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Vol. 9
ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL
APRIL 2018
CONSTRUCTION excitement and pitfalls
16 Company Showcase
Versus Technology
22 Biomed Adventures The Good Samaritan
26 Industry Updates
News & Notes
45 Roundtable
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CONTENTS
FEATURED
45 45
OUNDTABLE: R ENDOSCOPES
50 50
CONSTRUCTION EXCITEMENT AND PITFALLS
In this issue of TechNation, we take an expert look at endoscopes from industry veterans. The panel of roundtable participants includes representatives from KARL STORZ Endoscopy-America Inc., Capital Medical Resources and Ampronix.
Next month’s Roundtable article: RTLS
Rome wasn’t built in a day and most construction projects, additions and renovation projects require extensive planning, schedules, materials and equipment. Tighter health care budgets have made new projects an exercise in necessities versus allocated funds. In health care facilities, the input of the HTM department is a crucial part of the process.
Next month’s Feature article: CMMS: What YOU need in the 21st Century
TechNation (Vol. 9, Issue #4) April 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
APRIL 2018
TECHNATION
9
CONTENTS
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
Randall R. Cowens Jennifer DeFrancesco K. Richard Douglas Jim Fedele Brandon Giger Jeff Niederhausen Ernest Oates Inhel Rekik Manny Roman Cindy Stephens Steven J. Yelton Xu Zou
DIGITAL SERVICES
Cindy Galindo Jena Mattison Travis Saylor
ACCOUNTING
Kim Callahan
CIRCULATION
Lisa Cover Melissa Brand
WEBINARS
Linda Hasluem
EDITORIAL BOARD
Eddie Acosta, Business Development Manager, Colin Construction Company Manny Roman, Business Operation Manager, AMSP 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
INSIDE
Departments P.12 SPOTLIGHT p.12 Department of the Month: The Tucson Medical Medical Center Clinical Engineering Department p.16 Company Showcase: VERSUS p.20 Professional of the Month: Chuck Martoglio p.22 Biomed Adventures: The Good Samaritan P.26 p.26 p.32 p.34
INDUSTRY UPDATES News & Notes AAMI Update ECRI Institute Update
P.37 p.37 p.38 p.42
THE BENCH Shop Talk Biomed 101 Webinar Wednesday
P.58 p.58 p.60 p.62 p.64 p.67 p.68 p.70 p.73 p.74 p.77
EXPERT ADVICE Career Center Ultrasound Expert Turning Setbacks into Comebacks Risk Based Prioritization VLAN Versus Microsegmentation Building Your AEM Program Understanding the AEM Program The Other Side The Future Roman Review
P.80 BREAKROOM p.80 Did You Know? p.83 The Vault p.86 Where Is Ben C.?
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p.92 Service Index p.97 Alphabetical Index
Like us on Facebook www.facebook.com/TechNationMag MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com
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SPOTLIGHT
DEPARTMENT OF THE MONTH
The Tucson Medical Center Clinical Engineering Department BY K. RICHARD DOUGLAS
T
he Sonoran Desert is a region of the country unlike any other. It encompasses southern Arizona as well as southeastern California and parts of Mexico. The city of Tucson, Arizona sits within this desert region.
The metro-Tucson area is populated with nearly a million people. The city is home to the University of Arizona and Saguaro National Park. It is 60 miles north of the U.S. border with Mexico and is the second largest city in Arizona. Handling the medical needs of all of those people is the Tucson Medical Center (TMC), which is a stand-alone, community-based hospital licensed at 600 beds. “Hospital specialty areas include: pediatric emergency care, cardiology and orthopedics,” says Karla Brish, MBA,
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CBET, manager of clinical engineering at TMC. “TMC also has a network of 21 clinics that provide primary care and family medicine, internal medicine as well as a number of specialty services. Clinical engineering supports all of these areas as well as the following facilities affiliated with TMC: hospice, ambulatory surgery center, geriatric psych service and an employee gym,” she says. Clinical engineering reports to TMS Director of IT Infrastructure and Operations Susan Snedaker. The CE team is made up of 16 members. The team under Brish’s direct leadership includes Ellis Brittin, BMET II; Walter Cahill, imaging services lead; Roberto Calderon, BMET I; Dirk Call, BMET III; Tim Cassell, senior imaging services engineer; Brian Darr, biomedical equipment
specialist-systems; Guillermina “Mina” Garcia, BMET II; Darell Hendrickson, BMET III; Jaye Johnson, BMET II; John Lynn, BMET III; Scott MacLachlan, BMET III; Jim Pangrac, BMET III; Rebecca Rooney, BMET I; Joe Smith, imaging services engineer I; and Mark Weltz, senior imaging services engineer. Brish says service contracts were not centrally managed by clinical engineering; each department manager was responsible for the contracts for equipment in their department. In 2016, that changed and all medical equipment service agreements were assigned to the clinical engineering department to be managed. “This move was well-received by clinical leaders as many of them did not have the time or expertise to manage the deliverables of a service contract,” Brish says.
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SPOTLIGHT
The Tucson Medical Center Clinical Engineering Department is a diverse group of talented professionals.
“Since this change, a number of contracts have been eliminated and others bundled for cost savings. I meet with the contracting manager in purchasing on a monthly basis to discuss contracts coming due for renewal, contracts that will not be renewed and any potential problems with contracts,” she adds. The department was an early adaptor in the area of CE/IT integration as seen in the organization’s reporting structure. “There is a very advanced level of integration between the two departments,” Brish says. “TMC made the decision about 10 or 12 years ago to integrate CE with IT because they saw the trend, even at that time, of medical devices being network-connected. Today, we have a seamless crossteam function that helps work across the service continuum,” Brish adds. “For example, if we have a wireless medical device that’s not communicating, we contact our network team or our wireless expert; if we have data that’s not flowing from a medical system to our EHR, we collaborate with our IS counterparts. Working with these resources really improves our ability to provide great service for our customers. The level of integration here is higher than any organization any of us has previously experienced – and it’s part of our success,” she explains. Brish adds that the CE department has a dedicated systems specialist who actively works with members of the IT department on various projects and is a technical
resource for other members of the CE team. The team uses the Accurent/Four Rivers asset management system TMS for data collection purposes. “This system was put into place March [of] 2015 and has proven to be very valuable in collecting data. When this system was purchased, the decision was made to install the software on a TMC server instead of utilizing an Accurent hosted server. As a result, we have been able to customize the system to provide the information that is most important to us,” Brish says. CONSTRUCTION, RENOVATION AND PROJECTS The TMC Clinical Engineering Department has kept busy with a variety of projects. “Some of the projects we are involved with are the installation of a new MRI machine and renovating the entire MRI suite. Additionally, we are involved with installing a new hybrid cath lab and opening two additional ORs,” Brish says. Other projects that the clinical engineering team has worked on or are currently involved with are the opening of a new women’s surgery department, construction of a new women’s care department, updating all monitoring, installing a new house-wide nurse call system, setting up approximately 12 new clinics in the past three years, creating a new scope room in the GI lab and integrating data from vital sign monitors into Epic. The team has also put its diagnostic hat on to solve a vexing problem.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
“A while ago, we ran into a problem where we began receiving an increasing number of complaints from infusion pump users stating that pump modules were losing communication with controllers,” Brish explains. “When the pumps came to the shop, we could not duplicate the problem. We contacted the vendor, who could not offer any insight into the problem. One of our techs, responsible for pumps, disassembled the connectors between the pump and the controller and inspected the connectors under a microscope and found a film on the connectors. This film was enough to cause the pumps to lose communication with each other,” Brish says. “To immediately remedy this problem, all connectors on the pumps and controllers were replaced. As soon as the connectors were replaced, the problem stopped. The film was caused by improper cleaning of the pump. To keep this problem from reoccurring, a task force made up of nursing, logistics, infection control and education was put together. Together, we implemented a revised plan for cleaning the pumps and educated users on this new plan. Since then, we have not seen a repeat of this problem,” she explains. Through resourceful thinking and teamwork, the clinical engineering team at TMC keeps clinicians and patients confident that the medical equipment will be working perfectly.
APRIL 2018
TECHNATION
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ASSET MANAGEMENT FOR HEALTH CARE: (DEFINITION) The practice of locating and regulating the use of equipment at an optimal state in a health care environment.
HOW TO ELIMINATE AN Evasive Asset Epidemic (EAE) THE DILEMMA: AN EVASIVE ASSET EPIDEMIC Health care organizations today face a critical problem. Nurses can’t find the equipment they need when they need it. Biomeds struggle to locate equipment for preventive maintenance and recalls. You can’t provide safe, timely, effective patient care if you can’t find the equipment that makes it possible to do so. Meanwhile, hospital executives look to solve this problem by investing in more equipment. In reality, the equipment they already have sits idle, used at less than half of its potential, because it’s not in the right place at the right time. What’s going on here? Most hospitals have more than enough assets. What they really need is to use the assets they already own more effectively. This is such a glaring issue that, in true health care fashion, we’ve (jokingly) assigned it an acronym. The healthcare industry is struggling to overcome a widespread EAE: Evasive Asset Epidemic. THE SOLUTION: RTLS ASSET MANAGEMENT Real-time locating system (RTLS) technology proposes a useful remedy to an EAE. When used to its fullest, RTLS not only allows you to see at a glance where equipment is in your facility, it also helps you distribute assets more effectively, providing nurses with the equipment they need, when and where they need it, using your fleet to its fullest potential. RTLS has saved countless health care organizations millions of dollars – something that, in today’s landscape, is an invaluable ROI. WHO DOES IT HELP? An EAE affects just about everyone in a health care organization, and so does RTLS. No matter who you are, using RTLS for asset management is a beneficial investment: • C-Suite Executives: Managing assets with RTLS means less capital expense … fewer devices to purchase, no bloated inventory and fewer service contracts. • Operations (Director of Operations, Facilities Manager, Manager of Support Services): With RTLS, it’s easy to
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Preventive maintenance reports keep track of tagged equipment due for PM, allowing you to proactively plan maintenance and making it easier to find and service equipment.
locate and manage your mobile equipment inventory, ensuring that equipment is in the right place at the right time. This prevents hang-ups and delays in patient care and hospital operations. • Nursing (Director of Nursing, RNs, Nursing Staff): Nurses spend a lot of time looking for equipment. RTLS means less time searching, which means less frustration and more time for patients. • Clinical/Biomedical Engineering: Assets are easier to find for preventive maintenance (PM) and recalls. With RTLS, more equipment can be serviced in less time, improving productivity and patient safety. • Patients: As a patient, you’ll receive the timely care you deserve from your caregivers, and the equipment will be properly maintained, ensuring your safety.
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SPOTLIGHT
Health care has been hit with an Evasive Asset Epidemic (EAE). It’s up to RTLS to save the day. Locate your equipment with the Versus Asset Net tag, using both Wi-Fi and accurate infrared technology.
IT’S ALL ABOUT THE DATA RTLS can also collect data to help you make decisions for process improvement. Take IV pumps, for example. Data collected with RTLS can provide insights about: • Asset Utilization by Location. Which units use IV pumps the most? What is the utilization rate on a particular pump or our entire fleet? Are units or departments maximizing the use of equipment? • Asset Census. How many pumps were in a certain department over a certain period of time? Which units have a large quantity of equipment? What should the baseline number be for pumps in the ED? Do we maintain a consistent supply of pumps in the ICU? • Preventive Maintenance. When preventive maintenance data is added to the RTLS database, you can answer the following questions: When are pumps due for preventive maintenance and where are they? What will the preventive maintenance workload be for the next few weeks or months? Which assets were due for preventive maintenance last week?
ARE YOU READY? RTLS for asset management is a win-win for staff and patients alike. Evasive Assets become Available Assets – properly maintained and ready to provide high-quality patient care. Let’s eliminate the Evasive Asset Epidemic. Are you ready? FOR ADDITIONAL INFORMATION about RTLS Asset Management, download our comprehensive eBook “How to Eliminate an EAE” at versustech.com/EAE.
By showing equipment location at a glance, RTLS helps biomeds work more efficiently to proactively maintain equipment and adhere to preventive maintenance standards.
By answering these questions, you can make proactive decisions to improve your facility’s workflow (and prevent an EAE) based on real data gathered through RTLS. There’s always room for improvement!
A NOTE ABOUT PRECISION There are a variety of different RTLS vendors and technologies in the market. Different technologies have varying degrees of locating precision. For example, you can use your existing Wi-Fi network to see the general location of an asset, but you may experience issues with the signal skipping floors or other inaccuracies. Other technologies like infrared offer room-level or better precision. The more precise your location data is, the better you’ll be able to manage your fleet – and eliminate an EAE.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
APRIL 2018
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SPOTLIGHT
PROFESSIONAL OF THE MONTH Chuck Martoglio Ultrasound to Classic Rock BY K. RICHARD DOUGLAS
W
hether you work on cars or medical equipment, there are a few constants – diagnostics, knowing how to work with tools and understanding how different components work. The goal is always the same with both; to make that machine work as the manufacturer intended it to.
It’s no surprise then, that someone who is trained to work on automobiles would have the skill set to transition those skills to the HTM profession. That is exactly what Chuck Martoglio did. Martoglio is a field service specialist, ultrasound, in the clinical engineering services department at BayCare Health System, which is based out of Clearwater, Florida. “I was an auto repair technician for 23 years. I was in need of a career change, but had no idea of what I wanted to do. One day, a friend of mine who is a respiratory therapist mentioned that he thought I would be a good biomed,” Martoglio remembers. “I had never heard of the profession, but looked into it. The more I researched it, the more I realized that it was exactly what I was looking for. I found and joined the local biomed networking group, the Bay Area Association of Medical Instrumenta-
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tion (BAAMI), and went to a meeting to see if it was as good as it seemed. I was overwhelmed by the support I received that night,” Martoglio says. “I met David Booker, a manager at one of the BayCare hospitals. Not only did he answer all of my questions, he invited me to the shop to check it out. I was hooked. The caliber of people I work with in all areas of the hospitals continues to make me thankful I made the change,” he adds. Going from the auto technician profession into HTM meant some additional specialized training. Martoglio was able to go to school and receive hands-on experience at the same time. “I took the electronics engineering program at Hillsborough Community College and graduated with an A.S.,” he says. “While I was in school, I got a chance to work in Dave’s shop as a volunteer. I also met Bill Hart, biomed supervisor at Lakeland Regional Hospital, at a BAAMI meeting, and landed a part-time PM tech position there. These opportunities were extremely valuable experience while I was in school,” Martoglio says.“After graduation, I was hired as a biomed at BayCare. I was promoted to a biomed II and then to my current position, field service, ultrasound,” he says.
NETWORK SECURITY AND IMAGING ISSUES Projects and challenges come with the job and Martoglio has worked on network security projects and imaging issues. “It can be challenging taking care of multiple sites, especially when there are critical issues at the same time at different locations. Fortunately, that doesn’t happen very often and I get good support from the other field service staff or biomeds on site,” he says. “DICOM issues can be challenging as well because there are multiple causes that I do not always have access to or control of. Having good relationships with networking, clinical applications, and security team members has been key to troubleshooting,” he adds.“I’ve been involved in a number of network security and migration projects. I recently assisted three heart and vascular locations migrate to our network. This involved working with our clinical applications, networking, and security teams to ensure everything was configured and secured properly. With the challenges of healthcare security, we have been very active in securing our medical equipment. My responsibilities have included locking out USB ports, WannaCry patching, and gathering data for our security team,” Martoglio continues.
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SPOTLIGHT
Chuck Martoglio loves to fish and enjoys going on hikes with his wife.
HIKING AND JAMMING Not everything is related to work and Martoglio finds time to pursue some enjoyable pastimes. From rocking on guitar to hiking with his wife, and fishing, he gets some enjoyment on stage and in national parks. “I love hiking in the national parks with my wife, Renee. I also fish, golf and play guitar. So, I’m so lucky to have a wife that shares my love of nature and hiking. We’ve been to Great Smoky Mountains National Park, Yosemite National Park, Mt. Rainer National Park, Olympic National Park, Dry Tortugas National Park, Haleakala National Park and Grand Canyon National Park,” he says. “We’d like to visit all of them eventually. We are currently planning a trip to Banff, Yoho, and Jasper National Parks in Canada to celebrate our 25th anniversary, where we plan on hiking, fishing and relaxing,” Martoglio says Martoglio says that he has been fishing for as long as he can remember. “My parents took us camping and fishing a lot when I was a kid. I guess that’s where my love of nature comes
from. I mostly fish locally for redfish, snook and tarpon. I recently purchased a fly rod and reel and am trying to learn how to use it. I love to fish mountain streams and rivers when on vacation just because I find it so beautiful and relaxing in such a different environment,” he says. From the streams to the stage, he also knows how to jam on the electric guitar. “I’ve played in a few classic rock to hard rock cover bands, most recently a Metallica tribute band called Magnetica. We actually had a number of road shows in the southeast that were such an experience to play,” Martoglio says. “It is great fun, but also a takes a lot of free time which is why I just jam with friends on occasion now.” “As far as golf goes there’s not much to say other than I get my money’s worth every time,” he adds. In central Florida, ultrasound patients can be certain that the devices they, and the clinicians, depend on will work right, Metallica’s music will get its due respect and the national parks will be appreciated by one multifaceted HTM professional.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
FAVORITE BOOK Sky and Telescope magazine FAVORITE MOVIE “Caddyshack” FAVORITE FOOD Cookies HIDDEN TALENT I can ride a headstand on a skimboard. FAVORITE PART OF BEING A BIOMED Working with great people! WHAT’S ON MY BENCH? Notepad Pocket screwdriver Fluke Network Analyzer Coffee
APRIL 2018
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SPOTLIGHT
BIOMED ADVENTURES The Good Samaritan BY K. RICHARD DOUGLAS
F
rom Kenya to Vietnam, the organization Samaritan’s Purse has helped the world’s poor, sick and suffering. They have provided food, medicine and even gifts for children to thousands in need. Samaritan’s Purse is a nondenominational evangelical Christian organization and has operated since 1970. Even people who are not Christians are familiar with the story of the Good Samaritan, the source of the organization’s name.
Many children in developing countries will never know what a gift is and few will ever experience having a new toy or even toiletries. Through the assistance of many volunteers, Samaritan’s Purse brings the joy of a toy and some simple life-improving supplies to these disadvantaged children. One way Samaritan’s Purse helps these children is through a campaign called Operation Christmas Child. With the help of thousands of volunteers, shoeboxes are filled with crafts, toys, clothing, accessories, personal hygiene items, stuffed animals and other things. After being collected, the shoeboxes are dropped off at predetermined collection locations. The shoeboxes are then distributed to children in various countries around the world. One of the organization’s volunteers is Boyd Campbell, CBET, CRES. Campbell is the co-owner of Southeastern Biomedical Associates Inc. in Granite Falls, North Carolina. He has worked in a few different capacities within the Operation Christmas Child process. He has been an organizer at a local church, collection site team leader and an actual contributor, going shopping
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for shoeboxes and packing them. “I first got involved in Operation Christmas Child while I was a youth leader for my church. I had been searching for a mission project and came across this as what I thought would be a small easy project that I could use not only to help others around the world but also as a teaching opportunity,” Campbell remembers. “I thought about how blessed we are and that even a small amount can possibly go a long way. At that time our community was very economically depressed. We ‘were’ located in the furniture manufacturing capital of the world, and many in the community were without jobs, due to a large number of factories shutting down and going overseas due to cheaper manufacturing. I saw this as a project that would not require a lot of funds; around $10 per shoebox to pack,” Campbell adds. He says that in the first year, they were able to assemble about 30 shoeboxes that contained items such as school supplies, hygiene products and a small toy. Each year the project seemed to grow. Campbell says that occasionally they would receive a letter back from a child in a foreign country that received a shoebox and that just encouraged everyone to try and do a few more each year. He explains that there are several steps in the process of getting the shoeboxes prepared. “The process starts well in advance of collection week,” Campbell says. “There are meetings to attend and getting everything organized. First off, we have to have a location that can handle the capacity of boxes expected and figure out how we are going the get them from point
A to point B. Then, we have to get the volunteers in place,” he adds. Campbell says that the collection center has to be adequately staffed with people to greet those dropping off the boxes, carry the boxes into the collection center, someone to collect all the demographic information, someone to verify the counts and, lastly, people who will pray over each box before it is put into a carton. “Cartons can be quite a puzzle to put together sometimes; as all different shapes and sizes of shoeboxes are brought in. It starts a little friendly competition as to who can get the most in a larger carton. Somehow, that always turns out to be a competition between the women and the men. While we are all working very hard, it is also a great time for fellowship. Once in the shipping cartons, those have to be transported to a larger facility, where we will pack them onto tractor trailers,” Campbell adds. TRAVELING TO WEST AFRICA Campbell has not only been able to be on the collection and sending end of the Operation Christmas Child project, but he unknowingly got to witness the distribution of the shoeboxes. “I have had the privilege of going to Togo West Africa for the past six years and assisting two hospitals with their biomedical needs. It has been a partnership between Southeastern Biomedical and the Dalton Foundation to work with the Association of Baptists for World Evangelism (ABWE) to equip and repair the medical devices in these two hospitals,” Campbell says. He says that when he first arrived, there was only one hospital that he
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SPOTLIGHT
Boyd Campbell is seen in Togo West Africa.
worked with, which had two physiological monitors, a couple of vital signs monitors, two anesthesia machines and a few infant incubators. “I am happy to report that, over the years, this hospital now has two fully operational ORs, an ICU, recovery, neonatal unit, and labor and delivery that are fully equipped,” he says. “Once or twice a year, myself and Terry Morris with Drager go over and do all their biomed work. It can be a daunting task since the power quality is substandard and not having anyone for a year to do any repairs the amount can be quite extensive to get back up and running. While it does give a feeling of accomplishment when we are finished each year, one of the most touching things I got to witness was a distribution of shoeboxes at a small local church,” Campbell explains. “I had no idea, when I walked in that Sunday morning, what I was about to see. They may have mentioned it during the service but since everything was in French and the local tribal language, I didn’t really know what was going on. At the end of the service, they asked all the children to come up that had attended Sunday School that morning.
Children in Africa with their Operation Christmas Child boxes.
The missionary that was beside me was smiling so I assumed the kids were getting some type of award,” Campbell says. “Little did I know what was going on until I saw these large cartons with ‘Operation Christmas Child’ printed on them. I watched in awe, thinking this is something I always wanted to witness, but not ever thinking it would become reality. It was a joyous, yet at the same time, a sad occasion. The children that received the shoeboxes left with huge smiles on their faces, but there were also not enough shoeboxes to go around, so some of the children left without one. After seeing that it encouraged me to try and do even more,” Campbell adds. Campbell shares a suggestion for readers who might be inclined to join the Operation Christmas Child effort or another volunteer opportunity. “I encourage anyone out there to try and make a difference in this world. What may seem small to you can be huge for someone else,” he says. “There are so many opportunities both here and abroad. I have had the privilege to see firsthand the difference a small contribution can make, but even if I never saw it that impact would still be there. There is
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
a feeling of helping our fellow human beings that cannot be described at the end of a project knowing that you may have made some type of difference in someone’s life.” Besides understanding deeply the old adage about it being better to give than to receive, Campbell has also witnessed this principle in action in others. “We had a little girl who was about eight years old who had heard about Operation Christmas Child and decided she wanted to use the all money she had received for her birthday so ‘poor kids can have Christmas too.’ We had a family that helped us to place the shoeboxes in larger containers that had not worked with this ministry before, and the next year, they personally assembled and filled over 130 shoeboxes,” he says. Giving is caring; that can include your time, abilities or money. Boyd Campbell has that figured out and is helping to make a difference in the lives of children in faraway places. “This past year we collected a little over 8,600 shoeboxes,” he says. Boyd’s efforts as part of Operation Christmas Child have resulted in thousands of happy children.
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NEWS & NOTES
Updates from the HTM Industry CLEARWATER COMPLIANCE EARNS TOP RATING Clearwater Compliance, a provider of health care cyber risk management and compliance solutions, has been awarded the 2018 Best in KLAS designation in the Cybersecurity Advisory Services category in the 2018 Best in KLAS Awards: Software & Services report. Overall, Clearwater’s rating is 95.5. Clearwater outperforms the competition by earning top marks in each of the four scoring categories: general, implementation and training, sales and contracting, and service and support. The announcement furthers Clearwater’s ongoing commitment to help leverage the power of its SaaS-based software solutions for advancing patient safety and improving the lives of its customers. “Best in KLAS is more than a ranking. It
is a recognition of vendors committed to delivering superior solutions,” said Adam Gale, president of KLAS. “It gives voice to thousands of providers who are demanding better performance, usability and interoperability in healthcare technology.” “Earning KLAS’ highest rating for cybersecurity advisory services is a testament to the Clearwater team’s exceptional performance and commitment to patient safety and managing cyber risk to improve access to care, timely care and quality care,” said Bob Chaput, CEO of Clearwater Compliance. “Our team’s purpose-driven approach to assisting our customers is the key to accelerating health care cyber risk management strategies and deepening their impact on the lives of their patients and organizations.”
The KLAS report draws directly from interviews with thousands of health care vendors’ customers, including CIOs and C-suite leaders, before publishing the annual Best in KLAS report. The Best in KLAS report recognizes the outstanding efforts of vendors to help health care organizations deliver better patient care. The Best in KLAS designation is reserved for vendor solutions that lead their software and services market segments with the greatest impact on health care organizations. Each year, health care professionals rely on the Best in KLAS report to help shape their decisions to improve health care and patient safety. •
NUVOLO, HEALTHCARE IT LEADERS FORM PARTNERSHIP Nuvolo, a leader in cloud-based enterprise asset management (EAM), announced recently the formation of a new strategic partnership with Healthcare IT Leaders, one of the nation’s fastest growing healthcare IT implementation, workforce solutions and consulting firms. The partnership will expand Nuvolo’s go-tomarket capabilities and provide Healthcare IT Leaders with a clinical enterprise asset management (EAM) platform for its expanding health care client portfolio. Nuvolo is a cloud-based EAM innovator whose platforms meet the highest standards for ease of use, performance and
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online and offline mobility capability for managing clinical equipment for health care providers. Nuvolo is built on ServiceNow, one of the world’s leading enterprise cloud platforms relied on by more than 4,000 enterprise companies worldwide. Nuvolo was recently named a 2017 Gold Tier ServiceNow Technology Partner for its platform’s notable market adoption and high customer satisfaction. Healthcare IT Leaders is a KLAS-rated, national leader in health care IT implementation, workforce solutions and consulting with deep subject matter expertise in EMR, ERP, CRM and BI. Based in Georgia, the
company has ranked three consecutive years on the Inc. 5000 list of America’s Fastest Growing Private Companies (2017, 2016, 2015). Healthcare IT Leaders will join Nuvolo on joint marketing and selling activities and will provide a full array of consulting and implementation services for Nuvolo’s EAM platform. These same services will be provided by Healthcare IT Leaders sister company, RUN Consultants, to additional markets where clinical, laboratory, facilities and manufacturing asset management solutions are needed. •
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INDUSTRY UPDATES
AUE EXPANDS SONOSITE REPAIR SERVICES
Advanced Ultrasound Electronics (AUE) has announced a new Sonosite solution. Over the past 18 months AUE has invested significantly in research and development, systems purchases, and parts inventory to be able to handle all facilities’ Sonosite ultrasound needs including repairs, parts and sales of refurbished systems and some new systems. • System Repairs: Qualified technicians are well versed on all Sonosite systems, have replacement parts in stock, and AUE performs repairs in-house down to the component level. AUE can repair those systems that have been “retired”
by the OEM, and systems others can’t fix. AUE has a vast inventory of parts and common failure components on hand. The team of technicians, specializing in the Sonosites, will get system repaired and returned to fast. • Loaner Systems: AUE offers loaner systems while a system is being repaired, to keep facilities up and running with no downtime. • Tiered Pricing: No hassle, economical pricing structure. No hidden costs or unexpected charges. • Fast Turn-around Time: Ask us about AUE’s 24-hour emergency service.
• S ystems Sales: AUE sells refurbished systems and some new systems, all at significant savings compared to OEM pricing. • Probe Testing and Repairs: AUE has many common probes in stock and ready to ship. They can also repair most probes, depending on condition. AUE is a multi-vendor ultrasound company. AUE supports GE, Philips, Siemens, Toshiba and virtually all major brands. Now, AUE has added Sonosite as well. AUE currently offers sales and service to customers in all 50 states as well as Canada, Central America and Western Europe. •
OREGON BIOMEDICAL ASSOCIATION EXPO SET FOR MAY Planning for the fifth annual 2018 Oregon Biomedical Association (OBA) Expo and Vendor Fair is in full swing! The OBA Expo and Vendor Fair will be held May 17-18 at the PDX Holiday Inn (8439 NE Columbia Blvd. Portland, Oregon 97220). The OBA Expo and Vendor Fair brings together corporate, professional and academic individuals to advance understanding, celebrate and display equipment in the field of healthcare technology. The 200 members of the OBA also engage in series of classroom
presentations geared toward continuing education. A diverse assortment of medical equipment vendors encompassing over 50 tables will be on hand to show the latest in design and function of all types of clinical and medical devices. “With more vendors, more door prize drawing opportunities, and wider classroom topic scope, make your plans to get to this meeting now,” OBA Secretary Scott Stockton writes in an email. “The educational format remains the same as last year with three lectures and three independent tracks to choose
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
from. As before, flexibility has been maintained to choose the lecture best suited to your interest or need.” Registration is now open at orbmet.org/expo. Tickets are free but you must be registered to be eligible to win door prizes. •
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TRI-IMAGING SOLUTIONS CERTIFIED TO AWARD CEUS Tri-Imaging Solutions’ two-week BMET to Imaging 1 course is now certified to award 73 Continuing Education Units (CEUs) from the AAMI Credentials Institute (ACI). CEUs awarded by the ACI indicate a dedication to a BMET’s ongoing commitment to demonstrate renewed knowledge and competency in their industry. Health care is an ever-changing and evolving field and with that comes a
necessary commitment to education. The BMET to Imaging 1 course provides intensive imaging theory and unmatched hands-on education with the expectation that every student completing the course can successfully conduct imaging system PMs and troubleshooting Monday morning upon return to work. The BMET to Imaging 1 course is taught onsite at the Nashville training facility in two-weeks as opposed to the
industry standard of four-weeks. The proven method of combining online pre-course work, to be completed prior to arrival at the training facility, with classroom and hands-on training with equipment helps reduce time spent onsite without compromising content. Remaining 2018 BMET to Imaging 1 course dates include: April 9-20; June 18-29; September 17-28; and November 26-December 7. •
CYBER POWER SYSTEMS DEBUTS MEDICAL-GRADE UPS PRODUCTS
Cyber Power Systems (USA) Inc. has launched its new medical-grade uninterruptible power supply (UPS) product line, offering power protection tested for use in the UL-defined (UL 60601-1) Patient Care Vicinity. The new CyberPower Medical-Grade UPS systems are designed to provide clean and consistent power for electronic medical diagnostic, treatment and monitoring equipment, as well as health care computer and IT systems. The products protect against damage from power line surges and spikes and provide the appropriate voltage to equipment even when power line voltage drops during brownouts. Most significantly, when power fails, the UPS systems contin-
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ue to provide power to equipment, allowing time for a backup generator to come online or sufficient time for a graceful shutdown. Three models with line-interactive topology are available: the M550L (550 VA, 440 Watts), the M750L (750 VA, 600 Watts) and the M1100XL (1,100 VA, 880 Watts). Line-interactive topology includes automatic voltage regulation. When power line voltages vary between brown-out lows, as little as 88 volts, and over-voltages, as high as 150 volts, a line-interactive UPS continues to provide 120 VAC without switching into battery-powered backup mode. “The new CyberPower Medical-Grade UPS product line is our response to
increasingly frequent requests to provide our hallmark reliability and quality in products for patient care,” said CyberPower Director of Product Management Tim Derochie. “Beyond technical requirements, we looked into how people in a health care facility might interact with these products. That led to an LCD panel that’s sealed to resist harm from cleaning sprays, a one-button operation to mute alarms and a mini-tower form factor that can resist tipping if accidentally bumped.” The new medical-grade products are designed for use in hospitals, clinics, group practice, private practice, laboratory and other medical facilities. Products use hospital-grade 5-15R outlets, a 5-15P plug, and an isolation transformer to eliminate line noise and enhance safety by minimizing current leakage to less than 100 microamperes. CyberPower Medical-Grade UPS products are tested to UL 60601-1 which allows use within six feet of a patient (except those on life support or in critical care). M750L and M1100XL models include a SNMP slot for optional remote management cards, which allows for remote monitoring and control of the unit. The M1100XL has the option to add up to two extended battery modules for increased run-times. •
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Watch your
PRN NOW A DISTRIBUTOR OF RADCAL For over 40 years Radcal has in manufacturing radiation test equipment for quality assurance, manufacturing, service and compliance applications. The Radcal product line is designed to be tailored to the individual needs of a biomedical engineer, with a broad array of sensors, systems, displays and software. Physician’s Resource Network (PRN) has announced that it is now a resource for Radcal products. Since 1983, PRN Inc. has grown as a supplier of new, used and reconditioned medical equipment.
The addition of Radcal products is coming on the heels of a recent announcement in December 2017 that the PRN inventory would begin including products by Zoll Medical. These two product lines round out previous offerings from Datrend Systems Inc. and Medimizer. PRN strives to provide an unparalleled selection for biomedical shops.
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THE CHRIST HOSPITAL HEALTH NETWORK DEPLOYS 7SIGNAL 7SIGNAL, a Wi-Fi performance company, has announced that The Christ Hospital Health Network has completed the first phase of its deployment of 7SIGNAL’s Wi-Fi performance management system for enhancing Wi-Fi experiences across its network. The solution includes a system of software and client devices that continually monitor and measure Wi-Fi experiences for patients, doctors, nurses, clinicians and guests. Wi-Fi performance data is crowdsourced from hundreds of mobile devices and 7SIGNAL analytics tell IT staff where Wi-Fi experiences need additional care and attention. Recognized as one of the top 50 hospitals in America by U.S. News & World Report for the past 17 years, The Christ Hospital Network’s purchase of 7SIGNAL aligns with the second pillar of the hospital’s vision of being a national leader in clinical excellence, patient experience and affordable care. “The patient experience depends on doctors, nurses, and clinicians having reliable Wi-Fi for fast access to important systems required for delivering exceptional care,” stated Tom Barrett, CEO for 7SIGNAL. “It’s wonderful to see Christ Hospital incorporate our system of Wi-Fi telemetry for hospitals and health care.”
According to James Vajda, senior Wi-Fi engineer for The Christ Hospital Health Network and Certified Wireless Network Expert, the most important wireless enabled application is Voice over Wi-Fi. “We have about 1,000 Cisco 7925 phones and their performance can be sensitive to any RF disruptions. We use those for critical business processes in the hospital. We also have workstations on wheels (WOWs) that we run Citrix clients on, where the EMR application is served. Those are constantly moving up and down the halls and need good wireless performance also,” Vajda said. Christ Hospital deployed 7SIGNAL’s Mobile Eye software for its WOWs to capture Wi-Fi experiences on mobile devices. In addition, the hospital deployed 7SIGNAL’s high-performance clients, called Sapphire Eyes in the emergency department, and other clinical areas where wireless problems seemed to be the most elusive. Sapphire Eyes monitor Wi-Fi experiences 24 hours a day, seven days a week and automatically report issues relating to connecting, authenticating, voice quality, throughput speed and interference in the air. Phase two of the project will include Sapphire Eye coverage in both main hospitals, as well as enterprise-wide Mobile Eye deployment. •
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DIAGNOSTIC SOLUTIONS CELEBRATES SEVEN YEARS Diagnostic Solutions is a customer service based parts provider that specializes in all imaging modalities. Charlene Gregg created the company in February 2011 to offer hospitals and service organizations a cost-effective and time-saving solution for the procurement of imaging replacement parts. Over the past seven years the company has grown to supply multiple replacement parts for
most imaging modalities; including general X-ray, portables/C-arms, mammography, ultrasound, nuclear medicine, MRI, CT, bone densitometry, as well as CR/DR and imager parts. Longtime client Tony B. from Volant, Pennsylvania, said he “has used Diagnostic Solutions as a source for medical imaging parts since the company’s inception. They consistently provide the
highest quality parts for the best price. They work with us as if they are working for us, and we are a better business because of them.” •
MEDIGATE LAUNCHES MEDICAL DEVICE SECURITY PLATFORM Medigate has announced the launch of its dedicated medical device security platform for health care providers, a solution to secure medical devices that are connected to electronic medical records, enterprise networks and servers, and the Internet. The cloud-based security platform empowers healthcare IT and security teams to protect enterprises, securing data and safeguarding patient safety and privacy from malware, ransomware and other advanced cyberattacks targeting networked medical devices. Medigate provides three capabilities essential for effective IT security: visibility into all network connected devices, detection of potential threats and automated prevention of attacks. These capabilities are specifically designed for the health care industry. Medigate showcased the platform at the 2018 HIMSS Conference & Exhibition. •
OMEGAFLEX INTRODUCES CORRUGATED MEDICAL GAS TUBING OmegaFlex, a global manufacturer of metal hoses, has announced MediTrac as the world’s first corrugated medical tubing (CMT) for distribution of medical gases. Unlike rigid copper tubing, which is installed in numerous brazed sections and elbow joints to accommodate a facility layout, MediTrac’s semi-rigid tubing installs in a single, bendable length that can be routed around existing structures. Made from copper alloy and sold in continuous-length rolls, MediTrac includes a fire-retardant jacket and axial
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swaged brass fittings. Developed for the health care industry, the product can be used in hospitals; ambulatory care centers; dental, physician and veterinary clinics; laboratories; and any facility that uses medical gas. “MediTrac completely revolutionizes gas installation in health care settings,” said Kevin Hoben, OmegaFlex CEO. “Copper tubing has always been costly to install with countless brazed sections that make a system vulnerable to leaks and contamination. MediTrac comes in one, long length to eliminate hot work,
and its unique design makes it easy to bend as needed to fit a space.” MediTrac is non-flammable, non-reactive, and can distribute medical air, oxygen, nitrogen, nitrous oxide, carbon dioxide and medical vacuum. The product connects with all K, L and DWV medical tubing and is sized from one-half to two inches in diameter. Underwriters Lab (UL)-tested, MediTrac meets all 2018 National Fire Protection Association (NFPA) 99 requirements and has an ASTM E84 rating less than 25/50. •
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WE MAKE TRANSDUCERS BETTER. At Tenacore we leverage our in-house fabrication capabilities to manufacture custom parts for medical devices, restoring equipment to better-than-new condition.
When looking for better-than-new equipment, look to Tenacore.
Visit tenacore.com or call 800-297-2241
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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BY AAMI
AAMI UPDATE
AAMI Board Set to Welcome New Members
T
he AAMI Nominating Committee has selected two healthcare technology leaders to serve on the association’s board of directors. The committee also nominated three new executive board members for 2018, including a new chair-elect.
“The nominees are exceptional leaders in our industry, and we are pleased to have them join us in helping chart the strategic course of the organization,” said AAMI Board Chair Phil Cogdill, senior director of quality, sterilization and microbiology at Medtronic. “Our community is known for its leadership in advancing the safe use of health technology and I look forward to the fresh perspectives and valuable insight these new members will bring.” INCOMING DIRECTORS Michael C. McNeil Michael C. McNeil is a global product security and services officer at Philips Healthcare. He is a member of AAMI’s device security working group and chairs both AdvaMed’s and the Medical Imaging & Technology Alliance’s (MITA’s) cybersecurity working groups. McNeil also is a member of the National Health
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Information Sharing and Analysis Center (NH-ISAC) board. “I want to become a board member to better unite some of the insights from other external initiatives I participate in with the practices from AAMI, specifically organizations like MITA, NH-ISAC and AdvaMed,” McNeil said. “I look forward to working with the other board members and staff to increase awareness of the vision and mission of the organization across a broader constituency in the health care Walter M. Rosebrough Jr. domain and actively engaging in the execution of the strategic plan.” Walter M. Rosebrough Jr., president and CEO of STERIS Corporation, has been an executive in the health care industry for more than 30 years. He has been an AAMI member since 2010 and serves as a board member of several other organizations, including AdvaMed, Health Insights and the Rock & Roll Hall of Fame and Museum. “I am honored that the nominating committee considered me for the position and am looking forward to collaborating with the other members of the board and the AAMI staff to continue the work that AAMI has done for many years,” Rosebrough said. “AAMI is a very important constituent in the infrastructure of our health care system.
I believe it is important that those of us who are significant participants in health care give of our time to help AAMI be successful in its mission.” EXECUTIVE BOARD NOMINATIONS Janet Prust, director of standards and global business development at 3M Healthcare, was selected as treasurersecretary; Pierre Boisier, executive vice president and chief quality officer at Becton Dickinson & Company, was elevated to vice chair of industry; and Steven Yelton, professor of healthcare technology management for Cincinnati State Technical and Community College, was nominated as chair-elect. Yelton was excited and honored to be nominated during what he described as a “pivotal time within AAMI.” “I am most looking forward to continuing to work with the wonderful AAMI staff and volunteers on projects that will continue to enhance our field. There are many initiatives at AAMI that are in process and planned that I’m looking forward to seeing come to completion,” Yelton said. “I look forward to being a part of this process and following in the footsteps of the outstanding board chairs who have mentored me.” The official election of these individuals will occur at the association’s annual business meeting, which will be held during the AAMI
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2018 Conference & Expo in Long Beach, California, June 1-4. Their terms will begin immediately thereafter. More information about the conference can be found at www.aami.org/annualconference.
BIOMEDICAL INSTRUMENTATION TEXTBOOK GETS AN UPDATE Students, recent grads or hardened veterans who want to brush up on their biomed basics have a new resource to learn the fundamentals of healthcare technology. AAMI is now offering an updated, second edition of the “Introduction to Biomedical Instrumentation” textbook written by Barbara L. Christe, the program director of healthcare engineering technology management and an associate professor with the engineering technology department at Purdue School of Engineering and Technology at Indiana UniversityPurdue University Indianapolis. The book provides accessible information to those looking to develop a career as a biomedical equipment technician. “This fully updated second edition provides readers with all they need to understand the use of medical technology in patient care,” Christe said. “It is designed for readers with a fundamental understanding of anatomy, physiology and medical terminology as well as electronic concepts.” The update – the first since 2009 – incorporates the most recent changes in health care, regulations, standards and technology, and includes new sections on device testing and the interface of medical devices with electronic medical records.
WE MAKE INFUSION PUMPS BETTER. At Tenacore we leverage our in-house fabrication capabilities to manufacture custom parts for medical devices, restoring equipment to better-than-new condition.
When looking for better-than-new equipment, look to Tenacore.
This book and other HTM resources are available in the AAMI Store, www.aami.org/Store.
Visit tenacore.com or call 800-297-2241
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
APRIL 2018
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BY ECRI
ECRI UPDATE
Endoscope Reprocessing Failures Continue to Expose Patients to Infection Risk
E
CRI Institute’s annual list of the Top 10 Health Technology Hazards serves two key functions: It raises awareness about critical hazards associated with medical devices and systems, and it promotes solutions that can help prevent patient harm.
Each year, the nonprofit research organization identifies 10 health technology topics that warrant priority attention. Some are newly developing threats. The top hazard for 2018 – ransomware and related cybersecurity risks, which we described in last month’s issue – is one such example. Others can be classified as perennial concerns. This year’s Number 2 hazard – endoscope reprocessing failures – falls into that category. ECRI Institute has addressed cross-contamination from flexible endoscopes and other reusable medical devices and instruments in eight of the 10 previous editions of its list. Continuing reports of patient exposures to contaminated scopes, along with studies highlighting the challenges of endoscope reprocessing, underscore why this topic remains a critical concern. A CONTINUING CHALLENGE The failure to adequately reprocess contaminated flexible endoscopes – that is, the failure to clean and disinfect or sterilize the instruments before using them on subsequent patients – can have deadly consequences. Numerous reports in the clinical literature, as well as in the lay press, attribute the spread of fatal infections to scope reprocessing failures. Even in the absence of known
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infections, however, the discovery of inadequate scope reprocessing requires critical action. All too often, health care facilities have had to contact hundreds of patients to let them know that they might have been exposed to a contaminated endoscope. ECRI Institute and others have published extensively on this topic; yet incidents continue to occur. One reason the problem persists is that reprocessing is a multi-step process, with several manual steps that must be performed consistently and correctly. Missed steps or poor technique caused by insufficient training, time pressures, the use of out-of-date instructions, or a host of other factors can compromise the process. Recently, a study monitoring the quality of endoscope reprocessing raised an additional concern. In the February 2017 edition of the American Journal of Infection Control, Ofstead et al. reported the alarming finding that even when staff adhere to vendor instructions, the instruments sometimes remain contaminated after reprocessing. (See: Ofstead et al. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: results of visual inspections, biochemical markers, and microbial cultures, Am J Infect Control 2017 Feb 1;45(2):e26-e33.) Concerns also exist that it may not even be possible to reliably reprocess some types of scopes. Several models of duodenoscopes are being withdrawn from the market due to such concerns. So what’s a health care facility to do? DON’T IGNORE THESE STEPS Effective endoscope reprocessing
requires careful adherence to a multistep protocol. Typical steps include: precleaning in the room where the procedure was performed, transport to the reprocessing room, leak testing, manual cleaning, sterilization or high-level disinfection, rinsing and drying, and storage and handling ECRI Institute’s 2018 report highlights two problematic areas in the reprocessing protocol that require particular attention: 1. The manual cleaning steps. Effective disinfection or sterilization requires that biologic debris and other foreign material be cleaned from the endoscope first. Because reprocessing efforts can be hindered by dried, hard-toremove residues, flexible endoscopes and accessories should be precleaned at the point of use as soon as possible after the endoscope is removed from the patient. Additional cleaning should then be conducted in the reprocessing room. Cleaning endoscopes effectively is challenging because it is a largely manual, technique-dependent process. Thus, access to complete and current reprocessing instructions, comprehensive staff training, the availability of appropriate cleaning agents and supplies, and the allotment of sufficient time to do the job
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right are keys to successful reprocessing. Additionally, health care facilities should consider instituting quality control (QC) measures to verify the cleaning of reprocessed endoscopes. For instance: A lighted magnifier can be used to improve inspection of the instrument’s external surfaces before the final disinfecting step. The use of a borescope can be considered to inspect internal channel surfaces. A healthcare facility might even want to add biochemical testing to its QC program. Such testing can identify trace levels of adenosine triphosphate (ATP), protein, or blood that remain on, or in, an endoscope after inadequate cleaning. 2. Instrument storage after reprocessing. Moisture trapped in the channels of an endoscope can promote the proliferation of any microbes not eradicated by reprocessing. Thus, the instruments must be stored in a manner that facilitates the drying of channels. The use of drying cabinets with filtered, forced air can help dry any moisture retained in the channels following reprocessing. ECRI Institute notes that the most efficacious solution might be to use drying cabinets with channel connectors that direct air through the channels. ADDITIONAL RECOMMENDATIONS Following are a few additional recommendations from ECRI Institute: • Institute an ongoing process for assessing staff reprocessing competency. In addition to providing initial training, facilities should conduct refresher training at regular intervals to help staff maintain competency. • Seek input from staff involved with reprocessing when assessing new endoscopes for purchase. This feedback can raise awareness of devices that might require additional time or resources during reprocessing or that require unique methods or technologies. • Foster regular discussions between reprocessing staff and the clinical departments they support so that all stakeholders can gain a better understanding of each other’s needs. 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 e-mail at clientservices@ecri.org.
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Conversations from the TechNation Listserv Q:
I am curious to find out about the recent ICE conference (imaging conference) held in Las Vegas. Did anybody go?
A:
I did go! It was great! Clinical leaders and technology leaders collaborating on behalf of the patients we serve. The mutual respect among the attendees was palpable. The educational sessions were well done and the level of discussion the presentations fostered between attendees will yield operational improvements for my program from the “nuggets” that I took away from the conference. The “fun” events that MD Publishing planned for this conference were amazing for the camaraderie among the professionals. The free exchange of information was in a venue that is comfortable and facilitates team building between disparate groups, such as the HTM professionals, the clinical professionals and the vendors, who attend this event.
A:
I did not go and I am regretting it!
Q:
Does anyone have a good method or know of a vendor who can repair cosmetic damage to a Philips Integris tabletop? I have several with superficial damage to the gel coat where the underlying carbon fiber is showing and it is going to just collect grunge. It also could give someone a splinter. The rooms are way too old to spend money on a new tabletop and I do not feel the mechanical integrity of the top is at risk so I need a way to get it smooth and cleanable again without spending an arm and a leg. It would be nice if the repair was similar in color to the original material but even that is not a necessity.
A:
Is the damage to the table in the typical field-of-view (FOV) for the cases performed in the room? Does the damage involve any structural components of the table? If the damage is on the edges of the table, why not repair the table on your own with the appropriate supplies and process. Here is a video that could be helpful www.
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youtube.com/watch?v=6rTWaV1imzs. If the damage is very superficial, perhaps just a coating of new resin is all you need. The only challenge with repairing the table is the potential for changing the image quality, if the damage you are repairing is in the FOV, and/or if the damage has impacted structural components of the architecture of the table. Absent damage in the FOV or damage to structural components, repairing the table yourself is a fairly benign process.
A:
Contact a local boat repair place (they will generally do the best fiberglass/carbon fiber work.) Ask for a sample of their gel coat, and test it’s radiolucency back in the hospital. If it looks good, you can get it fixed for a fraction of the cost of replacement. SHOP TALK is compiled from TechNation’s ListServ and MedWrench.com. Go to www.1TechNation.com/Listserv or www. MedWrench.com community threads to find out how you can join and be part of the discussion.
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BY XU ZOU
BIOMED 101
Approach to Connected Medical Device Security: Walk before you can run BY XU ZOU
M
any clinical engineers face the daunting task of being on the frontline of medicine, responsible for ensuring the continued operation of connected medical devices. This task is now more difficult than ever with the impact of recent cyber attacks spilling over from the IT side of organizations. The new wave of cyber attacks, which kicked off mid-2017, has continuously targeted health care organizations. Not only has the frequency of attacks increased, the focus of the attack has shifted and expanded beyond PHI/EMR. Connected medical devices are now squarely in the crosshairs of modern hackers, with the intent of disrupting services.
Ensuring the continuous operation of purpose-built and uniquely designed devices takes significant time and resources, requiring a close working relationship with device manufacturers. If devices are not designed with security in mind, and if manufacturers are not prepared to respond to modern cyber threats, clinical engineers are left with one hand tied behind their backs. One approach I recommend to clinical engineers is to systematically break down their approach. You must walk before you can run. START WALKING: IDENTIFYING AND CATEGORIZING CONNECTED DEVICES Understanding what you’re trying to secure before you can secure it may seem like common sense. However, that concept has not typically been used in most security solutions. Traditional IT assets (such as laptops, PCs and servers) leverage a few well-known hardware and
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operating systems. This has allowed security vendors to develop a one-size-fitsall solution, such as a device that runs Intel processors with excess capacity to run AV and Windows OS with well-defined specifications. This approach is one of the primary reasons why traditional security solutions cannot secure connected medical devices. Abandoning traditional approaches, clinical engineers should first find a solution that will assist them in discovering all connected medical devices, identifying the devices and ideally categorizing them. This level of insight offers several key data points. First, it provides a real-time accurate device count which allows clinical engineers to understand the scale of the challenge at hand. It also confirms the number of devices believed to be in service against the count actually being used. Second, with the cost of connected devices differing by several orders of magnitude, clinical engineers cannot take the same approach to each device on their network. Insight into the type of device is critical; consider the number of IV pumps that can be purchased for the cost of a single MRI machine. Third, as many clinical engineers can attest, device manufacturers have their own unique processes which vary greatly from one manufacturer to another. Being able to identify the manufacturer and model number offers significant insight for clinical engineers. While these insights increase your field of view, many don’t associate the benefit directly to security. Imagine if you were able to assess how many connected medical devices were vulnerable to the WannaCry attack before a single PC or device in your network was
XU ZOU Co-Founder and CEO of ZingBox
compromised. What if you were able to identify which devices were using FTP protocol right after the FBI issued a warning of hackers leveraging the same protocol? What if you could identify how many IV pumps are affected immediately after ICS-CERT issues an alert? These are just a few of the security benefits afforded by having a new-found field of view into your devices. START RUNNING: SECURING CONNECTED DEVICES As you can imagine, the task of securing connected medical devices can be greatly simplified when you are armed with the details of individual devices. Recent advancements in artificial intelligence and machine learning are being employed in revolutionary ways to do just this. Being able to assess the normal behavior of an X-ray machine and identifying when the device has been hacked or misbehaving, without any human intervention, is now commonplace for modern security solutions. The method of chasing the latest malware and reducing the response time from days to hours is simply not effective against modern attacks. Unlike other industries, a downtime of several hours for critical devices such as heart rate monitors or IV pumps is unacceptable. A security solution that can detect anomalies in real-time and can quarantine or take other remediation action is a must for any health care organization.
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HIT YOUR STRIDE: OPTIMIZING DEVICE OPERATIONS Security for connected medical devices, unfortunately, is not a set it and forget it project. The inventory of medical devices continually changes – new devices are often put into service and old devices are retired or moved to other locations. Therefore, your security must adapt to an ever-changing set of assets. If you are able to automate much of the first two steps above, you are very close to hitting your stride. You will gain insight into new connected devices and can rest assured that new devices are being continuously monitored. You’ll truly hit your stride when you not only have insight into the security of every connected medical device, but all operational aspects of these devices. You can “predict” when devices are due for service based on actual usage rather than a fixed schedule. You can redistribute devices to maximize the ROI. And, you can pass audits in a breeze since your asset inventory is always up-to-date and accurate.
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based bring-your-own-device (BYOD) security product. Prior to Aerohive, he was senior director of CONFIRM Aruba Networks,THAT where he managed Aruba’s industrial and CORRECT carriPLEASE THE FOLLOWING ARE er product line. He also holds 10 international patents on security and networking.
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FREE HTM EDUCATION Tips Continue
T
he recent Summit Imaging-sponsored Webinar Wednesday presentation “TEE Care and Maintenance to Lower Total Cost of Ownership” attracted almost 300 healthcare technology management professionals from around the world. The live presentation was eligible for 1 CE credit from the ACI.
The webinar provided an insightful message as Larry Nguyen, CEO and CTO of Summit Imaging, and Kyle Grozelle, manager of global education and training at Summit Imaging, disassembled a TEE ultrasound transducer and identified the major components while they explained the vulnerabilities of failure from improper care. Attendees gained insight regarding the variations and effectiveness of cleaning techniques used in different hospitals. The discussion covered how different techniques can impact patient care as well as the total cost of ownership for health care facilities. This educational session also helped by illustrating different efforts to prevent unnecessary damage and costly downtime. The webinar also included a question-and-answer session where the Summit Imaging duo fielded queries from attendees and shared their expert opinions based on years of experience in the field. Attendees chimed in with positive reviews in a post-webinar survey. The Summit Imaging-sponsored webinar received a 3.8 rating on a 5-point scale with 5 being the best possible score. “I feel that this has been one of the most informative webinars I’ve seen. We have had multiple companies go through
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our facility to educate proper care and handling, but have never really been able to drill down to the reality of what happens to damage these probes during handling,” Senior Manager Sterile Processing K. Thompson said. “Very informative! A great primer for someone new to TEE ultrasound. Thank you,” said T. Flannery, CBET. “It was great to learn something new and become more familiar with equipment that is used in a facility, but be more knowledgeable about,” said R. Helou, BMET. “As usual an excellent presentation by Summit. I appreciate the information and the images of failures. Great info to share with our users,” said L. Shelman, CBET. The overall Webinar Wednesday series also continues to garner positive reviews. “Webinar Wednesday is a great asset for technicians to gain needed knowledge without having to go through the fire of a repair first hand for the first time,” Lead Biomedical Engineering Technician B. Winslow said. “I look forward to these webinars. They are a great way to come together with colleagues to learn a specific topic, without leaving your office,” Senior Manager D. Armstrong said. “Webinar Wednesday, you are just awesome. I’ve attended your webinars a couple of times even when I was in Japan. There were one or two topics that I know I could share in my shop so I made the sacrifice of waking up at 3 a.m. for the webinar but it was worth it. Now I’m back in the U.S. so I don’t have to worry about the time difference. The topics you offer are great, can be applied on the job and are definitely worth
sharing not just with other BMETs but also with medical providers,” BMET Instructor J. Seriosa wrote. “Webinar Wednesday provides a spectacular service to the hands-on technicians in the field. They provide relevant information on issues that we face in our everyday work. Thanks for helping me become a more valuable and knowledgeable technician with a greater capacity to assure our patients’ safety and our staff’s productivity,” wrote T. Johnson, CBET. “TechNation Webinar Wednesdays rock!!!” Attendees of the recent Webinar Wednesday presentation “ACI Updates: What to Expect in 2018” were eligible for 1 CE credit from the ACI. The 60-minute webinar featured Martin McLaughlin, program manager of ACI Certification at AAMI. He informed all certified individuals of the changes in recertification. McLaughlin also educated individuals who are interested in ACI certification of the recent changes to the CBET, CRES and CLES exam forms. More than 300 people attended the live presentation and more have viewed the presentation online. The webinar and the overall series impressed HTM professionals. “I am looking to get my CBET soon and this webinar helped me know how to prepare and what to expect after I get the certification,” shared J. Kinderman, clinical engineer. “This was a very informative and enlightening webinar delving deep into the re-certification requirements and exam restructuring. As always, you have provided spot on information extremely
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“ This webinar was really helpful in clearing up a bunch of questions that my co-worker and I had about getting re-certified.” H. Rodriguez-Perez, Medical Systems Engineering Technician relevant to our field and careers. Congratulations and keep.’em coming,” said T. Johnson, CBET. “This was one of the best Webinar Wednesdays yet. Earning a CBET credit while getting a lesson about all the different ways to earn recertification credit is pretty cool. Thanks for the helpful information,” said J. Smith, BMET. “This webinar was really helpful in clearing up a bunch of questions that my co-worker and I had about getting re-certified,” said H. Rodriguez-Perez, Medical Systems Engineering Technician. “Webinar Wednesday series is a great way to expand your education and earn CEUs in a convenient format,” said D. Minke, BMET. “Thank you so much for providing a constant source of current and relevant information to biomedical technicians. Webinar Wednesday is such an easy way to obtain free CEUs for recertification and with the email notifications, CEUs are finding me instead of me always having to finding them,” said S. Thibodeaux, BMET. “Webinar Wednesday is a great way to keep up with the industry and industry standards that are constantly changing. Keep up the great work at supplying the great information,” said J. Harwood, Senior Biomed. “I am essentially a one-man shop in biomed for my employer. The opportunity for continuing involvement in issues and presentations through Webinar Wednesday is unmatched. I don’t even have to leave my bench,” Biomed J. Curtis said. For more information about the Webinar Wednesday series, including recordings of previous webinars and a schedule of upcoming presentations, visit www.WebinarWednesday.Live
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ROUNDTABLE Endoscopes
In this issue of TechNation, industry veterans share expert insight on endoscope advances and key tips. The panel of roundtable participants for the endoscope discussion is made up of KARL STORZ Endoscopy-America Inc. Director of Field Operations, PROTECTION1 Crit Fisher, CST, FAST; Capital Medical Resources LLC Owner Lee Ann Purtell; and Ampronix Medical Imaging Technology Director of Marketing Michael Thomas. Q: WHAT ARE THE LATEST ADVANCES IN ENDOSCOPES IN THE PAST YEAR? Crit Fisher, KARL STORZ Endoscopy-America Inc. Fisher: We (KARL STORZ) recently introduced an FDA-cleared flexible video neuro-endoscope and comprehensive hydrocephalus portfolio. The device is designed to enhance visualization and access during diagnostic and therapeutic use in cranial procedures. The flexible video neuro-endoscope has a smaller outer diameter (with a shaft outer diameter of 2.90 mm and a 2.42 mm x 3.22 mm elliptical endtip), making it particularly useful for treating both adult and pediatric patients with a narrow foramen of Monro. Studies have found that flexible endoscopes can enhance the ease of endoscopic third ventriculostomy with endoscopic tumor biopsy (ETV/ ETB) procedures. Lee Ann Purtell, Capital Medical Resources Purtell: While not many changes have come in terms of imagining technology or design within the past year, you may find changes to the manufacturers’ instructions for use (IFUs) that warrant attention. For instance, several IFUs recommend regular visual inspection of the internal lumens of flexible endoscopes to validate cleaning processes and channel condition using a microflex or lumen inspection device. With some of the recent challenges and news around duodenoscope-related infections,
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we expect to see some technological and design changes to enhance the cleaning capability of these scopes including disposable distal ends, etc. Michael Thomas, Ampronix Thomas: Endoscopic visualization has significantly evolved within the past few years. For example, Toshiba has developed an innovative micro camera called the IK-CT2 Chip-on-Tip camera. This small camera provides crisp, ultra-HD 4K image quality and vivid color. The COT system differs from other endoscopic cameras because of its three high-mega-pixel sensors and stellar image processing that combines with the optics alignment to get the most out of the 220 x 220 pixel sensor. Q: WHAT FACTORS SHOULD HTM CONSIDER TO DETERMINE COST OF OWNERSHIP? Fisher: It is critical to understand that, in addition to purchase price and other common factors, the total cost of ownership for endoscopes also includes a critical service component. Service and repair programs should be selected that will offer a high degree of predictability and confidence in protecting your equipment investment. It is also important to partner with providers who can deliver data-driven cost savings and performance enhancement measures. Purtell: Two obvious considerations in cost of ownership are the purchase price (scope, video accessories/instrumentation needed and potential disposables) and maintenance. Maintenance of scopes may well exceed the original purchase price so factoring this into the cost of ownership is important, whether that be from the original equipment manufacturer (OEM) or an independent service organization (ISO). Frequency of maintenance is also key. Facilities that tend to be harder on their equipment, such as teaching facilities, may want to consider a point-of-sale OEM service contract with unlimited repairs. Facilities with historically lesser repair
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ROUNDTABLE
frequency, may be able to use transactional repairs with an OEM or ISO. Either way it is good to discuss average and not-to-exceed costs per repair and understand what is and what is not covered under warranty. Some not-so-obvious, but related, costs that can affect the total life cycle costs include: • Cost of personnel (sterile processing, OR, HTM, or other sub-contracted staff that clean, set up, use, reprocess, inspect scopes). Factors such as frequent turnover, staff competency on use and reprocessing or having dedicated personnel for cleaning and disinfecting can affect life-cycle costs. • Cost of cleaning, sterilizing equipment and consumables. • Cost of equipment and training needed to properly inspect scopes (such as leak testers, illumination testers, scope image testers, conferences, staff certifications, etc.) • Cost of shipping scopes out for repair. • Loaner/rental costs. • Cost of rescheduling or missed cases if scopes are not available for use. TIP: Consider closely analyzing and matching your inventory to potential usage/volume as you don’t want to get too few scopes, and overuse or flash sterilize them to the point of requiring premature service or replacement. • End-of-life or trade-in value? What can you expect to get for cash or trade-in value of old equipment toward new purchases? Thomas: Traditionally, HTM should consider the total cost of ownership before deciding if a certain endoscope is right for their facility. The TCO includes the initial cost, the cost of operation, maintenance cost, downtime cost, production cost and the remaining value. These factors represent the estimate of the collective expenses associated with purchasing and operating a piece of equipment.
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STAFF REPORT
Q: WHAT ARE THE PROS AND CONS OF BUYING BRAND NEW VERSUS BUYING REFURBISHED UNITS?
While it might be more money up front, the equipment will pay for itself over time.
Purtell: The pros of buying new include: • New equipment is the best way to tap into the most current technologies in the market. • Extended warranties and factory service agreements. • Financing options. Some cons of buying new are: • Higher initial acquisition cost. • Possible limitations on where equipment can be serviced. • May need to upgrade additional equipment such as video towers, mating instrumentation if new models are not compatible with existing equipment you had planned on keeping. Pros of buying refurbished: • Substantially lower acquisition cost in many cases • Can acquire through an OEM or reputable re-seller • Some resellers offer financing • You can “add” additional equipment compatible with your existing video equipment and instrumentation • Wide range of service options from ISO Some cons of buying refurbished: • Older technology that is closer to obsolescence • Possible variances in equipment condition • Due diligence is required to find a reputable re-seller – look closely at credentials, years in business, expertise and online ratings.
Q: CAN YOU EXPLAIN THE IMPORTANCE OF HOLDING AN IN-SERVICE OR CLINICIAN TRAINING ON HOW TO PROPERLY HANDLE ENDOSCOPES TO PREVENT DAMAGE?
Thomas: Generally, to get the most for your money, buying refurbished products can save the average buyer between 40 to 80 percent. However, because endoscopes are fragile, buying new is sometimes a safer option so you can guarantee the quality and care of the endoscope throughout its lifespan.
Fisher: Education and training are key aspects of managing endoscope handling, processing and storage. Each hospital employee who comes into contact with endoscopes must be thoroughly informed and trained on using proper techniques in transporting and handling these expensive devices. It is equally important for periodic re-training and refresher courses to be required as well. Purtell: Mistakes made in the care and handling of medical devices, particularly scopes, can add significant cost. It’s important to not only train the staff during installation, but to also provide continuing education throughout the life of the equipment. This includes proper usage in the clinical setting, as well as following the recommended cleaning, disinfection and sterilization parameters established in the IFUs. Since most maintenancerelated costs are associated with errors during use, sterilization or care and handling (aka people-factor), regular and comprehensive training can greatly reduce the overall cost of ownership related specifically to maintenance. Thomas: Proper training on endoscope usage and care is essential. It is incredibly easy to damage an endoscope with improper care, so it is vital they are handled and cleaned regularly and thoroughly. While there are plenty of published articles describing how to care and clean for an endoscope, an in-person clinician training is the best way to fully understand your equipment.
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ROUNDTABLE
Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING ENDOSCOPES? Fisher: High-quality surgical equipment and specialty endoscopes represent a significant investment for health care providers, so it is important to recognize that selecting and working with the appropriate vendor when making endoscope purchases and service decisions can pay off in the long run. Another essential part of this process is for customers to fully assess the total cost of ownership of endoscopes being purchased. It is equally important to understand that the repair and service of this costly, delicate equipment represents a critical component of the total cost of ownership. Purtell: Scopes can be intimidating because of the high cost and complexity of the design. Having one or two “endoscope specialists” within your staff that are highly trained on endoscope care, inspection and testing can be a huge advantage. Endoscope technician certification is on the horizon. To learn more, one source you can check out is the certified endoscope reprocessor certification from IAHCSMM. Thomas: When purchasing an endoscope, companies should keep renting or financing options in mind – especially if they are a newer company. Some endoscopes can cost upwards of $10,000, so while it is usually preferred to buy new, that isn’t always possible. Additionally, buying multiple pieces of equipment from the same company can save time and money. Rather than spreading your equipment purchases among several companies, try to purchase from one company and you are more likely to receive preferred pricing, convenient installation and other value-added services. Previous TechNation Roundtable articles are available online at https://goo.gl/79fqNj.
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hen the Eifel Tower was built, it took two years and several hundred workers. The tower was built for the 1889 World’s Fair. Today, it attracts more paying visitors than any other tourist attraction worldwide. President Herbert Hoover officially dedicated the Empire State Building in 1931. Construction took just over a year and came in under the budget of $40 million. On any given day, there were 3,400 workers employed in constructing the skyscraper. The Burj Khalifa Tower in Dubai stands 2,717 feet tall. Construction began in the fall of 2004. The building’s exterior was completed in 2009 and the project was completed in January of 2010. The exterior features 28,261 glass panels and the tower includes 57 elevators. The project required 431,600 cubic yards of concrete and 39,000 tons of rebar. Twenty-two million man-hours of labor brought the project to a successful finish. For now, the tower is the world’s tallest, but that will soon to be eclipsed by the Jeddah Tower in Saudi Arabia.
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CONSTRUCTION EXCITEMENT AND PITFALLS The approach to construction projects in the health care setting requires many of the same considerations as these historic projects; careful planning, the expertise and manpower to pull off the project and funding, along with safety and materials considerations. Rome wasn’t built in a day and most construction projects, additions and renovation projects require extensive planning, schedules, materials and equipment. Tighter health care budgets have made any new project an exercise in necessities versus allocated funds. In health care facilities, the input of the HTM department is a crucial part of the process. Speaking about both construction and medical facilities, Eddie Acosta, MBA, CBET(e), CLRT, EDDIE ACOSTA director of business development for Colin Construction Company says that “there have been many discoveries in both fields including building codes, safety and health codes and including advance technology discoveries.” Acosta has a unique perspective on construction in the medical facility setting, having had a long career as an HTM professional in both civilian and military settings. “In retrospect, the insights that I can recommend the most are to develop a comprehensive project plan, bring in the experts and partner with an experienced health care construction company. Each project is going to be unique, so whether it be new construction, renovating an imaging space or an expansion, it all starts with a plan,” he says. Acosta’s experience in both settings has offered him an opportunity to see how the process unfolds from all angles. “The process starts with the initial site visit to determine the space requirements for the new technology with the customers’ needs and wants. This is when a team consisting of the users of the technology and engineers can express their expectations to OEMs, 52
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designers, architects, contractors and sub-contractors,” Acosta says. “This allows the development of a construction proposal for the requirements to integrate the new technology. This will then be added to the cost of equipment for budget formulation and approvals for implementation of the customer’s health care strategy,” he adds. “With the information gathered, a project plan can be developed with all the details that include removal of old equipment and demolition of existing space. The plan will also include upgrading the space to current health and safety codes, utilities, building codes and any new local requirements.” Acosta says that in addition to these steps, finishes for the project are selected for paint color, lighting fixtures and artwork. “A timeline will be established with the project plan that will include the installation of the new technology once the space has been prepared,” he says. “Having partners in the project plan that include designers, architects and sub-contractors is key to being successful and completing projects on-time and on-budget.” THE HTM CHECKLIST Leadership in the HTM department can benefit by carefully considering resources, purchasing decisions, training, skill sets and warranties, among other things leading into a construction or renovation project, according to Matt Royal, CHSP, CHEP-FSM, CHTM, CLSO-M, CHC, CHFM, CBET, director of biomedical engineering for Eskenazi Health in Indianapolis, Indiana. “Get the inventory of all new equipment correct, this is the time where you have all the purchase orders, pricing, PM schedules, warranties, etcetera,” Royal says. “Additional resources are needed, it takes a toll on the a team when they are required to not only continue to support an old facility but oversee the installation of new equipment and the movement of existing equipment to the new hospital,” he adds. Royal says that typically new
technology is purchased for a new hospital and this can make current skills at the old hospital obsolete. There can be a large learning curve in the first couple of years as techs learn to support new equipment. “Ensure training is included in the purchase, typically the builder will hire a project manager who procures the equipment and ensuring training and service keys is the last thing on their minds. You have the most leverage to get this included at the time of purchase,” Royal adds. Royal also says that the HTM team needs to add IT skills to their tool bag. Either hire a biomed/IT hybrid or send multiple members to IT certification MATT ROYAL training such as A+, Net+ and, especially, IT security. “Evaluate all products for cybersecurity, perform a risk assessment during new equipment evaluation,” he says. “Determine who supports what; there are some gray areas when it comes to technology such as cybersecurity, servers, integration, medical systems and software that reside on common computer desktops,” Royal says. He says that a misconception with a new hospital in the first year is that all the equipment is under warranty and things are easy to support. “This is a huge myth; managing warranties are difficult and if the first year of maintenance is not included, it can result in unplanned expenses. Traditional warranties start when purchased, ensuring purchasing language that warranties start at first clinical use is important,” Royal says. Big projects can bring some new leverage to the HTM department. “When a biomed puts on the medical equipment planning hat, many other issues become a necessity to consider and plan for. One of the biggest opportunities, and also challenges, is WWW.1TECHNATION.COM
that during major renovation and planning begins in this phase with general construction, you are presented with an specifications, e.g. 1 CT or 2 CTs, and opportunity to consider vendor identifying all of the architecturally relationships,” says Rodney Nolen, significant equipment (ASE). The first clinical engineering manager for pass on the inventory and requirements, University of Minnesota Health in both ASE and non-ASE, start to be Minneapolis. developed here. For HTM to act as the “What I mean is this; because of the equipment planner or the lead for the large spend associated with equipment planning, this is projects, you are in a where HTM needs to get position to consider or involved,” he adds. change who your preferred Herr says that during vendor might be. This is a design development (DD) is responsibility, a challenge often where the actual ASE and an opportunity all equipment is identified and wrapped into one,” he adds. chosen by an equipment One of the projects that planner. RODNEY NOLEN Nolen honed his planning “For HTM, this is where skills on was the development of an equipment decisions and infrastructure IMRIS suite. requirements (HVAC, networks, “The planning of the IMRIS suite is electrical) and serviceability are made very carefully planned based on the and it is important for HTM to have physical shape and size of the room. No input. If HTM is to manage the two IMRIS suites are exactly the same so healthcare technology equipment/ every detail must be considered. The systems, the DD is where major decisions ‘doghouse’ is oftentimes a big topic of are made,” he says. conservation. This is the location where Herr says that equipment planning is the magnet will rest while not in use. a service needed during any project and This space is critical in the calculations involves the initial specifications in SD and considerations of the Gauss lines and ends with final delivery, installation which determine safe distances away and coordination of equipment to be from the MRI,” he says. operational for the go-live date. “Equipment planners may not be KNOWING THE PHASES specific to medical systems, and include Knowledge is power and a thorough furniture, carts, IT systems, network understanding of the process, from early planning, electrical requirements, design on, is beneficial to HTM etcetera. HTM can offer specific professionals according to Gregory Herr, knowledge and requirements of medical BSEE, MBA, CCE, CHTM, director of systems. If an HTM service does not Healthcare Technology Management at have the resources to be the medical The Christ Hospital Health Network in equipment planner, often they can be the Cincinnati, Ohio. service that contracts and controls the “First, it is important to understand the medical equipment planner. In any case, architectural process. There are multiple HTM needs to be closely aligned or phases. The equipment planning process control the medical equipment crosses all of these: Phase 1-schematic planning,” Herr says. design; phase 2-design development; phase He also says that not being involved 3-construction documents; phase can lead to non-standardized equipment, 4-bidding; and phase 5-construction inefficient designs for service/support, administration,” Herr says. and either not enough equipment, too “Getting involved in the schematic much, the wrong type and major design (SD) offers [an] opportunity for connectivity missed. HTM to have important input on the “Equipment planning also means to medical systems. Often equipment make sure the equipment is ordered, EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
deliveries coordinated, and a plan to have deployment completed by the dates specified, with application training, infrastructure connections and testing, and coordination of vendors. HTM can own a lot of problems after the construction is complete if not involved up front,” Herr adds. With the inherent pitfalls and opportunities in every construction or renovation project, there are some lessons to be learned. “Clearly define who is responsible for every item in the project with a responsibility matrix,” Nolen says. “For example, if you place a scope washer in a project, who is responsible for making sure the plumbing is completed, who has the electrical, and who is completing the overall install? A document should be created to capture all of this and then followed,” he says.“Always communicate all issues and concerns to all members of the team. More issues result from ‘sidebar’ meetings than anything else,” Nolen adds. In 2014, Gundersen Health opened a new 500,000-square-foot hospital addition to its La Crosse, Wisconsin campus. This allowed Ryan Motl, manager of IS Clinical Engineering at Gundersen a chance to sharpen his project teeth. “With any medical facility project, the institution and the end-quality of the project will benefit immensely by having a comprehensive strategy and representative to advocate for the needs of the medical equipment. The HTM department is uniquely qualified to do this,” he says. “A clinical department will often represent their usage and workflow needs, but the needs of the equipment are
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CONSTRUCTION EXCITEMENT AND PITFALLS not always well understood by the user, “Patient and staff safety is every and there are many details that are not hospital’s primary goal. Good space apparent in the spec sheets provided by planning greatly lends itself to the OEMs. The HTM professional supporting this goal. To design a safe should also help translate project needs room, consideration needs to be given to between the architect and the end user, ingress and egress, clearances around as well provide thematic information fixed equipment, space for ancillary that an individual department may not equipment, ready access to consumable know,” Motl adds. supplies and, in some cases, access to “For example, the echo department emergency equipment such as may not communicate with the OB and defibrillators and code blue equipment,” diagnostic ultrasound departments says Derek Contizano, project manager regarding site planning, as they are all for Colin Construction. under separate leadership Contizano also says that and spaces. The HTM lead-lined walls need to be well personnel can identify constructed and tested to areas that coordination prevent long-term radiation between all three exposure to technicians. Heavy departments will be doors are now being coupled needed, and help foster with automated opening those conversations. All of devices, which allow caregivers this is true, even if a to deliver gurney-bound RYAN MOTL medical equipment planner patients without reaching, is provided by the general opening a heavy door, or contractor or architect,” Motl says. touching any surfaces. Modern technology can save some “In rooms with swinging booms, we money and wiring. will often make the areas the boom can “In a large project, the infrastructure swing through a different color on the needs can really add up. In our experience, floor. A staff member can know based on we were able to save considerable sums the color they are standing on if they’re in from original design by more carefully the swing radius or not, which cues them tailoring network drops, which were too to be more aware of the heavy, moveable prolific at first,” he says. objects around them,” he says. “Having a good understanding of While lighting is a design element in network principles (wireless and home construction, it takes on a new traditional), frequencies, heat load, and importance in the health care setting, electrical is key for making the design with efficiency being a key element. and build process go forward with “LED lighting is the new standard, minimal re-work. Fortunately, as medical because they use less energy and generate equipment evolves, it tends to be smaller, less heat than typical lighting systems. more efficient, less heat load and is The reduction in heat generation greatly wireless – all of which makes the benefits the facility by reducing the power planning and installation easier and less bill at the lights and the mechanical costly,” Motl adds. units, ” Contizano says. He adds that lighting must be CONSTRUCTION COMPANY PERSPECTIVE strategically spaced, based on the types of Getting some insights from the HTM procedures that will take place in the room. angle is good to know and potentially “More sophisticated rooms will have actionable. One perspective that isn’t always multiple light types and dimmer controls heard is the view from a construction project that allow individual or small clusters of manager. It is a perspective that makes clear lights (zones) to be controlled how many considerations exist in planning independently of each other. This allows these projects. individual care providers to customize
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their environment based on their own personal preferences. A right-handed surgeon and a left-handed surgeon may stand on different sides of the patient table, and will want to change the lighting to suit,” Contizano says. He points out that mechanical codes are changing at a drastic rate and one of the most critical areas in planning is HVAC. “Requirements for air changes and outside air have grown considerably since 2013. Most construction activities trigger mechanical changes. Unfortunately, these are often the most expensive and maintenance heavy systems in a facility,” he says. “In order to meet the requirements, many of our projects have had to include supplemental cooling, humidity and exhaust components. Planning for future HVAC needs is exceptionally critical, as utilizing existing capacity for new spaces is oftentimes a far easier proposition then repairing, modifying or adding onto existing HVAC systems,” Contizano adds. With an understanding of the total construction or renovation process and the experience of those HTM professionals who have gone through the rigors of gaining this knowledge before, the HTM department can remain an important resource from the beginning. “Things like this are where an HTM department can really shine and prove their value outside of inventory, PM and repair activities,” Motl says.
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CAREER CENTER Professional Memberships Matter BY CINDY STEPHENS
I
n every profession, there are opportunities to join specialized organizations or associations to advance your career through professional development and networking to learn about industry trends, utilize career resources and hear first job openings.
We believe joining a professional association or organization is one of the best things you can do for your career. No matter what your career field is, you want to remain relevant and be known as a person who is “connected” in your career field. Of course, there are numerous ways to accomplish this, such as professional trade journals and networking with your peers. However, the best way to draw on all of the resources possible is to join a professional association. Too often, joining an association is a low priority, whether it is because of the daily responsibilities that a person is managing or because a person feels they just do not have time for any more commitments. However, by not joining, a person may miss out on the many benefits that a membership in a professional association offers. There are many associations with a local chapter or national trade organization where you will make valuable professional contacts, and have access to a wealth of useful information and resources. Here are some of the many benefits of a professional association membership: PROFESSIONAL DEVELOPMENT AND EDUCATION Professional development might be the most obvious because it is one of the most important. Many associations offer
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members the opportunity to update their knowledge or acquire new skills through seminars, workshops, and conferences. Many also offer courses and online training to keep members up-to-date on the latest industry trends. Joining a professional organization enhances and opens doors for educational opportunities through professional development conferences with industry-related trade shows and facilitated networking opportunities. These training opportunities put you one step ahead of the competition. DEVELOP LEADERSHIP SKILLS Professional associations also give you an opportunity to develop or improve your skills as a leader. This is important not only for your personal development, but for your progression within your firm. You can develop or improve these skills by speaking at industry events, or by answering questions or contributing content to the group’s newsletter or discussion forums. By establishing yourself as a trusted and respected addition to the group of industry leaders, you become a stronger leader in your field that will help you achieve your professional goals. NETWORKING AND SOCIALIZING There are endless networking opportunities in professional organizations. Numerous events are sponsored by many associations throughout the year that allow you to connect with your peers where you can share ideas, ask for advice, volunteer to be a speaker or become a member of a committee. You also have opportunities to learn about “best practices” or new ideas, hear about key achievers in your field and
CINDY STEPHENS, CPS/CTS Stephens International Recruiting, Inc.
brainstorm with others who are looking to share and learn new information. Another benefit of enhancing your network is that you may find a mentor to help you with your professional needs, or you can become a mentor. Participating in forums, chat groups or discussion boards sponsored by the association is a great way to grow your network and enhance your professional skills. Networking is also a great way to meet new people and build a long-lasting network of friends who share common professional interests. INDUSTRY UPDATES Your membership privileges usually include trade journaals, magazines, and newsletter access which provides a wealth of information on the latest industry trends, equipment updates and news. Most associations also provide access to unlimited resource information such as articles, books, white papers, case studies, updates from certification commissions and other critical organizations. This information is vital to keep you up-todate and relevant throughout your career. CERTIFICATION Another important reason to consider membership to a professional association is to take advantage of its seminars,
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training, certification classes and resources. Often these classes can be done through web-based training, podcasts and training CDs.
representing your association while supporting a great local charity. Bring the family and make a day of it.
JOB OPPORTUNITIES AND CAREER RESOURCES Associations often have job listings available to their members. It is a great way to find targeted job postings for your area. Additionally, many associations have career resources available such as tips on effective resumes or cover letters, job search strategies and negotiating techniques. Don’t forget, listing your association membership on your resume is impressive to current and future employers as it shows that you are dedicated to your career and connected in your professional career field. VOLUNTEERING Professional associations support many community fundraising initiatives, whether it is a food drive or a fun run for a local charity. Volunteer and enjoy
EMPLOYERS BENEFIT, TOO Professional memberships are important for the employer and there are quite a few reasons why. Most employers have a professional development plan with company-paid benefits for training, conferences and continuing education. Investing in employees’ continued professional development improves morale and the company’s bottom line. Through these efforts, employees become more competent, capable and confident in themselves and their work. In turn, performance improves and productivity increases. These company-paid benefits demonstrate a commitment to employees and to their professional development. It fosters a culture of the company investing and supporting employees, motivating staff through achievement and recognition. This often leads to advancement within the organization. Increased employee job
satisfaction results in reduced turnover; therefore, positively effecting retention. The word soon gets out, building a positive reputation that this is an employer who cares about its employees and strives to employ only the best. The company is then recognized as a great company to work for and the organization soon attracts better candidates. Whether you are looking for professional development, learning about job opportunities, gaining access to current technical information or just meeting new people, joining a professional association is a step in the right direction! Being a member of a professional association is beneficial for your professional development and the future of your career. In today’s economy, more than ever, you should show your commitment to your future. Your dedication for professional development and your desire to remain up-to-date with industry trends can be demonstrated through membership in a professional association or organization.
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BY BRANDON GIGER
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n the world of diagnostic ultrasound, dealing with probes that have failed or been damaged is a fairly common occurrence. Some types of damage are visible and obvious – bad cable, strain reliefs, damaged lenses and cracked housings to name a few. However, some of the failures you might encounter will be less obvious.
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As ultrasound probe cables are bent, flexed, stretched and coiled, the dozens of individual conductors within the cable rub against each other and wear, eventually to the point of failure. The failures 50% causedOFF by this kind of wear typically will not be FIRST PROBE REPAIR apparent until the probe is connected to a system. Dead spots or drop-out, image artifacts and a variety of other imaging related symptoms are all indicators that a probe that may look OK externally has suffered an internal failure of this type. With many ultrasound systems, probes that have this type of internal failure would just be repaired or replaced without incident. However, when a Sonosite probe begins to exhibit these symptoms, it could mean that it has become, or is well on its way to becoming, a “killer” probe which can permanently damage any system is it connected to.
NEW LOWERED REPAIR PRICING! SO HOW DO I DETERMINE IF A SONOSITE PROBE IS A KILLER? With most probes the occasional dead spot may be innocuous, but with a Sonosite probe this could be an indication that it has become or is about to become a “killer probe.” Conquest Imaging is developing a proprietary test device specifically to identify “killer” Sonosite probes. This low-cost, portable, battery-operated test device can accurately differentiate between actual “killer” probes, and probes that simply have bad transducer elements or detached/broken conductors.
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EXPERT ADVICE
BY JENNIFER DEFRANCESCO
TURNING SETBACKS INTO COMEBACKS BY JENNIFER DEFRANCESCO
W
ith our eyes eagerly set on the future, many HTM professionals are thinking about how they are going to continue to re-tool their programs to align with their vision and better support their organizations. Our goals may look something like – “become my own service line,” “re-organize our support of high-tech, high-cost equipment in a radically more cost-effective way,” or “secure the training budget I’ve requested to continue to develop my team.”
I’ve heard time and time again from HTM professionals that they are frustrated by not being able to take their program or their personal development to the next level. They feel that if their leadership could only understand how innovative their ideas were that they could completely transform the landscape of their organization and their support of it. People have reached out to me at their wit’s end wondering how they can change their program, how they can garner their leadership’s support and how to keep on trucking when times get hard. I’ve broken down my top three tips. GET SOME COMFY RUNNING SHOES While we could all likely benefit from some more running, I more so mean that your relationship with your leadership team is a marathon, not a sprint. I’m often contacted by individuals who have been in
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their positions for less than a year who feel like they just can’t get leadership buy-in. The reality is your leadership views you and your success as a body of work over a period of time. The good news is that not one single incident can make or break this relationship. Remember the equation for work? Work equals force multiplied by distance. The bad news is your worth or work output is evaluated by consistent force over a time, you can put in more force over a shorter period of time to get to a valued place with your leadership more quickly, but there is still a force and time element to this relationship. If you aren’t there with your leadership yet, write out a plan as to how you can use this year to enhance your work output and value to your leadership. Think, sustained effort and performance over a period of time, intermixed with periods of high-level effort with big bang for your organization in shorter sprints. For example, ensuring that all of your metrics on your balanced scorecard and your customer satisfaction exceed targets all year as well as integrating your staff into special projects that require additional work. For example, being key team members on rolling out a new EHR, being project managers on a new technology that will allow you to provide different services to patients, etc. Ultimately, consistency, quality and enhanced output of your work product builds your relationship with your leadership team.
GET COMFORTABLE WITH FAILURE Nobody necessarily loves to fail, but if you are really going to change processes and do things differently, you will fail – there is no question about it. In actuality some of my biggest failures in my career have been the catalysts for big positive changes. Your leaders will also watch what you do when you fail. A person’s true character will show in times of distress and this will let others know that you are dependable when all else fails. A common question that I get is about building your own service line or re-branding your HTM program and how to have your leadership be open to the concept. In my executive role, there are days where a service may have a 15-minute meeting with me at 3 p.m. and I may have been going since 7 a.m. and maybe had a few jellybeans and coffee to eat all day. You may have a great idea, but I simply don’t have the bandwidth (or it isn’t the most urgent thing at that time) for me to invest in at the executive level. Therefore, I may or may not be able to react positively. You need to know your leadership team and their style and be able to read when it is a good time to pitch your idea. This also may take a few sessions or various discussions to break the ice. If you fail in getting the outcome you want the first time around, you will always be able to knock on the door again at a later time.
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When you do have the opportunity, make sure you have all the data needed. Be prepared, hit the high points in a concise manner and let your leadership ask additional questions, if needed. REFRAME You have to take your failures less personally and look at them as opportunities to refine your goals and what you are asking for. You also have to allow yourself time to recover from your failures. Simply ignoring it and moving on doesn’t necessarily allow you to learn. I, as a rule of thumb, allow myself two days to deal with big professional let-downs. In these two days, I give myself the grace to do whatever I need to process what happened. This may mean I work until midnight refining my goal or this may mean I take a mental health morning off. Whatever it means for you, ensure that you allow yourself to do that. Once you’ve done this, instead of getting
into martyr mode, try to reframe why you are not able to achieve your goals. Ask for feedback on your delivery or what you could do better. Are your wants for your program in alignment with the organization’s goals or your boss’ needs? If not, use feedback to better align them. A common way that I use to help myself do this is asking myself or my leadership team the following: “OK, X didn’t happen the way I anticipated. This is still a goal of mine, what do I do between now and the next time I ask this again that makes this a yes next time?� By doing this, you can really challenge your pre-conceived notions and garner the feedback necessary to achieve your ultimate goal. This will also allow you to get out of your own way. Digging in your heels almost never gets you in good graces. It makes you look like a poor team member that cannot be counted on when things don’t go exactly your way. Best of luck in all your endeavors!
JENNIFER DEFRANCESCO Dayton VA Medical Center Jennifer DeFrancesco is a certified clinical engineer and certified healthcare technology manager. She is the VISN 10 Chief Biomedical Engineer which serves 11 hospitals in three states – Indiana, Michigan and Ohio. She is currently detailed as the associate director of the Dayton VA Medical Center in Dayton, Ohio.
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BY JON BENEDICT
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RISK-BASED PRIORITIZATION
The Importance of a Risk-Based Prioritization of Medical Devices BY JON BENEDICT
I
n my last article, we talked about the need to have a good solid inventory with both “physical” and “logical” data points for each medical device. Your scanning tools are in place and your boots-on-the-ground team has just left your facility. You may be asking: “Now, what do we do with it?
Understanding it’s probably an unrealistic expectation to successfully defend every single device 100 percent of the time, I recommend performing a risk-based prioritization of the medical device inventory, so you will be able to make better informed decisions about what devices to focus your defense budget on. What is a risk-based-prioritization? It’s exactly as it sounds, it’s utilizing a numerical scoring system to evaluate and rank the devices from the lowest risk to highest risk. Once completed, the prioritization will provide clear, tangible metrics to identify where you will get the greatest ROI for your cybersecurity budget by focusing on the devices that pose the greatest threat. Having a risk-basedprioritization of your medical assets should help you more clearly define a realistic goal of what to defend that meets with your organization’s tolerance for risk and also complies with the current information security policies and procedures. Like so many things in health care
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cybersecurity, there is no right or wrong way to do this as long as the output successfully defends the devices and patient data. There are countless methodologies, tools and algorithms out there that calculate perceived risk. When you add in the complexities of FDA 510K devices, this can quickly become more complicated and confusing than it needs to be. In an effort to help demystify which metrics to evaluate, I recommend the following to be some of the core attributes to consider factoring into a risk-based-prioritization (in no particular order): • T he class of medical device, i.e. whether or not it touches a patient directly • Connectivity to the network and/or the Internet • T he number of patient records stored or transmitted • The OS/firmware running on the device • Physical location and/or whether or not a device is mobile and moving around the facility • Logical location of the device within the network topology By evaluating these attributes, what we have found is that we can quickly reduce the number of devices we’re trying to protect to somewhere around 25 percent of the medical device install base. For example, if your hospital has 10,000 medical devices, we can narrow that down using a risk-basedprioritization to roughly 2,500 devices
JON BENEDICT Director of Information Security and Jump Team Operations for The InterMed Group
to focus your defense strategy on. What seemed to be a daunting and insurmountable task, suddenly seems to be much more manageable when taken one step at a time. Now that you have your risk-based prioritization completed, you’re able to identify the highest risk devices by manufacturer, model and modality. It’s probably time to get all of your key stakeholders together for a white-board session to start understanding where the devices are in their life cycle, how they are interconnected and the best ways to go about securing them. In some cases, you may find out that patching is no longer supported on older devices, so you may have to consider replacing an older device or accept the risks of keeping it in service. At least you now have solid metrics to help you make those decisions.
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EXPERT ADVICE
BY INHEL REKIK
VLAN VERSUS MICROSEGMENTATION BY INHEL REKIK
M
ore and more medical devices need to connect to the network to talk to other applications such as the EMR or to receive software updates. For the majority of medical devices, you can’t install your own antivirus on them or apply security controls at the operating system or application layer on the medical device. One way to protect medical devices from malicious activity is to segment the network. There are two ways to segment a network – VLAN or microsegmentation.
What’s a VLAN? A VLAN defines broadcast domain in a layer 2 network. It defines which devices talk to each other without having to physically install several networks. Routers operate at a layer 3 and are used to bridge layer 2 networks. The advantage of layer 2 networks is that all devices can talk to each other. This is the case of the patient monitoring network. The issue with the VLAN approach is that a corrupted frame can disrupt the whole network. This can affect one VLAN or several if NIC and switch ports are configured to do trunk access. Security professionals have come to the conclusion that VLANs are not enough. Microsegmentation is the new way of securing medical devices on a network. It allows networked devices to only talk to end point devices they are allowed to talk to and uses virtual routers to communicate between segments. It limits the propagation of malware or malicious activity. However, it requires a full understanding of applications’ interactions and communications patterns which makes security policies very difficult to put in place. Microsegmenta-
tion gives network administrators other ways to describe the workload such as type (database, server, web application), operating system, its use (production or test), and what kind of data will be transmitted through the network by the workload (PHI, financial, low sensitivity). These characteristics are all independent of the physical location and environment of the workload since these two requirements tend to change over time. They are combined to create sophisticated security policies. Since creating these policies and managing them can be very tedious and complicated, some network security tools use machine learning to analyze which applications are communicating and automatically generated rules. These rules need to be evaluated by security analysts. Microsegmentation is tedious to establish and maintain, but once it’s done it makes securing your environment a lot easier especially with IOT devices being deployed more and more. It’s important to note that not all HDOs will be able to segment their network, especially if they reside on old infrastructure. As we implement sophisticated ways to protect our network from an attack,
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
INJEL REKIK MedStar Health
medical device manufacturers need to work their way into being compatible with security tools. They also need to be aware that by creating more IOT medical devices they are also increasing cybersecurity risk, creating a vulnerable environment and increasing the impact of a compromise on patient health. One main question to ask when designing a medical device is what’s the risk versus benefit of connecting the medical device to the Internet or the local area network? Can some of the risk be eliminated by incorporating security elements such as encryption of the network communication and allowing the application of the security controls on the device itself? Inhel Rekik is director of health technology security at MedStar Health.
APRIL 2018
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EXPERT ADVICE
BY ERNEST OATES AND JEFF NIEDERHAUSEN
BUILDING YOUR AEM PROGRAM
ERNEST OATES Children’s Hospital Orange County
BY ERNEST OATES AND JEFF NIEDERHAUSEN
O
ne of the biggest things we have been hearing about in our industry centers concern an Alternate Equipment Maintenance (AEM) program. For many facilities, this program can be a struggle to build. Trying to figure out where to start is even worse. In our program, we have tackled this head on and have made great strides to complete the task of creating an AEM program that is effective.
The first step in this process is making sure there is a good understanding of what is allowed under an AEM program. Although there’s been a handful of articles written, the best source document is CMS’ S&C:14-07-Hospital. This document states, “Under certain circumstances, it also may be consistent with the regulatory requirements for a hospital to use maintenance activities or frequency of facility or medical equipment which may not be the same as those recommended by the manufacturer.” It goes on to give some exceptions for types of equipment that can be placed in an AEM program and some factors that should be addressed in the course of the AEM risk assessment. The second step in creating an AEM program is coming up with an AEM eligibility risk assessment that is easy to understand and can be applied to any and all of the hospitals you currently serve. One way is to use a method
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similar to the way biomed currently calculates the risk associated with a piece of medical equipment (high risk or non-high risk). The five scoring criteria are: 1) equipment function, 2) potential risk due to a device failure (extent of harm), 3) current maintenance requirements, 4) the maintenance history of the device (including a look at any past patient incidents involving that equipment), and 5) the use/environment of the medical equipment. The first factor: equipment function, requires an additional risk assessment to determine if the equipment is used for life support, is high risk/non-high risk, or if it’s a non-patient care device. It’s something to think about if you need to apply an additional risk assessment for the equipment that aligns more closely to The Joint Commission’s SAFER Matrix. From that you can develop a “severity x probability” risk assessment. For the probability component, you could use a calculation of the mean time between failure (MTBF) for each device type. It is important to define what types of corrective maintenance would go into that calculation as the MTBF would also be used as part of the annual assessment of the program’s effectiveness. Consider removing any work orders related to device recalls, incoming inspections and configuration changes as those work orders don’t give an accurate depiction of an equipment failure. Once you have the MTBF for each device type, defini-
tions can be created for what counts as probable, occasional, remote and improbable for the risk scoring process. An unexpected benefit of performing an additional risk assessment will be to validate if your device risk scoring process was accurate or not. Once a risk assessment has been applied to all the device types, we created four categories that the equipment fit into, based on their AEM risk assessment score. The categories ranged from adherence to manufacturers’ recommended activities and frequencies, to no preventive maintenance being performed at all (run to fail). Knowing there will be special circumstances you may not be aware of within a particular facility, the updated medical equipment inventories that now list the addition of AEM categories should be reviewed by each director (for programs that cover multiple facilities) for review, and allow them the opportunity to exclude individual assets from the AEM program. The final step in creating an AEM program is coming up with a way to assess its effectiveness. One way is to use the MTBF to be your litmus test for whether or not a change in the preventive maintenance program resulted in a decrease in that equipment’s reliability. We calculated the standard deviation to show the variance in MTBF year-overyear for a device type, and if a given year’s MTBF falls outside the baseline
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EXPERT ADVICE
JEFF NIEDERHAUSEN Tech Knowledge Associates
MTBF (plus/minus the standard deviation), then a risk assessment would be performed to determine whether it’s acceptable to leave that device type in the AEM program. The biggest indicator for that risk assessment is determining whether or not the corrective repair would have been prevented if the OEM’s preventive maintenance recommendations would have been performed. The biggest difficulty in creating a company-wide AEM program could be the lack of a standard in the community. One way to resolve this is to reach out to other organizations that have begun planning for an AEM program, and use them as a sounding board for the ideas you may have about your program. There are a few articles written by Stephen Grimes that can help shape your AEM risk assessment process. Another difficulty you might face is getting the needed changes made to your CMMS software. There could be limitations in what is possible and some challenges in getting the changes made within the time frame for implementing the program. It is expected that one of your difficulties to implementing this program could be pushback from the leadership within the hospitals you serve. If you are going to work on building this program, it is important to have open communication with hospital leadership. Be open with them about what is going to happen and how certain types of equipment will be serviced. Explaining to leadership how the program works, and having them understand how the program will allow you to put more focus on equipment with a higher associated risk and improve the turnaround time for corrective repairs should help get the support you are looking for from leadership. Ernest Oates is the TKA director at Children’s Hospital Orange County. Jeff Niederhausen is the chief financial officer of Tech Knowledge Associates. For more information, contact TKA at info@ii-techknow.com or visit www.ii-techknow.com.
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APRIL 2018
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EXPERT ADVICE
RANDALL R. COWENS
UNDERSTANDING THE AEM PROGRAM BY RANDALL R. COWENS
T
here is confusion in the Healthcare Technology Management (HTM) clinical engineering (CE) field about what exactly constitutes a quality CE program. My perspective is borne from over 20 years as a technician and manager, from working as part of an in-house team, third-party providers and as a third-party manager of an in-house team. Through the years, I’ve heard varying descriptions of what a HTM program should look like, varying ideas about how to create a quality program, and even more opinions on how to maintain a successful program.
So what does quality mean when it comes to the Alternative Equipment Maintenance (AEM) program? Does having a quality program mean PMs are being completed on all equipment? And what is PM? Preventative Maintenance? Planned Maintenance? Performance Monitoring? If we struggle as an industry to specifically define what PM stands for, how can we, as an industry, define and quantify what constitutes a sound HTM program? Does having a quality program mean that all PM tasks or all PM checklists are model-specific? Do all technicians in the facility or across the organization accomplish the tasks in the same manner? Is there standardization, and how is that maintained? What is the true goal of HTM professionals? One opinion, and the one I align with, is that the role of a HTM professional is “to provide a safe, reliable, and cost-effective HTM
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program.” Sounds good, but what does that mean? Let’s step back and look from the perspective of the Centers for Medicare and Medicaid Services (CMS). CMS, through the 2012 SOM, requires all medical equipment to be on the inventory with maintenance strategies assigned. Regarding specific task sheets, the organization must follow all manufacturer recommendations, including specific task sheets. However, CMS did drop the requirement for OEM tools and allow equivalent. An AEM program is not mandatory and has restrictions (i.e. imaging). It is only through an AEM program that the organization can use evidence-based information to deviate from a manufacturer’s recommendations. In developing a HTM program, facilities often rely on OEMs to determine if equipment requires a PM. Does the unit benefit from PM? Why or why not? Is the position on PM for each piece of equipment defensible? What is the PM meant to accomplish? How do we measure its efficacy? So where does this leave us? A true AEM program requires the collection and analysis of equipment specific data. A preliminary step is to determine a method of scoring equipment and establishing a baseline performance level. This method must consider CMS requirements. Once the baseline is established, data collection can begin. Analysis of the data will reveal that (1) the equipment is operating safely and that no adjustments are needed or (2) that the equipment (and therefore the program) would benefit from a PM program. An example may be a central
RANDALL R. COWENS, MBA, CBET Sodexo Clinical Technology Management
station in a carpeted area that benefits from an increased PM cycle because of the buildup of dust in the unit. Failures will be reduced by cleaning this unit out on an increased frequency schedule. Hence the term preventative maintenance. The goal should be to use the data collected to help determine true risk and then create a PM procedure that addresses the need. If this is completed correctly, the program is truly defensible and can viewed favorably. These are simple steps that we, as an industry, can take to focus on what actions truly keep our patients and staff members safe versus what may simply be rote and yield little in terms of safety or efficacy. Randall R. Cowens, MBA, CBET, is the regional district manager for Sodexo Clinical Technology Management and acting director of clinical engineering for St Luke’s Health System Idaho. His career spans more than 20 years in clinical engineering serving both in-house programs and third-party organizations. He is an active member of the AAMI Standards Committee and the Intermountain Biomedical Society.
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JIM FEDELE
THE OTHER SIDE EOL Doesn’t Mean End of the Line BY JIM FEDELE
E
nd of life equals end of use? In my opinion, one of the most valued tasks a biomedical technician can do is keep end of life (EOL) equipment repaired and working. Manufacturers want/need to sunset equipment to make room for new models and retire old technology.
However, replacing expensive medical equipment requires resource planning and sometimes the EOL notice is not given in time for any planning of purchasing to occur. That is when we are called to “perform miracles” to keep things running smoothly and safely. I would like to share some strategies we use to keep our EOL medical running smoothly for our patients. Due to our expansion, we have had a couple of small hospitals and a few clinics join our system. Unfortunately, these facilities have lacked any significant capital planning and have many pieces of equipment that have EOL letters on them. Fortunately for us, I have a great experienced team and they always work hard to fix this equipment no matter what the OEM says about its life. It is a great challenge for biomeds to keep EOL equipment running. Typically, the OEM will not give technical advice and their parts inventory can be very limited. We have had success employing a few strategies to keep equipment running. Our first resource is to use PartsSource, our CMMS ties directly to them so we can source the part through their network of vendors. If we cannot get the parts
through our regular channels we then dig into our bag of tricks to search for other options. For really old equipment, we can sometimes component-level troubleshoot the problem and purchase components directly from an electronics supply source. One option that has worked well for us is to keep a couple defective and/or spare units around when possible. This provides us an opportunity to scavenge parts and keep the equipment running. When we don’t have anything in storage, we will look at the used equipment market to purchase a unit for parts or replacement. In many cases we have had a lot of luck utilizing our local company KMA, however there have been times they cannot supply us what we need. When this occurs, I start searching the Internet. While searching for some equipment to scavenge parts from I noticed a “Buy” tab on MedWrench. com. This tab provides a search of over 70,000 listings, from accessories and parts to fully functioning units. Just select what you want, add it to the cart and check out with PayPal. What I liked about the website is the ease of use and intuitive search function. I was really surprised by the amount of items listed.
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JIM FEDELE, CBET
It is one-stop shopping as the listings are from multiple vendors. This is another great place to increase our odds of fixing an EOL piece of equipment. I feel like given all the things we biomeds get to help with there is nothing more satisfying than repairing an EOL piece of equipment. When I think about the smaller facilities that have joined our system, they have many equipment priorities. Being able to keep some EOL equipment in use helps make resources available for equipment that positively impacts patient care for our communities. Jim Fedele, CBET, is the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments via email at info@mdpublishing.com.
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EXPERT ADVICE
STEVEN J. YELTON
THE FUTURE
Include Mentoring in Your Department’s Educational Offerings BY STEVEN J. YELTON
I
n the hospital system where I am a consultant, our many values include continuing education, mentoring and a defined onboarding process. In a survey from a year or so ago, we found that many of our technicians wanted these goals to be better structured for them. We very quickly set out to do just that. In discussing this with colleagues, we also found that this is a pretty common problem among HTM departments. The comment that we heard most frequently was: “We try very hard but sometimes we simply don’t have the time to do it all.” We understand this completely and have similar concerns. We feel that this is important enough that we decided to incorporate it into our Medical Equipment Maintenance Program (MEMP) and our evaluation process of employees.
One goal of the onboarding process is to assign a mentor to the new employee. When deemed appropriate, that same employee should also become a mentor. Although it is a work in progress, we are making strides in aligning all of our training-related processes toward a common goal. I believe that making something like this work requires buy-in from the staff and upon investigation found that it could be linked to evaluations, raises and advancement. Our staff will appreciate having this clearly outlined for them so that they have a goal to work toward. In updating job descriptions, we will include mentoring as a requirement alongside traditional items like how well they repair assigned equipment and continuing education. Everyone from the Biomed I on up will be expected to mentor another employee. You may question whom a Biomed I would mentor? In our case, it is usually a co-operative education student (co-op) or intern. This is currently in place formally with respect to our co-ops and interns since it is usually a requirement for the educational program at their college. It is in place for other employees, but not totally formalized. Since this will be tied to advancement and raises, our hope is that technicians will seek out someone to mentor and someone to mentor them as opposed to the
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opposite. When a Biomed I wishes to fill a Biomed II position, we will ask: who do you have in mind to fill your position? The Biomed I should have relevant experience and can potentially fill the Biomed II position as well as provide a well-mentored person to be considered for the Biomed I position being vacated. We consider this a win-win. Also, during a yearly evaluation, the employee will be asked to update their supervisor on how both of their mentorships are going (the mentoring that they are giving and receiving). With this system in place, the entire department will participate in succession planning. Mentorship benefits succession planning in the hospital community as a consistent source of prepared employees to move into new or newly open entry-level and advanced positions. When executed properly, recruiting costs are lowered and filling positions is completed quickly. It is common for our technicians, engineers and supervisors to interact with each other to organize mentorship arrangements. An example would be when a technician who wishes to move into an imaging position might ask to be mentored by one of our imaging engineers. This mentorship would involve working together, attaining training and filling in when necessary. If an imaging position
STEVEN J. YELTON, P.E., CHTM
becomes open, we would hopefully have a qualified and trained person. Even if no position comes open quickly, we have a good person available for backup. The focus of this column is the future as it pertains to education. I have mentioned in the past that I feel that all of us in the HTM field are teachers and students simultaneously. I feel that one of the things that drew me into this field is the fact that since I began my career, I started learning new things and haven’t stopped yet. I feel that if you allow it to be, HTM is never boring and always exciting. The mentoring concept discussed in this column makes us all a mentor (teacher) and mentee (student) at the same time. As you can see, there are many benefits to this program for the hospital, the HTM department and the employees. Steven J. Yelton, P.E., CHTM, is a senior consultant for HTM in Cincinnati, Ohio and is a Professor at Cincinnati State Technical and Community College where he teaches biomedical instrumentation courses. He is the secretary-treasurer of AAMI’s board of directors, AAMI’s Foundation Board of directors, chair of AAMI Technology Management Council (TMC), chair of AAMI HTAC Committee and is a member of the Accreditation Board for Engineering and Technology (ABET), board of delegates.
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BY MANNY ROMAN
ROMAN REVIEW A Hole in the Head BY MANNY ROMAN
A
couple of months ago, I spoke about how emotions are at the forefront of all the decisions we make. As we go through our daily activities what allows us to quickly make conjectures, conclusions and decisions are the emotional tags that every stored memory has. This emotional tag is what is called up very quickly when any situation arises. The tag lets us quickly find similar previous situations and lets us know how we felt then. We can use that information to quickly decide what to do in this present situation. Scientific evidence demonstrates that the pattern recognition we use to assess what is going on is dependent on the emotional tags attached to them.
This process precludes having to analyze similar situations over and over again each time they show up. This expedient method allows us to continue to function in a relatively smooth fashion. We are distressed only when the present situation is not emotionally tagged in our memory. Since we do not have similar experiences tagged in memory, we now must perform a tedious analysis. This stuff is scientifically proven using modern medical imaging techniques. In this column, I want to discuss the beginning of the science – the ground zero of the study of the brain. In September of 1848, 25-year-old Phineas Gage had an interesting job. He directed a work gang that was charged with preparing the roadbed for a new railroad line in Cavendish, Vermont. He used explosive charges to blow up rocks that were in the path of the intended
railway. After drilling a hole in the rock, he would place blasting powder and a fuse in the hole. He then packed in sand using a 13-pound metal bar called a tamping iron. The tamping iron was 1.25 inches in diameter, three feet, seven inches long and weighed 13.25 pounds. It was tapered on one end. On September 13, around 4:30 p.m., he was distracted by the men who were working behind him. He looked over his right shoulder, which placed his head in line with the blast hole. As he began to speak, the tamping rod caused sparks that set off the blasting powder. The exploding charge drove the tapered end of the tamping iron through Mr. Gage’s cheek, under his left eye, and exited through the top of his head. It landed point-first, 80 feet away. Mr. Gage was coherent within a few minutes and sat upright on the oxcart ride to his hotel in town. About 30 minutes after the accident, Dr. Edward Williams found him sitting in a chair outside the hotel. Mr. Gage said to him, “Doctor, here is business enough for you.” Mr. Gage survived the accident that destroyed much of his left frontal lobe. Reports of the damage to his mental wellbeing, however, vary and much discussion has taken place regarding the extent of the injury. If you have curiosity and a strong stomach, see the Wikipedia article. It was also reported that it damaged the connection between the frontal cortex and the limbic system, which is involved in the regulation of emotions. Some reports state that the accident had a profound effect on his personality. He lost his social inhibitions and became profane and irreverent. His
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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injuries were some of the first demonstrated evidence that the frontal cortex is involved with personality and behavior. These symptoms apparently lasted for only a couple of years. He later became a stagecoach operator in Chile. This profession required him to perform tasks that could not be performed by the damaged brain unless it found ways to restructure. According to neuroscientist Dr. Antonio Damasio, another effect of the injury was that his ability to make sound decisions was also impaired. He was capable of analysis, however the requisite emotional processing was compromised. He used Mr. Gage’s situation, in conjunction with other patients he studied, to conclude “emotion and its underlying neural machinery participate in decision making.” Although Dr. Damasio has been criticized for over stating the extent of the behavioral changes to Mr. Gage and omitting facts of the case, his work with the human brain, behavior, emotion and decision-making is what led me to all of the above. I use his statement that “We are not thinking machines that feel, we are feeling machines that think” in my presentations regarding decision-making. So, there you have it. A hole in the head may have been instrumental in discovering how the human brain works and how we make decisions. Next time you hear someone use the words hole in the head, you will have an interesting tale to tell.
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INDEX
SERVICE INDEX TRAINING
SERVICE
PARTS
Company Info
AD PAGE
Intuitive
Thinking Works Solutions
Anesthesia A.M. Bickford 800-795-3062 • www.ambickford.com Gopher Medical 844-246-7437 • gophermedical.com Soma Technology, Inc 1-800-438-7662 • www.somatechnology.com USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
59 11 63 7
P P P P P P
Asset Management Asset Services 913-383-2738 • www.assetservices.com
81
Association
THE INTUITIVE BIOMEDICAL SOLUTION
AAMI 703-525-4890 • www.aami.org
P
84
Auction/Liquidation J2S Medical 844-342-5527 • www.j2smedical.com
15
Batteries PartsSource 877-497-6412 • www.partssource.com/shop
TIBS provides the preeminent Refurbished GE/OEC C-arms in healthcare today! TIBS is the premium choice for technical support and parts for all your GE OEC Products. Every GE/OEC C-arm and GE/OEC part is sold with a Standard warranty.
24
P
Biomedical ALCO Sales & Service Co. 800-323-4282 • www.alcosales.com BC Group International, Inc 314-638-3800 • www.BCGroupStore.com Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com Crothall Healthcare Technology Solutions (800) 447-4476 • www.crothall.com D.A. Surgical 800-261-9953 • www.da-surgical.com Health Tech Talent Management, Inc. 757-563-0448 • www.HealthTechTM.com iMed Biomedical 817-378-4613 • www.imedbiomedical.com PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
89 100 85 48 65
P P P P P
85 55 29
P P P
C-Arm Technical Prospects 877-604-6583 • www.technicalprospects.com/
75
P
P
Calibration Rigel Medical, Seaward Group 813-886-2775 • www.seaward-groupusa.com
Preeminent & Premium Refurbished GE OEC C-Arms The Intuitive Biomedical Solution Inc. 3315 Winchester Drive, Benton, AR 72015
866-499-3966 www.tibscorp.com sales@tibscorp.com (GE/OEC C-Arm Sales) parts@tibscorp.com (GE/OEC C-Arm Parts)
92
TECHNATION
APRIL 2018
3
Cardiology Gopher Medical 844-246-7437 • gophermedical.com Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/ Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/ Technical Prospects 877-604-6583 • www.technicalprospects.com/
11 56 18 75
P P P P P P P P
Cardiovascular Technical Prospects 877-604-6583 • www.technicalprospects.com/
75
P
P
WWW.1TECHNATION.COM
INDEX
91 65 69
P P P P P
Ins
P P P P P
40 75 92 82
P P P P P P P
Contrast Media Injectors Injector Support and Service 888-667-1062 • www.injectorsupport.com Maull Biomedical Training 440-724-7511 • www.maullbiomedicaltraining.com
65 75
43 25
57
P P
Cadmet 800-543-7282 • www.cadmet.com Capital Medical Resources 614-657-7780 • www.capitalmedicalresources.com Healthmark Industries 800-521-6224 • HMARK.COM J2S Medical 844-342-5527 • www.j2smedical.com PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com
93
P P
61 44
P P P P
15 29
Gas Monitors Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com
P P
85
General ALCO Sales & Service Co. 800-323-4282 • www.alcosales.com
89
Hand Switches
P P P
Diagnostic Imaging Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com PL_Ad_2018.ai 1 2/23/2018 3:36:28 PM Avante Health Solutions avantehs.com
91
Endoscopy
91 57
TRAINING
Altima 844.548.4540 • www.altimadis.com Injector Support and Service 888-667-1062 • www.injectorsupport.com International Medical Equipment and Service 704-739-3597 • www.IMESimaging.com International X-Ray Brokers internationalxraybrokers.com/ The JDIS Group 800-974-9729 • www.jdis.com RSTI 800-229-7784 • www.rsti-training.com RTI Electronics 800-222-7537 • www.rtigroup.com Technical Prospects 877-604-6583 • www.technicalprospects.com/ The Intuitive Biomedical Solution Inc 1-866-499-3966 • www.tibscorp.com Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
PARTS
International X-Ray Brokers internationalxraybrokers.com/ The JDIS Group 800-974-9729 • www.jdis.com
Computed Tomography
SERVICE
Company Info
AD PAGE
TRAINING
SERVICE
PARTS
AD PAGE
Company Info
P P P P P
inRayParts.com 417-597-4702 • www.inrayparts.com
P P
31
Imaging Health Tech Talent Management, Inc. 757-563-0448 • www.HealthTechTM.com The JDIS Group 800-974-9729 • www.jdis.com
85
P P
57
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INDEX
Infusion Pumps AIV 888-656-0755 • aiv-inc.com Elite Biomedical Solutions 855-291-6702 • elitebiomedicalsolutions.com
36 49
P P P P
Infusion Therapy AIV 888-656-0755 • aiv-inc.com Elite Biomedical Solutions 855-291-6702 • elitebiomedicalsolutions.com FOBI 888-231-3624 • www.FOBI.us J2S Medical 844-342-5527 • www.j2smedical.com Select BioMedical 866-559-3500 • www.selectpos.com Soma Technolgoy, Inc 1-800-438-7662 • www.somatechnology.com USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
36 49 6 15 97 63 7
P P P P
P P P P P
P P P
Laboratory 72
P P
Mammography Ampronix, Inc. 800-400-7972 • www.ampronix.com International X-Ray Brokers internationalxraybrokers.com/ RSTI 800-229-7784 • www.rsti-training.com
4
P P
91 Ins
P P P
97
P
Monitors Select BioMedical 866-559-3500 • www.selectpos.com Soma Technolgoy, Inc 1-800-438-7662 • www.somatechnology.com Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com
63 31,33, 35
P P
Monitors/CRTs Ampronix, Inc. 800-400-7972 • www.ampronix.com BMES 888-828-2637 • www.bmesco.com Integrity Biomedical Services 877-789-9903 • www.integritybiomed.com Technical Prospects 877-604-6583 • www.technicalprospects.com USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
4 99 96 75 7
P P P P P P P P
MRI Altima 844.548.4540 • www.altimadis.com Cool Pair Plus 800-861-5956 • www.coolpair.com
24
Nuclear Medicine E.L. Parts 847-421-1656 • nuclearmedimaging.com Global Medical Imaging 800-958-9986 • www.gmi3.com
81 2
P P P P P
Online Resource Adel Lawrence Associates 866-252-5621 • www.adel-lawrence.com J2S Medical 844-342-5527 • www.j2smedical.com MedWrench 866-989-7057 • www.MedWrench.com Webinar Wednesday 800-906-3373 • www.1technation.com/webinars
39 15 88
P
90
Oxygen Blender FOBI 888-231-3624 • www.FOBI.us
91 79
P P P
AIV 888-656-0755 • aiv-inc.com Ampronix, Inc. 800-400-7972 • www.ampronix.com Avante Health Solutions avantehs.com BETA Biomed Services 800-315-7551 • www.betabiomed.com/ Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com BMES 888-828-2637 • www.bmesco.com Gopher Medical 844-246-7437 • gophermedical.com Integrity Biomedical Services 877-789-9903 • www.integritybiomed.com J2S Medical 844-342-5527 • www.j2smedical.com Pacific Medical 800-449-5328 • www.pacificmedicalsupply.com PartsSource 877-497-6412 • www.partssource.com/shop PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/ Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/ Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
6
P P
36
P P P P P P P P P P P P P P P P
APRIL 2018
4 25 61 85 99 11 96 15 71, 89
24 29 56 18 31,33, 35
7
P P P P P P P P P P P P P P P
Portable X-ray inRayParts.com 417-597-4702 • www.inrayparts.com
TECHNATION
57
P P P P P P
Patient Monitoring
Ozark Biomedical 800-457-7576 • www.ozarkbiomedical.com
94
69
TRAINING
44
International Medical Equipment and Service 704-739-3597 • www.IMESimaging.com The JDIS Group 800-974-9729 • www.jdis.com PartsSource 877-497-6412 • www.partssource.com/shop
SERVICE
Healthmark Industries 800-521-6224 • HMARK.COM
PARTS
Infection Control
Company Info
AD PAGE
TRAINING
SERVICE
PARTS
AD PAGE
Company Info
31
P P
WWW.1TECHNATION.COM
INDEX
76
P
Radiology Ampronix, Inc. 800-400-7972 • www.ampronix.com RSTI 800-229-7784 • www.rsti-training.com Soma Technolgoy, Inc 1-800-438-7662 • www.somatechnology.com Technical Prospects 877-604-6583 • www.technicalprospects.com/ The Intuitive Biomedical Solution Inc 1-866-499-3966 • www.tibscorp.com
4 Ins 63 75 92
P P P P P P P P P P
Recruiting Adel Lawrence Associates 866-252-5621 • www.adel-lawrence.com Health Tech Talent Management, Inc. 757-563-0448 • www.HealthTechTM.com Stephens International Recruiting Inc. 870-431-5485 • www.bmets-usa.com/
39 85 79
Refurbish AIV 888-656-0755 • aiv-inc.com
36
Rental/Leasing Avante Health Solutions avantehs.com Elite Biomedical Solutions 855-291-6702 • elitebiomedicalsolutions.com
25 49
P P
Repair ALCO Sales & Service Co. 800-323-4282 • www.alcosales.com Elite Biomedical Solutions 855-291-6702 • elitebiomedicalsolutions.com
89 49
P P
Replacement Parts Elite Biomedical Solutions 855-291-6702 • elitebiomedicalsolutions.com Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com Engineering Services 888-364-7782x11 • www.eng-services.com Technical Prospects 877-604-6583 • www.technicalprospects.com/
49 43 14 75
P P P P P P P P
Respiratory A.M. Bickford 800-795-3062 • www.ambickford.com FOBI 888-231-3624 • www.FOBI.us J2S Medical 844-342-5527 • www.j2smedical.com
59 6 15
Software Nuvolo eam.nuvolo.com/clinical Pheonix Data Systems 800-541-2467 • www.goaims.com
19
P P P
TRAINING
Interpower 800-662-2290 • www.interpower.com
SERVICE
Power System Components
PARTS
P
Company Info
AD PAGE
P
TRAINING
SERVICE
75
PARTS
Technical Prospects 877-604-6583 • www.technicalprospects.com/
AD PAGE
Company Info
Surgical Capital Medical Resources 614-657-7780 • www.capitalmedicalresources.com Healthmark Industries 800-521-6224 • HMARK.COM Prescott’s, Inc. 800-438-3937 •surgicalmicroscopes.com
61
P
44 39
P P
36
P P P P P P
Telemetry AIV 888-656-0755 • aiv-inc.com Biomedical Repair & Consulting Services, Inc. 844-656-9418 • www.brcsrepair.com BMES 888-828-2637 • www.bmesco.com Elite Biomedical Solutions 855-291-6702 • elitebiomedicalsolutions.com Gopher Medical 844-246-7437 • gophermedical.com Integrity Biomedical Services 877-789-9903 • www.integritybiomed.com J2S Medical 844-342-5527 • www.j2smedical.com Pacific Medical 800-449-5328 • www.pacificmedicalsupply.com Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com/ Tenacore Holdings, Inc 800-297-2241 • www.tenacore.com USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com
85 99 49 11 96
P P P P P P
15 71, 89
18 31,33, 35
7
P P P P P P P
Test Equipment A.M. Bickford 800-795-3062 • www.ambickford.com BC Group International, Inc 314-638-3800 • www.BCGroupStore.com PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com Pronk Technologies, Inc. 800-609-9802 • www.pronktech.com Radcal Corporation 800-423-7169 • www.radcal.com Rigel Medical, Seaward Group 813-886-2775 • www.seaward-groupusa.com RTI Electronics 800-222-7537 • www.rtigroup.com Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/
59 100 29
P P P P
5 72 3 40 56
P P
Training Adel Lawrence Associates 866-252-5621 • www.adel-lawrence.com Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com ECRI Institute 1-610-825-6000. • www.ecri.org International Medical Equipment and Service 704-739-3597 • www.IMESimaging.com
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Ultrasound Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com Ampronix, Inc. 800-400-7972 • www.ampronix.com ATS Laboratories atslaboratories@yahoo-com • www.atslaboratories-phantoms.com/
Avante Health Solutions avantehs.com
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TRAINING
Cadmet 800-543-7282 • www.cadmet.com PartsSource 877-497-6412 • www.partssource.com/shop Technical Prospects 877-604-6583 • www.technicalprospects.com/ Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
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SERVICE
Tubes/Bulbs
Conquest Imaging 866-900-9404 • www.conquestimaging.com Global Medical Imaging 800-958-9986 • www.gmi3.com Innovatus Imaging 844-687-5100 • www.innovatusimaging.com J2S Medical 844-342-5527 • www.j2smedical.com Summit Imaging 866-586-3744 • www.mysummitimaging.com Trisonics 877-876-6427 • www.trisonics.com
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Company Info
AD PAGE
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TRAINING
Ins
SERVICE
PARTS
RSTI 800-229-7784 • www.rsti-training.com Technical Prospects 877-604-6583 • www.technicalprospects.com/ Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
AD PAGE
Company Info
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X-Ray Engineering Services 888-364-7782x11 • www.eng-services.com International X-Ray Brokers internationalxraybrokers.com/ RSTI 800-229-7784 • www.rsti-training.com RTI Electronics 800-222-7537 • www.rtigroup.com Technical Prospects 877-604-6583 • www.technicalprospects.com/ Tri-Imaging Solutions 855-401-4888 • www.triimaging.com
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WWW.1TECHNATION.COM
We ONLY use OEM Parts!
Providing support services and quality rebuilt equipment for over 17 years!
ALPHABETICAL INDEX A.M. Bickford, Inc................... 59
Integrity Biomedical Services........ 96
AAMI...................................... 84
Intermational Medical Equipment and Service........... 69
Adel Lawrence Associates, Inc.... 39 Advanced Ultrasound Electronics, Inc....................... 43 AIV......................................... 36 ALCO Sales & Service Co......... 89 Altima..................................... 91 Ampronix, Inc........................... 4 Asset Services........................ 81
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.
ATS Laboratories..................... 33 Avante Health Solutions.......... 25 BC Group International, Inc......100 BETA Biomed Services, Inc..... 61 Biomedical Repair & Consulting Services, Inc.............85 BMES..................................... 99 Cadmet.................................. 93 Capital Medical Resources...... 61
EQUIPMENT PURCHASERS…
Conquest Imaging..................... 8 Cool Pair Plus.......................... 79
International X-Ray Brokers......................... 91 Interpower.............................. 76 J2S Medical............................ 15 The JDIS Group....................... 57 Maull Biomedical Training....... 75 MedWrench............................ 88 Nuvolo.................................... 19 Ozark Biomedical.................... 72 Pacific Medical ................ 71, 89 PartsSource............................ 24 Pheonix Data Systems............. 40 Physician’s Resource Network/ PRN....................................... 29 Prescott’s, Inc......................... 39 Pronk Technologies, Inc. .......... 5 Radcal Corporation................. 72 Rigel Medical, Seaward Group...... 3 RSTI...................................Insert
• We sell and rent the highest quality refurbished infusion pumps available.
Crothall Healthcare Technology Solutions................................ 48 D.A. Surgical........................... 65
Select BioMedical................... 97
• We work with you to provide tailored solutions specific to your equipment needs.
E.L. Parts................................ 81
Soma Technolgoy, Inc............. 63
ECRI Institute.......................... 78
Southeastern Biomedical, Inc....................... 56
• Our IOT experience ensures we can help with your M2M connectivity issues.
Elite Biomedical Solutions....... 49 Engineering Services............... 14 FOBI......................................... 6 Global Medical Imaging............. 2 Gopher Medical...................... 11 Health Tech Talent Management, Inc.................... 85 Healthmark Industries............ 44
RTI Electronics....................... 40
Southwestern Biomedical Electronics, Inc....................... 18 Stephens International Recruiting Inc......................... 79 Summit Imaging..................... 66 Technical Prospects............... 75 Tenacore Holdings, Inc...............31, 33, 35
Contact us today!
Innovatus Imaging.....Front Cover
The Intuitive Biomedical Solution Inc............................ 92
iMed Biomedical..................... 55
Tri-Imaging Solutions.............. 82
www.selectbiomedical.com | 866.559.3500
Injector Support and Service............................. 65
Trisonics................................. 35
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
inRayParts.com...................... 31
USOC Bio-Medical Services...... 7 Webinar Wednesday............... 90
APRIL 2018
TECHNATION
97
BREAKROOM
“ A day without laughter is a day wasted.” – Charlie Chaplin
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TECHNATION
APRIL 2018
WWW.1TECHNATION.COM
whatever the problem... www.bmesco.com 888.828.2637
NEW IPA-3400 Infusion Pump Analyzer The High Accuracy, Easy-to-Use System with Full Touch Screen Control of All Processes
Large 7” Color Touch Screen 1,2,3 and 4 Channel Models available (Field Upgradeable) User Swappable, Fully Self Contained Flow Modules Calibration in Flow Modules No need to be down for calibration or service! Smooth Dual Syringe System Eliminates Drain Cycle Inconsistencies Whisper Quiet Operation Auto Start Built-in Auto Test Sequences Built-in Data Collection
THE BLACK PIR ANHA: EASY AND FAST X-RAY QUALITY CONTROL RTI Black Piranha Features:
All-in-one multifunction X-ray meter
Can measure on scanning beams as well as tomosynthesis
Built-in energy compensation
Automatic recognition of external probes
One-shot HVL for Mammography, Radiography, CT, and Dental Solid-state detectors = no need to compensate for temperature & pressure Optimized for X-ray equipment from a large number of manufacturers 100 meters Bluetooth range Unique detector design to minimize position and rotation dependence Small, compact & robust – easy to place Long-lasting rechargeable battery
RTI Black Piranha
Always free firmware upgrades 2-year Calibration Cycle
The Black Piranha and Ocean software are quick. Ocean can perform instant real-time analysis during measurements as well as a report in the background. When the work is done, you can print a complete report of your work. Use your MS Windows tablet or laptop as both an interactive display during the measurements and as a powerful analysis tool when you are back at the office. All your measurements, along with the result and the report will be stored inside your tablet or laptop. There is no unnecessary, time-consuming data transfer at the end of the day. Phone: 1-888-223-6763 Email: sales@bcgroupintl.com Website: www.bcgroupintl.com ISO 9001 & 13485 Certified ISO 17025 Accredited