fitbit or with any of the many other wearable devices that generate bio data. New sensor technology will include glucometers on smartphones to monitor sugar levels or analyze ECGs or to predict epileptic seizures. New technologies in 3D printing will afford patients the ability to have personalized parts made, such as knee and hip joints for replacement.

They say the only constant is change and nowhere is that more evident than in today’s health care. Besides providing better health care, what do you think is another by-product of all this change?

You guessed it, stress. So how do we deal with all this change and stress and still perform at our peak on the job? I propose you deal with these changes along with the added stress by your mindset. Your “mindset” is a lens or frame of mind, which orients you to a particular set of associations and expectations. A perfect example of this is shown in patient studies dealing with pain. When a health provider gives patients an analgesic at the bedside, they report a marked improvement in their pain level. However if the same amount of morphine is given without the patient’s knowledge the pain levels do not decrease at the same levels as the patient that had the expectation of getting relief by knowing the drug was administered.

The patient’s mindset was that they were going to get relief, and they did. This is one of the reasons there is an audible tone every time a patient pushes the button on a PCA pump. This study repeated with other types of data prove that psychological and physiological effects are influenced by your mindset.

There are two ways to look at stress, either stress is debilitating or enhancing.

We know that stress creates more adrenaline in the body. If your mindset about stress is that adrenaline diminishes your ability to think clearly, deteriates your focus, drive and performance then stress

JOHN NOBLITT M.A.ED., CBET

would be debilitating in your mindset.

However, if your mindset is that adrenaline fuels the body and the mind with extra blood and oxygen, increases energy and alertness to enhance your drive, performance and decision making you have an enhanced mindset of stress.

You have the ability to change your mindset on just about any subject. So, how would one change a mindset? It boils down to how your brain works. Your brain always does what it thinks is in your best interest. Your brain is also hardwired to seek pleasure and avoid pain. Your brain will tell you what you say to yourself in words and pictures. So, to change your mindset, you must collaborate with your brain. Here is an example: If you don’t enjoy your work and don’t want to go, your brain will give you reasons why you should not go to work, as it’s always seeking pleasure. However, if you collaborate with your brain about all the good things associated with your work the brain will find reasons why you should go.

When I find myself falling into that mindset of not wanting to go to work, I always remind myself that if I go to work I may have the opportunity to change someone’s life. This invariably makes me get out the door and off to work. This is the entire point of this article. To help provide for the best patient outcomes we all must perform at our best and that includes having the right mindset.

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EXPERT ADVICE

BY MANNY ROMAN

ROMAN REVIEW Experiential and Emotion

BY MANNY ROMAN, CRES

L

ast month I wrote about how science demonstrates that we are emotional beings who sometimes think rationally.

To quote Dr. Antonio Damasio, “We are not thinking machines that feel; rather we are feeling machines that think.”

I watch Ted.com talks quite a bit in my attempt to understand more about humans and how we interact with others. I watched a talk by Dr. Lisa Feldman Barrett titled “You aren’t at the mercy of your emotions your brain creates them.” In the talk she appears to be contradicting what other researchers have noted. She states that emotions are not uncontrollable hard-wired brain reactions.

This seems to go against what I wrote about last month and have been presenting at shows and conferences. I was on tilt for quite a while. How can highly trained and educated researchers have such divergent theories while studying the same data?

Dr. Feldman Barrett states that emotions are guesses that your brain constructs at any moment in time. You have more control of these guesses than you imagine you do.

Emotions are not built into your brain at birth, they are just built.

The building process involves sifting through your life experiences looking for similar situations and making guesses at the probabilities that this experience is similar to a past experience. The brain is looking to match this present experience to a past experience to decide the emotion that should be attached. This prediction process is the basis for every experience that you have and every action that you take.

As you are reading this, your brain is actively predicting and guessing what I am actually saying and about to say. This prediction and guessing is what allows us all to quickly make sense of things and know what to do, how to react and what

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emotion to use in any particular situation.

In other words, your brain does not blindly react to the present experience, using stored past experiences, it predicts your reaction.

This past experience based prediction process is why people witnessing the same event have different reactions and emotions to that event. Each individual will predict the response based on their own set of personal past experiences. This also explains why we have difficulty communicating with others whose experiences are different thus their predictions will be different.

I also conduct nonverbal communication presentations where I speak on how the body communicates more honestly than the words might intend. Here again, the good doctor hits me, and the proponents of body language interpretation, hard. It seems that much of the emotion that we attribute to the body language of others is based on our own predictions and therefore is in our heads. Physical movements only have meaning in context. A smile can indicate friendliness, nervousness or sadness. Crying can indicate anguish, pain, sadness or happiness. It is only in context that there is real meaning.

Feelings are not emotions. The body sends signals to the brain summarizing what is physically happening. Your brain then predicts what emotion to apply to those feelings. Butterflies in the stomach is a physical discomfort that indicates what?

It could be anxiety of having to speak in public, it could be anticipation of an exciting event. The brain predicts what emotion to attach based on your own previous experiences.

So … the bottom line is: Since the predictions are based on previous experiences, if we can feed the brain different emotions for a particular experience, then in the future the

MANNY ROMAN, CRES AMSP Business Operation Manager

predictions will be altered. We are then in control of our future predictions and thus our future emotions. We are responsible for our emotions, not because we are to blame for them, but because we are the only ones who can control them.

Now, what do I do about the apparent disparity in what Dr. Feldman Barrett and I present? Do I now change all my carefully developed and stunningly delivered presentations? No, I do not.

You see, I have been presenting that our experiences are stored with an accompanying emotion for quite a while. I have been stating that when met with any incoming event, the brain immediately looks for similar experiences so that we quickly know what to do and how to feel about it. If we had to analyze every incoming event from scratch, we would go crazy. This is expedient and effective and allows us to move on to the next incoming event. Sometimes we get it wrong and must add that to our experience database for future use.

What makes us nuts is when the new incoming event has no similar stored experience. Dr. Feldman Barrett calls this “Experiential Blindness.” There is nothing to compare it to so we must analyze it until we come up with some crazy, emotioncharged decision or give up saying, “I don’t know what to make of this.”

My own brain was in quite a quandary when I viewed the Ted talk. I watched it a few times until my brain found the appropriate experiences to make sense of what I was hearing. I had heard it before. I was coming from a different angle, however it was not really new to me. I chose to change my emotion from anxiety to relief to happiness. Then, I celebrated with some fava beans and a nice Chianti.

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INDEX

SERVICE INDEX 17

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TRAINING

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Anesthesia

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Company Info

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61

P

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34

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P P P

34

P P

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Biomedical

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59, 61

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

72

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

63

P P

Diagnostic Imaging

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

26

P

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

61

P

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

33

P P

Retrieve Medical Equipment 330-963-0277 • retrievemedicalequipment.com

70

Healthmark Industries 800-521-6224 • HMARK.COM

41

Sodexo CTM 1-888-Sodexo7 • www.sodexousa.com

3

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

33

Maull Biomedical Training

C-Arm

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

29

P P P

Retrieve Medical Equipment 330-963-0277 • retrievemedicalequipment.com

70

Endoscopy

ALCO Sales & Service Co. 800-323-4282 • www.alcosales.com

70

Cardiology

P P

59, 61

Hand Switches

Gopher Medical 844-246-7437 • gophermedical.com

11

P P

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

6

P

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

50

P P

TECHNATION

P

General

Retrieve Medical Equipment 330-963-0277 • retrievemedicalequipment.com

66

50

440-724-7511 • www.maullbiomedicaltraining.com

MARCH 2018

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

26

P P

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

41

WWW.1TECHNATION.COM

INDEX

TRAINING

SERVICE

PARTS

Infusion Pumps

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

AD PAGE

Company Info

Nuclear Medicine

AIV 888-656-0755 • aiv-inc.com

54

P P

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

2

P P P

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

30

P P

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

6

P

Infusion Therapy

Online Resource

AIV 888-656-0755 • aiv-inc.com

54

P P

Adel-Lawrence Associates, Inc 866-252-5621 • www.adel-lawrence.com

61

FOBI 888-231-3624 • www.FOBI.us

54

P P

MedWrench 866-989-7057 • www.MedWrench.com

40

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

69

P

Webinar Wednesday

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

7

P P

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

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

800-906-3373 • www.webinarwednesday.live

34

P P

54

P P

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

Mammography

P

36

P

47

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

4

P P

Patient Monitoring

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

47

P P P

AIV 888-656-0755 • aiv-inc.com

54

P P

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

4

P P

BMES 888-828-2637 • www.bmesco.com

71

P P

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

30

P P

Gopher Medical 844-246-7437 • gophermedical.com

11

P P

37, 63

P P

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

33

P P

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

50

P P

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

17

P P

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

69

P

Tenacore 800-297-2241 • www.tenacore.com

25

P P

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

4

P P

BMES 888-828-2637 • www.bmesco.com

71

P

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

7

P P

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

Pacific Medical

800-449-5328 • www.pacificmedicalsupply.com

MARCH 2018

TECHNATION

67

INDEX

SERVICE INDEX P P

FOBI 888-231-3624 • www.FOBI.us

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

7

P P

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

Portable X-ray inRayParts.com 417-597-4702 • www.inrayparts.com

26

P P

Interpower 800-662-2290 • www.interpower.com

53

P

20

20

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

Radiology

P P

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

Power System Components

54

41

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

4

P P

Telemetry

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

47

P P P

AIV 888-656-0755 • aiv-inc.com

54

P P

BMES 888-828-2637 • www.bmesco.com

71

P P

Recruiting Adel-Lawrence Associates, Inc 866-252-5621 • www.adel-lawrence.com

61

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

30

P P

Sodexo CTM 1-888-Sodexo7 • www.sodexousa.com

3

Gopher Medical 844-246-7437 • gophermedical.com

11

P P

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

59

37, 63

P

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

17

P P

Tenacore 800-297-2241 • www.tenacore.com

25

P P

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

7

P P

Pacific Medical

800-449-5328 • www.pacificmedicalsupply.com

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

54

Repair ALCO Sales & Service Co. 800-323-4282 • www.alcosales.com

59, 61

Test Equipment

Replacement Parts

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

61

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

29

P P P

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

72

P P

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

16

P

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

33

P P

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

5

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

50

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

68

TECHNATION

MARCH 2018

61

TRAINING

25

SERVICE

Tenacore 800-297-2241 • www.tenacore.com

PARTS

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

AD PAGE

Company Info

P

P P

WWW.1TECHNATION.COM

INDEX

We ONLY use OEM Parts!

TRAINING

SERVICE

PARTS

AD PAGE

Company Info Training Adel-Lawrence Associates, Inc 866-252-5621 • www.adel-lawrence.com

61

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

29

P P P

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

48

P

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

47

P

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

49

P

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

49

P P

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

29

P P P

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

4

P P

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

8

P P P

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

2

Retrieve Medical Equipment 330-963-0277 • retrievemedicalequipment.com

70

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.

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

16

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

6

Retrieve Medical Equipment 330-963-0277 • retrievemedicalequipment.com

70

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

47

P P P

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

49

P P P

P P

• 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

MARCH 2018

TECHNATION

69

AFFORD NEXT GEN EQUIPMENT

ALPHABETICAL INDEX A.M. Bickford ������������������������61 Adel-Lawrence Associates, Inc �����������������61 Advanced Ultrasound Electronics, Inc. ��������������29 AIV……………………………………………………………………………54 ALCO Sales & Service Co. ����������������� 59, 61 Ampronix, Inc. ������������������������ 4 Asset Services ������������������������57 BC Group International, Inc ������������������72

Retrieve Medical Equipment purchases retired imaging and biomedical equipment helping you turn the old into new.

CALL NOW

for quick offers and generous valuation

Service that Outperforms 330-573-5706 retrievemedicalequipment.com

70

TECHNATION

MARCH 2018

BMES ���������������������������71 Conquest Imaging ���������������������� 8 Crothall Healthcare Technology Solutions �������������63 D.A. Surgical ������������������������26 ECRI Institute ������������������������48 Elite Biomedical Solutions �������������������30 Engineering Services, KCS Inc �����������������16 FOBI ���������������������������54 Global Medical Imaging �������������������� 2 Gopher Medical �����������������������11 Healthmark Industries ��������������������41 iMed Biomedical, Inc ���������������������61 Injector Support & Service �������������������34 inRayParts.com �����������������������26 The InterMed Group ��������������������� 6 Interpower �������������������������53 Maull Biomedical Training �������������������50 MedicalDealer.com ���������������������54 MedWrench ������������������������40 Ozark Biomedical ����������������������34 Pacific Medical ��������������������� 37, 63 PRN/ Physician’s Resource Network ���������������33 Pronk Technologies, Inc. ������������������� 5 Retrieve Medical Equipment ������������������70 RSTI ����������������������������47 Select BioMedical ����������������������69 Sodexo CTM ������������������������ 3 Southeastern Biomedical Associates, Inc �������������50 Southwestern Biomedical Electronics, Inc. ������������17 Stephens International Recruiting Inc. ��������������59 Tenacore ��������������������������25 Tri-Imaging Solutions ���������������������49 USOC Bio-Medical Services ������������������ 7 Versus ���������������������������20 Webinar Wednesday ���������������������36 WWW.1TECHNATION.COM

www.bmesco.com 888.828.2637

WHY BUY AN ESU-2400?

THERE ARE MANY GREAT REASONS TO PURCHASE AN ESU-2400:

ESU-2400H

AUTO-SEQUENCES

EASE OF USE

WAVEFORM GRAPHING

PDF REPORTS

TOUCH SCREEN

UPGRADEABLE

USB CONNECTIVITY

PROVEN RELIABILITY

CALIBRATE AND PM TO FACTORY REQUIREMENTS

HERE ARE A FEW REASONS YOU MIGHT NEED AN ESU-2400: The ONLY all-in-one analyzer validated to Covidien ForceTriadTM factory requirements and PM ± Meet the Spec: The ESU-2400’s DFA Measurement Technology makes it the only all-in- one device that meets the specifications for testing the Covidien ForceTriadTM • 1% Accuracy – Twice the accuracy of competitive devices • Crest Factor of 500 – 25 times the capability of competitive devices • Don’t take our word for it – See the ForceTriadTM Service Manual section 6-11 ± Save Time: Automated PM Procedure for the ForceTriadTM and Covidien Valleylab FT10 cuts time to perform the PM in half • Watch the video: esu.bcgroupintl.com ± Measurement Range up to 5500 mA needed to calibrate the ForceTriadTM ± Tissue Response testing available to measure and graph the current delivered during the tissue sealing process using the optional TRL-2420 ± Only Analyzer that can communicate with the DUT ± Uses factory stipulated Current Measurement Method

The ONLY all-in-one testing of Pulsed Output Generators

NEW VIDEO

Valleylab FT10TM

Covidien ForceTriadTM

± Measures pulsed mode ESU generator output ± Provides Duty Cycle and Pulse vs RMS measurements ± Upgradable to the ESU-2400H, future-proofing for next gen pulse generators

The BEST all-in-one ESU Analyzer in the world ± Generates PDF test reports - Saves to internal memory, flash drive or network drive ± Waveform graphing for debugging and output analysis - No Oscilloscope Required ± Remote control capability for display function and SCPI command protocol is standard ± 3 USB Ports allow for the connection of a barcode scanner, keyboard, mouse or storage device Any of the trademarks, service marks or similar rights that are mentioned, used or cited within are the property of their respective owners. Their use here does not imply endorsement or affiliation with any of the holders of any such rights.

Copyright © 2014 Covidien. All rights reserved. Reprinted with the permission of the Surgical Solutions business unit of Covidien. Copyright © 2014 Conmed. All rights reserved. Copyright © 2016 Olympus. All rights reserved.

Conmed System 5000TM

Olympus ESG-400TM (Plus numerous other models and manufacturers.)

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