TechNation - August 2018

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Vol. 9

ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

AUGUST 2018

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50

OUNDTABLE: R ULTRASOUND SYSTEMS

TechNation reached out to industry professionals to find out more about ultrasound systems, discovering significant information about these highquality imaging applications.

Next month’s Roundtable article: Anesthesia

56

PART OF THE CLEAN TEAM I ndustry professionals dive deep into the issue of hospital hygiene. Every effort must be taken to protect the HTM professional from contracting an illness because of a piece of contaminated equipment. TechNation offers advice on how to prevent illnesses and promote cleanliness.

Next month’s Feature article: Alarm Management Revisited

TechNation (Vol. 9, Issue #8) August 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

AUGUST 2018

TECHNATION

9

CONTENTS

INSIDE

PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Jayme McKelvey Megan Cabot

ART DEPARTMENT

Jonathan Riley Karlee Gower Kathryn Keur

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Jenifer Brown K. Richard Douglas Jim Fedele Inhel Rekik Manny Roman Cindy Stephens Steven J. Yelton

DIGITAL SERVICES

Cindy Galindo Kennedy Krieg Travis Saylor

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

Departments P.12 SPOTLIGHT p.12 Department of the Month: BSA Health System Clinical Engineering Department p.14 Company Showcase: RepairMED p.18 Professional of the Month: Neil Davidson, CBET p.20 Biomed Adventures: Terry Boyles p.24 Company Showcase: Innovatus Imaging P.28 p.28 p.34 p.37 p.38 p.40

INDUSTRY UPDATES News & Notes Stave Medical Ribbon Cutting B.R.I.T. Technical Institute AAMI Update ECRI Update

P.44 p.44 p.47 p.48

THE BENCH Biomed 101 Tools of the Trade Webinar Wednesday

P.62 p.62 p.64 p.67 p.68 p.71 p.73

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

P.74 BREAKROOM p.74 Did You Know? p.76 The Vault p.79 Oregon Biomedical Association Scrapbook p.80 Where in the World is Ben C.? p.82 Service Index p.86 Alphabetical Index Like us on Facebook www.facebook.com/TechNationMag

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

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SPOTLIGHT

DEPARTMENT OF THE MONTH BSA Health System Clinical Engineering Department

BY K. RICHARD DOUGLAS

A

marillo, Texas is the largest city in the panhandle part of Texas and is situated where the southern plains meet the desert. It includes the nation’s second largest canyon; Palo Duro Canyon.

From Cadillac Ranch, with its famous row of Cadillacs, nose-dived into the dirt in a field, to a highly rated botanical gardens and the Texas Air and Space Museum, Amarillo is an interesting place to visit.

In 1901, four sisters from the Sisters of Charity of the Incarnate Word in San Antonio arrived in Amarillo and started a hospital named St. Anthony’s. The hospital later joined forces with a second hospital, as the population in Amarillo grew, and in 1996 became BSA Health System. BSA is an

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affiliate of Ardent Health Services and is the fourth largest employer in Amarillo.

The health system’s clinical engineering department is made up of 11 team members including Manager Jeremy Hendrick and Supervisor Courtney Haschke.

Department members also include Carlos Osorio, Braxton Bjork, Robert Webb, Maggie Olszynska, Wade Smith and Mario Flores.

On the imaging side of the team are radiology equipment specialists Neal O’Shaughnessy, Lucas Mosqueda and Monty Mayo.

The team provides services to a 400-bed hospital with 20 operating rooms, a 20-bed NICU, 20 labor rooms and a 42-bed ICU and step down unit. They also serve 10 outside clinics and two surgery centers.

They are constantly acquiring more ventures.

The CE team has taken a more active role in the purchasing process recently.

“Over the past year we have worked to gain the trust of our leadership and the buying team so that biomed is now a part of all equipment and system demos. Any and all projects moving forward have a biomed representative at every meeting and through the entire process. We have learned that this not only saves time, but money and headaches,” Haschke says.

She says that in the past, there was a huge chasm between biomed and other departments in the hospital.

“Not a lot of communication was happening between us and the rest of the hospital. So, things were being bought and

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SPOTLIGHT

The BSA Health System Clinical Engineering Department is located in Amarillo, Texas. put in place without biomeds input or knowledge and there would be problems with connectivity or getting parts or even service with equipment,” Haschke says.

“So, within the last year, we have tried to build trust and assurances with the hospital staff. We encourage nurses to talk with their biomed representative and learn about better options out there for medical devices,” she adds.

She says the CE team now is invited to meetings with sales reps where team members can ask about the technical aspects of the equipment.

“So, now we don’t have devices coming in that are hard on parts, expensive to fix, or known to have massive amounts of downtime,” Haschke says.

For data collection, they use a tool called Facility Survey/CMMS and the group is working hard at bringing as much service in-house as possible and relieve the hospital of most service contracts.

There has also been an effort to bring more imaging service in-house.

“Right now, we do have a lot of our radiology equipment under a contract. Our team is working to dissolve that contract and bring everything in-house. As far as general medical devices, there are little to no contracts in place. Mostly we have service ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

agreements that cover parts, but our biomeds take care of the needs of the machine itself,” Haschke says.

IMPROVING THE NUMBERS The old expression about pulling one’s self up by the bootstraps is something the CE team has embraced. They worked overtime to improved PM stats by diligently focusing on a goal for improvement.

“Last spring, biomed received three NC1s on the DNV survey. Through a leadership shake up and team members stepping up the rest of the year, we fixed all NC1s and went from a PM completion rate that is too embarrassing to acknowledge to 100 percent type one completion for the year, and 98.65 percent completion for type 2s,” Haschke says.

“We had team members stay late, come in on the weekends and the holidays just so that we could make our goal every month.

And with this past DNV inspection, biomed got no hits and the inspectors were impressed with our improvement and our processes,” she adds.

They also took a creative approach to communicate with some of their clinical colleagues and improve the environment for understanding PMs and procedures.

“We also had a hard time getting

nursing services to read PM stickers and know what is going on with biomed. In January, we made posters and headed to nurse competencies and explained our processes. We were welcomed with open arms and have greatly reduced the frustration between nursing and biomed as well as helped our numbers improve since nursing now knows what to look for when reading our stickers,” Haschke says.

She says that through talking with nurses in small groups, light bulbs started going off.

“Nursing is finally understanding that the PM is important to biomed, of course, but also to our patient safety. We now get calls on equipment that is past due on the inspection and the nursing staff also has more patience and understanding when biomed needs to take something down for maintenance. We have also been invited by multiple educators and directors to attend off-campus competencies and unit meetings to teach understanding to staff outside the main hospital,” she adds.

The CE team at BSA Health System has made great strides in establishing a great rapport with their clinician colleagues and taking their game up a notch or three. They prove that setting goals to improve is the first step on the road to success.

AUGUST 2018

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SPOTLIGHT

SPECIAL ADVERTISING SECTION

COMPANY SHOWCASE R

epairMED continues to live up to its customers’ and its own high expectations as well as its signature tagline “Merging Technology and Experience.” The big news coming from RepairMED in recent months includes certification to the new ISO 9001:2015 standard and the opening of the company’s new California facility to go with its excellent component-level repair capabilities, reverse engineering solutions and continued expert work on depot repair offerings.

ISO 9001:2015 RepairMED was proactive in securing the ISO certification update well ahead of the industry deadline obtaining notification of its certification of registration from Perry Johnson Registrars Inc. in March 2018.

The new ISO 9001:2015 certification is described by the International Organization for Standardization as follows: “ISO 9001:2015 specifies requirements for a quality management system when an organization: a) needs to demonstrate its ability to consistently provide products and services that meet customer and applicable statutory and regulatory requirements, and b) aims to enhance customer satisfaction through the effective application of the system, 14

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including processes for improvement of the system and the assurance of conformity to customer and applicable statutory and regulatory requirements.”

RepairMED President and CEO Diane Geddes says that the ISO certification adds to company’s history of delivering quality service.

“Achieving ISO certification is crucial to our industry especially during a time when the HTM industry as a whole is being forced to scrutinize quality objectives, on-time delivery and repeatable process performance tighter than has typically been experienced in the past,” she explains. “Obtaining our ISO 9001:2015 certification is a testament to our customers and the HTM industry of RepairMED’s commitment and dedication to quality, while ensuring consistent reliable processes that are both valid and credible.”

NEW FACILITY In June of 2017, RepairMED expanded its operations by opening a new repair depot in Bakersfield, California. Some of the company’s engineers with family ties to the West Coast of the United States, relocated to California.

“Instead of leaving a void where they had filled key roles in our component level depot previously, we worked with them to make it possible to expand our

offerings, by opening a West Coast repair depot,” Geddes says.

The California depot is a vital asset to RepairMED, providing the full gamut of depot repair that it currently offers from its Florida facility. It also allows RepairMED to significantly increase its volume capacity.

Some of the types of equipment serviced at the new California depot include Sigma Spectrum infusion pumps, ESUs, defibrillators, feeding pumps, gas benches, monitors and many other types of medical devices.

The benefits of the new depot are already paying off for customers.

“A West Coast presence is a needed complement to our service

“ Obtaining our ISO 9001:2015 certification is a testament to our customers and the HTM industry of RepairMED’s commitment and dedication to quality, while ensuring consistent reliable processes that are both valid and credible.”

- Diane Geddes

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SPOTLIGHT

team and allows RepairMED to be better positioned for customers when geography is a key decision driver,” Geddes explains.

COMPONENT-LEVEL REPAIRS RepairMED is the leader in component-level depot repair capabilities that provides biomedical services to health care facilities, medical equipment resellers and independent service providers of various sizes. The company has brought together innovative and proprietary technical expertise from the high-tech industries of electronic manufacturing, aeronautics, biomedical engineering and military applications to take the repair of medical equipment to the next level in quality, turn-around, service and cost-reduction.

COMPREHENSIVE SERVICES RepairMED’s services include the most comprehensive and costeffective flat-rate pricing in the industry with a no-hassle warranty on all repairs. RepairMED’s flat-rate electronic repair pricing is truly flat, with no additional charges! No matter what the electronic issue with the medical device, RepairMED will repair it. The only repairs/parts not included in the flat-rate pricing are ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

any cosmetic/exterior damage, missing components and/or accessories.

RepairMED also offers committed, one-stop and cost-plus contracted flat-rate pricing to customers who wish to create the most efficient and costeffective service model for all of their biomedical depot repairs.

QUALITY RepairMED is committed to providing prompt, consistent, reliable and excellent quality services in all areas of operation, as well as ensuring customer satisfaction by considerate understanding of the needs and expectations of it’s customer, and complying with and continually improving the quality management system through the achievement of the company’s quality objectives.

MISSION STATEMENT The intended mission of RepairMED is to consistently bring exceptional value and integrity to the healthcare technology management industry, the global business sector and the company’s team of diverse employees as a dependable consistent partner and resource, providing outstanding quality and support for managing assets, maintaining cost and ensuring to the health care community safety, reliability and extreme stewardship with regard to

the medical equipment used to support patient care.

RepairMED’s intent is to create a diverse team of passionate, confident and committed employees by providing a culture of empowerment, fairness and diversity that embraces growth, provides for training and establishes stable and secure career paths within the markets it serves.

RepairMED’s heart and soul rests in a deep desire to be a valuable and committed asset to the health care communities that it serves.

“Our goal is to strengthen our value by offering products and services that serve to meet a need, make sense for our customers, and meet the goals of the industry and those we serve,” Geddes states.

“By continually striving to make an impact by bringing a consultative cost-saving philosophy, tailored with strong quality, and vetted ISO processes, RepairMED is able to consistently be a dependable partner to the health care community,” Geddes says.

For more information, visit repairmed.net. Contact a RepairMED sales associate toll-free at 855-813-8100 for more information, including how to qualify for these programs.

AUGUST 2018

TECHNATION

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SPOTLIGHT

PROFESSIONAL OF THE MONTH Neil Davidson, CBET Standing Behind Every Decision

BY K. RICHARD DOUGLAS

S

eventy miles east of Memphis is the city of Jackson, Tennessee. It is a city of over 65,000 people in the western portion of the state.

ReNew Biomedical is an independent medical equipment repair and service provider located in Jackson. Serving as the company’s biomedical director is Neil Davidson, CBET. Davidson is a military-trained HTM professional and has been a biomed for 14 years.

“Now, I am the director of biomedical services for ReNew. I have developed a training program for all our techs. I play a big role in customer relations. I work alongside MME, our parent company’s ops manager, to help with the workflow of all equipment, and definitely still turn wrenches on high-level repairs,” he says.

He first learned equipment repair while serving in the military.

“The majority of my family was in the military under a Combat MOS (Military Occupational Specialty).

They all recommended I join under a Medical MOS. I researched medical jobs and came across biomedical equipment repair. Since I am not a huge fan of blood and guts, but I could turn a wrench, I decided to check that one out,” he says. One of his colleagues says that he is known

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as their biomed guru — he knows the ins and outs of defibrillators and is always willing to go the extra mile to help out a customer.

“I did have a specialized program.

After basic training, I went to advanced individual training for a 50-week course in biomedical equipment repair at Sheppard Air Force Base in Wichita Falls, Texas and received my diploma from the Department of Defense Biomedical Equipment Maintenance Technician Training Course,” Davidson says.

Before taking his current position with ReNew, Davidson gained experience as an Army biomed, a field service technician for OrthoClinical Diagnostics and a BMET at Cookeville Regional Hospital.

LEARNING EVERY YEAR IN BIOMED Working in biomed for 14 has provided a number of challenges.

“In my five years at Fort Hood, we removed and reinstalled all new equipment in five different dental clinics, which was around 500 wired and plumbed chairs,” Davidson says.

“Those things are a total nightmare. We also removed and replaced X-ray equipment, sterilizers, and all the small equipment you see in a dental clinic. It’s a time-

consuming and logistically driven task,” he adds. “My next challenge was as director of ReNew Biomedical.

We faced the challenge of taking a new third-party company, who serviced medical equipment, and stepped up our game to be an ISOcertified company that provides the same level of service that you get from the original manufacturers. I’ve learned that a lot of companies perform electrical safety test only and simply place stickers on units; we’ve come to call them sticker companies,” Davidson says.

Davidson has also learned that experience can be the best teacher. He has had to troubleshoot all models of defibrillators including Zoll, Physio Control and Philips.

“I had performed preventative maintenance on these models but had few repairs under my belt. I practically spent the first year disassembling and reassembling and learning the parts that failed on all of these models. And the parts that were delicate and needed to be handled with care during the repair and have now provided this knowledge to my staff and continue to learn new things about these models four years later,” Davidson says.

Davidson is also an officer with a biomed association. He is anxious to see the group prosper.

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SPOTLIGHT

FAVORITE BOOK: It’s a tossup between Mad Magazine and Dr. Seuss.

FAVORITE MOVIE: “A Knights Tale” When a simple peasant boy returns to his dad a knight, it gets me every time!

FAVORITE FOOD: Hot wings HIDDEN TALENT: Freestyle rapper and liquid dancing FAVORITE PART OF BEING A BIOMED: “When you’re troubleshooting a piece of equipment for what seems like weeks and you finally solve the issue. Replacing the correct part and having the machine test out is always a great feeling. I like finding solutions to help people out.”

WHAT’S ON MY BENCH? Coffee, Gerber, headset, my kids’ pictures and toys pending repair, and Jon Bryant, who keeps track of where I lay stuff down.

“As the vice president of the Midsouth Biomed Association, I am responsible for finding vendors, guest speakers and providing that information to the president. It has been a struggle to spark interest in the members which has made it hard to get vendors because I want it to be worth it for the vendors. It is definitely a work in progress and the website needs to be updated ASAP. I have only been a member for about 18 months,” he says.

On the home front, Davidson enjoys spending time with family.

“I have a big family. The driving force behind my success is my

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

beautiful wife, Shawna, my oldest son, Nathan, my sweet girls, Callista and Kelsi, and my two wild baby boys; Nolan and Tolliver.

Football and beekeeping are among Davidson’s favorite pastimes.

“I love anything outdoors and if you know me I consider myself the best beekeeper in the business. I’m also an avid Tennessee football fan,” he says.

He has been recognized for his efforts both in the military and as a civilian.

“I have received the Army Commendation Medal for serving as the Senior Medical Maintenance NCO during Operation Enduring Freedom in Afghanistan, the Achievement

Medal for Leader of the Decon Team, Soldier of the Month, Soldier of the Fourth Quarter, Certificate of Achievement for support of the renovation and re-establishment of the Billy Johnson Dental Clinic at Ft. Hood, and my proudest award to date is ReNew Biomedical Biomed of the Year.”

Some of those awards reflect how Davidson describes himself as driven and ambitious. He also says that he stands behind every decision he makes 100 percent.

It is an attitude that serves his employer, customers, family and a biomed association.

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SPOTLIGHT

BIOMED ADVENTURES Making Good People and Great Athletes

BY K. RICHARD DOUGLAS

V

olleyball, as with most sports, represents an accumulation of skills that make a person more adept at beating an opponent.

It teaches agility, strategy and teamwork. In the process, many life lessons can be learned as well. Girls’ high school volleyball is one of the most popular venues for the sport.

Terry Boyles is a BMET and senior IS analysist for Parkview Health System in Fort Wayne, Indiana. Parkview Health is a not-for-profit, community-based health system serving patients in Northeast Indiana and Northwest Ohio. Boyles also coaches girls’ volleyball at the high school level.

“I started coaching when my daughter, Amanda, made the sixthgrade volleyball team at Kekionga Middle School in 2006 and I told the head coach I would be glad to help if she needed any. She said any help would be great since she

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had never really played before,” Boyles recalls.

“So it was a learning experience for us both since I had only played in recreational leagues. The following year, Amanda played travel volleyball and had a great coach, Fabiana Souza, who was at the time a graduate assistant at IPFW women’s volleyball team. I went to every practice to learn from Coach Souza. I continued researching volleyball and coaching it while Amanda continued to play through the eighth grade,” he adds.

“Then, thinking my coaching career was done, my stepdaughter Jessica made the volleyball team at Lane Middle school for seventh grade and the head coach approached me to help since she knew I had coached at the rival school with my Amanda. Yes, my daughter had to play against my step-daughter since they went to different schools in the same town. While at Lane, I was mentored by Snider High School coaches,” Boyles says.

He says that he coached Jessica through her seventh-grade year and was approached by a travel club director to coach a travel team. Boyles says that it was at this point that he really developed a love for the game.

“I continued to coach travel volleyball and also became a certified USAV official. I then started coaching a travel team so I was coaching year round. While Jessica was finishing her eighth-grade year in volleyball the head coach stepped down and I was asked to fill the position. So, with the support of my loving wife, Roxanne, I stayed at

Lane to be the head volleyball coach when I had no more of my own children there,” Boyles adds.

Boyles say that it was one day, while driving in the car with Roxanne, that somehow the topic came up about being a high school coach.

“Roxanne said if I wanted to do it, to go for it, since there where two positions open at local high schools. I applied for both positions and got the job at North Side High School in May 2017 with the season to begin in August 2017. The first thing I did was hire my daughter Amanda as my JV coach. I knew I was taking over a school that had been struggling over the last several years, only winning one to two games a year,” Boyles says He admits to being a little nervous his first game and even though he had been turning in lineups the past 12 years, he says that he messed up the first one he turned in as a high school coach and put the players in the wrong position.

“While we only won four matches last year, we gave a lot of teams a run for their money and look to be even better this year. The girls have really responded and have improved so much in the short time Amanda and I have been with them,” Boyles says.

LIFE COACH AND MENTOR Boyles is of the mindset that a coach’s job is not just about rallying players to do their best on the court, but also in life.

“While I coach volleyball, I also try to make the girls be better people. I WWW.1TECHNATION.COM

SPOTLIGHT

Terry Boyles is bringing out the best in athletes and biomeds.

teach them your integrity is worth more than any game. I never let them yell at an official or the other team no matter what. We play our game and do not worry about what we cannot control,” he says. “The team is more important that any individual accomplishment.”

“I also served six years in the Navy so I make sure they honor our country when the anthem is being played.

While at Lane they always did a Veterans Day special and I would attend and be escorted by someone from the volleyball team,” Boyles says.

He says that he plays sand volleyball on Sundays during the summer and that either girls he has coached, or is currently coaching, always play on his team.

“I put my heart into each team and ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

care for the girls more than just players. I have been used as a reference for job applications by many over the years. I get invited to several graduation parties every year from the girls I had in sixth, seventh and eighth grade. I would not be able to do any of this without the support of my wife, Roxanne,” Boyles adds.

Boyles has been in biomed since January 1999. His role at work has changed somewhat to adapt to the times.

“I have recently passed my Comptia Network exam, I already had my A+, so they decided I was the best person for the job,” he says.

“So now, my main job is to maintain any computer-based system in the Parkview Health System, which includes seven hospitals and one ER/

MOB center, to ensure they have current software, patches and make sure all the information is updated in our records. Also, I have to maintain current network diagrams of all systems and help with the gray area between IS and biomed when it comes to interfacing. I also collect MSD2 forms from companies,” Boyles adds.

He says that since his position is new, he is still learning his roles.

“The IS personnel have been very supportive and have taught me how to operate their software and tools they use to monitor different network servers,” he says.

Many high school volleyball players have had their lives enriched because of their experience with this HTM professional.

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SPOTLIGHT

SPECIAL ADVERTISING SECTION

SEE BEYOND: A New Approach to Device Repair, Service & Development Innovatus Imaging sees beyond boundaries to help health care professionals provide better patient care.

The company offers the widest breadth of repair capabilities, taking a holistic approach by coupling reverse engineering and rigorous testing to ensure the highest quality of repair and yield rates.

The company’s knowledge and experience spans the entire life cycle of medical imaging products – from design, development and manufacturing to distribution, sales and service.

“We have documented, verifiable experience and can point to results across the board that demonstrate this expertise,” said Dennis Wulf, chief executive officer. “Our commitment to R&D and constant innovation help our customers serve their higher purpose – delivering exceptional patient care.”

PROBE REPAIR Customers partner with Innovatus because of the company’s unparalleled expertise in ultrasound probe repair. And it’s that expertise that enables Innovatus to see beyond the ordinary.

Yielding exceptional repair rates within the third-party industry, the company’s foundation for comprehensive ultrasound repair services is built with customer care, knowledge and experience.

“Our team brings experience from the clinical environment,” said Bill Kollitz, president and chief operating officer, “so we understand and can often anticipate customer challenges to improve efficiency.”

The Innovatus probe repair services include TotalRepair – a 100% guaranteed repair solution on 140 popular

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ultrasound probes. The program also allows customers to elect to SWAP at the repair price; the company was the first in the industry to offer a program of this kind. This is one way Innovatus gives its customers peace of mind – knowing they will be back up and running as quickly as possible.

Innovatus was first to offer repairs for 3D/4D probes among non-OEM service providers. The company uses proprietary repair processes and tooling for oil handling and replacement to ensure longevity.

The company also repairs transesophageal echocardiography probes (TEEs), including advanced repair capabilities on 3D/4D TEE probes like the Philips X7-2t and GE 6VT-D. Rather than using a one-size-fits-all technique, Innovatus diagnoses the problem and disassembles each TEE to identify and rectify damage caused by fluid invasion often missed by other repair processes.

The company’s culture of continuous improvement includes investment in research and development to constantly enhance the organization’s device repair capabilities. Innovatus also has an FDA-registered site for the design and manufacturing of specialty ultrasound probes.

“We have the mindset of a device manufacturer. We understand the thinking and processes used in

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SPOTLIGHT

manufacturing and incorporate it into everything we do, including service and repair,” Wulf said.

MRI REPAIR The company knows MRI coils from the inside and out. Leveraging more than a quarter-century of experience as a coil manufacturer credited with numerous coil patents, the company is the leader in third-party coil repair.

With extensive electrical, mechanical and cosmetic repair capabilities, paired with one of the most extensive loaner inventories in the industry, Innovatus makes the repair process as simple as possible so health care providers experience maximized uptime.

CR SYSTEM AND DRY FILM PRINTER SERVICE Innovatus offers incomparable field service for CR systems and dry film printers so health care providers can extend the life of their equipment and

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

help optimize their bottom lines.

Comprehensive services are available for CR systems and dry film printers made by Agfa, Carestream/ Kodak, and Fuji. From preventative maintenance to emergency response, Innovatus offers quality repair service and delivery in the field where – and when – it matters most.

DIGITAL RADIOGRAPHY

When customers are ready to transition to digital radiography, the company offers the MVi-DR retrofit solution, which is designed to seamlessly integrate and convert a conventional X-ray room or portable unit into a digital radiography system. The team at Innovatus is highly trained, and can help walk providers through the steps of upgrading their suite.

“SEE BEYOND” It’s more than a slogan for Innovatus. It’s

the guiding vision for three companies that came together as one to provide best-in-class imaging devices and repair services.

Formed in September 2017, Innovatus is the result of three former companies – Bayer MVS, Wetsco Inc., and MD MedTech – joining forces to draw on their combined expertise.

Innovatus launched the new face of its combined global brand at the start of 2018. At the same time, the company underscored its renewed focus – to push past conventional boundaries in the medical imaging device industry, and to empower health care professionals to take patient care to the next level.

Headquartered in Pittsburgh, Innovatus maintains operations in Tulsa, Denver and the Netherlands.

For more information, visit www.innovatusimaging.com

AUGUST 2018

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INDUSTRY UPDATES

STAFF REPORTS

NEWS & NOTES

Updates from the HTM Industry

PHILIPS ACQUIRES REMOTE DIAGNOSTIC TECHNOLOGIES Royal Philips has acquired Remote Diagnostic Technologies (RDT), a UK-based innovator of advanced solutions for the pre-hospital market providing monitoring, cardiac therapy and data management.

“RDT’s portfolio of comprehensive connected emergency care solutions will complement Philips’ Therapeutic Care business and strengthen its leadership position in the EUR 1.4 billion resuscitation and emergency care market,” according to a press release. “Moreover, RDT will strengthen Philips’ ability to innovate, drive digital transformation in health care and enter new markets. Financial details of the transaction were not disclosed.”

Philips already offers a range of monitoring and therapeutic products and solutions to help emergency medical services, hospitals and lay responders accelerate the delivery of care at the scene. This offering includes automated external

defibrillators (AEDs), advanced life support monitors and data management solutions. RDT will complement this with a product range for ambulance and emergency responders, which includes Tempus ALS, a modularized monitor and defibrillator that offers premium functionality in a smaller, lighter and more flexible package. RDT also offers lightweight monitors equipped with telecommunication capabilities for various emergency responders.

“We are delighted to become part of Philips and continue on our journey that began over 20 years ago,” said Graham Murphy, CEO of RDT. “Our mission is very much aligned with Philips’ own, as we are committed to transforming the delivery of care and improving patient outcomes driven by customer-focused innovation. Together, we will continue to enable pre-hospital caregivers to make a real difference to patient outcomes everywhere.” •

COOK MEDICAL TO REPURPOSE CIGARETTE FACILITY Cook Medical announced a letter of intent was signed with the Whitaker Park Development Authority Inc. to acquire a long-standing facility at Winston-Salem’s Whitaker Park. A portion of the R.J. Reynolds building will transform into a modern, world-class medical device manufacturing facility.

“To turn part of the R.J. Reynolds building into a life-saving and life-changing medical device manufacturing facility is an exciting transformation,” said Barry Slowey, president of Cook Medical’s Winston-Salem facility. “We’re proud to reinvest in the community, the history and the local economy.”

Built in 1961, the 850,000-square-foot facility will be home to Cook Medical’s current workforce of more than 650 employees in Winston-Salem. Production at the facility ended in 2012. With a history of revitalizing 28

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once-vacant buildings, Cook plans to invest in the property so it will once again be an economic driver for the community.

“We need the new space to modernize and transform our operations and manufacturing that will continue providing innovative technologies to help treat patients around the world,” Slowey continued. “The flexibility that the R.J. Reynolds space provides will allow us to purpose build for efficiency in our production lines.”

The completion of the acquisition is subject to certain conditions, including inspections of the property and finalization of agreements with the City of WinstonSalem, Forsyth County and the state of North Carolina and is expected to occur in the third quarter of this calendar year. •

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PARTSSOURCE LAUNCHES NEW MOBILE APPLICATION At this year’s 2018 AAMI Conference & Expo, PartsSource introduced its new mobile application and text messaging notifications to help increase the speed and efficiency of placing an order in the hospital supply chain. With an increasingly mobile workforce, the PartsSource Mobile App with more than a dozen new features, plus the addition of text message notifications, enables clinical engineering teams to initiate the often complex and extensive ordering process for medical replacement parts.

Customers can access the entire PartsSource catalog via their mobile device, and quickly order a part while on the go, or take a photo right inside the PartsSource mobile app to send a quote request to a team of sourcing professionals. Approving managers can then receive push notifications and/or text notifications when a quote is ready for approval and authorize a purchase with a single touch within the mobile app.

“Complex procurement processes with many steps and required approvals can impede decision making, equipment uptime and patient care in a hospital,” said Mark Tomasetti, chief technology officer for PartsSource. “PartsSource now allows a technician to immediately initiate the ordering process on the go from the site of a repair, and empowers a manager to quickly approve an order and speed-up the process for an increasingly mobile workforce.”

The PartsSource mobile app allows instant mobile access to its marketplace including 4 million medical replacement parts and services and related order information. The PartsSource mobile application is available for download at The Apple App Store and Google Play store. Customers can also opt-in to receive text messaging, and can choose their preferred frequency for receiving text notifications. •

That’s where AUE comes into play.

For more information, visit PartsSource.com.

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INDUSTRY UPDATES

STAFF REPORTS

GE HEALTHCARE INTRODUCES VIRTUAL REALITY TRAINING With 25 percent of the Healthcare Technology Management (HTM) population expected to retire over the next 10 years, hospitals and health care systems face an increasing challenge to train the next generation of professionals safely, affordably and efficiently. At AAMI 2018, GE Healthcare introduced interactive, customizable training options enabled by Virtual Reality (VR) technology for HTM professionals who service CT and MR equipment.

GE Healthcare trains more than 8,000 HTM professionals each year. This training features “mixed reality” training using wearable devices and web-enabled technology that supports guided instruction for service and repairs. VR technology enables training to be conducted onsite at a provider’s facility.

“We have a few quantifiable outcomes achieved through the VR training technology,” said Amato DeRosa, system director, biomedical engineering, Hartford Healthcare. “The obvious is cost savings by eliminating travel to a GE training facility. Less obvious, but equally important, is the boost to employee engagement and morale. We no longer must ask engineers to travel over the weekend and take time away from their families. We have seen a quality of life improvement, too.”

The benefits of VR training also include helping impact a provider’s productivity and offering a safe learning environment: • Productivity: Students gain experience maintaining and troubleshooting a system at their work site. This allows them to avoid abandoning their station to travel to a training facility, from which they would be unable to provide

emergency support. Also, customized, on-site training is unique to each hospital and health system.

• Safety: VR training offers a safe, low-risk learning environment. It allows for mistake-driven learning where employees can safely make mistakes and learn along the way.

“Training the next generation of HTM professionals is a very hot priority right now, and virtual reality is going to be a big enabler,” said Art Larson, general manager, global services training & documentation, GE Healthcare. “This technology allows for the flexibility and customization health care providers want, making training available when and where it works best for them.”

VR is already being adopted in other industries including retail, hospitality and entertainment, and continues to introduce new applications in health care and medical training. •

BIOMEDICAL REPAIR & CONSULTING SERVICES INC. EARNS ISO 13485:2016 Biomedical Repair & Consulting Services Inc. has received a certificate of registration to the Medical Devices Quality Management Standard of ISO 13485:2016 with full design certified, in addition to its existing ISO 9001:2015.

Biomedical Repair specializes in the repair, parts and reconditioned equipment sales, and certification of all types of medical equipment for health care organizations, clinics, laboratories, hospitals, medical schools and pharmaceutical industry facilities nationwide from its Jupiter, Florida headquarters.

Founded in 2007, Biomedical Repair grew to become a national independent service and repair center for

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physiological monitoring products. The company is focused on innovation that delivers enhanced product support to the biomedical and clinical community.

Capabilities range from component level to system support. • For more information about Biomedical Repair & Consulting Services Inc., visit brcstechnical.com.

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INDUSTRY UPDATES

ACERTARA ACOUSTIC LABORATORIES R&D TEAM RECEIVES 43RD PATENT Acertara Acoustic Laboratories’ research and development team has been awarded United States patent #9,983,175 related to a device used for testing diagnostic ultrasound probes.

“This patent represents the 43rd patent our R&D team has been awarded related to diagnostic ultrasound system and probe testing devices. Our engineering team first developed the modern ultrasound probe testing paradigm more than 20 years ago when we introduced FirstCall at Sonora Medical Systems,” Acertara President and CEO G. Wayne Moore said. “It is our passion to continue redesigning the probe testing market by creating disruptive technologies that match the very complex and sophisticated ultrasound probes being used today, including 2D matrix arrays, single crystal arrays, and cMUT arrays. Our team is focused on the continuing challenge of taking our test equipment product development legacy to the next level and creating products that insure the safety and efficacy of ultrasound probes and systems for our most important customers – patients.”

“We have already made significant strides in that area by our introduction of the Aureon and ATLAS devices, both of which have patents issued as well as multiple patents pending,” he added.

The research and development team at Acertara Acoustic Laboratories has been awarded more than 40 U.S. and international patents for productas ranging from 3D ultrasound devices and complex test devices to devices that deliver supersaturated levels of oxygen to the myocardial tissue of heart attack patients. •

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INDUSTRY UPDATES

STAFF REPORTS

MOBILE MEDICAL REPAIR OFFERS NEW SERVICES Mobile Medical Repair has announced new service offerings, as well as a new partnership with Medimizer.

Mobile Medical Repair was recently trained to service the Carefusion Revel and Enve ventilators. Mobile Medical Repair can provide many benefits for customers. It offers a quick turnaround time for customers who choose to come to them for ventilator service as opposed to sending it back to the manufacturer. Mobile Medical Repair provides 24- to 48-hour

turnaround time on PMs. Mobile Medical Repair is also a company that takes the guesswork out of knowing when equipment needs to be serviced.

“We send reminder emails for necessary service so we can get your equipment scheduled in a timely manner keeping all equipment to code. In addition, we tag each piece of equipment with next due information for easy-at-your-fingertips review,” explained a company employee.

Through a partnership with Medimizer and a new software implementation, Mobile Medical Repair will be able to grant customers direct access to service records through a customer portal.

Customers can also request service through an “I Request” form. •

PHOENIX DATA SYSTEMS ANNOUNCES IOT PARTNERSHIP Phoenix Data Systems Inc. and Zingbox have completed the interface of AIMS and Zingbox’s IoT Guardian for Healthcare.

By integrating these two applications, HTM professionals gain visibility and security for medical devices by combining device context from AIMS with the device behavior powered by machine learning from Zingbox.

“With medical device security risks on the rise, IoT integration has become the

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focal point of cybersecurity in hospitals.

This partnership will provide AIMS users with a seamless interface that will allow them to identify and manage cybersecurity issues,” said Ben Mannisto, president and CEO of Phoenix Data Systems Inc. “Health care providers have been challenged for years to make sense of disparate and static solutions to ensure accurate inventory, protection from cyber threats, and ongoing maintenance of

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connected medical devices,” said Xu Zou, CEO and co-founder at Zingbox. “The integration of Zingbox and AIMS solutions enables health care providers to focus their effort on networks and connected devices that need it the most, by arming them with real-time visibility and device insight that they can trust and rely on.” •

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INDUSTRY UPDATES

BY ERIN REGISTER

RIBBON CUTTING

Introducing Stave Medical Equipment Services

BY ERIN REGISTER

D

avid Hanna, founder of Stave Medical Equipment Services, says the business is focused on reducing the cost of ownership of medical devices. The company’s name is a reference to a specific type of drum. As a drummer, Hanna has always admired the beauty and sound of a stave constructed drum kit.

“Stave is a construction method used where individual pieces come together harmoniously to form a finished product that, if done well, becomes a precision instrument,” David explained, “The health care system is similarly made of many different areas. Each area is responsible to identify how we can cut waste and make our organizations function with efficiency and precision. Medical equipment and service contracts are just one of these areas that we can look to cut waste.”

“I have been in the HTM/clinical engineering field for 15 years, operating as a biomed and imaging technician, as well as managing in-house HTM/clinical engineering departments,” Hanna said, “I have been very fortunate throughout my career to work with incredibly talented people who have a deep love for people and their profession. I was fortunate to work for a health care system that valued lean/kaizen work, which is focused on process improvement as well as a deep level of respect for each person you work with. I started to apply this methodology to our service contracts with great success while reaching agreements with our contractors that moved us from transactional relationships to partnerships. We soon started to see this success positively impact the budget, which turned heads in finance, drawing attention to clinical engineering.

Our department was also seen as contributing toward the reduction of health

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care costs. My desire in starting Stave is to help other health care providers achieve this same success in reducing operational costs and increasing value while strengthening vendor relationships.”

Q: WHY DID YOU CHOOSE TO START THIS COMPANY? A: I started Stave with a desire to live with purpose, driven by faith and family. This experience has drawn our family closer together in a way few experiences can.

Professionally, I wanted to focus in an area that strengthens the local HTM/clinical engineering department and positively impact the big picture of health care expenditures.

Q: WHAT IS THE MAIN FOCUS OF STAVE? A: Our work is to help health care providers cut their costs, but our “why” is focused on helping each client toward better living. If we can research and negotiate a service contract for our clients, does that allow them to focus on their core work that has been needing more attention? Can we get them home earlier to see their families rather than working late to get this accomplished? Can we help them achieve their strategic financial goal and reduce stress and/or anxiety that often come with these goals? Each of these are ways that can result in better living.

Q. CAN YOU TELL US A LITTLE ABOUT THE SERVICES STAVE OFFERS? A: Our company’s focus is to reduce the cost of service contracts and bring this service to the in-house clinical engineering team. We develop transitional plans and service training to get their team involved.

Most hospitals will still have some devices or modalities they choose to have serviced by an outside source. We still work to reduce the cost of these contracts, as well.

David Hanna awaits visitors to the Stave Medical Equipment Services booth at the 2018 AAMI conference.

STAVE MEDICAL EQUIPMENT SERVICES Website: www.stavemes.com Contact: David Hanna Phone: 509-237-9848 Email: david.hanna@stavemes.com

We also consult to streamline contract and/ or clinical engineering operations.

Q: HOW DOES YOUR COMPANY STAND OUT IN THE MEDICAL EQUIPMENT FIELD? A: All of our work intersects at the patient.

Every health care organization differs in the deployment of medical devices to deliver care to their patients. We connect with the front-line clinical staff to ensure any changes to service contracts will not adversely impact care or lead to lengthier down times. We then connect back to HTM/clinical engineering to strengthen the support structure to keep these devices in service and ready for patients.

Q: DO YOU HAVE ANY SPECIFIC GOALS THAT YOU WANT YOUR COMPANY TO ACHIEVE IN THE NEAR FUTURE? A: We want to be well established and recognized as a company dedicated to reducing health care costs and strengthening the HTM/clinical engineering field.

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INDUSTRY UPDATES

STAFF REPORT

B.R.I.T. TECHNICAL INSTITUTE SEEKS INVESTORS IN HTM DEVELOPMENT A

desire to serve, educate and advance the HTM/biomedical industry continues to fuel J.C. Newell in her quest to provide a solution that will fill a gap that she sees widening as more and more baby boomers retire from the profession and the next generation is tasked with maintaining more advanced technology.

A veteran with an educational background, Newell teamed up with like-minded individuals, Lisa Thomas and Douglas Redwine, to launch B.R.I.T. Technical Institute (Biomedical, Radiology, and Information Technology) to serve those interested in biomedical, radiology and information technology. The institute is conveniently and centrally located in the thriving Dallas-Fort Worth Metropolitan area.

“Our goal is to provide comprehensive, quality post-secondary education to equip students to enter the growing Healthcare Technology Management (HTM) and IT job market,” Newell explains. “Certificate programs will be offered for the first two years per a Texas Workforce Commission requirement. These offerings will target individuals who have already attained an associate degree and are looking to enhance their

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

skills and education. Once we have fulfilled our two-year requirement, we plan to add associate degree programs to our catalog.”

Newell says the organization could have certificate programs in anything, including customer service, but the goal is to serve the HTM community. She says that offering certificate programs geared specifically toward HTM professional will grow B.R.I.T. Technical Institute’s reputation and strengthen its bond with the community.

One-year certificate programs offered by B.R.I.T. Technical Institute are Biomedical Equipment Technology, Radiology Equipment Repair Technology, Information technologyMedical Device Integration and Information Technology-Cybersecurity.

Grants and scholarships to help offset the cost of the education and help with relocation and childcare are all part of the plan. The cost of the certificate programs is very competitive.

More than 20 people have already expressed an interest in attending classes at B.R.I.T. and becoming the next generation of HTM professionals who will be more advanced technicians.

The initial concept had B.R.I.T. Technical Institute as a not-for-profit education facility, but due to the high

J.C. Newell

costs of equipment and other obligations a decision has been made to be a for-profit organization.

“So, to ensure that we can infuse fresh new talent into the HTM workforce, reducing the gap of entrylevel technicians in the HTM field, while reducing the gap caused by baby boomer retirements, we are opening up 30 percent of our organization for investment,” Newell says. “Our goal is to infuse $500,000 into this venture.

We would like to invite you to join us in this endeavor, so that we may alter the perceived course of HTM today.”

For more information about the B.R.I.T. Technical Institute, including educational programs and investment opportunities, can be found online at www.redwell-ed.org.

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INDUSTRY UPDATES

BY AAMI

AAMI UPDATE AUSTRALIAN CLINICAL ENGINEERING DEPARTMENT WINS HTM WEEK CELEBRATION CONTEST The Clinical Engineering Department at The Royal Melbourne Hospital (RMH) in Victoria, Australia has been named the winner of this year’s best celebration contest for Healthcare Technology Management (HTM) Week for its unique, educational and fun combination of events.

Although there were a number of dynamic submissions for the contest, the events at RMH really stood out to AAMI’s Vice President of HTM Danielle McGeary. “I just kept thinking, ‘I wish I was there!’ when I was reading their submission,” McGeary said.

HTM Week, which took place May 20-26, is designed to promote awareness of, and appreciation for, the critical work of biomedical equipment technicians (BMETs), biomedical engineers (BMEs), clinical engineers and other HTM professionals – something that often goes unacknowledged, even by those working in the field.

“It is easy to fall into the routine that there is not enough time to celebrate the work of BMEs and BMETs with competing priorities from our healthcare technology management efforts,” said Simon Cowley, acting manager of RMH’s Clinical Engineering Department. “I have wanted to run events for HTM Week for a number of years. This year, a prior conference presentation and a great idea for a pump challenge from one of our BMEs aligned well with HTM Week.”

Cowley’s presentation, which he originally gave at the Society for Medical & Biological Engineering (NSW) Conference in March, focused on common medical device vulnerabilities and effective cybersecurity controls. The event attracted about 40 attendees, including HTM and IT professionals from multiple hospitals and government officials.

“Although I have run my medical device cybersecurity presentation multiple times, I was most pleased by the turnout and wide interest of the HTM Week medical device cybersecurity presentation,” Cowley said. “It is good to see

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that along with my team and IT colleagues at RMH, I am on the right path with highlighting the risk of cybersecurity for medical devices.”

RMH’s second event, the brainchild of Clinical Engineering Supervisor Emma Strachan, pitted three HTM professionals against each other to see who could rebuild an Asena PK syringe pump first. (All the pumps used in the competition had been decommissioned and were awaiting disposal – they were not returned to clinical use.)

Marina Alfons, an RMH biomedical engineer, was declared the winner with a time of one hour and two minutes.

Although the other competitors assembled their pumps faster, Alfons was the only one to successfully power up and start an infusion with a 50 mL syringe, according to Cowley.

TECHNOLOGY MANAGEMENT COUNCIL ADDS NEW MEMBERS Three healthcare technology management (HTM) leaders joined AAMI’s Technology Management Council (TMC), a group responsible for representing all professionals and disciplines that purchase, service and maintain healthcare technology, including BMETs, clinical engineers, quality assurance professionals and others.

The TMC works to create opportunities and resources for HTM professionals as well as elevate and advance the profession.

The newest members of the TMC are: Barbara L. Christe, program director of healthcare engineering technology management and an associate professor with the engineering technology department at the Purdue School of Engineering & Technology at Indiana University–Purdue University Indianapolis.

Janice Courtois, a BMET III at Allina Health in Saint Paul, Minnesota.

Bhaskar Iduri, director of clinical engineering and quality assurance at Renovo Solutions in Irvine, California.

Their terms began following the meeting of the TMC at the

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AAMI PUBLICATIONS WIN ASHPE, EXCEL AWARDS AAMI’s peer-reviewed journal, BI&T, and its twice-yearly supplement, Horizons, won gold awards from the American Society of Healthcare Publication Editors (ASHPE) in a national competition that recognizes “editorial excellence and achievement in the field of health care publishing.”

The cover story for the January/ February 2017 issue of BI&T, “The Danger Within: Confronting the Challenge of Healthcare-Associated Infections,” written by AAMI Director of Communications Amber Logan, received ASHPE’s gold award for Best Single News Article. The fall 2017, cybersecurityfocused issue of Horizons, edited by Senior Editor Gavin Stern, received a gold award for Best Special Supplement.

Two AAMI publications also advanced to the finalist round for the EXCEL Awards, a competition sponsored by the Association of Media and Publishing that recognizes excellence and leadership in nonprofit association media, publishing, marketing and communications. These were Logan’s BI&T cover story and an AAMIBlog post authored by Larry Fennigkoh, professor of biomedical engineering at the Milwaukee School of Engineering, that focused on why HTM professionals need to turn their data into knowledge.

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INDUSTRY UPDATES

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ECRI UPDATE

Shining a Light on the Must-know Technology Issues of the Moment

E

CRI Institute has addressed many new technologies in each edition of its annual Top 10 Hospital C-suite Watch List. Some have panned out, some have not, and some, like Google Glass, continue to be studied for new health care uses. As ECRI Institute celebrates its 50th anniversary of separating fact from fiction in health care, we trust that this 9th edition of the Watch List will help you better understand some of the technology and infrastructure changes in patient care this year.

This year’s list includes topics such as direct-to-consumer genetic testing, which is changing the face of what front-line clinicians encounter when patients walk in with test results they received on their own, asking, “What do variants of unknown significance mean? Should I be worried?” Below ECRI highlights two of the issues highlighted on the list; Acuityadaptable Rooms and Insertable Cardiac Monitors.

ACUITY-ADAPTABLE ROOMS: WILL STAFF ACCEPT THIS PATIENT-CENTERED CARE MODEL? Each time a patient is moved from intensive care to a step-down unit,

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from a telemetry unit to a regular med/surg unit, there is a risk to both the patient and the staff, as well as an impact on the patient’s anxiety.

These patient handoffs are known to cause a risk with medication, and health care leaders are looking at ways to reduce or eliminate handoff risks. Some hospitals are experimenting with an acuityadaptable care delivery model wherein a hospital keeps a patient in the same room from admission to discharge, regardless of acuity level. The aim is to improve workflows, enhance care continuity, improve patient safety, decrease length of stay and reduce costs. Every patient handoff avoided when an intrahospital transport is eliminated is probably associated with a reduced risk exposure, either via minimized medication errors, preventing patient falls or overburdening nursing staff that remain on the unit while one accompanies a patient transport.

Also, acuity-adaptable units eliminate the holding costs associated with keeping a patient in an intensive care unit while he/she awaits transfer to a step-down or telemetry unit.

While acuity-adaptable models make intuitive sense, many challenges exist in staffing, infrastructure and workflow to actually improve patient

outcomes. Just ensuring and maintaining staff competencies across all care levels requires a major rethink of nursing and hospitalist support models. How does a hospital using an acuity-adaptable model ensure that its highly trained critical care nurses are willing to work at lower care levels and, conversely, does every staff member have to be Advanced Cardiac Life Support certified?

Generally, hospitals that have implemented acuity-adaptable models focus on a particular type of patient to “house” in such a unit; cardiac, transplant and oncology patients are likely patient groups that can be

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INDUSTRY UPDATES

coordinated across acuity levels in one area.

For acuity-adaptable models to work, the medical equipment used for patient care is directed to the patient instead of transferring the patient to another unit. For that reason, some hospitals focus on step-down through discharge rather than critical care through discharge. The equipment intensity from step-down through discharge is much more manageable.

Infrastructure wise, acuityadaptable rooms generally include shower facilities in the toilet area and, depending on local building codes, may have to adapt for nursing staff being able to view the patient’s head in a critical care setting to a need for more privacy as the patient improves.

Some hospitals using acuityadaptable rooms are reporting significant cost savings per patient. In value-based medicine, these will be important to sustain.

WHAT YOU NEED TO KNOW • Form a steering committee of multidisciplinary members to address training, room design and patient charges.

• Include nursing staff early in the design consideration process to ensure competencies and buy-in to change the culture of care.

• Consider using a human factors expert in the design process to examine patterns of activity – current ones and future ones.

• Visit hospitals that have implemented acuity-adaptable care models.

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INSERTABLE CARDIAC MONITOR: CAN YOU GET IN FRONT OF STROKE BY GOING INSIDE THE HEART? About 6 million people in the United States have atrial fibrillation (AF), the most common heart arrhythmia often leading to stroke. For patients with AF, long-term continuous heart monitoring by electrocardiograph can help long-term medication management. Such monitoring is typically done using a Holter monitor for 24 hours to 7 days. However, Holter studies require placing several electrodes on the chest and abdomen and for the patient to carry a recorder, which patients find inconvenient. Also, Holter monitoring analysis is performed retroactively and requires multiple additional steps by both the patient and caregiver for data analysis and interpretation.

Enter the Confirm Rx™ Insertable Cardiac Monitor (ICM) (Abbott Laboratories, Abbott Park, IL, USA).

The small device is an implantable loop recorder cardiac monitor. This ICM is the first of its type to interface directly with a patient’s smartphone, which proactively transmits data to the patient’s physician. While a Holter monitor is worn externally and can be bulky, the ICM is implanted and connects via Bluetooth to the patient’s smartphone. Because the ICM transmits the data via a smartphone, the patient no longer needs to use a separate bedside telephone transmitter, and the transmitted data are fully encrypted and secure.

At intervals programed by the treating physician, the smartphone app automatically uploads patient data to the Merlin.net Patient Care Network for clinician access. Besides

being able to detect AF, the device can also record the heart’s electrical activity, which the patient controls by pushing a button on the app. This feature is useful when the patient has physical symptoms such as chest pain or syncope. The small device – 49 mm x 9.4 mm x 3.1 mm (about 2 inches x 1/3 inch x 1/10 inch) – weighs 3 grams. The Confirm Rx has no contraindications for use.

Implanting Confirm Rx is similar to implanting a pacemaker or ICD. The procedure is usually performed under local anesthesia, but patients with certain medical conditions may warrant moderate sedation. In 2017, the estimated worldwide ICM market was approximately $800 million and was expected to grow by $100 million a year.

WHAT YOU NEED TO KNOW • Determine how many patients would benefit from the Confirm Rx ICM. • Gauge your cardiologists’ interest in using implantable monitoring devices.

• Evaluate the payer mix and your reimbursement issues.

• Carefully develop credentialing criteria for interested cardiologists.

This article is excerpted from ECRI Institute’s 2018 Top 10 Hospital C-Suite Watch List. To download the full report, visit www. ecri.org/2018watchlist.

For more information on ECRI Institute’s evidence-based health technology assessment or consulting services, contact communications@ ecri.org, or call (610) 825-6000, ext. 5889.

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H

ealth care providers are adopting a similar mind-set to other data-centric industries when it comes to cyber risk. It is not a matter of if, but when an attack will take place. WannaCry provided a wakeup call for the industry and served as demonstrable evidence of the importance of proactive cybersecurity risk management.

This very public cybersecurity breach made clinical engineering teams reconsider service management best practices as well as tools and technology being employed to reduce their threat profile. The single goal is better protection for the network connected medical device fleet and patient data. The percentage of network connected medical devices is growing at a rapid pace. The American research and advisory firm Gartner predicts that connected medical devices requiring cybersecurity protection will grow 45 percent by 2020. In order for clinical engineering teams to have a fighting chance of improving the security posture of their medical device fleet, careful consideration must be given to the software and tools currently in use and embrace modernization and a technology-agnostic approach.

No single technology is a panacea for cybersecurity risk mitigation. The critical common denominator in good cybersecurity remediation across all industries is end-to-end technology and process interoperability. The more seamlessly integrated modern clinical asset management

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technologies are with IT security operations tools, the lower likelihood of a major system-wide cybersecurity event.

A lot has been discussed and written on best practices for clinical engineering teams to improve connected medical device security.

The focus is generally in traditional areas including audit, device identification, onboarding and monitoring. All of these are essential focus areas. However, contemporary cybersecurity planning also must include audit and evaluation of the supporting technology portfolio.

Here are four steps clinical engineer teams need to take to begin their journey toward embracing a modern, technology agnostic approach to medical device cyber risk mitigation.

1) Embrace the cloud: It is the health care provider’s prerogative to keep sensitive data and processes locked up in their legacy on-premise infrastructure. The challenge is that medical device data is inherently mobile, needed by multiple, simultaneous stakeholders and requires automation and analytics that legacy tools and technologies cannot accommodate. The rigid nature of existing solutions and the inability to embrace secure, modern cloud-based technology to store critical medical device data puts the clinical engineering team and the health care providers they support at a critical disadvantage.

2) Conduct a data interoperability litmus test: Clinical engineers are working more collaboratively with their peers in IT and information

security, playing the role of “boots on the ground” when it comes to mitigating new medical device cybersecurity risks. A deeper level of collaboration is dependent on ease of data sharing across functions, technologies and tools being used every day in the environment. Do your current tools and technologies have the right APIs? Can data flow freely from one system to another without heavy lifting on the part of clinical engineering or IT? Do you have to do manual data mining? Is working together with your peers hard because the tools and technology are old or don’t work together? These questions are an important part of the litmus test for your organization on your commitment to modernize or maintain the status quo. A technology and tools audit will provide you visibility into the answer to this question.

3) Determine the feasibility of standardizing disparate information to establish a common data model: The clinical engineering, IT and information security partnership relies today on a multitude of nonstandard nomenclature, taxonomy and naming conventions which limit clarity and visibility into the extent of the cybersecurity risk profile for the medical device fleet. Disparate data and non-standard naming make risk mitigation hard or impossible. An expanding number of network connected medical devices and a greater need for IoT data is not achievable with a common data model. Every day that goes by

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Alaris Replacement Parts & Repair Service without a commitment in this area expands the risk profile for the health care provider. Adopt technologies that provide the flexibility and extensibility and allow for easy conversion of disparate data into one clear data model. Progress in this area will have a positive, cascading effect on risk profile interpretation and cyber remediation activities for the entire medical device fleet. If the process of standardizing disparate data has to be manual, it’s time to retire the technology and move on to a new, modern cloud-based solution.

4) Adopt partner-friendly providers: No technology provider can do everything when it comes to medical device cyber risk mitigation.

Technology providers who prioritize the end-user experience over short-term revenue will ultimately win the day. Medical device cyber risk mitigation requires significant back-end systems orchestration. These requirements necessitate strong partnerships among key EAM, CMMS and cybersecurity technology providers. The cybersecurity marketplace affords ample opportunities for best-of-breed providers to team up and provide deeper levels of integration across their tools and solutions that give clinical engineers a lot of choices to make the health care provider safer.

These four steps should serve as a baseline for any technology or tool audit associated with medical device cyber risk mitigation initiatives.

Connected medical devices are becoming increasingly more important to safety in patient care and are increasingly susceptible to new cybersecurity threats. Extending the life of your old CMMS tools equates to putting a square peg in a round hole. This is no longer a viable option for modern clinical engineering teams. The time is now to embrace a technology agnostic approach.

Tom Stanford is the founder and CEO of Nuvolo.

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WEBINARS CONTINUE TO DELIVER CE CREDITS STAFF REPORT

T

he Webinar Wednesday presentation “Cyber Security for Medical Devices” by Nuvolo Director of Solution Consulting Andrew Sweet and Nuvolo Chief Technology Officer Asim Rizvi addressed key points. Almost 300 people attended the live presentation and even more have viewed a recording of the webinar. Attendees of the live presentation were eligible to receive 1 CE credit from the ACI.

The webinar focused on the challenges health care organizations face securing and protecting medical devices from cyber threats. Participants learned about four key disciplines of a prudent medical device security program.

The session was well received by attendees with several posting positive comments via a post-webinar survey.

“The webinars keep getting better and better. This one was very appropriate since AAMI emphasized cybersecurity at their recent meeting,” said C. Nanney, a national quality manager.

“This was a very informative webinar, addressed a lot of key points that a health system has to be aware of and track,” Clinical Technology Supervisor N. Braver said.

“Awesome webinar! Very relevant!

Very important to me. We just hired a biomed cybersecurity technician and this information is awesome,” Biomed Manager C. Donmoyer said.

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“This was a great webinar with a lot of necessary information for any hospital that is serious about keeping PHI safe,” Clinical Engineer A. Hipskind said.

“I have a professional background in computer information systems and biomedical technologies. Information security for health care services is unquestionably critical considering patient care risks and monetary damages due to retroactive responses to incidents. I am very pleased to see the Nuvolo EAM software platform combines many of the most important tools necessary for an organization to expand awareness and accountability and to proactively defend against threats before an incident occurs,” Biomed P. Baugher said.

“Wonderful and powerful presentation that not only addressed today’s hottest biomedical engineering departments headache – edical device network security life cycle management, it also provided the solution,” Clinical Technology Consultant F. Eslami said.

The overall webinar series also received praise from attendees.

“If you do not have Webinar Wednesday on your calendar, you are missing out on a wealth of relevant industry information,” Clinical Engineering Manager D. Mills said.

“Webinar Wednesday is great because I can learn about different biomed issues without having to be somewhere else physically. And I can

attend the seminar during my lunch time,” Biomed K. Hyun said.

“Webinar Wednesday is the best place, where you get hot info. I like it,” Medisend College Instructor D. Georgescu said.

“Presentations provided in the Webinar Wednesday series are delivered in a professional and efficient manner, covering important and timely topics.

Well worth the time to participate,” said Director of Biomedical Engineering S. Blumberg.

“Webinar Wednesdays are a great opportunity to learn about relevant topics that affect our industry. I always learn something new and look forward to the next webinar,” Biomedical Engineering Manager G. Havens said.

The recent PartsSource-sponsored webinar “Ensuring Quality in the Supply Chain” drew 170 HTM professionals and each was eligible to receive 1 CE credit from the ACI. The webinar featured PartsSource Vice President of Quality Assurance Jina Tweed and PartsSource Vice President of Commercial Operations Erin Tournoux. They discussed how great quality enables sustainable growth for an organization. There are several key performance indicators (KPIs) that health care organizations can use to measure and monitor the quality of medical device parts and the suppliers that provide them. They also explained how to ensure quality in the procurement process.

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Attendees learned best practices to evaluate for quality in the supply chain and how to build in benchmarks to ensure ongoing quality.

The webinar drew several positive comments from attendees and can be viewed at WebinarWednesday.live along with other previous webinars.

“Very thorough presentation on managing suppliers using quality as significant measure. System detailed among the best I have heard about. Very worthwhile webinar for quality professionals,” Quality Engineer J. Chapman wrote in a post-webinar survey.

“The presenter has an extensive background in quality and I was very impressed with the clarity and specificity she gave on the subject. I am forwarding this information to my colleagues to improve our own vendor dashboard,” C. Geibel, Program Manager said.

“It was a great webinar and provided good insight to the parts (supply chain) process,” Director of Healthcare Technical Management K. Forsythe added.

“This was my first Webinar Wednesday session. The topic was extremely important to me and the presenters were clear knowledge experts in the medical equipment service field,” Frontier Imaging Services President F. Vonder Haar said.

The overall Webinar Wednesday series also continued to receive praise from HTM professionals.

“Webinar Wednesdays fill a void for much needed continuing education in which the entire team can be involved and grow. Thanks TechNation,” said E. Clark, BMET Supervisor.

“The Webinar Wednesday series has done an excellent job of putting interesting and timely topics into one-hour segments to help keep HTM professionals updated,” Biomed L. Velasquez stated.

“These webinars are very helpful for staying on top of industry changes and trends,” Manager of Biomedical Engineering W. Scowden said.

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ROUNDTABLE

STAFF REPORT

ROUNDTABLE Ultrasound Systems

The global ultrasound devices market accounted for $7.80 billion in 2017 and is expected to reach $14.98 billion by 2026 growing at a CAGR of 7.5 percent, according to Research and Markets. Factors influencing the market growth are an increase in invasive medical and imaging procedures, rising demand for ultrasound technologies, increasing usage of geriatric medicines and growing investments and funds for upgrading devices. Moreover, developing high-quality imaging applications provides ample growth opportunities for the market during the forecast period.

TechNation reached out to industry professionals to find out more about ultrasound systems. Participating in this roundtable on ultrasound systems are Avante Ultrasound, formerly GMI, Marketing Specialist Doug Adams, Conquest Imaging Senior Director of Technical Operations Bob Broschart, Trisonics Global Sales Manager Chris Wildman and Mindray North America Senior Director of Service and Operations-Ultrasound Scott Williams.

Q: WHAT SHOULD HEALTH CARE FACILITIES LOOK FOR WHEN PURCHASING AN ULTRASOUND SYSTEM? Adams: When purchasing new equipment, the focus should be on image quality, proper diagnosis and improved outcomes for patients.

Too often the purchase experience revolves around brand loyalty, bells and whistles, new technology and pricing. A comprehensive and openminded approach to new equipment purchases should guide you to the best equipment for your needs.

Broschart: First and foremost, does the new system meet or fill a need clinically? Does it improve patient outcomes or fill a gap clinically?

Additionally, you always need to look at the cost of ownership over the life cycle of the system. What are my maintenance costs going to be? Is the system reliable? Is it a brand-new system on the market?

Will there be “bugs� in a new platform I need to be concerned about?

How are software upgrades managed? And lastly, is the new platform sustainable? By this I mean is the model upgradable to newer hardware functions as new clinical applications emerge.

Wildman: Look for a reputable company that will deliver on what it promises and that also provides outstanding customer service before and after the sale. Facilities should also ensure that the company they work with has a quality management system in place so the buyer can be confident in the quality of the product they purchase. Lastly, it is essential to discuss the total cost of ownership in regards to the ultrasound system so that the buyer understands the long-term financial ramifications revolving around the purchase as well as any service needs after the initial investment.

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ROUNDTABLE

Williams: When evaluating ultrasound technology, consider how the equipment will advance, grow or scale as your business needs change and evolve. Do they offer living technology? As the technology advances are you eligible to receive these capabilities during your warranty (i.e. expanded features or imaging improvements, etc.). Understanding how living technology is provided versus software patches is key to maintaining state-of-theart performance. With the equipment warranty and support offerings during the life cycle, a few companies are now offering five-year warranties that can also cover maintenance items like batteries and transducer damage.

Q: WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN AN ULTRASOUND SYSTEM PROVIDER REGARDING SERVICE AND PARTS? Doug Adams, Avante Ultrasound, formerly GMI Adams: Ultrasound providers should positively impact the readiness of your facility.

While pricing is a key factor, value adds such as field service engineers, technical support, training, transducer repair and parts should factor in the decision. ISO 13485 certification ensures that the provider is invested and committed to the highest standards of quality and service.

Broschart: Will the vendor provide service training? Will they make their training manuals available? How do they handle software upgrades when the service is being performed by in-house or third-party servicers? The basic question around parts is availability.

Does the vendor have adequate parts and probe supplies? Can they delivery parts/probes next day? What are their warranty terms? I also like to ask what a vendor’s warranty rates are.

Wildman: One of the most important factors facilities should look for is a service provider that has experienced, local engineers. This enables them to respond to needs thoroughly and quickly which limits machine downtime. Also, consumers should verify that the service company has a quality management system in place to assure that all parts are tested and of the highest quality. Another recommendation would be to check with local references to garner personal feedback and get firsthand accounts of the company in question.

Williams: Look for scalable offerings for facilities with on-site biomedical engineers or satellite offices. What programs do they have for training, parts depots and support for maintenance items like depleted batteries or accidental transducer damage?

Q: WHAT ARE THE PROS AND CONS OF NEW AND REFURBISHED ULTRASOUND SYSTEMS? Adams: New equipment has the latest and greatest technology and features that comes with a higher price. New equipment rushed to

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market can lead to software and hardware issues that could result in unwanted downtime. Refurbished equipment offers leading edge technology and features at a much lower cost to acquire. The age of the refurbished equipment can lead to parts availability issues due to end-of-life protocols by the manufacturers.

Broschart: I believe that from a practical standpoint there is little difference today in refurbished or new systems of the same model.

New platforms that add substantial new technologies and features are a different story. If you want or need new clinical applications that your current system does not have, or you want improved imaging, Doppler, etc. – and again, your current system cannot be upgraded – then new is the way to go. If you want to add a system or more to your existing inventory and you want to use the same model, then refurbished is a great way to go as you will save cost and get the added capacity you may need.

Wildman: The quick and obvious answer is the “price vs. peace of mind” mentality. There are two schools of thought and both are warranted and necessary for the health of the industry as a whole.

Some buyers love the new car smell and the feeling of having a multi-national corporation supporting them, but that feeling comes with a premium price tag. On the other hand, the buyer can consider a “lightly loved” or refurbished machine at a significant discount. The perceived trade-off is that with a lower price tag the consumer receives a lower commitment or expectation of reliability and service. Buyers need to research and get references for companies they are buying/servicing the machine through to bolster their confidence and increase the power of their budget.

Scott Williams, Mindray North America Williams: Many manufacturers offer demo or refurbished systems. You receive the latest technology but at a more affordable price. These systems will typically have a 12-month warranty with options for covering batteries, extended transducer coverage and preventive maintenance programs. Refurbished systems can offer good value for obtaining the latest technology, but have a shorter warranty term and exclusions.

Q: WHAT ARE THE MOST COMMON REPAIRS ULTRASOUND SYSTEMS REQUIRE? Adams: The most common repair for ultrasound continues to be transducers. Year after year, transducers remain the most delicate aspect of diagnostic ultrasound equipment. With more options than ever for repair of transducers, replacement is no longer the overwhelming standard.

Broschart: The ultrasound probes are the most failed/repaired items on ultrasound systems. They have a variety of problems that occur. The front-end boards on most systems tend to be the most

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ROUNDTABLE

failed system parts. Obviously, power supplies fail regularly. We see a lot of cosmetic issues such as broken control panel frames, switches and buttons, etc. LCD screens and monitors as well.

Chris Wildman, Trisonics Wildman: Typically, the transducers are the most common item to fail on an ultrasound system due to the constant use and possible user damage. With machines becoming smaller and more powerful, many common repairs are due to the lack of a regular preventative maintenance appointment. Where there were once 20 boards doing the computing in a large boxy unit, the new modern consoles and portable systems put many times the computing power in an ever-smaller space so keeping this area well ventilated and clean is essential.

Williams: System repairs and maintenance are often a function of how the equipment will be deployed. The point–of-care market continues to grow for ultrasound applications. More systems are now going mobile or to the bedside than in previous years. Hence, maintenance items like batteries are more critical along with transducer care. During portables or in a busy ER/trauma center, it’s challenging to protect the transducer from being dropped or having other equipment run over the cord during critical situations.

Under these circumstances, transducers see more extreme conditions and may require replacement for performance degradation or damage.

Q: HOW LONG CAN A HEALTH CARE FACILITY EXPECT A NEW ULTRASOUND SYSTEM TO LAST BEFORE IT NEEDS TO BE REPLACED? Adams: I have seen instances of equipment lasting 10-plus years, with proper care and maintenance, systems should last between 5-7 years. Technological advancements typically make the equipment obsolete before the system reaches the end of its operational life cycle.

Broschart: Typically, systems have a life span in ultrasound of 5 to 7 years. Obviously, some people keep units much longer. If a platform is easily upgradeable, the base unit can last many years. It, again, goes back to clinical needs. If your system meets all your clinical applications and patient needs and no new applications or technologies are on the market, then you can keep a unit a long time. One thing that can limit the life cycle of an ultrasound system is parts/probes availability. At some point, the support of parts and probes will dry up. When that happens, you need to upgrade.

Wildman: The answer will vary based on the facility, the function for which the system is used and how much use the system gets.

Proper care and preventative maintenance are a huge factor in how

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long the machine will last. Determining what new technologies are needed will also play a role as to when a facility will be ready for an upgrade or wants to replace their current system.

Williams: Historically, facilities would plan for the equipment to support their needs for 5-7 years based on the technology. As technology has advanced along with growing pressure on medical expenditures, facilities are looking for equipment to grow during the product life cycle and last 7-10 years.

Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING AN ULTRASOUND SYSTEM? Adams: The most influential factor on the longevity of any medical device, including ultrasound, is the education of the end user and biomed staff. Educating the clinicians on proper care and maintenance of the ultrasound machine, transducers, peripheral devices and network features will directly affect the life cycle of the equipment. Biomed departments have more options than ever for in-depth, hands-on training and support for maintaining the ultrasound equipment, transducer and related devices.

Bob Broschart, Conquest Imaging Broschart: Again, from my perspective, what new technologies and clinical applications am I going to receive from this new system? Am I going to generate more revenue for my hospital or practice and most importantly, improve patient outcomes? Does the system meet our needs currently and in the future? Regrading service and support, how long is my parts/probes availability going to last? Is the vendor easy to work with from a service perspective (training, technical support, parts/probes, etc.)? How easy is the system to service? This can make or break you in the long run.

Wildman: It seems customers can purchase ultrasound equipment anywhere these days, including eBay. It is important to realize that price shouldn’t always be the determining factor when choosing a system. Do your research on the company selling and make sure it has policies and procedures in place to deliver the highest quality both during and after the sale.

Williams: As the list of manufacturers narrows, consider how your team will receive clinical or technical support. If you have questions or maintenance issues, where will support be provided from, hours of operation and, importantly, how easy or accessible is technical support? If your warranty has expired, how does the support process or experience change? Can you talk with support before making a purchase decision or will payment be required in advance?

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PART of the

CLEAN TEAM

BY K. RICHARD DOUGLAS

Health care or hospital acquired infections (HAIs) infect one in 25 patients every day, according to the Centers for Disease Control and Prevention (CDC).

The introduction of an illness into a patient who is seeking wellness is paradoxical to the goals of the health care industry.

Many hospitals lose one percent of their Medicare payments because of the penalties they must pay under the Affordable Care Act through the Hospital-Acquired Conditions Reduction Program. As of this past January, that number included 751 hospitals that were guilty of having too many infections or patient injuries. This figure does not include many “specialty” hospitals that are exempt from the penalties.

The program requires that the worst performing 25 percent be punished even if they have shown improvements since they were last evaluated. Among other procedures, Medicare considers the rates of infections from hysterectomies, colon surgeries, central line tubes and urinary tract catheters.

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

The CDC reports that “more than half of all H A Is occurred outside of the intensive care unit.”

Bacteroides fragilis, clostridium difficile, staphylococcus aureus, norovirus, escherichi coli (E . coli), hepatitis A , B and C , psuedomonas aeruginosa and the list goes on and on; are just some of the infectious bacteria and viruses that make people sick in health care settings.

These pathogens could exist on equipment that is being serviced by the H TM department. Every effort must be taken to protect the H TM professional from contracting an illness because of a piece of contaminated equipment. Through cooperation with clinical colleagues, H TM can be an important link in the chain of responsibility for cleanliness and safety. It is a two-way street.

“AAMI and Association of

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PA RT of the C L E A N T E A M periOperative Registered Nurses (AORN) recommend a weekly testing of the cleaning process,” says Matt Smith, marketing manager for Healthmark in Fraser, Michigan.

Smith’s company provides monitoring tools to help verify that proper reprocessing of surgical instruments and equipment is routinely taking place.

Nobody wants to think that they played any part in even one patient acquiring an infection that they didn’t have before entering a health care facility. In the biomedical or clinical engineering department, steps can be taken to help mitigate that possibility.

All professionals in the health care setting play a role.

“ECRI Institute is concerned about the reprocessing (defined as cleaning and disinfection or

interchangeably. The CDC defines cleaning as the ‘removal of visible soil (e.g., organic and inorganic material) from objects and surfaces, which is normally accomplished by manually or mechanically using water with detergents or enzymatic products,’ ” Sivek says, referencing data from the CDC. “Thorough cleaning is essential before disinfection and sterilization because inorganic and organic materials that remain on the surfaces of surgical instruments and medical devices or equipment can interfere with the effectiveness of these processes,” Sivek adds.

She also explains that disinfection refers to a process that inactivates many or all pathogenic microorganisms, except for bacterial spores, on inanimate objects; whereas sterilization describes a

“ It’s important to understand the difference between cleaning, disinfection and sterilization since these terms are sometimes incorrectly used interchangeably.” AMANDA SIVEK, PH.D sterilization) efficacy of all reusable medical devices used within a patient environment. Proper cleaning and disinfection or sterilization of medical devices and equipment, such as endoscopes, infusion pumps and mattresses, are important factors in reducing the risk of patients developing healthcare-associated infections,” says Amanda Sivek, Ph.D, senior project engineer in ECRI Institute’s Health Devices Group.

“First, it’s important to understand the difference between cleaning, disinfection and sterilization since these terms are sometimes incorrectly used

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process that destroys or eliminates all forms of microbial life.

Sterilization is performed in health care facilities by physical or chemical methods such as steam under pressure, dry heat, ethylene oxide (EtO) gas, hydrogen peroxide gas plasma and liquid chemicals.

Sivek says there are three device categories that convey the degree of infection risk associated with the use of reusable medical devices. Critical devices, such as surgical instruments and endoscope biopsy accessories, come in contact with blood or normally sterile tissue. There is a likelihood of microbial transmission and risk of infection if a critical

device is not sterile. Users that perform reprocessing should be instructed to disassemble (if applicable), thoroughly clean, and sterilize critical devices after each use, she cautions.

“Semi-critical devices, such as endoscopes, come in contact with intact mucus membranes non-intact skin. Users that perform reprocessing should be instructed to thoroughly clean these devices and then reprocess them by sterilization,” Sivek says, noting FDA information.

“If the device design does not permit sterilization (e.g., device materials cannot withstand sterilization), then high-level disinfection should be used. Highlevel disinfectants ‘will kill all microorganisms except large numbers of bacterial spores.’”

She adds that non-critical devices, such as blood pressure cuffs, come in contact with unbroken skin. FDA recommends thorough cleaning, then intermediate or low-level disinfection for non-critical devices depending on the nature and extent of contamination. The CDC states that “low-level disinfectants can kill most vegetative bacteria, some fungi, and some viruses in a practical period of time (≤10 minutes). Intermediatelevel disinfectants might be cidal for mycobacteria, vegetative bacteria, most viruses, and most fungi but do not necessarily kill bacterial spores.”

“Unfortunately, any of these device types (critical, semi-critical, noncritical) can harbor infectious material and potentially contribute to patient infections in acute care, long-term care, ambulatory care or home care environments if they are not effectively reprocessed (cleaned and disinfected or sterilized),” Sivek says.

HTM’S ROLE The HTM professional has a role to play in the mitigation of infection control and damaged equipment that could lead to the spread of

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PA RT of the C L E A N T E A M

“Infections are a huge issue in our hospitals and we all must work together to insure patient safety so pointing fingers and blaming is not the aim of our proces.” DONALD ARMSTRONG pathogens. Communicating with affected departments and practicing safe handling procedures are a starting point. There is also the consideration that the cleaning process could damage a piece of equipment, which requires attention.

“We in biomed depend on our PEMS and SPD/CDS partners to bring us clean and disinfected equipment to work on, but sometimes equipment still makes it to us pretty dirty. We then use universal precautions to insure our safety. We will clean the units best we can (as we are not trained on cleaning and disinfecting), then we repair or evaluate the units, then return them to the units to be cleaned further,” says Donald Armstrong, CBET, CHTM, senior manager of biomedical engineering at Stanford Health Care in Palo Alto, California.

Armstrong and Richard Fechter presented on infection control and damaged equipment at the 2017 A AMI Conference in Austin, Texas.

Armstrong says that this has always been a process that needs to be continuously evaluated as staff turnover is high in some of the partner departments.

“We as biomeds are always trying to educate and inform when we find that we are getting dirty devices in our shops,” he says.

“Infections are a huge issue in our hospitals and we all must work together to insure patient safety so pointing fingers and blaming is not the aim of our process but to keep everyone aware that these devices

need to be cleaned and disinfected correctly before returning to the floors,” Armstrong says.

He points out that pictures are worth a thousand words. “So, we would take a picture and show the SPD/ PEMS/CDS manager the shape of some of the equipment is in when it comes to us,” he says.

“We will also take a device back to SPD/ PEMS/CDS and ask for the unit to be cleaned. Both methods work for that one device but does

“ We can expect the cleaning staff to address the exterior of a machine, but when blood gets inside and the machine needs disassembly to reach it, then it becomes our job.”

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

RICHARD FECHTER

not solve the greater issue. I have not come up with a formal report to trend how many devices come to us dirty. That would be the best way to track and trend how we are doing on this front,” Armstrong adds.

“Clinical/biomedical engineers can support the safe use of reusable medical devices by facilitating

effective device reprocessing by: working with EVS and nurse managers to ensure that non-critical medical device cleaning and disinfection instructions and supplies are readily available and that appropriate staff have the time and space to perform thorough device cleaning and disinfection,” Sivek says.

She says that HTM professionals can also facilitate the process by ensuring that updates to medical device cleaning and disinfection instructions are distributed to appropriate staff when they become available.

“Our policy also states equipment is to be cleaned before it is brought to our department for service. If we get one that is obviously still dirty, we will send it back to SPD for cleaning first,” says Richard Fechter, chief clinical engineer at UCSF Medical Center and UCSF Benioff Children’s Hospital in California.

“But even when it is clean on the exterior, we frequently find blood and fluids that have ingressed to the inside where it can only be accessed after disassembling the equipment.

We consider every piece of equipment to be contaminated unless it is wrapped sterile,” Fechter says.

“When taking something apart that has a reasonable expectation of being contaminated, we use appropriate PPE (gloves, gowns, face protection) and try to clean things as much as possible using our standard disinfection products,” Fechter says.

“For example, we might get a

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PA RT of the C L E A N T E A M piece of blood handling equipment like a heart-lung bypass machine or cell saver that had a disposable failure and was extensively contaminated with blood. We can expect the cleaning staff to address the exterior of a machine, but when blood gets inside and the machine needs disassembly to reach it, then it becomes our job,” he adds.

Fechter says that in the AAMI presentation, he recounted the incident that brought his attention to this topic.

“My presentation last year focused on the problems caused by using cleaning products that are incompatible with the materials used to make the equipment causing millions of dollars’ worth of damage and creating new patient safety hazards,” he says.

“I first recognized this problem while investigating an incident in 2004 where a new cleaning product had damaged the syringe holder on a syringe pump, causing the pump to sense the wrong size syringe and deliver double the intended dose of morphine to the patient. The patient in this incident survived, but this could have easily resulted in a death,” Fechter adds.

Fechter says that in the ECRI Top 10 Health Technology Hazards for 2018, three of the top five are related to disinfection of equipment.

“This is still a big problem in health care today. Many device manufacturers have changed the formulations of plastics used to better resist damage from cleaners,” he says.

“Companies making disinfectant products have also changed some of their formulations to be less destructive while maintaining adequate germ killing ability. I have worked with cleaner manufacturers, plastic manufacturers and medical device companies to minimize the problems, but there is still a lot that could be done.”

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COOPER ATIVE VIGILANCE Protecting patients, clinicians and HTM staff is a team effort. All departments that have any cleaning or disinfection role must coordinate and collaborate to cover all bases.

“The reprocessing of critical and semi-critical devices is normally performed by Central Sterile Processing; whereas the reprocessing of non-critical devices is usually

“ One of the most effective ways to ensure something is flagged for special attention is adding a label to the piece of equipment.”

MATT SMITH

performed by Environmental Services (EVS)/Housekeeping staff or point-of-care clinical staff,” Sivek says.

She says that for clinical/ biomedical engineering staff, it is important to collaborate with management in EVS/housekeeping, central sterile processing and nursing to facilitate the effective reprocessing of medical devices and equipment. A collaborative relationship with nurse managers, EVS/housekeeping managers, and central sterile processing managers may facilitate the faster identification of potential device problems in between inspection and preventive maintenance (IPM) intervals.

“In its 2018 Top 10 List of Health Technology Hazards, ECRI Institute identified that improper cleaning may cause device malfunctions,

equipment failures, and potential for patient injury,” Sivek says, citing ECRI Institute’s own published findings.

“To address the improper reprocessing of medical devices, clinical/biomedical engineering departments can: Affix labels to non-critical medical devices that specify the recommended reprocessing instructions and appropriate reprocessing materials to be used (reported in the medical device instructions for use).”

“Ask nurse managers, EVS/ Housekeeping managers, and Central Sterile Processing managers to inform their staff to inspect reprocessed devices and instruments for damage and wear,” Sivek adds.

Smith agrees that communication and cooperation are key.

“One of the most effective ways to ensure something is flagged for special attention is adding a label to the piece of equipment,” he says.

Biomeds can specifically mention that something is in need of repair or even simply notify staff if the equipment they are dealing with is clean or sterile.

“There are many options for customizing your labels so your message is being communicated to all staff throughout different departments,” Smith adds.

Constant and consistent open lines of communication and vigilance in taking precautions will go a long way in keeping patients, clinical staff and HTM safe from dangerous infections.

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EXPERT ADVICE

BY TODD H. ROGERS

CAREER CENTER

Rotten Bananas are for Banana Bread

BY TODD H. ROGERS

W

hen you come to work at TRIMEDX as a field manager one of your new-hire training sessions will be with me. I get one hour to provide a brief overview of our company’s interview and selection process. One hour is hardly enough time to cover all of the things that you will need to know so my lecture covers three essential elements. For the first 20 minutes, I rapidly cover the entire process. Next, I cover the importance of the hiring manager always being on the look-out for talented and ambitious people. Finally, I hold up my one and only visual aid and we talk about candidate perishability. That is the subject of this article.

Perishability refers to what happens to candidates whose interview cycle takes too long: the candidate loses interest and for whatever reason withdraws from consideration. The visual aid that I use is two pieces of paper. One is a picture of a nice ripe yellow banana.

The other is a picture of a rotten brown banana. The difference between the two is only a matter of days but one is delicious and the other resembles something that might require a shovel in order to remove it from your yard. To the new managers, this sends the message home that once a person enters the job interview process, the clock starts ticking. As time moves forward but the process does not, the candidate starts to experience fatigue. As time drags on, the level of fatigue steadily increases. Eventually the candidate’s attitude toward the employer starts to sour and shortly after that, the candidate’s attitude about your company is the same as a rotten banana.

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At this point, something else bad usually happens. The once excited candidate is now a sour former candidate who unfortunately tells other people about the unpleasant experience he or she had with your company.

Sometimes that person will even go online and write a review of the experience and suggest that future job-seekers avoid your company all together. For a recruiter, this is the kiss of death.

Here’s a typical sequence that will illustrate what this looks like from the candidate’s perspective as well as from the employer’s perspective. The candidate is sitting at home scrolling through jobs online and eventually finds your company’s open job. The candidate creates a user profile on the employer’s career site and applies to a job. The recruiter gets the application, calls or emails the candidate and a preliminary phone interview is scheduled. The recruiter phone screens the candidate and things go well. The recruiter tells the candidate, “I’m going to send over your resume and my notes and I’m going to recommend to the manager that he schedule an interview with you.

You can expect to hear back from me in 2-3 days.” The recruiter does as he says.

The hiring manager is busy doing manager things. He sees an email from you and it’s got a little paperclip on the email indicating that there’s a Word document attached to the email. He opens the email, then opens the attachment, reviews the resume, contemplates whether or not there’s a potential fit. The phone rings and it’s someone important with something urgent. The resume and email get disregarded as the manager tends to whatever issue just showed up. The

TODD H. ROGERS Talent Acquisition Specialist for TRIMEDX

manager finishes his work day, goes home and the resume is long forgotten.

Two to three days go by and the candidate is wondering what’s going on.

The recruiter said, “give me a couple of days and we will set up the next step.”

But the candidate hasn’t heard anything and is beginning to wonder if something is wrong. The candidate wonders about a lot of things. Is there an error on my resume? Is the job no longer available?

Do they not like my resume? Did something else change? All of these things get louder and louder in the mind of the candidate. He is beginning to show initial signs of interview fatigue and at this point he’s only spoken with the recruiter.

The recruiter calls the hiring manager and leaves a voice message, “Hey, it’s Todd, I’m calling to see whether you’d like me to schedule time with you and that candidate I sent over a few days ago. Please call me back.”

The hiring manager remembers he’s got a job open and that H.R. is interviewing applicants for him. He looks at his inbox for your email from a few days

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ago but then sees a few other emails that appear to be more urgent and more important. So, he decides to deal with those issues and never actually re-visits that resume. The candidate calls the recruiter to find out what’s taking so long. The recruiter doesn’t know because the hiring manager, being busy dealing with a crisis, forgets to call the recruiter back, again. So, the recruiter doesn’t have any new information to pass along to the candidate. The candidate, who also applied to other jobs, by the way, is starting to seriously wonder if your company is actually a decent place to work. The fatigue is growing and his opinion of your company is in decline.

Sadly, you and your company haven’t actually “done” anything wrong, because, well, you haven’t “done” anything.

Now it’s a week or two later and the hiring manager suddenly realizes that if he doesn’t get his job filled he’s going to be in big trouble. So, he locates your email with the resume, reviews it, and instructs the recruiter to set up an interview. But, guess what? That delicious banana no longer looks delicious. It looks rotten. It’s spoiled. The recruiter calls the candidate. The candidate recognizes the phone number and lets it go to voicemail. He has no intentions of returning the call. The recruiter emails the candidate, “Hey, I finally heard back from the hiring manager and he’d like to schedule an interview.” The candidate does not reply. The candidate already had two or three other interviews with other employers and in both of those instances, the process moved in a timely fashion.

The recruiter is frustrated because he’s got dozens of other jobs to fill and has to allocate his time carefully. If you’re a slow responding hiring manager, I hate to break it to you but you’re no longer on the top or even near the top of his list or priorities. But you need your job filled because stuff needs to get done and in order to do that stuff, you need people. So, what’s a hiring manager supposed to do? Here is where it gets easy. As the hiring manager, when that emailed resume arrives, you make a binary decision: “Yes, please set up and interview, my Outlook calendar is current.” The other option is, “No, the resume isn’t what I’m looking for. This resume isn’t a fit because…” and you provide the recruiter with a few details to share with the candidate as to why things are not going to move forward.

Read that last sentence again. It applies at every step throughout the process. If the candidate is, for whatever reason, being eliminated from consideration, you must give the recruiter some feedback to pass along to the candidate.

Otherwise, the candidate is very likely to feel slighted, and away he goes to Glassdoor to tell the world what a lousy company yours is. You don’t ever want that to happen.

So, the moral of the story is this. When you have an open job and your recruiter sends you a candidate, read the resume and respond with your decision or feedback. The absolute worst thing you can do is nothing at all. Doing nothing at all quickly produces rotten bananas. Unless you’re making banana bread, there’s absolutely nothing you can do with rotten bananas.

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EXPERT ADVICE

BY MICHAEL DAVIS

Sponsored by Because Quality Matters ISO 9001:2015 CERTIFIED

ULTRASOUND EXPERT Dropouts, Artifacts and Noise — Oh My!

BY MICHAEL DAVIS

I

received a call the other day from a customer stating they had moving lines throughout the image area.

These lines were curved and started at the top of the image area, slowly moving down and across. They appeared to be similar to spokes of a bicycle. After asking a few questions, I was able to determine the cause of the lines and offered up a solution. Here are some tips for troubleshooting noise and artifacts on an ultrasound system.

First, determine what type of image problem we are seeing on the screen.

There are four main problems that we usually see. They are dropouts, artifacts, noise and banding.

Dropouts are an actual loss of image.

They normally manifest as black lines running down the image. You will want to determine if the issue is with the probe or the system. Try moving the probe cable and connector on the system to see if dropout moves/changes.

Also try testing multiple probes on different ports and on another system.

All of this will help determine if it is caused by the probe or the system.

Artifacts are objects in the image area that should not be present, normally dots and lines that interfere with the image. They are usually confined to a specific portion of the imaging area and can look like snow or lines. Common causes are the boards

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associated with transmit/receive.

Noise is a subcategory of artifacts but generally covers a larger area of the image and are random. Noise can be described as speckles or lines in the image area. Noise can be seen in all imaging modes such as 2D, color or PW Doppler. Here, possible sources include probes, channel/TR boards or the power supply.

Banding is where a line is seen horizontally across the image area. The banding can be dark or light. Banding manifests itself in two ways, solid or moving. Solid banding is normally caused by one of the time gain control potentiometers. A defective or failing potentiometer will leave the portion over- or under-compensated. The other banding is a moving line that rolls from the top to the bottom and side to side, again described much like the spokes of a bicycle. This is called a 60 cycle hum and is commonly picked up through the AC line. One of the main causes we have run across is when a MRI or X-ray machine is nearby. Try moving the system to another room. If this is not feasible then you will want to install an AC isolation transformer in-line with the ultrasound system.

While there are many causes for these issues, I always follow one rule of thumb ... if the issue is horizontal, it’s the back end. If it’s vertical then it’s the front end. This little tip will save you a lot of time troubleshooting.

MICHAEL DAVIS Technical Support Specialist For ultrasound technical tips and tricks blog visit www.conquestimaging.com. See our online installation and removal videos.

Conquest Imaging Technical Support is available 24/7/365 at 866-900-9404.

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EXPERT ADVICE

BY INHEL REKIK

TECH TIPS

Cyper Profiling Medical Devices Is Important

BY INHEL REKIK

H

TM departments are overwhelmed with information on what they need to do to build their medical device security program and don’t know where to start.

It’s important to start with an accurate inventory and cyber profiling of medical devices. This means gathering: MAC addresses, IP addresses, hostnames, types of the network connection, operating systems and application software version on the device and keeping this information current in the CMMS system. Collecting this information will require touching every single networked device in your inventory.

This can be a major endeavor for some. HTM should either dedicate time for this effort or resort to hiring a third-party company to do it. The collected information should be centrally available for the HTM team and IT team.

Network attributes such as IP addresses and Mac addresses help the IT security and network team perform vulnerability scans on these medical devices as well as set up firewall rules.

HTM members need to familiarize themselves with all types of operating systems and how they are patched.

Knowing the OS of every medical device helps with life cycle management of medical devices. For instance, HTM can either upgrade or replace medical devices whose operating systems are near or at end of support. For the

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

devices that have an operating system that is no longer supported and cannot be replaced, HTM will need to provide a security exception request to the IT security team to have compensating controls put in place such as a physical firewall.

Having an accurate inventory of operating systems and application software versions running on the medical devices help quickly identify which medical devices are impacted with certain vulnerabilities. This will help to start the remediation or implementation of compensating controls.

HTM should have a standard on how hostnames are assigned to medical devices that will easily identify the facility, department and the device.

These should be registered with the network team. Hostnames are often what the Security Operation Center provides to the HTM team with when they detect that a device is infected with malware. Oftentimes medical devices are shipped with default hostnames and will require additional efforts from HTM and the networking teams to change and register new hostnames.

In conclusion, HTM will need to cyber profile any new medical device and make sure that this information is kept accurate in the CMMS system. This effort will save time and effort in the long run and will make preventing and addressing a cyber incident easier.

INJEL REKIK Director of Health Technology Security at MedStar Health

Inhel Rekik is Director of Health Technology Security at MedStar Health.

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EXPERT ADVICE

BY JIM FEDELE

THE OTHER SIDE Got a New Equipment Quote?

Watch Out for This New Line Item.

BY JIM FEDELE

I

nherently companies are always trying to grow and improve their bottom line; medical equipment manufacturers are no different. Like negotiating for that new car, most medical equipment manufacturers discount the purchase price of equipment. However when they provide discounts it means their profits are going down. I would like to share with you a new line item that is showing up on my new equipment quotes that caught me completely be surprise.

The line item is called “project management” and you better hold on to your wallet because it is an expensive number. So far only a couple of OEMs added this line, but I am seeing it occur more and more every day. Here is my experience with this new line item and the associated “value” it brings.

Because of the new hospitals we are adding to our system, almost weekly I am requesting quotes for new monitoring systems. I meet with the users and the leadership to ensure everyone’s needs are met. The process takes time as we need to make sure we have thought of everything that is needed. I ensure there are site visits, demos and reference calls. I try to ensure we over communicated every aspect of the new purchase to feel good that the quote will accommodate everything we need.

During a recent request for a quote, the sales rep was calling often with new questions about infrastructure items and installation questions even after we felt we covered these questions

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previously. As I recall the experience, I do remember him using the word project manager. I did not think too much about it, but that would soon change. When I finally received the quote, I noticed that the amount was over the budgeted amount that we had talked about at length. As I reviewed the quote line by line, I noticed a new line item called project management.

The number was significant and, as a matter of fact, it pushed the quote over the budgeted amount. I questioned the sales rep and he explained that it was needed to handle the implementation and installation of the system. I asked for a meeting with the sales rep and project manager to discuss this line item face to face.

My meeting with sales rep and project manager went well, I explained to them that I really needed to understand what the project management fee meant and if it could go away because it was pushing us over budget. They proceeded to tell me about why it was necessary to have a project manager and that it was required by the company. They said the project manager would coordinate everything needed to ensure a seamless transition. They would schedule the user training, work with IT, work with maintenance and requirements the monitoring system needed would all be channeled through him. Of course, I suggested that it is expected that you do all these things as part of the purchase? It kind of felt like buying a new car and then being charged to learn how to use it. They explained

JIM FEDELE, CBET Director of Clinical Engineering for Susquehanna Health Systems

that we always paid it, the number used to be part of the individual monitor price. I also did not like that the amount was just a percentage of the total quote, not a true representation of actual costs. I wasn’t completely sold, but conceded after our purchasing director checked the discounts and the pricing was good.

We cut them the purchase order to do one of the hospitals. It was a small installation, which I felt would be a good test for this project manager line.

The project has been completed, the monitors are installed and the users are happy. How do I feel about the project management line? I was very disappointed to say the least. I felt like all he did was waste people’s time with big meetings, it was like he was trying to justify his position. I felt bad for our nurse managers who were pulled into hour long meetings for two minutes that applied to them. I was going crazy because the project manager didn’t find out anything on his own. He went through me for everything. I might as well have installed the system myself.

Maybe it was just this project manager that was the problem or maybe he knew I had been questioning the value of his assistance, but I did more work getting this monitoring system installed than any others before it. At the end, I told the sales rep that he

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EXPERT ADVICE

owed me the money for project management because his guy REPAIRMED OFFERS A NO-HASSLE WARRANTY ON ALL REPAIRS! did not do anything that earned him the cash.

As I reflect on the lessons learned, and advice for you the reader, here is what I would suggest to you given that most companies using a paid project manager will not be willing to remove their services from the quote. Meet with the project manager before cutting a purchase order and interview him/her to make sure they have a personality that RepairMed is a one-stop component-level repair depot will “fit” with your facility. Don’t be afraid to ask for a whose services include the most comprehensive and cost effective flat rate repair pricing in the industry! different person. Ask to review any presentation or meeting items ahead of time to ensure only the needed staff attends RepairMed repairs all models of these the meeting. Insist they visit your site before the kick off and devices to component level: two weeks before installation, so they have time to fix anything missed. Be sure they understand that they need to • Defibrillators/AED • Infusion Pumps Including meet with the key people individually to understand their Baxter Sigma Spectrum • LCD/Surgical Displays needs and timelines.

• Feeding Pumps • Precision Flow – Based on my experience, I am not impressed with this Vaportherm • Syringe/PCA Pumps project management line. I think it could be a perception • Electro Surgical Units (ESU) • Patient Monitors issue. If it was hidden in the monitor cost andNEEDED appeared to be PROOF APPROVED CHANGES • External Pacemakers • EKG Carts free I probably would like it better – even if it was a wash.

• Many other devices • Vital Signs Monitors WhenSIGN–OFF: I see companies moving dollars around I get CLIENT not listed.

• Pulse Oximeters suspicious. Be aware, as I am sure you will see more project management items in your future.

PLEASEline CONFIRM THAT THE FOLLOWING ARE CORRECT

PROOF SHEET

LOGO PHONE NUMBER WEBSITE Jim Fedele, CBET, is the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/ or comments via email at info@mdpublishing.com.

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EXPERT ADVICE

BY ROGER A. BOWLES

THE FUTURE Different Generations

BY ROGER A. BOWLES

J

udging by the number of people inquiring about our program and taking tours, the fall 2018 semester should be a good one as far as attendance. The age distribution of these potential students seems to be shifting younger. Today, students in my classes vary in age from 18 to 45, with seemingly equal representation from each age group. However, the tide may be turning.

After teaching here for over 21 years, I’m starting to see that I’m one of the old guys and I feel it every time I look around. Walking down the hall, I see a lot people staring down at their “devices,” white ear buds planted firmly in each ear, and, for the guys, caps turned backwards (perhaps to be able to read those dim screens better). At my age, I’ve given up reading those screens without my readers and my coordination evidently isn’t what it used to be because I wouldn’t even think about walking down the hall looking down at a screen. I might accidentally run into someone else or even an open door.

I’ve heard other instructors lament about “millennials” and the next group, “Gen Z’ers,” but it is now starting to really draw my attention. One example is email. I will email out a message to students on their school email (about an assignment or if a class schedule change) and over half will not read it. “We are actually supposed to check that?”

“Email is for old people.” Well, I guess

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that would be me. Another example is using outdated references. When talking about resumes, I would say, “your resume is like a Yellow Pages ad,” just to be looked at with totally blank stares and the inevitable question, “What is a Yellow Pages ad?” Another example is seeing a student Google answers on his cellphone during a test. “I didn’t think that was cheating.” My fault, perhaps I didn’t make the purpose of tests clear enough.

In all seriousness though, it is obvious that some things have changed.

It sometimes feels good to lament with other veteran instructors about things we see, but the truth is that we have to find ways to reach these students and properly engage them in order to create future technicians. Some things I’ve learned. First, they enjoy interaction in the classroom. Instead of just pure lecture, we incorporate activities like “Jeopardy” to reinforce key points.

Second, the learning has to have context. Incorporating stories, short YouTube videos and real, working equipment with hands-on learning, makes topics relevant. Third, standing up in front of a class and droning on for an hour is a good way to ensure that I am tuned out early. Talking about something for 10 minutes, demonstrating it, having them do it and then talking about it again for 10 minutes seems to hold their attention and excites them. I ask questions and move around the room to make sure everyone is participating. Also, I

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

respectfully ask that they not engage with their “device” while in class.

Finally, I’ve learned a lot of my ability as an instructor revolves around respect for the student and being a “normal guy” and not be up on a pedestal. Yes, I laugh and poke fun at them sometimes, but I also laugh at myself when I make mistakes. Being human, while it doesn’t make us the same age, shows that I’m a person and therefore more approachable.

I can’t always identify with the stuff they do. Last semester, one student asked me what my favorite video game was. When I said “I don’t play video games”, he asked me what I do for entertainment. “I go outside,” was my response. I didn’t mean it to be funny, but apparently it was taken that way.

But, the interaction in the class improved dramatically.

The bottomline is that every generation changes. Those of us in the older generations don’t need to change, but as instructors and trainers we do need to learn to relate. There are literally thousands of articles on this so I will not cite research … just something to think about.

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EXPERT ADVICE

BY MANNY ROMAN

ROMAN REVIEW Problem or Opportunity

BY MANNY ROMAN

I

heard it again just the other day.

Statement, “We have a problem.”

Reply, “That is not a problem, it is an opportunity.”

Somebody, somewhere, decided for the rest of us that we should never say the word “problem.” The word has such negative connotations that some managers actually get angry with anyone that uses that nasty word when presenting a newly found “opportunity.”

We are required to substitute “opportunity” for the “P” word.

Opportunity is supposed to reframe the situation into a positive, thus we should be happy that the situation showed up.

This reframing can be a great thing. It allows people to maintain a positive attitude and drive toward a solution.

However, the drive toward the solution is performed without regard for the cause of the “opportunity.” The focus is on driving ahead with a forward-looking attitude.

An opportunity is a great thing. We all love opportunities. They are everywhere if you look for them. In business, these are the gold nuggets we look for in order to grow and prosper.

They are to be taken advantage of with great delight. We even feel that we can create opportunities. Long live opportunities.

Problems are bad. They cause anxiety, frustration and high blood pressure.

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

They are to be avoided and prevented.

They are not to be discussed or even mentioned. They must be converted into an opportunity. Death to problems!

If you agree with all of the above, stop reading this and move along because you are not going to like what I am about to say.

A true opportunity tends to have an easily discovered and seen condition. It is as if, “There it is, let’s go for it.” We are truly happy when an opportunity shows up. A problem will normally have a cause, and often it will be a hidden cause. Hiding a problem further with the “opportunity” word may make people feel better for a while. Is anyone really happy when a problem shows up, even a disguised one? Does anybody really believe that a problem is actually an opportunity in disguise? It may be, but only after analysis and due consideration.

I believe in calling a problem a problem. You see, if you insist on calling it an opportunity, you are going to be forward-looking for the good in it. This is not bad in itself as long as you are not deluding yourself and others in the process. Sure, it sounds negative, however calling it what it is causes us to view it in reality. We then understand that there exits a cause. Problems have causes.

Ascertaining the cause of a problem is a backwards process. We look back to see what happened not forward while ignoring the cause. If we define the

MANNY ROMAN, CRES AMSP Business Operation Manager

problem well, we will see the cause well.

We then can correct the cause and the problem. Thus preventing the reemergence of the problem in the future.

We fix problems and take advantage of opportunities. My concern is that I see leaders refuse to see problems for what they are: caused by something. That something needs to be addressed. Taking the attitude that if we don’t acknowledge it, it does not exist, has never worked well.

Oh, you know what? Why not reframe it, not as an opportunity but as a “challenge.” Yeah, that is much more positive and not as disconcerting. If I “challenged” you to a duel, your focus is on ensuring that you aim well, not on what caused me to present the challenge. Again, the cause may wind up ignored because we are looking forward, not backward.

Apollo 13 Astronaut Jack Swigert said, “Houston, we’ve had a problem.”

He did not happily say, “Houston we’ve had an opportunity here.” It was indeed a life-threatening problem.

So, in closing, if you have a problem with anything I have said, I challenge you to turn it into an opportunity to ignore my great wisdom once again.

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BREAKROOM

STAFF REPORT

DID YOU KNOW? Science Matters

Why some get cold hands fast and some don’t Researchers have found that muscle mass predicts how fast a person loses heat from the hands in severe cold, while height, body weight and fat mass do not.

Scan 1

Scan shows how cold hands are

Scan 2

Fingers chill quickly because they have a large surface area and small volume

Coldest

Images at left are infrared camera pictures of hands showing effect of soaking in ice water

Warmest

Analyzing effect of body type 1 Hands of 114 volunteers

4

The cooling was compared statistically with each person’s body measurements

Fat insulates,

age 18 to 50 were imaged with an infrared camera

2

They then submerged their hands in ice cold water for 3 minutes

3

Warmth of specific areas of the fingers was then measured

Study found great variation among individuals

but muscles are crucial, producing heat to warm the rest of the body – and the hands

More muscle

Less muscle

Source: Stephanie Payne of University of Cambridge; American Journal of Physical Anthropology; TNS Photos Graphic: Helen Lee McComas, Tribune News Service

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THE VAULT D

you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your o chance to prove it! Check out “The Vault” photo. Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will be entered to win a $25 Amazon gift card. To submit your answer, visit 1TechNation.com/vault-august-2018. Good luck!

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JUNE 2018 WINNER

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expand your knowledge and earn CEUs

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Webinar Wednesdays are all-right!

Webinar Wednesday series is a great way to expand your education and earn CEUs in a convenient format.

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SCRAPBOOK

Oregon Biomedical Association Expo

T

he fifth annual Oregon Biomedical Association Expo and Vendor Fair was held on May 17-18. Dennis Minsent from The Joint Commission delivered the keynote address, “Joint Commission Updates 2018: Medical Equipment Standards.” Nearly 130 attendees registered for the event which saw the first joint educational venture with the Oregon Society of Radiologic Technicians. Three separate classroom tracks were available to choose from where topics ranged from IT networking and cybersecurity to conflict management. Nearly $700 in gift cards and donated prizes were raffled off to the members. The Oregon Biomedical Association officers wish to thank the members who turned out and the nearly 30 vendors that made the 2018 OBA Expo and Vendor Fair a success. For more information visit orbmet.org

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BREAKROOM

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Inc Be ch ludinn C. an g is ma ce fo fish grea ke r B ing t at the en . Th pl pe C. t is is enty rfe o g de o ct et fin f th mi in ite ing ni no ly s! fis va a hin tiv go g r e a od od nd .

Ben C. g o way from es to Mexico! H e is h biomedicome, but still loo a long kin al duties to comp g for lete. ly ct rfe him pe g n in s i lp . fit he sks C. hile ta en w ily ! B sk da fit de is ct l’s te h rfe nie le pe tha mp s a a co It’ n N o

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SERVICE INDEX 11

P P P

14,69

7

P P

Asset Management Asset Services 913-383-2738 • www.assetservices.com Technical Life Care Medical Co. 651.407.9300 • technicallifecare.com

P

31

77 17

ALCO Sales & Service Co. 70 800-323-4282 • www.alcosales.com BC Group International, Inc 88 314-638-3800 • www.BCGroupStore.com Biomedical Repair & Consulting Services, Inc. 36 844-656-9418 • www.brcsrepair.com Crothall Healthcare Technology Solutions 75 (800) 447-4476 • www.crothall.com D.A. Surgical 23 800-261-9953 • www.da-surgical.com iMed Biomedical 85 817-378-4613 • www.imedbiomedical.com Master Medical Equipment 65 866-468-9558 • masterfitmedical.com Medical Equipment Doctor, INC. 6 800-285-9918 • www.medicalequipdoc.com PRN/ Physician's Resource Network 49 508-679-6185 • www.prnwebsite.com ReMedPar 77 800-624-3994 • www.remedpar.com ReNew Biomedical 23 844-425-0987 • www.ReNewBiomedical.com RepairMED 14, 69 855-813-8100 • www.repairmed.net Retrieve Medical Equipment 86

P

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

(330) 963-0277 • www.retrievemedicalequipment.com

34 31 35

P P P P P P

C-Arm ReMedPar 800-624-3994 • www.remedpar.com

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32

P

P

Calibration Rigel Medical, Seaward Group 813-886-2775 • www.seaward-groupusa.com Technical Life Care Medical Co. 651.407.9300 • technicallifecare.com Soaring Hearts Inc (855) 438-7744 • www.soaringheartsinc.com

31

Biomedical

Stave Medical Equipment Services 509-237-9848 • www.stavemes.com Technical Life Care Medical Co. 651.407.9300 • technicallifecare.com Total Scope, Inc (800) 471-2255 • www.totalscopeinc.com/

86

3 31

P

16

P

11

P P P P P P P P P P

Cardiac Monitoring

Batteries Holden Battery Services, LLC 800-594-9257 • www.x-raybatteries.com PartsSource 877-497-6412 • www.partssource.com/shop

Technical Prospects 877-604-6583 • technicalprospects.com

TRAINING

85

(330) 963-0277 • www.retrievemedicalequipment.com

SERVICE

Retrieve Medical Equipment

A.M. Bickford 800-795-3062 • www.ambickford.com Gopher Medical 844-246-7437 • gophermedical.com RepairMED 855-813-8100 • www.repairmed.net USOC Bio-Medical Services 855-888-8762 • www.usocmedical.com

PARTS

Anesthesia

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

AD PAGE

Company Info

77

P P

Cardiology Gopher Medical 844-246-7437 • gophermedical.com InterMed Group 386-462-5220 • www.intermed1.com ReMedPar 800-624-3994 • www.remedpar.com Southeastern Biomedical, Inc 828-396-6010 • sebiomedical.com/ Southwestern Biomedical Electronics, Inc. 800-880-7231 • www.swbiomed.com Technical Prospects 877-604-6583 • technicalprospects.com

26 77 43 27 32

Cardiovascular Technical Prospects 877-604-6583 • technicalprospects.com

32

P

39

P P P P P

P

Computed Tomography Altima 844-548-4540 • www.altimadis.com Exclusive Medical Solutions 866.676.3671 • emedicalsol.com Injector Support and Service 888-667-1062 • www.injectorsupport.com International X-Ray Brokers • internationalxraybrokers.com/ Retrieve Medical Equipment (330) 963-0277 • www.retrievemedicalequipment.com

RSTI 800-229-7784 • www.rsti-training.com Technical Prospects 877-604-6583 • technicalprospects.com Tri-Imaging Solutions 855-401-4888 • www.triimaging.com

42 70 39 86 66 32 55

P P P P P P P P P

Contrast Media Injectors Injector Support and Service 888-667-1062 • www.injectorsupport.com Maull Biomedical Training 440-724-7511 • maullbiomedicaltraining.com

70

P P

69

P

29

P P P

Diagnostic Imaging Advanced Ultrasound Electronics, Inc. 1-866-620-2831 • www.auetulsa.com International X-Ray Brokers • internationalxraybrokers.com/

39

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Healthmark Industries 800-521-6224 • HMARK.COM PRN/ Physician's Resource Network 508-679-6185 • www.prnwebsite.com Total Scope, Inc (800) 471-2255 • www.totalscopeinc.com/

22 49 35

P P P P

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

36

P P

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

70

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

22

45 46 65

P P P P P P

Infusion Therapy AIV 45 888-656-0755 • aiv-inc.com Elite Biomedical Solutions 46 855-291-6702 • elitebiomedicalsolutions.com FOBI 77 888-231-3624 • www.FOBI.us Master Medical Equipment 65 866-468-9558 • masterfitmedical.com RepairMED 14, 69 855-813-8100 • www.repairmed.net Select BioMedical 63 866-559-3500 • www.selectpos.com USOC Bio-Medical Services 7 855-888-8762 • www.usocmedical.com

P P P P

P P P P

P P P

36

P P

4

P P P

Mammography Ampronix, Inc. 800-400-7972 • www.ampronix.com Exclusive Medical Solutions 866.676.3671 • emedicalsol.com International X-Ray Brokers • internationalxraybrokers.com/ ReMedPar 800-624-3994 • www.remedpar.com RSTI 800-229-7784 • www.rsti-training.com

42 39 77 66

P P P P P

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

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iMed Biomedical

Leading the Industry in Biomedical Solutions

A Full Service Dialysis Package

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Calibrate, Calibrate, then then Celebrate.

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Dialysis technology is essential for your patients undergoing renal replacement therapy. Therefore, it is vital for hospitals to keep their dialysis machines working properly to ensure patient safety. OEM provisions require these machines to receive PMs per every 4,000 hours of usage, but even with proper upkeep - things happen.

Riken FI-8000P Portable Gas Indicator Riken FI-8000P Portable Gas Indicator

Parts break and systems fail. Dialysis repairs can be costly, and time-consuming. iMed Biomedical offers its customers a full service agreement that covers the annual cost of PMs, repairs, and parts for $3900 per unit.

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SIMPLE TO USE 01 TO USE 01 SIMPLE RAPID ANALYSIS 02 ANALYSIS 02 RAPID NO CONVERSION FACTORS 03 03 NO CONVERSION FACTORS

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ALPHABETICAL INDEX A.M. Bickford…………………………

85

Maull Biomedical Training……………

Adel Lawrence Associates……………

85

Medical Equipment Doctor, INC.……… 6

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

29

MW Imaging…………………………

53

AIV……………………………………

45

Ozark Biomedical……………………

36

ALCO Sales & Service Co.……………

70

Pacific Medical …………………… 42, 72

Altima…………………………………

39

PartsSource…………………………

17

Ampronix, Inc.…………………………… 4

Phoenix Data Systems………………

16

Asset Services…………………………

31

ATS Laboratories………………………

35

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

49

BC Group International, Inc…………

88

Pronk Technologies, Inc. ……………

61

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

ReMedPar……………………………

77

36

Renew Biomedical……………………

23

BMES…………………………………

87

RepairMED………………………… 14, 69

MedWrench……………………… 75, 80

Conquest Imaging………………… 8, 64

Retrieve Medical Equipment …………

Crothall Healthcare Technology Solutions…………………

75

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D.A. Surgical…………………………

23

ECRI Institute…………………………

54

Elite Biomedical Solutions……………

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FOBI…………………………………

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Global Medical Imaging………………… 2

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Southwestern Biomedical Electronics, Inc.………………………

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Stave Medical Equipment Services…………………

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Holden Battery Services, LLC…………

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Technical Life Care Medical Co.………

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Total Scope, Inc………………………

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Tri-Imaging Solutions…………………

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InterMed Group………………………

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Trisonics………………………………

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International X-Ray Brokers…………

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USOC Bio-Medical Services…………… 7

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Master Medical Equipment…………

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We can fix that. www.bmesco.com 888.828.2637

NEW IPA-3400 Infusion Pump Analyzer The High Accuracy, Easy-to-Use System with Full Touch Screen Control of All Processes         

Large 7” Color Touch Screen 1,2,3 and 4 Channel Models available (Field Upgradeable) User Swappable, Fully Self Contained Flow Modules Calibration in Flow Modules No need to be down for calibration or service!

Smooth Dual Syringe System Eliminates Drain Cycle Inconsistencies Whisper Quiet Operation Auto Start Built-in Auto Test Sequences Built-in Data Collection

THE BLACK PIR ANHA: EASY AND FAST X-RAY QUALITY CONTROL RTI Black Piranha Features:   

All-in-one multifunction X-ray meter

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One-shot HVL for Mammography, Radiography, CT, and Dental Solid-state detectors = no need to compensate for temperature & pressure Optimized for X-ray equipment from a large number of manufacturers 100 meters Bluetooth range Unique detector design to minimize position and rotation dependence Small, compact & robust – easy to place Long-lasting rechargeable battery

RTI Black Piranha

Always free firmware upgrades 2-year Calibration Cycle

The Black Piranha and Ocean software are quick. Ocean can perform instant real-time analysis during measurements as well as a report in the background. When the work is done, you can print a complete report of your work. Use your MS Windows tablet or laptop as both an interactive display during the measurements and as a powerful analysis tool when you are back at the office. All your measurements, along with the result and the report will be stored inside your tablet or laptop. There is no unnecessary, time-consuming data transfer at the end of the day.

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