TechNation - May 2018 by MD Publishing

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Vol. 9

ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

APRIL2018 MAY 2018

GUIDE

TO THE AAMI 2018 CONFERENCE & EXPO

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C M M S:

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WHAT YOU

NEE D IN THE

Current Capabilities and Shortfalls

16 Company Showcase

EQ2 LLC

26 News and Notes

Industry Updates

42 Roundtable RTLS

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CONTENTS

FEATURED C M M S:

WHAT YOU

NEED IN THE Current Capabilities and Shortfalls

ROUNDTABLE: RTLS

With all the capabilities of current CMMS software platforms, is there anything that can be improved or added? What do HTM professionals want to see added or updated? From CMMS providers, what are the latest features and offers? For HTM professionals, what meets muster and what would be a good addition to make the perfect system?

Next month’s Roundtable article: Test Equipment (Imaging)

CMMS: WHAT YOU NEED IN THE 21ST CENTURY

Knowing where medical devices are located within a facility makes life easier for everyone on the staff. And, it helps HTM professionals be more efficient. TechNation reached out to several people in the RTLS world to find out about the latest advances, cost of ownership and more.

Next month’s Feature article: The Robots Are Coming

GUIDE

TO THE AAMI 2018 CONFERENCE & EXPO

PAGE 48

TechNation (Vol. 9, Issue #5) May 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.

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

MAY 2018

TECHNATION

CONTENTS

PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Jayme McKelvey Megan Cabot 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 Ernest Oates Inhel Rekik Manny Roman Cindy Stephens Steven J. Yelton

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 Jim Fedele, Sr. Program Director, Clinical Engineering, BioTronics, UPMC Susquehanna

INSIDE

Departments P.12 SPOTLIGHT p.12 Professional of the Month: Jorge Contreras p.16 Company Showcase: EQ2 LLC p.18 Department of the Month: Texoma Medical Center HTM Department p.22 Biomed Adventures: Two-Wheel Trainer P.26 p.26 p.30 p.32

INDUSTRY UPDATES News & Notes AAMI Update ECRI Update

P.34 p.34 p.36 p.38 p.40

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

P.62 p.62 p.64 p.67 p.68 p.71

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

P.74 BREAKROOM p.74 Did You Know? p.76 The Vault p.77 Trick Out Your Biomed Cart p.82 MedWrench Bulletin Board p.85 Service Index p.89 Alphabetical Index

Izabella Gieras, MS, MBA, CCE, Director of Clinical Technology, Huntington Memorial Hospital Inhel Rekik, Clinical Engineering Manager, Medstar Georgetown University Hospital

Like us on Facebook www.facebook.com/TechNationMag Follow us on Twitter twitter.com/TechNationMag

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

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SPOTLIGHT

PROFESSIONAL OF THE MONTH Jorge Contreras, CBET When Circumstances Call BY K. RICHARD DOUGLAS

t was the love of musical instruments that relied on electronics, that first got Jorge Contreras, CBET, interested in electronics. The plan was to go to school to be an electronics technician. Contreras wanted to be able to repair his own electronic musical instruments as well.

Contreras is a biomed who works for enBio Corp. He has been assigned to Sonoma West Medical Center in northern California since May of 2017. He is the sole biomed at the facility and manages all the equipment himself with the exception of radiology and respiratory equipment. He has seen much of the country firsthand and lived in several locations before landing in northern California. “I was born in Brooklyn, New York. Shortly after 9/11, we moved to Pennsylvania. After that I’ve been to Florida, Oklahoma, Colorado and now California. In the four years since I’ve been involved in biomed, work has taken me to Texas, Arkansas, Minnesota, Illinois, back to New York and even Maui,” Contreras says. He says that he first became interested in biomed in college. “I was a drafting major but quickly realized it wasn’t capturing my interest. I wanted a career where I could help the public and really feel good about myself at the end of the day. I went through the

TECHNATION

MAY 2018

college catalog and found biomed and I immediately knew this was the field for me,” he says. Contreras changed his major from drafting to biomedical equipment technician. “My professor, Hugh Holly – from Tulsa Community College and owner of Commercial Medical Equipment in Tulsa – took notice of my interest and hired me before graduation. With his mentoring, I made it through college, and through specialized training from various manufacturers,” Contreras says. He earned his CBET certification in November of 2017. WHEN DISASTER STRIKES Emergencies and disasters have become an additional challenge for many in the HTM community, as hurricanes, tornados and mass shootings have impacted health care facilities. Add to that list; fires. Asked about challenges, Contreras recalls the massive wildfires that raged through parts of Sonoma County, California, last year. “The fires started hours before the sun came up. By the time I woke up, we were in full-on disaster mode. I made it in as early as I could and there were many unexpected challenges. Two of the other hospitals had closed and the hospital I support, Sonoma West Medical Center, was the only hospital open in the western part of the county,” Contreras says.

“We received a large number of patients and suddenly there wasn’t enough staff because many had to escape the fires themselves with their families. I helped other departments whenever I could. I picked up empty food trays, helped environmental services out, whatever was needed – it was all hands on deck,” he adds. He says that one big challenge that occurred during the fires was the short supply of biomedical equipment at the hospital. “It’s a 37-bed facility, but suddenly, we had patients out in the hallways and we needed equipment direly. Other hospitals in the area helped us out by loaning us their equipment, and as the sole biomed, I was responsible for testing each device before placing it in service,” Contreras says. “Other challenges were a lack of patient beds. I sought out vendors who could rent us the equipment, but because of the fires, there weren’t many responses. But, we pulled through, and the county, the staff and the residents of the town all became closer because of these events,” Contreras adds. Another challenge was not as much of an emergency, but still important. “One of the projects I was involved in was a recall for infusion pumps. I located pumps in the facilities I operated at, but also at other facilities managed by my company. I take patient care seriously

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SPOTLIGHT

Jorge Contreras enjoys music and his job. and I’ll go out of my way to help out health care facilities and my coworkers,” Contreras says.“Unless your equipment has tracking devices it’s not easy locating the items that move around the entire building. I made a spreadsheet of each infusion pump in inventory and highlighted those affected under the recall. I isolated the pumps and began testing them according to the manufacturer’s specifications. Then, I searched the inventories of other hospitals that my company is contracted to manage, and I passed the message on to management so they could begin the process of testing the pumps under the recall,” Contreras says. MAKING MUSIC When not on the job, a couple of musical instruments are Contreras’ passion. He spends his free time playing the guitar and piano. He is self-taught and now teaches family members how to play. “I picked up the guitar at 14 and started playing the piano at 28. I went

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

into the electronics field in hopes of repairing my own musical equipment. With the knowledge I gained in school, I was able to not only work on my gear, but I had a small business/hobby working on other people’s equipment. I always said to them, ‘If I can repair a defibrillator, I can repair your amplifier,’ ” Contreras says. What should readers know about Contreras? “I’ve taken jobs and worked on projects and I’m fortunate to have seen this great country. I’m very happy with my decision to become a biomed. It’s very satisfying and I recommend the field to anyone who is interested in helping others and still wants to pick up tools and repair equipment,” he says. It’s clear that this rural hospital in northern California has the right person holding down the fort in biomed. And when unusual circumstances throw a wrench in the machine, he is up to the task.

FAVORITE BOOK “The Godfather” FAVORITE MOVIE “The Godfather” FAVORITE FOOD Pizza HIDDEN TALENT I’m a great cook. FAVORITE PART OF BEING A BIOMED “Working on medical equipment that most people are afraid of touching such as defibs, ESUs and radiology equipment.” WHAT’S ON MY BENCH? A Leatherman tool A hydroflask filled with ice water Copies of NFPA 99 and the hospital’s policies and procedures My electrical safety analyzer My multimeter

MAY 2018

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SPOTLIGHT

SPECIAL ADVERTISING SECTION

COMPANY SHOWCASE EQ2

Q2 has a unique perspective on managing the maintenance of hospital assets in that its HEMS® software “was born in a hospital.” In fact the acronym HEMS itself speaks to those roots as it stands for “Hospital Equipment Management System.”

It all started in 1983 when the University of Vermont, the American Society for Healthcare Engineering (ASHE), and the Kellogg Foundation worked together to create a software product to help the university and other hospitals manage biomed and facility maintenance activities. Seeing numerous benefits from using the fledgling software application, hospitals soon put HEMS to work managing the maintenance of their biomed equipment and also for facility management as well. In 1993 EQ2 was formed in Burlington, Vermont to commercialize HEMS and further develop it into a multi-faceted hospital product. Twenty-five years later, HEMS is the leading CMMS product dedicated to providing hospitals with software for use by HTM (including imaging), facilities, IT and environmental services. HEMS is now in its seventh release and available on a cloud platform or for installation on a local server. Today, EQ2 has offices in Charlotte, North Carolina and Camarillo, California. FOCUSED ON THE NEEDS OF HOSPITALS So why has EQ2 continued to focus just on hospitals? “Because HEMS was designed and continuously evolves to address the specific and unique needs of hospitals,”

TECHNATION

MAY 2018

Kim Stovall, EQ2 Director of Sales

says EQ2 CEO Joe Eichberger. “The evolving technology advancements, changing compliance requirements and demands for improving efficiency in hospitals cannot be met with a general industry product. Nor does a product crafted to satisfy the hospital fit the needs of other industries. Further, the focus and expertise needed to make and support a really good hospital product cannot be put together when trying to service a number of industries. A hospital is a very unique type of organization. While it has some things in common with traditional businesses, it has the unique mission of treating ill or injured people. This is why HEMS has stayed true to its hospital roots and every new or improved module we release is to better serve the hospital’s needs. And, we’re not finished – we have a long list of projects in our pipeline to keep HEMS on the leading edge.”

MODULAR AND AFFORDABLE Speaking of modules, HEMS has evolved dramatically from its roots as a basic software application to one that now offers many modules that a hospital can choose from based on its needs due to size, number of locations, budget and the specific service areas that it wants to serve. It also can be deployed on a hospital’s own server or in the cloud as a SaaS solution. “With the modular and SaaS concept, we truly are affordable and easy to deploy for anyone,” says EQ2 Director of Sales Kim Stovall. “We have small, stand-alone hospitals using HEMS and we have large hospital systems that use HEMS in dozens of locations, as well as everything in between. The hospital just picks the modules, service areas and number of locations that it wants HEMS to support and gets started. Later they can always add additional modules, service areas and locations as the budget or other conditions allow or require.”

Vishal Malhotra, EQ2 Chief Technology Officer

WWW.1TECHNATION.COM

SPOTLIGHT 1

1. Automated AEM dashboard 2. Data can be analyzed any way the user chooses to 3. HEMS is accessible anywhere on any type of mobile or desktop device

Rich Sable, EQ2 Product Manager

The modules cover everything from the use of mobile devices in the field to ECRI recalls to dashboards with a unique view, depending on the user’s role. In fact, the dashboards module now addresses, in part, a challenge facing all HTM departments – Alternative Equipment Maintenance (AEM). It guides HTM staff

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

throughout their AEM journey by identifying which devices can be on an AEM program and which ones must remain on device manufacturers’ recommendations per the requirements of The Joint Commission, CMS and standard EC.02.04.01. Since AEM practices are device specific, HEMS takes a lot of the work out of setting up and maintaining the AEM program, making it much easier for the HTM staff to make the program effective and compliant. EQ2 AND EVENTS EQ2 participates in many events including the AAMI Annual Conference and MD Expo as a way of connecting with the HTM community. At AAMI, the company has exhibited in the expo for many years, has participated in the interoperability showcases and has presented numerous times in the educational conference. And at last year’s event, AAMI announced the

release of a new book titled Computerized Maintenance Management Systems for Healthcare Technology Management, 3rd Edition which includes examples of HEMS. “We always enjoy seeing old friends at AAMI, some of which have been our customers for over 20 years,” says EQ2 Chief Technology Officer Vishal Malhotra. “And when meeting new customers we enjoy hearing about their successes as well as their pain points. Their feedback plays a key role in our development. Often, we can show them a new release that provides a solution to a problem they’re having or we can advise them when a solution will be available.” And with this year marking the twenty-fifth year of EQ2 serving hospitals, the staff is just as excited as always for AAMI. “We invite all attendees to come by booth #642 and be part of our 25-year celebration!” says EQ2 Product Manager Rich Sable.

MAY 2018

TECHNATION

SPOTLIGHT

DEPARTMENT OF THE MONTH

The Texoma Medical Center Healthcare Technology Management Department BY K. RICHARD DOUGLAS

he birthplace of Dwight D. Eisenhower, the 34th president of the United States, is a city called Denison, Texas, 75 miles north of Dallas. It is part of the Texoma region of Texas, close to the Oklahoma border.

The Texoma Medical Center in Denison is a 294-bed health care facility, which will soon have a new tower that will increase its bed count. The center is staffed by a six-man healthcare technology management department. Members include Steven Thompson, medical systems engineering technologist I; Todd Johnston, medical systems engineering technologist I; Dean Palmer, medical systems engineering

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MAY 2018

technologist I; Joshua Knight, CBET, medical systems engineering technologist II; Ryan Harris, CBET, director of healthcare technology management and Don Allen, program director. In addition to the medical center, the HTM team provides services to the TMC Bonham hospital nearby, which is a 25-bed critical access facility. They also serve seven offsite clinics. According to Harris, some members of the department are specialists. “Todd Johnston specializes in respiratory equipment, physiological monitors and dialysis. Dean Palmer specializes in OR equipment. He is trained on anesthesia, and heart lung bypass. He also manages all of the flexible and rigid endoscope repairs,” he says.

“Joshua Knight specializes in imaging equipment and is trained on many systems. Right now, he works on C-arms, portable X-ray, ultrasounds, bone density scanners. We have plans to expand his service to other imaging equipment in the near future,” Harris says. TRANSITIONING TO IN-HOUSE The HTM team hasn’t always been an in-house operation. “Our biggest project has been converting from a contracted biomed department to in-house back in October of 2016. Dean Palmer and I had been working here for a few years before the conversion. We were able to find three other great technicians to join our team,” Harris says.

WWW.1TECHNATION.COM

SPOTLIGHT

From Left: Dean Palmer works on a heart lung bypass machine. Steven Thompson services and IV pump. Todd Johnston tests a pacemaker.

“Our shop was too small for five people, so from day one, we had to hit the ground running by moving into a bigger space while still taking care of any urgent maintenance needs. For parts and test equipment storage, we assembled a five-shelf sliding storage system. We also put together five workbenches. The hard work and team effort that went into this project set the foundation for a great future,” Harris adds. He says that nobody complained or acted negatively when faced with these tasks, so it was an early indication that the team had the right attitudes in place. They also did a remarkable job keeping costs down. “After we got settled in, we had to adjust to the expanded work load and increase our skillsets. To get us started, we had plenty of help and insight from Chris Nowak, our corporate HTM director, who was also overseeing concurrent transitions at all other UHS hospitals. A few months after the transition, Don Allen joined the team as our regional program director. Don has many years of experience in our field, so having him available to help guide me has been very effective. Our preliminary cost of service ratio calculation for 2017 is 3.79 percent, and we are proud of that,” Harris says. In January of 2017, the HTM department took over management of all imaging equipment maintenance. “We are responsible for coordinating all service activities with the vendors, and

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

everything is captured in our CMMS, providing an unprecedented view for that equipment at our facility, and our radiology management team loves it, because they can now access our database from the Internet and see all of the maintenance documentation right there in one place,” Harris says. He says that in July of 2017, they began to inventory all flexible and rigid endoscopes along with powered surgical instruments and respond to the OR when problems with those devices were reported. “When they fail, they are being sent out for repair by the HTM staff. Like the imaging equipment, we now have solid data in our CMMS to study when making decisions about service strategies for this equipment,” Harris says. “After only six months of history, we were able to target certain problematic models of endoscopes to consider for service contracts. We also coordinated some on-site education for our OR staff that covered proper handling and disinfection procedures in hopes to decrease repair costs,” he adds. Harris says that when his team took over the maintenance of hospital beds, he could immediately sense frustration from nursing, and knew that they had their work cut out for them. “There was uncertainty among them about which beds were capable of interfacing with our nurse call system. As it turned out, almost all of our beds could

interface, but they were either missing their communication cables or the connections on the bed were damaged,” he says. “My team went through and put cables on beds that didn’t have them and repaired the beds that needed work. About six months later, we had to go back through and physically attach the cables to the wall in each room because some of the rooms and beds were missing the communication cables,” Harris adds. Today, almost 100 percent of the beds are integrated to the nurse call system. “We still face challenges with the beds, but by listening and communicating properly with nursing, while providing education when needed, I think that we are in a good place right now and providing the staff with a level of response for the beds that they were not getting in the past,” Harris says. The HTM team also has a close relationship with their IT department and works with them collaboratively on networked devices. “We are currently working together on a project involving IV pump integration with our EMR, and the project’s success will rely on help from both of our departments,” he says. In northern Texas, the HTM functions get done right because of a small, dedicated team of professionals who work in the same place where a great general and president emerged. Both dedicated to getting it right.

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BIOMED ADVENTURES Two-Wheel Trainer BY K. RICHARD DOUGLAS

ife on two wheels is something that many develop early on in life or is a decision that seems to come out of mid-life crisis. A shiny Harley-Davidson motorcycle becomes a sought-after goal of many a baby boomer.

In either case, knowing how to ride safely and learning the rules of the road for a motorcyclist, is part of making the transition. Like driving a car, it is a learned skill, often best obtained through an experienced teacher. When that experienced teacher has already mastered teaching biomed, it’s not a stretch to teach motorcycle riding. Roger Bowles, Ed.D, CBET, is a professor in the Texas State Technical College Biomedical Equipment Technology Department. For the past six years, he has also taught safe motorcycle operation. “I’ve been teaching this since April of 2012. I first became interested in teaching motorcycles in 2008 when I went through the basic rider course for the first time. I had been riding, but I didn’t know I needed a separate license endorsement to ride on the street. I took the course and enjoyed it and the instructor mentioned that the state was looking for instructors. I didn’t pursue it until 2011 and it took about a year to get fully qualified to teach,” Bowles says. When he applied, he was assigned a

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mentor and given assignments. He says that he went through the basic course again and then started hanging around most weekends; learning cone placement on the range and getting more familiar with the course. “The state of Texas has a nine-day intensive course to become a certified Motorcycle Safety Foundation RiderCoach. I have since completed certification courses for teaching dirt bikes (dirtbikeschool.org), three-wheel motorcycles and the total control intermediate riding clinic,” Bowles adds. YEARS OF EXPERIENCE To teach a skill, it helps to be well versed in it yourself. Bowles has plenty of experience sitting in the seat of various motorcycles. “I first started riding when I was about four-years old on a little pull-start minibike. From there, it was a Yamaha YZ80 and a couple of other dirt bikes. I got my first street bike, a Honda 250, in 1985 when I was in the Navy,” he says. “I took a break from riding when my kids were little. My second wife’s dad is a Harley guy and had three in the garage. I went riding with him one day and re-caught the riding bug. I went out and bought a 1987 Harley Softail. Over the years, I have owned several HarleyDavidsons; a 2008 HD Fat Bob, a 2010 Road King, a 2012 Road Glide Ultra, and

a couple of Kawasaki KLR 650 dual-sport bikes. Right now, I have a 2017 HarleyDavidson Road Glide Ultra, a 2015 Harley-Davidson Police Road King, a Suzuki DR650 dual-sport and a Honda CRF250X trail bike. I also own two Kawasaki 140 trail bikes for training,” Bowles adds. He says he doesn’t do much in the way of long-haul riding, although he would like to. “I don’t do as much touring as I would like. We did go to the Tennessee Motorcycles and Music Revival last year and we plan to go to Sturgis and Daytona when I’m not working every weekend. As it is, most weeks, I ride to work — which is a 30-minute commute so that is nice,” he says. “I’ve got many long rides on my bucket list, but right now, my priority is to build my business. For the business, I will be teaching the total control intermediate riding clinic (for riders with their own bike and some experience) and the dirt bike school. I will still fit in a weekend a month, or maybe every other month, to teach a basic course for Harley-Davidson,” Bowles adds. THE BASICS; WHAT’S REQUIRED? There’s an old saying about once you have ridden a bike, you can always ride a bike. That may be true of the non-motorized variety, but motorcycles are a breed apart.

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SPOTLIGHT

Roger Bowles teaches future biomeds and provides motorcycle operation classes.

Then, there are differences among sports bikes, dirt bikes and big touring bikes. For anyone seeking the know-how to get on that first motorcycle, Bowles explains the first steps. “First things first, he or she needs to be able to balance and ride a bicycle. If that is no problem, they can sign up for a basic rider course. In most cases, they can just Google ‘motorcycle training’ in their location and get a list of providers,” Bowles says. “For the basic (entry-level) street course, there is an ‘e-course’ that must be completed before coming to class. The cost varies from state to state and provider to provider but it ranges from around $175 to $300. This is usually a two- to three-day course with about 10 hours spent actually riding on the range and around five hours in the classroom,” he adds. His suggestion is to get started on a dirt bike. “A person can learn the fundamentals in the dirt bike school and then practice off-road before taking the street course and dealing with traffic,” Bowles says. “Yes, the street endorsement can be earned in one weekend, but learning to ride a motorcycle is a lifelong endeavor. You can always be better and those basic skills have to be practiced in order to keep them and improve on them,” he says. As Bowles settled in to teaching these motoring skills, he learned what is required to teach people to ride safely and

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

responsibly. “It took me a year or so as a coach to become really good at observing students and pointing out things that can help them improve their skills. One issue I see a lot is people not really having the ability to balance or the physical stamina to ride a motorcycle,” he says. “We occasionally get older riders who want to fulfill their bucket list but haven’t ridden a bicycle in decades or have physical issues. Sometimes it is very young riders who say they have ridden a bicycle but neglect to mention it was one or two times when they were six years old. But overall, if someone wants to learn the skills bad enough, they can be successful — maybe not the first time they take the class but after a couple of times,” Bowles adds. He has found also that communication skills are paramount and he has honed his instructor skills through feedback. Are there any interesting stories he can relate about his experience teaching novices to ride a motorcycle? “Oh, yes there have been a few. The incidents are very few and far between but I have had a couple go off the range and hit a curb; one that ended up getting ‘bucked off’ of the motorcycle because of improper hand placement on the throttle and no clutch control; and a couple I have had to send home because they showed up under the influence. My job as an instructor is to keep these incidents from occurring by seeing and correcting basic control

mistakes early before they become an issue,” Bowles says. What does he suggest for those who want to try their hand at entering the world of two-wheel transportation? “Start with a smaller weight and a smaller displacement, used bike. Yes, most salespeople will tell you that you will quickly outgrow it; and that may be true. But, it is important to develop the skills on a smaller bike, and then gradually move up the scale as your skills improve and your confidence grows,” he says. “People do not learn to drive, fly a plane, or even play football or baseball in one weekend, so motorcycling is really not that different. Building skills takes time, practice and observed practice. Don’t let the first course you take be the only course you take. The basic course is like kindergarten. In order to improve skills and be a safer, more skilled rider, a person has to realize that motorcycling is a life-long learning endeavor,” Bowles adds. “I wish more parents would buy dirt bikes for their kids and themselves and make it a family effort. It really can be a rewarding, memory-making pastime and those dirt bike skills do pay off on the street,” he adds. Apparently, those skills teaching the biomed profession also pay off when teaching people to transition to a motorcycle. Roger Bowles is proof of that as he turns novice riders into safe motocyclists.

MAY 2018

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INDUSTRY UPDATES

STAFF REPORTS

NEWS & NOTES

Updates from the HTM Industry AIV MEETS ISO 13485:2016 CERTIFICATION UPGRADE DEADLINE AIV has implemented the ISO 13485:2016 certification one year ahead of the March 2019 deadline. It is required that all ISO 13485 companies be certified to the newest standard by March 2019. BSI issued AIV’s certificate on February 13, 2018. AIV’s quality and regulatory department conducted a detailed review of the company’s entire quality management system, including the quality manual, quality systems procedures and applicable forms. All new requirements outlined in ISO 13485:2016 were added to the quality management system prior to AIV’s January 2018 re-certification and transition audit. According to the International Organization for Standardization, ISO 13485:2016 specifies requirements for a quality management system where the organization needs to demonstrate the ability to provide medical devices and related services that consistently meet customer’s needs and regulatory requirements. The new ISO 13485:2016 standard requires the application of a risk-based approach to quality management systems. Some of the updates from the ISO 13485:2003 standard include design control and development changes, product handling

and storage, the evaluation of safety and performance of products, and the associated training of the end user. AIV was initially certified to ISO 9001 and upgraded to ISO 13485:2003 on March 29, 2006. Choosing to implement ISO 13485 was a requirement for the company to address the European Medical Device Directives, regulations and responsibilities, and for the safety and quality of medical devices. It also ensures the consistent design, development, production, and delivery of medical devices and replacement parts manufactured by AIV. “The transition to the newest quality standard included the review of AIV’s entire quality management system, including the quality manual, quality systems procedures and applicable forms which provide evidence that documented procedures are being followed. Auditors were impressed with the maturity of AIV’s quality system and manuals and felt AIV’s technicians knew their jobs. The auditor felt that she could perform the explained tasks with the work instructions and little guidance,” according to a news release. Renee Gould with Global Regulatory

www.aiv-inc.com Compliance, AIV’s internal auditor, commended the achievement saying, “the AIV team is passionate and focuses on meeting customer and regulatory requirements. This is demonstrated by AIV planning, implementing and achieving ISO 13485:2016 certification one year prior to the deadline. This is a significant achievement. Congratulations!” AIV’s ISO 13485:2016 Quality Management System complies with the requirements for the following: The design, manufacture, service and distribution of ultrasound and toco dynamic fetal monitor transducers, components for infusion pumps, pulse oximeters and fetal monitor transducers, patient monitoring devices and ventilation devices; the service only of infusion pump, pulse oximeters and fetal monitor transducers. •

ELITE BIOMEDICAL SOLUTIONS UPGRADES ITS DUAL ISO CERTIFICATIONS

Elite Biomedical Solutions, a manufacturer of new medical replacement parts and repair services, recently upgraded its dual certifications to ISO 9001:2015 and ISO 13485:2016 standards. Elite Biomedical Solutions has been ISO

TECHNATION

MAY 2018

9001:2008 and ISO 13485:2003 since 2016. ISO 9001 is the world’s most recognized quality standard for a company’s Quality Management System (QMS). ISO 13485 specifies requirements for an organization’s ability to consistently meet customer and regulatory requirements applicable to medical devices and related services. Elite Biomedical Solutions is also an FDA-registered company and adheres to the FDA’s 21CFR: 820 requirements for the

health care industry. “We take this responsibility as a health care company very seriously to strictly comply with the FDA’s requirements and standards,” Company President and Co-owner Jeff Smith said. “All of these great accomplishments are a testimony of the care and passion of the Elite team. They understand the criticality of patient safety and make it their responsibility each and every day.” •

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INDUSTRY UPDATES PROBO MEDICAL INC. AND MEDCORP LLC ANNOUNCE MERGER

One of the fastest-growing companies in medical equipment refurbishment announced a merger that will expand its services in the ultrasound industry. Probo Medical is partnering with MedCorp LLC. With the merger, Probo Medical will have an extensive ultrasound system resell and repair business to complement its current ultrasound probe sales and repair departments. Probo Medical was established in 2014

and has quickly become one of the U.S.’s largest resellers of refurbished ultrasound equipment. With 55 employees and two probe repair facilities in Indiana and Oklahoma, Probo Medical offers comprehensive probe repair and resale for all 2D, 3D/4D and transesophageal ultrasound probes. MedCorp, established in 1999, is a full-service resource for ultrasound systems, equipment and ongoing maintenance. “We are excited about the union of these two great companies,” said David Trogden, who will be president of the combined companies. “MedCorp’s extensive ultrasound system experience, coupled with

Probo Medical’s ultrasound probe focus, will create the unquestioned market leader in stocking ultrasound systems and probes.” Probo Medical and MedCorp will continue to operate under their current names. MedCorp partners Michael Asmer, Mike Dilick and Chris Munyon will remain officers of the combined businesses. “This merger will result in one of the most experienced teams in our industry,” said Trogden. “We are in a dynamic environment and believe our united companies will be a platform for continued growth and expansion for years to come.” •

SONITOR ANNOUNCES ULTRASOUND-BASED INDOOR POSITIONING PLATFORM Sonitor has introduced its ultrasoundbased technology positioning platform named Forkbeard. “Sonitor’s Forkbeard is the first ultrasound-based technology that enables smart mobile devices to become highly accurate indoor positioning tools offering an innovative and convenient alternative to standard RTLS tags or badges. Lyra, the first release of this breakthrough platform, delivers never before achieved smartphone positioning accuracy enabling wayfinding to within 1 foot in a corridor, 100 percent room level accuracy and 1-2 second update rates,” according to a news release. “Forkbeard is compatible with the billions of iOS, Android and Windows smart devices on the market today and has

been heralded by leading mobile technology insiders as a disruptive force in indoor navigation and positioning. By leveraging the capacity of the smartphone’s microphone and powerful processor, no modifications or accessories are required to transform a smartphone into an accurate positioning device or tag.” “Forkbeard represents a fundamentally new approach to ultrasound decoding developed to deliver accurate distance measurements and to find powerful Doppler effects when a device is in motion,” said Sonitor Technologies CTO and Lead Developer Wilfred Booij, Ph.D., “The result is a scalable and accurate indoor positioning platform that delivers GPS-like performance indoors.”

“Forkbeard is a major technology breakthrough with applicability in health care and other industries, such as retail and warehousing, where reliable and accurate indoor positioning can deliver significant value,” Sonitor Technologies Inc. President and CEO Anne Bugge added. “With the ubiquity of consumer and professional smart devices, and the fact that we spend over 80 percent of our life indoors, Forkbeard has the potential to make transformative changes across multiple markets.” •

RELINK MEDICAL ACQUIRES ASSETS OF O’BRIEN WHOLESALE INC.

reLink Medical has acquired the assets of O’Brien Wholesale Inc. (OWI). Shane O’Brien, OWI’s founder and CEO will be joining the reLink Medical executive team as vice president of products. “As we continue to explore sales

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

channels to improve the return to our reLink360 customers, we recognized the leadership role that OWI was playing in the medical equipment liquidation and web sales channel. O’Brien’s processes and expertise were a natural addition to our expanding model,” relink President and COO Jeff Dalton said. “We look forward to integrating OWI’s expertise and methodology to improve our broad offering of disposition channels.” “I’m extremely excited to be joining the

reLink team,” said O’Brien. “reLink’s vision for providing unparalleled value to hospitals through a full-service disposition process is similar to OWIs but on a much larger scale. By joining the reLink team I can see that happening even more efficiently.” OWI is the first of many channels that reLink Medical looks to acquire as it continues to seek additional processes that enhance its customers’ return on liquidated assets and provide the best possible disposition options. •

MAY 2018

TECHNATION

INDUSTRY UPDATES

STAFF REPORTS

ACCRUENT ACQUIRES CONNECTIV

Accruent, a provider of physical resource management solutions, has acquired California-based Connectiv, enhancing Accruent’s ability to meet the needs of clients in health care. This marks Accruent’s seventh company acquisition in the past 24 months to help clients have control and visibility across asset management solutions. Connectiv is a cloud-based, mobileenabled software company that allows biomedical and clinical engineering groups to manage and control all aspects of their medical devices and equipment. Connectiv software helps health care organizations fulfill their mission by mitigating risk, ensuring regulatory compliance and maximizing utilization. Connectiv is a ServiceNow

Technology Partner automating the management of medical applications, devices and facilities. “With 67 percent of medical device manufacturers and 56 percent of health care providers believing an attack on their devices is likely to occur within a year, we saw the urgency to provide a solution for managing biomedical assets,” said John Borgerding, CEO, Accruent. “We are acquiring Connectiv because their software, co-created with clinical engineers in national health care organizations, enables management of medical devices across the lifecycle, including automatic security monitoring that identifies threats in minutes. Connectiv’s biomedical asset management solution has the feature set and the flexibility to address changing health care needs, new technologies and regulatory demands.”

With hospitals and clinical providers looking for the user-friendliness and control of a master IT platform, Connectiv leverages the proven reliability of the widely adopted Now Platform from ServiceNow Inc., enabling more powerful automated management across clinical applications and medical assets. The acquired solution set and its planned enhancements will continue serving existing Connectiv customers, and will be offered as a complement to Accruent’s existing suite of health care solutions in asset and maintenance management, lease accounting and capital planning. The acquisition, effective immediately, includes the continuation of existing Connectiv product development, support and sales resources. •

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INDUSTRY UPDATES

DIRECTMED PARTS & SERVICE LLC RECEIVES ISO CERTIFICATION DirectMed Parts & Service LLC, a medical imaging parts and service company, has received the ISO 13485:2016 certification for its magnetic resonance imaging (MRI) and computed tomography (CT) parts and service. This achievement is in addition to the company’s ISO 9001:2015 certification. The International Organization for Standardization (ISO) is the world’s largest developer and publisher of international standards for the implementation of quality management systems. The ISO 13485:2016 Quality Management Standard for Medical Devices represents the requirements for a comprehensive management system for the design and manufacture of medical devices. ISO 9001 specifies requirements for a quality management system where an organization needs to demonstrate its ability to consistently provide products that meet customer and applicable statutory and regulatory requirements. “Achieving ISO certification demonstrates that DirectMed has successfully implemented a quality management system that conforms to the world-wide standard for medical device and medical imaging parts and service,” said Tim Kearney, director of inventory management at DirectMed. “The ISO 13485:2016 certification represents an important milestone for our company and reflects our commitment to providing high-quality products that meet or exceed customer expectations and comply with regulations.” “This ISO certification is a testament to the high level of performance, quality control and continuous improvement we expect at our company. With an expanding global customer base, this level of rigor is important to ensure our 16,000 imaging products continue to provide reliable and measurable results,” said DirectMed Parts & Service LLC CEO Brad de Koning. •

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

MAY 2018

TECHNATION

INDUSTRY UPDATES

BY AAMI

AAMI UPDATE

Celebrate the Contributions of Biomeds, Clinical Engineers during HTM Week

rom May 20-26, AAMI, scores of hospitals and other health care facilities and service organizations will be showing their appreciation for the crucial work performed by the dedicated professionals who support, service and maintain medical equipment.

AAMI’s annual Healthcare Technology Management (HTM) Week was created to promote awareness of – and appreciation for – the critical work of biomedical equipment technicians, clinical engineers, imaging specialists, laboratory equipment specialists and other members of the HTM field. With increasingly complex medical devices and technology being introduced into health care facilities, the purchase, maintenance and use of this equipment is more important than ever. So too are the HTM professionals who manage these activities. “HTM professionals are crucial for keeping patients safe and delivering high-quality health care, yet their role can be underappreciated,” said Patrick Bernat, AAMI’s director of healthcare technology management. “AAMI’s Technology Management Council (TMC) created HTM Week to shine a light on their efforts and to say thank you.”

TECHNATION

MAY 2018

The TMC has planned a number of events that will run throughout the week. To learn more, visit www.aami.org/HTMWeek.

AAMI RESOURCE TAKES MYSTERY OUT OF DEVELOPING AN AEM PROGRAM In the healthcare technology management (HTM) field there is a lot of confusion surrounding three little letters – AEM – starting with what the acronym even stands for, according to Matt Baretich, president of Baretich Engineering based in Fort Collins, Colorado. “The Centers for Medicare & Medicaid Services [CMS] (the originator of the AEM concept) says that AEM is an abbreviation for ‘alternate equipment management,’ ” Baretich wrote in the introduction to his new AEM Program Guide. On the other hand, “The Joint Commission [TJC] … says it stands for ‘alternative equipment maintenance.’ … And that’s just the beginning.” In the AEM Program Guide, Baretich, who has been consulting on HTM-related issues for two decades, seeks to address AEM-related terminology, offer ideas for practical implementation, and explain how to remain compliant with applicable standards and regulations. “Unfortunately, there is not yet a consensus on exactly how to create an AEM program,” Baretich wrote. “Some

of the proposed AEM policies I have seen are, in my opinion, simply not compliant with CMS and TJC requirements. That’s why the AEM Program Guide goes into such (excruciating?) detail about those requirements.” Eventually there might be a formal AEM standard for the profession – one is currently in development – but many HTM departments need guidance now. “This valuable document is designed to bridge from where we are today (limited resources) to a project that is just beginning and sponsored by AAMI: development of a formal standard focused on AEM,” George Mills, TJC’s former director of engineering, wrote in the foreword to the guide. “This document should begin to assure those curious enough to read it that implementing an AEM program is not only possible, but will result in improved HTM program management.” Those improvements? Saving time or money, or both, according to Baretich. “When we can reduce our costs while achieving the same level of safety, we should do it,” Baretich wrote. “Adopting an AEM procedure is not an academic exercise; it’s good business.” The AEM Program Guide can be purchased from the AAMI Store online at www.aami.org/store or at the AAMI 2018 Conference & Expo.

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EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

MAY 2018

TECHNATION

INDUSTRY UPDATES

BY ECRI

ECRI UPDATE

A Hazard Lurking Beneath the Surface – Mattress and Mattress Cover Contamination

t’s not a pleasant scenario to imagine: A patient is placed on a seemingly clean bed or stretcher, and blood from a previous patient oozes up from the mattress, contacting the patient.

“Nobody wants to experience that,” notes Amanda Sivek, a senior project officer in ECRI Institute’s Health Devices Group. “Unfortunately, several patients have.” ECRI Institute’s research – including literature reviews, database searches and investigations of incidents reported by health care facilities – has identified multiple cases in which a mattress that had become contaminated during patient care remained contaminated after reprocessing (i.e., after cleaning and disinfection). The result is that subsequent patients were put at risk of exposure to body fluids or other microbiological contaminants. In addition to possessing a high “ick factor,” this hazard carries a considerable risk of infection. For that reason, ECRI Institute designated it as Hazard Number 3 on the nonprofit organization’s list of the “Top 10 Health Technology Hazards for 2018.” UNNOTICED BODY FLUID OR MICROBIOLOGICAL CONTAMINATION A hospital bed or stretcher consists of a frame, a mattress (foam or air) and a mattress cover. The mattress cover is designed to prevent body fluids and other contaminants from entering the mattress. During room cleaning, the mattress cover is cleaned and disinfected

TECHNATION

MAY 2018

to prepare the bed or stretcher for the next patient. Because it is protected by the cover, the mattress itself is not cleaned between patients. If, however, the integrity of a mattress cover is compromised, contaminants can contact or seep into the mattress during patient care. These contaminants can remain on, or in, the mattress after cleaning, putting subsequent patients at risk of exposure. Protecting patients, therefore, requires not only effective measures for cleaning mattress covers, but also effective – and consistently followed – practices for inspecting mattresses and covers for signs of damage. In addition, protocols must be in place for promptly remediating any problems that are identified. ONE COMMON CAUSE: USING INCOMPATIBLE REPROCESSING MATERIALS OR PROCEDURES A mattress cover can remain contaminated after reprocessing if the cleaning and disinfection materials or procedures that are used are not appropriate for the contaminants present. For example, a tuberculocidal product may not be an effective disinfectant for a mattress cover that is contaminated with blood, body fluid or bacterial spores. Additionally, the use of incompatible materials or procedures can damage or degrade the cover material. Such damage may allow contaminants to penetrate the cover during subsequent use, resulting in the mattress becoming contaminated. Such errors can result from staff

being unaware of the mattress cover reprocessing instructions or from staff choosing to disregard those instructions. But there’s also a third factor to consider, as ECRI Institute describes in its report: Not all mattress cover suppliers specify appropriate reprocessing materials and procedures for the circumstances of use. “What really puts hospitals in a bind,” explains Sivek, “is when a manufacturer or rental company fails to recommend materials and procedures that are in accordance with the U.S. Food and Drug Administration’s medical device reprocessing guidance.” RECOMMENDED PRACTICES All health care facilities – from acute care hospitals, to ambulatory care centers, to long-term care facilities – must institute effective processes for reprocessing mattress covers and for identifying and remediating any mattresses or mattress covers that have been compromised. Following are some of the key practices that ECRI Institute recommends for reducing the risks of body fluid and microbiological contamination of mattresses and mattress covers:

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• Confirm that your facility’s mattress covers can be disinfected using at least one antimicrobial product specified as being effective against Mycobacterium tuberculosis, human HIV-1 and hepatitis B virus and at least one product specified as being effective against Clostridium difficile spores. (The U.S. Environmental Protection Agency maintains lists of registered products, designated as List E and List K, for each of these uses.) • If your mattress cover supplier (i.e., the manufacturer or rental company) does not recommend at least one antimicrobial product for each of these uses, press them for details about how your facility can properly reprocess the mattress cover. For future purchases or rentals, avoid suppliers that do not provide adequate reprocessing guidance. • Verify that environmental services (EVS) staff are provided with the recommended procedures and materials for cleaning and disinfecting your facility’s mattress covers. • Train EVS staff to recognize potential problems with mattress covers, including exterior damage (cuts, tears, cracks, pinholes, snags, stains or compromised zippers); material wear; shorter-thannormal cover drying times, which could indicate that fluid has penetrated the mattress cover; or heavier support surfaces, which could indicate that the mattress has absorbed fluid. Inspections of mattresses and covers should be added to relevant EVS checklists, and staff should be instructed how to respond if damage is identified or suspected. • Do not use bed and stretcher mattress covers beyond their expected service life. – This article supplements ECRI Institute’s “Top 10 Health Technology Hazards for 2018.” An executive brief of the report can be downloaded from ECRI Institute as a free public service. The full report, which includes detailed problem descriptions and recommendations for addressing the hazards, requires membership in certain ECRI Institute programs or separate purchase. For more information, visit www.ecri.org/2018hazards, or contact ECRI Institute by telephone at 610-825-6000, ext. 5891, or by email at clientservices@ecri.org.

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

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MAY 2018

TECHNATION

THE BENCH

BY CHANSOTHEA R. PHOK

BIOMED 101

Seven-Step Troubleshooting Guide for HTM Professionals BY CHANSOTHEA R. PHOK

ot knowing the answer to any problem can be frustrating. One can find themselves in a conundrum when spending hours attempting to find the answer and end up going back to the drawing board. No one wants to exacerbate the problem after spending hours troubleshooting. There are seven steps that I follow to troubleshoot any challenges that I encounter. Here are the steps I use:

PRIORITIZE THE PROBLEM If there is only one issue, then it is an easy decision to make. However, when there are multiple problems to tackle, then you or your manager will have to choose the more urgent problem. Another way to help prioritize the problem is dependent on back-up or loaner equipment availability.

for something out of the ordinary like a smoke or a gas leak. Feel if something is loose, wet or giving off excessive heat. Another way is to look for common faults such as checking to see if the power cord is plugged in or if the switch is turned on. A third way to find the problem is to get the service manual and use the diagram, troubleshooting table or error code list. If the service manual does not work, then call the company or vendor.

REPAIR THE PROBLEM This is when you determine what part is needed to order for the repair if you do not have the part in stock. Make sure the part needed is the correct one by verifying the part with technical support from the manufacturer. One can also verify with a coworker or look at the history in previous work orders.

VERIFY THE PROBLEM The best way to verify the problem is to verify the problem yourself. If you are not able to respond in a timely manner, then communicate to the actual user and ask questions to get a better description of the issue. Examples of questions you can ask are what did he/she observe or when did the problem occur? FIND THE PROBLEM There are many ways to find the problem. One way is to use four of your five senses. This means looking for signs if the device is cracked or burned. Listen for noise like clicking or squeaking. Smell

TECHNATION

MAY 2018

PUT DEVICE BACK TOGETHER Once you get the part for the repair, there are different ways to help you put the device back together. You can take a picture on your phone to document the process of disassembly that you performed to find the issue. You can also make notes, tag wires and keep parts in logical order. I personally like using small trays/containers to organize screws and bolts.

VERIFY THE REPAIR Perform operational and safety testing such as an electrical safety check. Make sure it meets factory specification. The best advice that I was given in school and

CHANSOTHEA R. PHOK

on the job regarding repair of any medical equipment is to ask myself the question, â&#x20AC;&#x153;Would you want this device used on yourself or a loved one?â&#x20AC;? This helps put all of the work and repair into perspective and reminds me why I chose this career in the health care field. Also verify with staff using the device and educate staff when necessary.

DOCUMENT THE REPAIR It is important to document your repairs in your work order. Documentation is very important, especially when someone from regulatory compliance asks you for paperwork on a specific device. Also, you can check the history and use it for future repair. All seven steps have helped me simplify even the most complicated challenges or problems I have encountered. This is what I was taught and what works for me. Everyone will have his or her own way of troubleshooting. Others might use a different tactic when troubleshooting issues with medical devices. Hopefully this guide helps give a fresh perspective for troubleshooting medical devices.

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ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

MAY 2018

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STAFF REPORTS

SHOP TALK

Conversations from the TechNation Listserv Q:

What does your department do to prepare for Daylight Saving Time (or any time change)? What is the most efficient way to set clocks on multiple devices?

Our facilities developed a staffing plan for Daylight Savings using HTM paid “volunteers” to work the required time to ensure appropriate time changes. The amount of staff varies based on the volume of non-networked mission critical devices, such as defibrillators. Most of our networked medical devices are pointed to NTP servers. The NTP server is necessary because of our integration with the electronic medical records (EMR). The EMR requires medical device results to be validated, therefore the time of the physiological data acquisition must nearly match the time stamp in the EMR. The EMR allows a refractory period due to potential network latency. Therefore, for Daylight Saving Time changes, the medical device server is always synchronized with the NTP server and time is updated by the appropriate servers on the network, such as a patient monitoring system. For situations of non-networked medical devices, such as a defibrilator, these devices must be manually updated by the HTM professional. The HTM professional validates networked and non-networked device time changes, hence the need for on-site labor. Work orders in our CMMS product are opened for all the devices that require time validation and then the work orders are closed once the time is validated by the on-site technologist.

Most our devices are connected to our internal network. Thus, we configure NTP. The time on each device is synced to the NTP server. Thus, we do not need to adjust the time except some units that are not connected.

TECHNATION

MAY 2018

Does anybody have a policy on blanket warmer temperature settings for neonate patients?

The IEC 80601-2-35 Standard (Particular requirements for the basic safety and essential performance of heating devices using blankets, pads or mattresses and intended for heating in medical use) does not differentiate ages in the operational temperature limits of blankets and warmers. But it has different limits depending on the type of warmer. In my procedures, I’ve set the maximum temperature in infant warmers at 40°C. IEC 80601-2-35-basic safety and essential performance of heating devices using blankets, pads or mattresses and intended for heating in medical use 201.11 Protection Against Excessive Temperatures And Other Hazards 201.11.1 Excessive Temperatures in ME Equipment 201. 11.1.2.1 Applied Parts Intended to Supply Heat to a Patient Addition: 201.11.1.2.1.101 Requirements for Heating Devices Other Than Forced Air Devices 201.11.1.2.1.101.1 Maximum Contact Surface Temperature in Normal Condition Applied parts of ME equipment intended to supply heat to a patient shall not have a contact surface temperature exceeding 40 °C in normal condition. 201.11.1.2.1.101.3 Maximum Contact Surface Temperature in Single Fault Condition The surface temperature of a heating device shall not exceed 41 °C in single fault condition. ------------------201.11.1.2.1.102 Requirements for Forced Air Devices 201.11.1.2.1.102.1 * Maximum Contact Surface Temperature in Normal Condition When tested according to the methods described in Annexes FF and HH, the maximum contact surface temperature shall not exceed 48,0 °C and the average contact surface temperature shall not exceed 46,0 °C.

201.11.1.2.1.102.2 Sensor Any sensor whose position can be changed without the use of a tool shall not be used to control the maximum temperature which the controller can attain. 201.11.1.2.1.102.3 * Maximum Contact Surface Temperature in Single Fault Condition The forced air device shall be equipped with a thermal cut-out to eliminate the risk of excessive contact surface temperature. The thermal cut-out shall activate within 10 min after the occurrence of the single fault condition described in Annex GG or when the contact surface temperature exceeds 56 °C. The forced air device shall be equipped with an alarm system that includes at least a low priority technical alarm condition that indicates when the thermal cut-out has activated. Consideration shall be given to lower limits or different risk control measures for forced air devices intended for infants. -------------------201.15 Construction of ME Equipment 201.15.4.2.1.101 *Temperature and Overload Control Devices – Additional requirements for application For liquid-filled devices, the contact surface temperature shall not exceed the limits in the following table, which does not apply to infants: Table 201 .1 02 – Temperature Limits In Dependency To Time For infants the temperature shall not exceed 43 °C. Except for forced air devices and circulating liquid devices, the thermal cut-out shall prevent the contact surface temperature from exceeding 41 °C (see also 201.11.1.2.1.101.3). 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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MAY 2018

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he Webinar Wednesday program continues to provide quality educational opportunities to HTM professionals around the world.

One recent Webinar Wednesday presentation – “Why a Nuclear Medicine Camera Evaluation is Vital to Ensure SPECT Camera Performance and Longevity” sponsored by Universal Medical – was among those eligible for 1 CE credit from the ACI. The 60-minute webinar featured Chad Watson, evaluation program director, Universal Medical, and Ann Hamilton, radiology director, Texas County Memorial Hospital. The presenters discussed the evaluation experience from the perspective of the company conducting the evaluation and the owner of the SPECT camera. Their presentation featured insightful information, including: • Why it is important to have your SPECT camera(s) evaluated periodically • Actions you can take after receiving the results of your evaluation to improve performance and useful life of your nuclear medicine camera(s) • An overview of what must be included in evaluation and how you can use the information • A radiology director’s firsthand experience before, during and after an evaluation was performed on their

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MAY 2018

SPECT camera. Webinar attendees were impressed by the presentation based on a post-webinar survey. “There is always something new to learn when viewing Wednesday webinars. Each vendor has helped find answers to problems that you might face in your daily job. The tips to improve my job and performance are appreciated,” said H. Martin, CBET. “This is an excellent way to stay sharp and keep current in the field! Outstanding,” Biomed L. Countee added. “Webinar Wednesday is a great way to stay in touch with our industry,” said Imaging Specialist T. Jasensky. “Excellent and concise information regarding nuclear camera evaluation,” Imaging Equipment Specialist K. Revallo wrote. More than 200 HTM professionals attended the webinar “How a CMMS Upgrade Can Empower HTM and Clinical Engineering Teams” sponsored by Nuvolo. Participation in the presentation was eligible for 1 CE credit from the ACI. In the 60-minute webinar Ben Person, senior director for solution consulting at Nuvolo, discussed how innovative health care providers are advancing HTM programs by replacing their legacy CMMS. He shared how these thought leaders are

upgrading with Nuvolo Clinical EAM – a modern, cloud-based CMMS alternative designed to improve patient care, cut costs and boost compliance. In his presentation, Person shared how Nuvolo can help a department make data-driven decisions with real-time reporting and analytics designed for health care providers as well as eliminate expensive and lengthy customization. He also shared how the process can empower technicians with an effortless mobile experience. The webinar received outstanding reviews in a post-webinar survey sent to attendees. “Great information! Good to know there’s someone out there thinking like someone on the front lines,” shared Biomed L. Smith. “This was an extremely useful presentation. I enjoyed that a demonstration was added into the middle of the presentation instead of everything just being slides,” said Metrology Professional S. Strzalkowski. “Ben did a great job presenting; good speed, transitions and made time to answer questions throughout the presentation, thank you,” said B. Kara, Jump Team Operations Manager. “Wow, from what I saw today, this would greatly increase our productivity,” said S. Orrin, Biomed

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ROUNDTABLE

STAFF REPORT

ROUNDTABLE

RTLS

Knowing where equipment and medical devices are located within a health care facility makes life easier for everyone on the staff. And, it helps HTM professionals be more efficient when it comes to their high-priority tasks. There have been some growing pains dating back to the first introduction of real time locating systems (RTLS), but the fast pace of technology advances makes RTLS a valuable tool in 2018. TechNation reached out to several experts in the RTLS world to find out more about the latest advances, cost of ownership and more. Participating in this roundtable article on RTLS are ZulaFly Managing Partner Stephanie Andersen, Intelligent Locations Vice President of Sales Jake Bartnicki, GE Healthcare Senior Program Manager of Service Technology Matthew Cannell, Manager of Solution Architecture for Midmark-Versus Barry Cobbley, Connectiv Co-Founder and CTO Tommy Lee and GE Healthcare Global Marketing DirectorDigital Solutions Jatinder Sihra. Q: WHAT ARE THE LATEST ADVANCES IN RTLS IN THE PAST YEAR? Andersen: We have seen advances in the hardware that facilities are looking at to collect data. The value that ZulaFly brings to any client solution is our ability to take in data from multiple systems, into a single customer. Not only does the customer no longer need to replace their existing hardware, they do not need to standardize either. This allows for leveraging best-of-breed technology to deliver each use case. We have also seen a huge increase in the drive for a strong workflow software application. Facilities of all kinds are looking to understand bottlenecks, drive efficiencies and provide a better patient experience. We see this mostly in clinics, EDs and ORs with the consistent message of understanding where patients are spending their time, automating the “what’s next” process and then introducing un-biased analytical reports to increase efficiency. The other consistent movement we have seen is to a cloud-hosted model. We offer both a cloud-hosted solution along with on-premise for the customers that want to have the data on-site or hosted through their own data center. The cloud-based solution allows for an easier implementation and better support process while reducing the amount of hardware the customer needs to procure and maintain.

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MAY 2018

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ROUNDTABLE

Bartnicki: RTLS has come a long way in the past 12 months. Using new and exciting technologies, like Bluetooth Low Energy, to decrease the cost of legacy systems really stand out in my mind as the greatest leap forward in the industry. RTLS has the potential to alleviate some of the revenue pressure on hospitals that choose to implement it, so finding a technology that allows for adding additional use cases will be important for hospitals to realize incremental savings. Cobbley: In recent years, more health care organizations have sought to gain campus-wide visibility to mobile assets with existing Wi-Fi infrastructure. Wi-Fi locating is now being paired with accurate room-level technology in areas where it is critical to analyze equipment utilization and manage PAR-level inventory. This pairing of solutions results in lower total cost of ownership, a key consideration for health systems that struggle to manage assets across multiple facilities. In the outpatient environment, many are deploying RTLS solutions to enhance patient flow, especially in busy ambulatory clinics. Further, smaller, wrist-wearable badges offer next-level convenience for patients and staff. Lee: IoT has influenced RTLS vendors to begin utilizing communication technologies in innovative ways such as low-energy Bluetooth, Wi-Fi, ultrasound, etc. Jatinder Sihra, GE Healthcare Sihra: The Encompass platform, a wireless solution developed by GE Healthcare and Zebra Technologies and introduced in 2017, is poised to make the benefits of RTLS accessible and affordable to a much broader range of care providers. This approach, built upon open standards and Bluetooth Low Energy and Wi-Fi technologies, eliminates the classic objections to proprietary hard-wired locating systems. By combining Bluetooth Low Energy with the hospital’s existing Wi-Fi infrastructure, Encompass can be installed in a matter of days instead of months and with no need to open ceilings or drill into walls to run cable. As a cloud-based application, the location system is accessible to authorized staff from any computer or mobile device with Internet access. This means staff can find equipment from wherever they are, instead of having to first find a computer loaded with custom locating system software. Q: WHAT FACTORS SHOULD HTM CONSIDER TO DETERMINE COST OF OWNERSHIP? Andersen: Besides the obvious costs associated with software and hardware, there is also time invested from the facility to ensure that the system is being utilized,

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hardware is maintained and that efficiencies are being gained by frequent review of the information the software will provide. It’s important that there is a soft dollar ROI, along with the hard dollar ROI when using an RTLS solution. No longer is staff searching when equipment is up for preventative maintenance or looking for hours on end for equipment that has been recalled. With RTLS, you can see where equipment is in real-time, not only does staff save time to give back to patient care, rentals will be returned on-time, and the facility can minimize additional risk with equipment past the PM date being used in patient areas. With HTM’s commitment to this type of solution, they will spend less time searching, see a hard dollar ROI on equipment they are no longer purchasing because it cannot be found, and will be able to locate equipment within seconds when needed. Jake Bartnicki, Intelligent Locations Bartnicki: In many cases, institutions have to piece together software and hardware packages making it difficult to calculate the total cost of ownership. The system should be able to “pay” for itself if used to its full potential, so HTM professionals should look at the total cost of installation and whether or not the initial investment can accomplish the long-term RTLS vision of the institution without unnecessary added expense. Ideally, the system can easily measure KPI’s and other metrics from the data collection giving an unbelievable amount of value to an organization. Cobbley: To gain a better understanding of initial investment and ongoing solution costs, there are two important considerations. First, if your care space needs room-level or chair-level locating, there may be additional hardware requirements that are not factored into a vendor’s preliminary scoping and pricing. Not all solutions deliver the same level of location granularity in their baseline offerings. Likewise, the rate at which badges and tags report location information should be compared, along with battery life. Some solutions claim long battery life but at the expense of less-than-real-time location reporting. Second, ongoing costs can quickly inflate the total cost of ownership. Some solutions require annual license fees for tags, per-user fees, system recalibration fees, or high badge replacement costs. Other solutions require special batteries that must be recycled as hazardous materials, also driving added expense. Lee: HTM should view RTLS as another tool to integrate into a modern CMMS that will help hospitals take in all aspects of cost of ownership when deciding the value of a solution. HTM should consider whether they can leverage

MAY 2018

TECHNATION

ROUNDTABLE any of their existing network ecosystem to reduce the upfront cost of implementing an RTLS solution. RTLS could also be viewed as a tool to help reduce costs in other areas, such as asset and work management. Sihra: The ultimate benefits of a cost-effective RTLS deployment are clear: • Patient care: Helps ensure mobile assets are delivered when patients need them. Helps caregivers provide prompt diagnosis and treatment. Nurses can spend more time on patient care, rather than looking for devices. • Operation efficiency: Staff members easily and quickly locate equipment; time spent searching is greatly reduced. Biomedical staff can locate equipment to perform timely and compliant planned maintenance. • Financial performance: Mobile device inventory is right-sized and capital, maintenance and labor costs reduced. Loss, theft and rental of mobile assets like IV pumps and telemetry boxes may be minimized. Q: WHAT ARE SOME OF THE LATEST INNOVATIONS IN RTLS? Stephanie Andersen, ZulaFly Andersen: From a software perspective, we have the ability to take in data from BLE, RFID, RTLS and a nurse call solution to name a few, into a single customer, giving the customer the flexibility to pick the best means of capturing data to meet their use cases and goals of a new solution. By using RESTful APIs the customer has access to all of the data to pull into an ESB, data warehouse or BI tool very easily instead of creating SQL queries. Also, customers expect a user-friendly solution and experience that utilizes current technology allowing for flexibility when making changes easily to accommodate customer requests. We are also seeing an increase in cloud-hosted temperature monitoring solutions everywhere from blood banks, and pharmacies to every medication fridge throughout an entire hospital. Customers now expect the ability to be notified a limitless number of times until the issue with a medication fridge is resolved, or the functionality to notify anyone, anywhere via an individual’s preferred method of communication. Expectations are now much higher, and our software is designed to meet those needs. Bartnicki: Real time location services can be a foundational strategy in decreasing both operational and capital budgets for an institution. Personally, I believe the most important innovation is using this technology to solve many problems hospitals face in terms of location services. From asset and patient tracking to wayfinding and hand hygiene monitoring there has to be a focus on data collection and analysis so we can use data to innovate and help make better decisions.

TECHNATION

MAY 2018

STAFF REPORT

Cannell: The opportunities to innovate around RTLS are endless, however it is important that the innovation solves a business need and provides a timely return on investment. Leveraging open standards like Bluetooth Low Energy enables innovation and rapid deployment, as most modern mobile devices have those capabilities already. Barry Cobbley, Midmark-Versus Cobbley: Many health systems are leveraging the raw location data captured by RTLS and merging it with other data sources such as the EMR, scheduling, population health or financials to create additional insight into operations and the correlation with outcomes. Cross-referencing multiple data sources enables health systems to enhance patient care, maximize efficiencies and support cost containment measures. Lee: RTLS is not only being used for medical equipment, but personnel and patients as well. The latest iterations are being used by patients to navigate their way around hospital campuses, to and from different appointments, and then back to their original destination. Naturally, these types of solutions can also allow hospitals to track guests as well. Q: WHAT ARE THE DIFFERENT TYPES OF RTLS TECHNOLOGY AND WHAT ARE THE BENEFITS OF EACH? Andersen: Although there are different types of technology, the most important place to start for a facility thinking about a new RTLS implementation is understanding the goal of a RTLS solution and what they are looking to accomplish. By understanding those two items first, this will then help drive technology that is right to accomplish those goals. A good software provider will be able to take in data from any hardware vendor chosen along with bringing in data from disparate systems such as nurse call, capital asset management or any EMR to maximize the customer investment. By choosing the right software vendor, they are able to provide unbiased feedback on best of breed hardware to accomplish the customer’s goals. It’s important to keep in mind that once the RTLS infrastructure is in place, it becomes more straightforward to grow the solution. Having a close relationship with a software vendor that will work with the customer to determine phases of implementation, will ensure the customer is taking full advantage of the solution. Bartnicki: RTLS technology has been in use for a number of years. As with every technological advancement, it only gets better, faster and cheaper. RFID/Infrared is an expensive and labor-intensive option to install, but has

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ROUNDTABLE the ability to locate very granularly. Wi-Fi can leverage the infrastructure already in place, which is a plus, but does not give the granularity needed to fully realize the benefits of an RTLS system. Bluetooth Low Energy (BLE) is a relatively newer technology, but gives users a very flexible solution that is easy to install and layer on many types of use cases without additional hardware installations. As with everything, there are positives and negatives to every type of technology, so choosing one that is easy to grow and expand should be high priority. Matthew Cannell, GE Healthcare Cannell: There are many RTLS technologies available, and most function in a similar way (e.g. provide location to tagged options). Often the difference lies in the use cases that can be implemented based on locate specificity. Typically, the more use cases desired, the higher the investment on maintenance – both initially and over time. RTLS technologies that leverage open standards (such as Bluetooth Low Energy and Wi-Fi) have significant advantages over proprietary technologies, as they leverage a customer’s pre-existing Wi-Fi network investment and technology that is available on most modern mobile computers. Cobbley: There are many RTLS technologies (infrared, RFID, Wi-Fi, ultrasound, etc.) and each have their pros and cons. In addition, some technologies are used in different ways or in different combinations by different vendors. The main concern for health systems looking to improve operations with RTLS should be choosing a technology that can reliably and cost-effectively achieve room-level or better location, which requires locating signals that do not pass through walls or ceilings. For example, radio-frequency based solutions such as RFID or Wi-Fi are unsuitable for anything more than zone-based location. Lee: There are many different types of RTLS technology such as newer versions that utilize Wi-Fi, low energy Bluetooth and ultrasound as well as the more traditional versions like RFID tagged or sensor driven solutions. All RTLS solutions have their pros and cons, but it is more important to find one that is a good strategic fit for each organization, not just the shiniest new toy on the shelf. Additionally, it is important to ensure that the RTLS solution has, and supports, a robust modern API for integration into modern CMMS applications. Ideally, the RTLS solution should also have URL-driven cross-launch capabilities so that overlapping capabilities (e.g. live mapping) can be significantly reduced.

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Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND USING RTLS? Andersen: You can start small! The entire solution does not need to be purchased to get started. Starting small also helps with alert fatigue so that staff do not become inundated, but allows staff to ease into how to use it while learning the benefits. Soon, they’ll have suggestions and ideas as well! Understand what the “must have” priorities are and start there. Bartnicki: As much as I wish implementing an RTLS solution was turnkey, it is not. There are many hospital stakeholders that need to be involved to ensure success. It is important not to select a vendor, but rather a partner that will help build and execute an RTLS vision/plan that fits the present and future needs of an organization. Cannell: RTLS technology purchasing decisions should be outcome-driven. All too often, decisions are made based on location-based specificity, irrespective of that specificity being a requirement to meet the use case. This can lead to overspending on technology, long implementation projects, costly and time-consuming system updates, and a dramatic annual maintenance investment (e.g. replacing tags often). Cobbley: Often a health system’s RTLS journey starts with selecting the hardware-software infrastructure. However, many technology projects meet significant challenges due to unexpected change management issues that have very little to do with hardware or software. Technology implementations affect people’s roles, behaviors and processes, all of which can undermine outcomes. Failing to plan for the impact on work culture leads to user frustrations, disengagement and potential investment failure. A second consideration is vendor accountability. When an RTLS solution is provided by separate hardware and software vendors, technical performance issues frequently fall into a gray area where neither believes the issue is within their product’s boundaries. This lack of clear accountability typically results in project delays and escalated implementation costs.

Tommy Lee, Connectiv Lee: It is important to find a tool that is a good strategic fit for your organization. Something that fits your needs for location update frequency, network connectivity, and power consumption, just to name a few factors and not just focus on the newest and most advanced solution available.

MAY 2018

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ith spending on healthcare technology increasing and the pace of innovation accelerating, AAMI is hosting its 2018 Conference & Expo this June in Long Beach, California. This event is tailor-made to support the professionals who make, purchase, support and service the dizzying array of sophisticated medical devices that are transforming the delivery of health care around the world.

During the conference, set to run June 1-4, thousands of members of the healthcare technology management (HTM) field and wider healthcare technology community will gather to learn about the latest innovations and advances, get solutions to some of their toughest challenges, and connect with their peers. “This is a very exciting time for the HTM field, but keeping up with a rapidly changing health ecosystem can be difficult,” said Robert Jensen, president and CEO of AAMI. “The AAMI Annual Conference & Expo fosters an environment where sharing ideas, connecting with others, and learning are top priorities, giving attendees the tools and information they need to stay on top of the vast array of changes that are going on in the world of health technology.” FEATURED SPEAKERS The main stage presentations will kick off Saturday, June 2, with motivational speaker Christine Cashen, who will provide tips to help attendees communicate more effectively, handle conflict like a pro, and use humor to increase job satisfaction, improve morale and reduce stress. “I hope people can find not just one

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MAY 2018

thing, but two things – or even five things – right away that they can do differently to have more energy in their day, to be aware of how they are communicating – both verbally and nonverbally, and what they can do to reclaim their passion for their job,” Cashen said in an interview with AAMI News. On Sunday, adventurer Aron Ralston will take the main stage. Ralston, who was the subject of the film 127 Hours, which depicts his harrowing ordeal trapped inside a Utah canyon, will reflect on his remarkable triumph over insurmountable odds and share the lessons he’s learned about the importance of examining one’s priorities and outlook on life.

ROBERT JENSEN - AAMI, CEO

Finally, on Monday, attendees won’t want to miss the chance to hear from Kenneth Monroe, senior associate director in The Joint Commission’s Standards Interpretation Group’s department of engineering. This session will give members of the HTM community the opportunity to get to know Monroe, who was named the

successor to George Mills in late December 2017, and take home some important updates from the accreditation body. EDUCATION SESSIONS Throughout the conference, attendees will be able to choose from more than 50 education sessions and workshops. “The Annual Conference Planning Committee sorted through hundreds of session proposals to deliver a diverse lineup of workshops, events and education sessions to help HTM professionals gain insight into the innovations and trends in health technology, tackle pressing challenges facing the field and advance their careers,” said Sherrie Schulte, AAMI’s senior director of certification and the annual conference. HERE ARE A FEW SESSION HIGHLIGHTS: FDA Action on Device Service: What You Need to Know and Do Binseng Wang, director of quality and regulatory affairs at WRP32 Management Inc. & Greenwood Marketing LLC The Food and Drug Administration (FDA) Reauthorization Act of 2017 required the agency to draft a report for Congress and the public “on the continued quality, safety, and effectiveness of devices … with respect to servicing.” That report is due May 15. After submitting the report, the FDA may issue an Advance Notice of Proposed Rulemaking on how it plans to regulate all device servicing, affecting both manufacturers and third parties (including in-house teams). During this session, attendees will hear from an FDA representative about its report and plan, as well as gain analyses and insights from other panelists.

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INDUSTRY UPDATES

How to Prepare for a Successful Joint Commission Survey Arif Subhan, chief biomedical engineer at the VA Greater Los Angeles Healthcare System Get information about Joint Commission standards, the process, and the documentation and records needed to prepare effectively for a survey. Learn how participating in a Joint Commission readiness team can help HTM professionals become more organized and better prepared to answer questions. Get valuable tips, including how to network with other facilities that went through a recent survey to glean insights on any “hot topics” that may arise.

and IT professionals, including PsExec, PingGUI, Putty, Wireshark, System Internals and Nmap.

A Biomed’s Guide to the IT World Roman Szewczyk, biomedical technician III at New York-Presbyterian Hospital Health care systems and devices are becoming more integrated with the hospital network, so it’s vital that HTM professionals develop a better understanding of information technology (IT) and forge stronger relationships with their IT peers. During this presentation, Szewczyk will discuss important networking tools that can support successful collaboration between biomeds

EXPO HALL In addition to education, networking and professional advancement activities, the conference will host an Expo Hall featuring the latest technology from more than 200 medical equipment manufacturers and service providers. Companies, such as Aramark, Nihon Kohden, Philips, Siemens Healthineers, Sodexo, Summit Imaging and USOC Bio-Medical Services, will be on hand to give attendees an up-close look at state-of-the-art technology and demonstrate cutting-edge medical equipment.

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How to Use Artificial Intelligence to Reduce Your Workload Amaury Jose Agoncillo, president of Morigon Technologies LLC Artificial intelligence, or AI, can play a valuable role in the maintenance and service of medical equipment. As the amount of equipment and technology that HTM professionals manage increases, AI or web bots can help tackle basic tasks. AI also can serve as a first responder to a customer in need, giving HTM more time to tackle other high-priority tasks.

REGISTRATION Full conference registration includes access to: • The general sessions and concurrent education breakout sessions described above • Expo Hall • AAMI University to view and download AAMI 2018 presentations • AAMI’s Career Center • Welcome Reception on Friday • Award Reception on Saturday • Appreciation Reception on Sunday A number of other registration options also are available. To learn more, visit www. aami.org/2018registration.

NEW EVENTS YOU WON’T WANT TO MISS • AAMI’s first Fun Run & Walk • Global Forum, powered by AAMI, ACCE and IFMBE/CED • Leadership Academy, in partnership with CHIME • AAMI Connect Live • Sunrise sessions

For more information about all these events – and more – visit www.aami.org/ac.

MAY 2018

TECHNATION

EXHIBITOR SPOTLIGHT Be Sure to Visit These Exhibitors! AUE

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Advanced Ultrasound Associates Inc Booth: 704 www.auetulsa.com

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Ampronix Inc Booth: 546 www.ampronix.com

Asset Services Booth: 928 www.AssetServices.com

BC Group International Inc Booth: 337 www.bcgroupintl.com

Beta Biomed Services Inc Booth: 557 www.betabiomed.com

Bio-Medical Equipment Service Company Booth: 764 www.bmesco.com

Biomedical Repair Consulting Services Inc Booth: 756 www.brcsrepair.com

TECHNATION

MAY 2018

ECRI Institute Booth: 715 www.ecri.org

Elite Biomedical Solutions Booth: 362 www.elitebiomedicalsolutions.com

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Avante Health Solutions Booth: 321 www.avantehs.com

Crothall Healthcare Technology Solutions Booth: 221 www.crothall.com

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Fluke Booth: 526 www.flukebiomedical.com

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Injector Support and Service LLC Booth: 655 www.injectorsupport.com

Phoenix Data Systems Inc Booth: 735 www.goaims.com

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Integrity Biomedical Services LLC Booth: 707 www.integritybiomed.com

InterMed Group Booth: 240 www.intermed1.com

Pronk Technologies Inc Booth: 814 www.pronktech.com Tenacore Holdings Inc Booth: 700 www.tenacore.com Radcal Booth: 541 www.radcal.com

Medimizer Inc Booth: 615 www.medimizer.com

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Medwrench Booth: 167 www.medwrench.com

TriImaging Solutions Booth: 141 www.triimaging.com

Retrieve Medical Equipment Booth: 902 www.retrievemedicalequipment.com Trisonics Inc Booth: 225 www.trisonics.com

Nuvolo Booth: 621 www.nuvolo.com

oneSOURCE Booth: 453 oneSOURCEdocs.com

PartsSource Inc Booth: 729 www.partssource.com

EMPOWERING ADVANCING THE THE BIOMEDICAL/HTM BIOMEDICAL/HTM PROFESSIONAL PROFESSIONAL

RSTI Booth: 628 www.rsti-training.com

Biomedical

USOC Medical Booth: 721 www.usocmedical.com

Select Biomedical Booth: 136 www.selectbiomedical.com Versus Technology Inc Booth: 335 www.versustech.com MEDICAL EQUIPMENT SALES AND SERVICE

Southeastern Biomedical Associates Inc Booth: 530 www.sebiomedical.com MAY 2018

TECHNATION

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C M M S:

21 21 Century WHAT YOU

NE ED IN TH E

st st

Current Capabilities and Shortfalls

By K. Richard Douglas

A reliance on technology has been a double-edged sword in many ways. While many innovat ions have helped make life easier and more efficien t; social media, video games and t ex t ing have led to t he phenomenon of too much screen t ime and t hat has impact ed peopleâ&#x20AC;&#x2122;s lives in ot her ways. On the plus side is the usefulness of databases and the capabilities that such stores of information can provide. Relational databases can connect the dots and pull even more relevant information into the mix to help make the data more meaningful. Add the ability to store all of this information in the cloud, and access it when needed, and the genius of the modern-day CMMS becomes clear. Managing a large and diverse asset inventory is no easy task. Keeping records of those assets, scheduling maintenance, along with keeping a historical record of work performed on any given device, requires tedious and astute documentation. Staying in compliance is yet another focus. As with all technologies, the potential of CMMS is ever-evolving, taking full advantage of other technologies and greater capabilities. Off-site storage of data is just one advance. Integrating mobile devices brings a new level of convenience to these systems. With all the capabilities of current CMMS software platforms, is there anything that can be improved or added? What do HTM professionals want to see added or updated? From CMMS providers, what are the latest features and offers? For HTM professionals, what meets muster and what would be a good addition to make the perfect system? Like anything that is used regularly, whether it be a car, computer software or a bank, the user soon forms an opinion about what works, where there may be a deficiency and how the user would change the product or service. It explains the product lifecycle of anything that is used regularly; introduction, feedback, refinement

and improvement. Software and cellphones so often

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this reason.

So, it goes with CMMS.

CMMS: WHAT YOU NEED IN THE 21ST CENTURY “An organization’s CMMS is one of the most important tools an organization has and it touches almost all aspects of the HTM field,” says Benjamin Lewis, regional director of clinical engineering for Georgia/ Florida for Novant Health. “Regulatory data, materials, labor, assets, service actions and more will all be stored in your CMMS. Sounds great right? All of these were available in my DOSbased CMMS system that I used at my duty station as a biomed 20 years ago, when we were still in the 20th century,” Lewis says. “There has been a vast improvement in the CMMS since then and competition has increased innovation in the field. Today, a CMMS must do more and we as HTM professionals should use these resources to bring value to our organizations. My expectations for a CMMS is to remain cutting edge by meeting our always changing needs,” Lewis adds. HTM CHECKLIST The CMMS wish list from the HTM community comes out of personal experience and a recognition of the strengths and shortcomings of different systems. “For me, the ideal CMMS system would be one that has good tools for data analysis. It should have good reports, but should also have tools built in for data mining. It should be able to be flexible, but at the same time rigid in its input structure,” says Jim Fedele, CBET, senior program director, clinical engineering, BioTronics, UPMC Susquehanna.“Some of the systems I used in the past were too flexible and this made data analysis very difficult as people call the same piece of equipment many different things. However, it also needs to be able to easily accommodate the addition of new items or ‘gray area’ entries,” Fedele says. The capabilities of a system should allow HTM to make competent decisions. “The system must have robust data analytics to enable rapid and comprehensive decision making – safety and security, financial and operational. Comprehensive cybersecurity management. Portability and ease-of-use

TECHNATION

MAY 2018

are key,” says Michael W Lane, MBA, CMQOE, CHTM, director of instrumentation and technical services at the University of Vermont. Systems should have the ability for real integration also. “Better tools for medical device cybersecurity – this starts with just adding all of the necessary fields that we need to add network settings, security configurations, machine addresses, software and hardware revision, configuration data, whether devices have ePHI or not and how that is encrypted,” says Perry Kirwan, vice president of technology management for Banner Health in Phoenix. “Integration into IT service management systems e.g. Service Now, so that work orders can be cleanly handed off between disparate service entities – this is for hybrid medical devices that are part diagnostic/therapeutic system and part IT system. Once things get connected into the IT environment, the service responsibilities change and HTM does some of the work, while the other parts of the work may be IT,” Kirwan says. “Working in disparate dispatch and work order systems creates opportunities for error – missed calls, incomplete service response or verification, disparate documentation,” he adds. He also suggests better/more flexible reporting tools. “Most CMMS providers provide canned reports which are useful. The problem is that once you want to deviate from the canned reports, the report writer either doesn’t exist or are more complicated to use than they should be,” he says. Additionally, Kirwan says that better business intelligence/analytics tools would help along with better tools to support dispatch and call center management and better integration into ERP systems for central accounting, parts ordering, invoice payment; not just interfaces. Lewis agrees with the cybersecurity features, as well as the importance of good data to build an AEM program. “New pressure around the AEM has many people scrambling, building probability reports to create an

organizational justification for their AEM program. Today’s CMMS should have risk and probability baked in to the software and should easily show you what can be on AEM based on your service data,” Lewis says. “Extensive cyber data points should be a prerequisite when choosing a CMMS. There are systems out today that are lacking in the number of data points you can track. MAC address, IP address, AE title, software version and OS should all be available and easily reportable fields,” he says. “Most systems are there now, but some rolled out slower than others. In addition to data points, analysis on those points are a plus. There are systems out there that can tell you the last place your networked device touched your network,” Lewis adds. Fedele says that some of the features that he would look for would include the “ability to use the program on mobile devices, ability to use modern day peripherals like barcode scanners and phone cameras to input devices.” “The ability to do predictive search on part or accessory orders. [For] example, if I get a work order for a thermometer, the system would know, based on the history of like devices, that probes are a common part I would be ordering and it would ask me if I wanted to order the part,” Fedele says. MORE HTM SUGGESTIONS Fedele suggestions borrowing from technology already used in search engines. “You know how Google remembers your search history and then puts related ads on the websites you visit, we should be able to do that with common parts and common processes. User-defined defaults to streamline process would also be good. Integration to test equipment would be good but I am not sure it is a must have,” he says. He also suggests following the lead of an online retailer. “The database should be cloud-based, it should also sync to the service manual library. Also, when doing a PM, the procedure checklist should be able to be viewed in the CMMS and steps checked off

WWW.1TECHNATION.COM

Benjamin Lewis regional director of clinical engineering for Georgia/Florida for Novant Health

Vishal Malhotra EQ2 LLC, Chief Technology Officer

Jim Fedele, CBET senior program director, clinical engineering, BioTronics, UPMC Susquehanna

Perry Kirwan vice president of technology management for Banner Health in Phoenix

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

and commented on. Common functions should be able to be automated to reduce the amount of clicks needed to get work done,” Fedele says. “I think we really need to throw out what we know about CMMS systems and look at how Amazon and Google manage data and the searching/shopping experience and copy that,” he adds. Lewis is another member of leadership who sees the need for integration. “Your CMMS should be able to integrate with other industry standard programs, like ECRI, to help with recall alert information. How great would it be for your CMMS to not only recognize ECRI alerts by the active models in your system, but also automatically by the serial numbers identified in the alert when run against your inventory?” he asks. He also points out that a comprehensive billing module is a must today. “There are many successful programs that are no longer just a cost center to their organization. Having the flexibility to bill external customers or just run a great in-house program is important,” Lewis says. “Customization is a must for a CMMS to be successful. The days of needing a feature and waiting two years for a relatively simple change until the industry catches up with your organization’s needs are over. A CMMS that is not able to be nimble to their customer’s requirements is one that is going the way of the dinosaur,” Lewis says. “Finally, a friendly user interface is a 21st century must. I grew up on a Commodore 64 with 5.5- inch floppy disks on a DOS operating system. I am a mid-career HTM professional. The newest biomeds starting their career grew up on the Apple iPhone. Although I own an Android, Apple set the standard for a friendly user interface. Like an iPhone, a CMMS should be intuitive for a technician to navigate. A friendly user interface will increase the integrity of the data, and good data is the reason we have a CMMS in the first place,” Lewis adds.

Kirwan explains why integration with ERP systems for central accounting, parts ordering, invoice payment is important. “This is referring to some work that we just did at Banner. We became so frustrated with our CMMS provider to do inventory management/control and parts/service ordering with complete reconciliation to the ERP – that we decided just to not use the CMMS anymore for those functions,” he says. “The only way that we were going to get the integration that we needed was to do the inventory management and parts ordering through the ERP and then backfeed the information as needed into the CMMS. Most facilities are doing their operational budget accounting through their ERP and if the CMMS and ERP don’t talk and dynamically interact with each other – you have little hope of your numbers between the CMMS and the ERP ever matching,” Kirwan says. “I could tell you horror stories on something as simple as accurately tracking where we were on any given month with just accruals where the proper integration of CMMS and ERP can make or break your month. This only gets amplified when you start putting for-profit implications into the mix,” he adds. PROVIDER PERSPECTIVE There are many providers of CMMS systems. Most have branded names for their systems. The provider’s insights provide a glimpse into the thinking behind system design and the direction in the innovations are coming. What direction have recent design changes and additions taken? “The CMMS has evolved more rapidly in the last few years than before. A CMMS is not just a repository system used to document work orders for the HTM department anymore and is no longer separate from other systems. Hospitals can no longer survive with this kind of isolated environment in place,” says EQ2 LLC Chief Technology Officer Vishal Malhotra. “In this day and age, with the advancement of technology causing more devices to become smart (interconnected),

MAY 2018

TECHNATION

CMMS: WHAT YOU NEED IN THE 21ST CENTURY and with the evolution of Integrating the Healthcare Enterprise-Patient Care Devices (IHE-PCD) profiles, CMMS can no longer stay isolated,” Malhotra says. “CMMS can now provide most critical information like utilization, software version, OS version, MAC Address, IP Address, etc. directly from medical devices. Devices can also send error codes directly to the CMMS which can then auto-generate repair work orders and assign to the right technician/ engineer. This opens the door for more efficient maintenance of devices and also more effective overall life cycle management of medical devices, which was not possible before,” he adds. Malhotra also says that a modern CMMS has the built-in intelligence to guide HTM with regulatory compliance requirements and capital budget planning tools. “Along with this, most CMMS are now accessible on smart devices like cellphones and tablets, evolving from the old PDA platform. And most CMMS vendors are now offering SaaS-based

“

more information will combine with greater capability of the CMMS to use that information,” says EQ2 LLC, Product Manager Rich Sable. “The CMMS will ‘learn’ from this information using artificial intelligence. Information from automated testers will be used by the CMMS to guide predictive maintenance. And information from MDS2 (Medical Device Security), Zingbox, and other systems and processes will empower the CMMS to help provide a more secure infrastructure,” Sable says. “CMMS users require more interfaces and seamless integration with third-party applications. Dashboards, personalized user interfaces and availability of analytics covering multiple points of view,” says Ben Mannisto, president and CEO of Phoenix Data Systems. “Future systems must allow for protection against cybersecurity attacks, specifically as related to patient devices. Vendors must support OS updates and allow customer accessibility in order to keep up to date to protect against these threats,” Mannisto adds.

A n o r g a n i z at i o n ’ s C M M S i s o n e o f t h e m o s t i m p o r ta n t t o o l s a n o r g a n i z at i o n h a s a n d i t touches almost all aspects o f t h e H T M f i e l d . –Benjamin Lewis

solutions along with an in-house solution,” he says. Looking into the future, what are potential innovations that can be expected? “Innovations in both CMMS and medical devices will mean that the CMMS will utilize the power of information in new ways. Increased interconnectivity of devices producing

TECHNATION

MAY 2018

”

FEEDBACK MATTERS “As with any systems development life cycle, customer feedback plays a critical role in achieving a platform that provides a great customer experience. The usability of the interface can be greatly enhanced with feedback from HTM professionals,” Malhotra says. He recalls one good example some years back when customers started asking whether there was a way for EQ2’s

HEMS to get error codes from devices and generate a work order. “We made sure to understand the specifics of what they needed and how it would be used, and then we worked with Integrating the Healthcare EnterprisePatient Care Devices (IHE-PCD) team to develop the functionality to accomplish the request,” he adds. “CMMS software must be user-driven with respect to changes and updates. Recent needs have included the use of the GPS feature on mobile devices,” Mannisto says. “Using this feature, work can be assigned to the technician closest to the location, saving valuable time. Another innovation provides the opportunity for management to be immediately notified of an adverse or unique circumstance, such as when one of the hospital’s two CT machines is down,” he adds. “Health care organizations today need better data and simpler tools to manage a growing array of complex equipment and networked devices,” Connectiv CEO Rob Woodbyrne was quoted as saying in a recent press release. Connectiv, a SaaS healthcare technology management platform, was recently acquired by Accruent. Accruent CEO John Borgerding says that 67 percent of medical device manufacturers and 56 percent of health care providers believe an attack on their devices is likely to occur within a year, according to a press release. For this reason, manufacturers and health care providers believe that automatic security monitoring, that identifies threats quickly, is an important component of these systems. When it comes to advances in technology, CMMS has proven to be an indispensable and integral tool for every HTM department. In many cases today, with mergers and acquisitions, asset inventory proves too large to be managed any other way. Through continuous innovation, CMMS providers will listen to the HTM community and offer ever-more-useful tools for managing large databases of critical information.

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BY TODD H. ROGERS

CAREER CENTER How Do You Handle Salary? BY TODD H. ROGERS

bout three weeks ago a colleague had a noteworthy experience. As he tells the story, “I’m sitting at my desk like any other workday and my phone rings. I answer and it’s some headhunter telling me about a job that sounds kind of interesting. So, I listen to what he has to say, he asks me a few questions, and then all of the sudden he asks me how much money I make a year. Todd, what should I do in those situations?”

This “salary question” has got to be the single most written-about topic among all career blogs, career forums and career publications. There are books, book series, training videos, and courses that are all dedicated to this one topic. I’ll keep it simple. How do you respond when a potential employer (or headhunter) asks you about your current income? There are a handful of ways that you can respond and each one comes with its own set of possibilities and consequences. I want to dig into all of it. Let’s start with the basics: Why ask an interviewee about their current income? The easy answer is that employers budget for labor and we benchmark our ranges based on our ability to pay, our willingness to pay, and our perceived benefit of hiring someone good. But, we also don’t want to leave money on the table. Simply put, we want to make sure we’re not wasting time by even looking and we have a pretty good idea what it’s going to cost to hire someone with your skills and experience. You, as the candidate, want to make sure that you’re not wasting your time by even listening and if you’re diligent, you’ve 62

TECHNATION

MAY 2018

done your homework and you have a pretty good idea of your worth. So, you aren’t required to answer the question, but we aren’t required to continue speaking with you. It’s fair play. Rest assured, we are going to ask and if we are large enough to have our own recruiting software, we will ask you at the front end when you fill out the online job application. We won’t let you skip that step, either. So, when you are confronted with the salary question, what are you options? 1) D elay. You can attempt to delay answering the question until you’ve collected more information. 2) R efuse. You can refuse to answer. Of course, you do it politely but you can always not answer. 3) R edirect. You can redirect the question by asking a question in response such as, “What does the position typically pay?” You can also supply a range that you’d consider. 4) S ubmit. You can simply submit by disclosing your current income truthfully or you can submit by being untruthful and provide information that isn’t accurate. From the perspective of the jobseeker, delay is probably the safest option and is likely to yield the more beneficial outcome. It is very reasonable to want to know more before you tip your hand. The likely response you’ll get during an interview, “Well, you should tell me what you’re making so we know we’re not wasting each other’s time.” Maybe. But, it’s only a 30-60 minute interview and the time lost is minimal. And, incidentally, the employer wants to anchor you because what you’re presently making is also an indicator of

TODD H. ROGERS Talent Acquisition Specialist for TriMedx

what you’re willing to accept. The worst that can happen is the interviewer ends the interview and after a moment of awkwardness, you part ways. With refusal, there’s a right way and a wrong way. Now, if you’re unemployed, have no income, and are really worried about where your next meal is coming from, this is probably your worst option. If you’re gainfully employed or wealthy, you can refuse all day long. You have alternatives and you don’t need the job. Some people try to create the impression that they don’t need the job and then refuse to answer. But, in my years of recruiting, I’ve gotten pretty good at spotting someone who’s using this ploy and I just simply wait that out. If no indication of income is supplied, I generally suspend the interview process. In redirection, you also carve yourself a little wiggle room. And, it’s really not that confrontational. You’re essentially signaling to the interviewer, I’m not opposed to telling you what I make, but you’re going to have to tell me what you’re willing to pay first. This route has the potential to become a WWW.1TECHNATION.COM

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tangle but if you’re polite about it, a lot of interviewers will tip their hand. For the unemployed jobseeker, this response is slightly risky but the consequences aren’t likely to be as harsh as you might get with refusal. Submission is the easy route. Both parties quietly hope that the other party just submits and reveals the financial facts. This angle is a punt on the part of one member of the discussion. But, everyone breathes a little easier from this moment forward. If you’re unemployed, as noted above, this is a safe play. Now, this topic wouldn’t be complete if I didn’t mention perception and signaling. I’ll keep it light as this area has volumes already in circulation that I don’t need to revisit. If you are someone who’s got the confidence of an NFL quarterback then you’ve probably already made your millions and you don’t need to be in the interview. However, if your confidence is sound, you could signal that your needs aren’t sufficient to be willing to tip your hand, even if you’re flat broke and living with your parents. George Costanza was able to do this once and it landed him a job with the Yankees. But, if you’re a “Seinfeld” fan like me, you also know that George wasn’t an expert at getting what he wanted with any degree of frequency. In all of the negotiation books that I’ve read, the most important element is either having a viable alternative or being able to create the perception that you’ve got a viable alternative. If you can create the perception when you do not have any other option, congratulations, you’re on your way to fabulous riches and you should be working on Wall Street. When you actually do have a viable alternative, it’s perfectly OK to make the other party aware of it. I urge you to be cautious, as it’s easy to over-play your hand and come off as rude. When a headhunter calls, I think it’s perfectly acceptable to ask, “good question, what did your client tell you they’re willing to pay?” The headhunter only makes money if he closes the deal; he gets paid on the transaction. So, he’s only going to try and bargain with you inasmuch as necessary to get you to agree to an interview. So, those are some options and my take on the question regarding salary. ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

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