TechNation - February 2019 by MD Publishing

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Vol. 10

ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

FEBRUARY 2019

MOVING

LOOKING BEYOND CE CREDITS 12 Department of

the Month The Adventist Health Feather RiverÂ Clinical Engineering Services Department

31 Biomed 101 Cybersecurity

39 Roundtable

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CONTENTS

FEATURED

ROUNDTABLE: ULTRASOUND PROBES

I n this month’s installment of the popular Roundtable article, we look at ultrasound – specifically ultrasound probes and transducers. We asked several experts from throughout the industry to participate and share some of their insights regarding these valuable diagnostic imaging tools. Next month’s Roundtable article: RTLS

MOVING UP – LOOKING BEYOND CE CREDITS I t takes hard work and determination to get ahead in healthcare technology management and accumulate more knowledge in the process. The process includes continuing education, training, reading and research. Career advancement can be strategically planned out by taking several proactive steps and methodically working a plan. Getting involved in professional organizations, finding a knowledgeable mentor and networking all play a role.

Next month’s Feature article: Biomed Life Hacks: Tips & Tricks of the Trade

TechNation (Vol. 10, Issue #2) February 2019 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. ©2019

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

FEBRUARY 2019

TECHNATION

CONTENTS

INSIDE

Departments

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

Roger Bowles Jenifer Brown K. Richard Douglas Jim Fedele Joe Fishel 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

ACCOUNTING

Diane Costea

EDITORIAL BOARD

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

P.12 SPOTLIGHT p.12 Department of the Month: The Adventist Health Feather River Clinical Engineering Services Department p.14 Professional of the Month: Arif Subhan, MS, CCE, FACCE p.18 Biomed Adventures: Bowling to Barbeque with Enthusiasm P.21 p.21 p.26 p.28

INDUSTRY UPDATES News & Notes AAMI Update ECRI Update

P.31 p.31 p.33 p.34 p.36

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

P.51 p.51 p.52 p.55 p.56 p.59 p.60 p.63 p.65

EXPERT ADVICE Career Center 20/20 Imaging Insights Cybersecurity Series Part 1 Third-Party Service Providers The Future Ultrasound Expert The Other Side Roman Review

P.66 BREAKROOM p.66 Did You Know? p.68 The Vault p.70 MedWrench: Where in the World is Ben C.? p.77 Service Index p.81 Alphabetical Index p.82 Parting Shot

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

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SPOTLIGHT

DEPARTMENT OF THE MONTH

The Adventist Health Feather River Clinical Engineering Services Department BY K. RICHARD DOUGLAS

dog sat outside a burned down home in Paradise, California as it waited for its owner. The same wildfire, that destroyed this home, had destroyed thousands of other homes and killed at least 86 people in the area. The Camp Fire was the deadliest in California history. It began on November 8, 2018 and continued its rampage for almost a month before being extinguished by the brave and tireless work of firefighters and hotshot crews.

It was nearly that long also before many residents were allowed to return to where their homes had once stood, evaluate the damage and search for anything that might remain. The ashes from some of the first homes and thousands of trees were carried by the flames high into the air, where they fell back to earth. That was one of the first tangible indications of the encroaching fire that Marc Silver, BMET III, lead biomedical engineering technician for Adventist Health Feather River, experienced. Adventist Health Feather River

TECHNATION

FEBRUARY 2019

(AHFR) is a 100-bed medical center in Paradise, California. “On November 8, I arrived around 7 a.m., and began unloading my vehicle from working offsite the previous evening. As I was gathering test equipment, I noticed that small charred chunks of tree and ash were beginning to rain down on me,” Silver says. “The air was smoky, and when I got inside, we were told there was a fire two ridges over and to be ready for evacuation, but be calm to not panic the patients. Then, the air became even heavier with smoke and we had noticed rolling smoke from the canyon very shortly after we got the order to evacuate, the fire was on our ridge,” Silver adds. California has known many wildfires and, along with earthquakes, they are something to be aware of and educated about. Silver says that it quickly became apparent that this fire was different, as he looked out the CNU entrance and saw red flames in the parking lot. “I’m the site director and at this time I have three BMET staff members. We manage about 5,500 pieces of medical

equipment on the main campus as well as 30 other facilities,” says Rob Harry. Besides Harry and Silver, the team includes BMET III David Falcon, and clinical information systems BMET Jared Wilson. “On my way to work I could see the plume of smoke several miles away over the Ridge. Fifteen minutes after I arrived, an incident command center formed, and a few minutes after that an evacuation alert was given. We could see smoke directly behind the hospital,” Harry says. He says that they jumped into action and found as many wheelchairs as they could and staged them in front of every patient room in the med and cardiac/ neuro units. They pushed patients in their beds to the ambulance bay for evacuation. After they finished, Harry gave the word to disperse. Harry says everyone has their own story at that point. “Mine was, trying to evacuate myself. I became trapped by the fire along with several other vehicles,” he says. “With the help of a bulldozer, coming out of nowhere, [it] helped us get back to the

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SPOTLIGHT

Members of the Adventist Health Feather River Clinical Engineering Services Department, from left to right, David Falcon, BMET 3; Rob Harry, Director; Marc Silver, BMET 3; and Jared Wilson, BMET 3, helped evacuate patients before the Camp Fire destroyed the hospital.

hospital where I helped in a makeshift triage to help patients that were trapped from leaving the area,” Harry adds. Silver remembers the procedures they used to evacuate patients. “We began to assist by gathering up as many wheelchairs as we could, the nursing supervisor had asked us to fit them with the leg braces and get each one to a door of a patient room. The nurses and CNAs began loading patients into chairs and the order was given to move them to the ER ambulance entrance,” he says. “Then, they began moving the beds to the elevators for the patients that could not get into a chair. Because there were so many beds and only two elevators, the decision was made to push some beds outside and up the hill to the ambulance entrance. My wife Jennifer – an RN at AHFR – and I worked together to push a patient up. I know the other biomeds were doing the same, just trying to get patients to the ER for evacuation,” Silver says. He says that once the evacuation line was set, they returned to CNU and assisted with the final closing; shutting doors, making sure rooms were cleared, etcetera, then returned to assist with the

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

loading of patients. Silver says that they began to see buildings on campus ignite and burn and hear propane tanks explode. “There were not enough ambulances available, so we began to put patients in any vehicle we could. One of the biomed staff — David Falcon I believe — took a woman who just had a baby in his car to try to escape. I assisted my wife in loading her patients into sheriff’s vehicles and hospital staff vehicles, anything we could find. It became controlled chaos getting the patients loaded,” Silver says. Silver says that once the last patient was loaded, they were told to “leave now.” They jumped into a 4Runner owned by one of the IT techs, a great friend of his named Jacob Boone, who had been in the line to evacuate a patient if needed, and he began the slow drive out as everything around them began to burn. ADVICE FROM EXPERIENCE While biomeds have had to respond to hurricanes, tornados, a spike in patient arrivals because of a terrorist attack and wildfires, there is a lesson to be learned from each experience. “Pay attention to, and know what to

do, in a disaster. Be prepared and be ready. Know your role and learn the job of others as well so you can assist. Know where things are stored or how to properly mark a room cleared in a fire/ drill,” Silver says. “Keep a calm head, and be flexible. Adapt and overcome,” he adds. In addition to the thousands of people displaced and left homeless, the lives lost and the community badly damaged, the Camp Fire took a toll on the biomed staff at Feather River. “One of our staff lost their home and has had to relocate. Others could not get back to their homes for the past month and had to find places for their families. My friend, that drove my wife and I out, is now living with us,” Silver says. “Our shop burnt down completely, everything inside lost, all tools and test equipment. Estimates for rebuilding, I have heard, from 2020 to 2024, but nothing official,” Silver adds. There are times when a team of HTM professionals have to react and respond to circumstances far outside what is routine. The biomed team at Feather River proved that they have what it takes to face down the most challenging situation and save lives.

FEBRUARY 2019

TECHNATION

SPOTLIGHT

PROFESSIONAL OF THE MONTH Arif Subhan, MS, CCE, FACCE From Math Wiz to Chief BY K. RICHARD DOUGLAS

he city of Los Angeles is the country’s eighth most populated city with four million residents. It is home to UCLA and much of the American film industry. Among the population of the surrounding Los Angeles County are an estimated 325,000 military veterans.

According to a study conducted by the USC School of Social Work, “Twentyfour percent of post-9/11 veterans and 19 percent of pre-9/11 veterans, indicated severe physical health symptoms.” Addressing these health concerns and others in the Los Angeles area is the VA Greater Los Angeles Healthcare System, which provides services to Veterans in Southern California and Southern Nevada. It is one of the largest health care facilities within the VA. To support the management of all of the medical equipment in this large facility is a biomedical department headed up by Arif Subhan, MS, CCE, FACCE, chief biomedical engineer. Subhan first became interested in the HTM profession through a series of family experiences and educational pursuits.

TECHNATION

FEBRUARY 2019

“I was interested in pursuing a career in medicine as a young child. Both of my parents and two of my elder brothers were doctors, so I heard stories about their work told around the kitchen table. When I was older, I enjoyed visits to the hospital and the medical school with my father, who later in his career became a hospital director and a medical school administrator,” Subhan remembers. Those family stories and the hospital environment proved to be very exciting to Subhan. But; destiny would lead him in a slightly different direction. “I seriously considered a career as a doctor for most of my boyhood. As a young child, I developed a talent for mathematics, and someone in the family suggested that I should consider becoming an engineer,” he says. “Without much guidance, as I was the first in the family to pursue a career in engineering, I attended an engineering school. In my senior year, one my professors introduced me to the articles in the Institute of Electrical and Electronics Engineers’ Transactions in Biomedical Engineering. These articles brought together my childhood interest in

medicine with my current major in electrical engineering and led me to do a senior project related to biomedical engineering. This led me to a career in biomedical engineering,” Subhan adds. Education and training to prepare him for this new career was geographically varied and comprehensive. “I pursued graduate studies in biomedical/clinical engineering at the University of Surrey, England and Drexel University. Additionally, I completed an internship in clinical engineering at Aga Khan University Hospital and the Hospital of the University of Pennsylvania. Also, I obtained Certification in Clinical Engineering (CCE),” Subhan says. In addition to the education and training, Subhan accumulated an extensive amount of on-the-job experience. “I worked as a clinical engineer and later as senior clinical engineer for Masterplan (an independent service organization that managed medical equipment across the U.S.). I was the chief biomedical engineer at VA Nebraska-Western Iowa Healthcare System and South Texas Veterans

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SPOTLIGHT

BY K. RICHARD DOUGLAS

Arif Subhan speaks at the 2018 AAMI Conference and Expo.

Health Care System,” he says. Subhan and his department have been involved in many medical equipment installation projects including clinical information system (CIS), imaging equipment projects (CT scanner, a single-plane GI unit, one IR suite, one PET/CT, two mammography units, and one tomotherapy unit), multiple network integration projects, various new equipment installs in surgery, cardiology, laboratory, pharmacy and ophthalmology and an emodel of the emergency department. ACTIVE IN THE FIELD Professionally, he has been very active in the field and held several positions, including columnist for the Journal of Clinical Engineering (JCE) and a member of several editorial boards. “I have been a member of the American College of Clinical Engineering (ACCE) Board for a long time and am currently the president of

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

ACCE,” Subhan says. “Also, I served as the Chair, United States Certification Commission; Chair, ACCE Education Committee; Chair, ACCE BOK Committee; and Co-Chair, AAMI Annual Conference Program Committee,” he adds. On the recognition front, Subhan has garnered some prestigious awards, including the ACCE Professional Development/Managerial Excellence Award in 2013 and the AAMI Clinical/Biomedical Engineering Achievement Award in 2012. He is a Fellow of the American College of Clinical Engineering (ACCE). Subhan’s wife is a health care architect and his two daughters attend UCLA. It has been a long road from stories around the dinner table to heading a busy biomedical department responsible for millions of dollars of medical equipment. Subhan does it all with mathematical precision.

FAVORITE BOOK: “1776” by David McCullough “Jinnah of Pakistan” by Stanley Wolpert FAVORITE MOVIE: “Scent of a Woman” “Catch Me If You Can” FAVORITE FOOD: Biryani (a dish made with spices, rice, meat and vegetables) HIDDEN TALENT: Ability to know what mood someone is in and how to make them feel better when they are sad FAVORITE PART OF BEING A CHIEF BIOMED: “Mentoring and educating the future generations through the VA TCF Program and UConn Clinical Engineering program.”

FEBRUARY 2019

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SPOTLIGHT

BIOMED ADVENTURES Bowling to Barbeque with Enthusiasm BY K. RICHARD DOUGLAS

uring the 1960s and 1970s, professional bowlers earned more money than NFL stars. They were celebrities and were featured on a popular TV show. Although bowling is thought to have originated around 300 A.D. in what is now Germany, the sport really hit its peak in the sports world during this era.

Beer leagues were once a part of the sport because so many professional bowlers were sponsored by beer companies like Stroh’s, Budweiser and Miller. Pro bowlers like Dick Weber and Buzz Fazio were household names. Since the creation of the Professional Bowler’s Association (PBA) in 1958, the sport grew even more popular with ABC Sports televising the PBA Tour starting in 1965. Among those bowling enthusiasts in the 1963 was Larry Schroeder. Today, Schroeder is an account executive for Merry X-Ray Corporation in Arizona. “I remember the beginning of my bowling career 55 years ago as if it was 18

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FEBRUARY 2019

yesterday. My mother was in a bowling league when I was five years old in San Jose, California at Saratoga Lanes,” Schroeder remembers. “I was very busy as a youth; Cub Scouts, Boy Scouts, Little League, football and bowling. I believe it was these activities that kept me out of trouble as a kid. Certainly, bowling was my favorite. I remember I had a dream to be a professional bowler as early as a 10-year old as I watched the PBA tour every Saturday afternoon,” he says. Schroeder attended PBA tournaments at Saratoga Lanes when they would come to town. Little did he know that a few years later he would meet the great Earl Anthony, Dick Weber, Ernie Schlegel and Carmin Salvino as a senior in high school. “I was the captain of the varsity bowling team in high school. I became a member of the PBA soon after high school. In fact, Earl Anthony endorsed my application,” Schroeder says. He is very proud that he was able to accomplish his lifelong dream and

become a professional bowler, although he says there aren’t many notable accomplishments. “A few 300 games and having the opportunity to bowl with many of the bowling greats over several decades,” Schroeder says when asked about the highlights. “I am still an active member of the PBA 50 Tour, however my busy health care career has yet to let up to allow me to bowl in more tournaments. In 2005, [while] I was bowling in the qualifying rounds of the U.S. Open, I obtained a slipped disk in my cervical spine (C6/C7). Shortly after having spinal fusion surgery, doctors told me my bowling career was over,” Schroeder adds. When it comes to putting bowling into perspective, Schroeder waxes philosophically more than being braggadocios. “I set my sights to becoming a professional and did it. Sure, there are a few dozen honor scores and wins along the way but nothing really to brag about. I guess I could be noted as WWW.1TECHNATION.COM

SPOTLIGHT

Larry Schroeder sells, installs, and services imaging equipment at work. He prepares award-winning barbecue in his spare time.

one of the local ‘hot shot bowlers,’ but in the professional ranks it is a different world. Highly competitive; it is a different world. That being said, at 57, I am still a PBA member and qualified to compete with the best in the world,” he adds. BARBEQUE PITMASTER While one passionate pastime may have come to an end, another was in the wings for Schroeder, or more appropriately, the ribs. Although his days of bowling strikes had ended, a new opportunity was to be discovered. “During my recovery, I attended my first barbecue contest in California. It was that contest where I met Todd Eves, owner of Out of this World BBQ. Todd became my mentor as a barbecue pitmaster. I attended barbecue contests as a team member and assisted in many catering events learning a great business at the same time,” he says. Eventually, he branched out and learned with other BBQ teams. “I took classes with barbecue world ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

champion Mike Davis of Lotta Bull BBQ, Johnny Trigg of Smokin‘ Triggers, Harry Soo of Slap Yo Daddy BBQ and others,” Schroeder says. “I started my own competition barbecue team and catering company called Rib Tickler BBQ. We won many awards including the Grand Championships in California’s largest BBQ competition,” he adds. “We have our barbecue sauce and rubs and continue to cater small private events as time allows.” Schroeder’s BBQ is in Maricopa, Arizona, and is described as an Arizona-based barbecue catering company specializing in the ultimate Southern-style barbecue party. When not applying secret sauce or rub to a rib or remembering bowling tournaments gone by, Schroeder has a job that keeps him busy. He is an account executive and a field service engineer for Merry X-Ray Corporation. “I started my career as an X-ray technologist and administrator in the U.S. Navy. In 1989, I got out of the

Navy and went into sales (radiology capital equipment and software). In 2015, Merry X-Ray asked me to move to a hybrid role of sales and service; something very rare and specialized. I would sell, install and service everything in my territory (Arizona). So, 50/50 sales and service,” Schroeder says. Somehow, he managed to exceed sales expectations. “Currently I’m in the top five percent of my sales colleagues. My manager asks me how I do it. I simply set the goal and keep my eye on the prize. ‘Cry when it hurts, laugh when it’s funny, chase after the dream, don’t chase after the money,’ Schroeder says, quoting an Old Dominion song. Schroeder likes to say jokingly that he is in the same class as other multisport professional athletes like Bo Jackson or Deion Sanders except that his sports are bowling and BBQ. “It is good for a laugh, which is my goal,” he says.

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Updates from the HTM Industry NEW BIOMED BOOK AVAILABLE The new book “Medical Device Quality Management Systems: Strategy and Techniques for Improving Efficiency and Effectiveness” by Susanne Manz, medical devices consultant, MBA, MBB, RAC, CQA, is now available. It teaches readers how to create a vision, strategy and tactical plan for a quality management system for medical devices. It is written for the needs of quality, compliance and regulatory professionals in medical device companies. It includes secrets for developing an effective, yet efficient, Quality Management System (QMS) and explains how to create a vision as well as strategy and tactical plans. Manz

shares lessons on leadership, key roles and responsibilities within a medical device company, while also exploring the concepts of process ownership, individual accountability and how to cultivate a culture of quality and compliance. This book is useful for all executive, functional leaders and organizations in the highly regulated medical device industry. •

KASPERSKY LAB RESEARCH ANALYZES CYBERSECURITY IN HEALTH CARE According to a new survey report from Kaspersky Lab, employees of health care organizations in the U.S. and Canada, who admit their awareness of a ransomware cybersecurity attack, also claim that it wasn’t a one-time occurrence – with a third claiming it happened more than once. The findings from Kaspersky Lab’s latest report, “Cyber Pulse: The State of Cybersecurity in Healthcare,” uncover a continuous pattern of ransomware cybersecurity attacks plaguing organizations in the health care industry, while also providing insight on employee perceptions and behaviors related to cybersecurity in the workplace. Data breaches heavily targeting health care organizations, such as WannaCry, have brought attention to the vulnerabilities that exist in the industry, making health care organizations an even bigger target for cybercriminals. In fact, there were over 100 hacking/IT-related health care organization incidents affecting 500 or more individuals in the U.S. in 2018, according to the U.S. Department of Health and Human Services. In turn, this creates an ongoing risk for health care IT staff to prevent and protect against. Managing this risk has proven to be a challenge for health care organizations. In fact, more than one-in-four health care IT employees in North America admit that their employer has experienced a ransomware cybersecurity attack within the past year. In addition, of those health care employees aware of a cyberattack occurring, 85 percent of Canadians and 78 percent of Americans claim to have experienced up to five ransomware cybersecurity attacks in the past five years or more. The research shows that the industry is not learning from its mistakes, and continues to suffer. Even though the

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

health care industry has its cybersecurity challenges and has lost many battles to cybercriminals, health care employees do care about the protection of the organization. The top reason health care employees care about having cybersecurity measures in place at their organization is to protect patients. In addition, three out-of-five people claim they care because they want to protect people and organizations they work with, and nearly a third of respondents say they care because they do not want to lose their job as a result of not having appropriate cybersecurity measures. Although there is room for improvement, health care employees seem to have confidence in their employer’s cybersecurity strategy. “Through our study, we found that health care employees in North America were confident that their organization would not suffer a data breach in the forthcoming year, but whether they realize it or not, their industry is suffering hundreds of breaches a year,” said Rob Cataldo, vice president of enterprise sales at Kaspersky Lab. “Health care companies have become a major target for cybercriminals due to the successes they’ve had, and repeatedly have, in attacking these businesses. As organizations look to improve their cybersecurity strategies to justify employee confidence, they must examine their approach. Business leaders and IT personnel need to work together to create a balance of training, education, and security solutions strong enough to manage the risk.” The research is the result of a survey conducted by research firm Opinion Matters of 1,758 employees based in health care organizations – in a variety of roles, ranging from doctors and surgeons, to admin and IT staff – in the United States and Canada. •

FEBRUARY 2019

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INDUSTRY UPDATES

STAFF REPORTS

Photo by Maj. Simon Flake

BIOMEDICAL TECHNICIANS TRAINED AND READY Fourteen biomedical technicians from the 3rd and 807th Medical Command Deployment Support completed the General Electric Military Extern Partnership Program recently. The 10-month course culminated with a tour of the GE Repair Services Center of Excellence and a graduation event at GE Health Care Institute in Waukesha, Wisconsin. The graduation event featured Maj. Gen. Michael O’Guinn, the commander of the 807th Medical Command Deployment Support, and General Electric Vice President and General Manager of Services at GE Healthcare Rob Reilly as guest speakers. Sgt. Octavia Fuller, a biomedical technician, recent graduate of the program and current program coordinator for the 3rd Medical Command said, “As a new 68A (biomedical technician) you don’t have much hands-on experience and when you go through the schoolhouse it’s very fast paced and intense. The program provides a more relaxed atmosphere for externs to learn and receive direct mentorship from GE

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FEBRUARY 2019

technicians and hands-on opportunities to work on real equipment.” The externship program was created for the Army Reserves to increase Warrant Officer and NCO Strength while enhancing retention. The program also allows 68As who may not be working as biomedical technicians in their civilian careers to train with leading industry professionals in turn sustaining and increasing their skills in a highly technical and rapidly advancing industry. Biomedical technicians are invaluable professionals in the medical field. They are responsible for servicing, maintaining and installing medical equipment as well as routine maintenance and troubleshooting on mechanical, hydraulic, pneumatic, electronic, digital, optical and radiological health care systems. “Biomed techs” maintain hospital equipment vital to screening, diagnosing and treating patients on a daily basis. •

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INDUSTRY UPDATES

When Quality Matters

Medfusion Replacement Parts & Repair Service NEW CERTIFICATION PREPARES WORKERS FOR HEALTH CARE Working in a health care facility is different from working in any other environment. A new certification program offered by the American Society for Health Care Engineering (ASHE) helps workers in facility management and construction understand the complexities of the health care physical environment and helps hospitals reduce risks associated with construction. The Certified Health Care Physical Environment Worker program (commonly referred to as the ASHE worker certification) covers important topics such as construction in health care facilities; infection control and prevention; fire and life safety; and utility system shutdowns. The certification from ASHE, a professional membership group of the American Hospital Association, is keenly focused on patient safety. For contractors and subcontractors, passing the online certification exam can demonstrate to employers that they are ready to work in a hospital or other health care facility. For hospitals and health systems, the ASHE worker certification can help reduce risks associated with construction while saving time on internal orientation programs. “Hospitals are different. We operate around the clock and we work hard to protect our patients from construction issues that may be common in other types of buildings, such as dust or noise,” said ASHE Deputy Executive Director Chad Beebe, AIA, CHFM, FASHE. “By requiring workers to earn this new certification, hospitals can reduce risks by ensuring people working in their facilities understand important patient safety concepts.” • For more information, visit www.ashe.org/certifiedworker.

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FEBRUARY 2019

TECHNATION

INDUSTRY UPDATES

STAFF REPORTS

UNIVERSAL HOSPITAL SERVICES BECOMES AGILITI MEDEQUIP BIOMEDICAL ACHIEVES ISO 13485:2016 MedEquip Biomedical has been awarded ISO 13485:2016 certification from NSF International Strategic Registration, converting from ISO 9001:2008 standards. Founded in 1992, MedEquip Biomedical was the first multi-vendor patient monitoring service company in the nation to adopt and achieve the ISO 9001 quality standard, according to a press release issued by the company. “Quality is the core of MedEquip’s business. This is representative of our commitment to quality and our customers,” says Michael Lipson, vice president. “Our entire team is committed to the rigorous quality standards associated with this certification.” MedEquip serves hospitals and independent service organizations nationwide. •

BLANDI APPOINTED SPBS VICE PRESIDENT OF SALES AND MARKETING SPBS Inc., an employee-owned clinical equipment services company, has announced that James “Jim” Blandi has joined the company as the vice president of sales and marketing effective December 3, 2018. “We are excited to welcome Jim to the SPBS team, as we continue our mission to provide clinical equipment service to our customers, nationwide,” said Jeff Daugherty, CEO, SPBS. “As VP of sales and marketing, Jim will grow SPBS’s sales team and build out the sales infrastructure to support planned growth.” As a well-known figure in the HTM space, Blandi comes to SPBS with over 20 years of sales leadership experience in the HTM and imaging sector. Prior to joining SPBS, he served in several managerial and executive roles while with Insight Imaging, Shared Imaging, LFC Capital, and SouthWest Medical Resources. •

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FEBRUARY 2019

Universal Hospital Services Inc. (UHS), a provider of healthcare technology management and service solutions, announced that UHS launched its new name and brand identity on December 3. The company will now be known as Agiliti, reflecting its offerings that enable safer and more efficient medical equipment management processes for health care providers. “Agiliti is a new name for a known and trusted leader in health care services,” said Tom Leonard, chief executive officer of UHS, soon to be Agiliti. “We are proud to serve more than 7,000 customers with an end-to-end solution called Equipment Value Management that helps providers reduce the cost and complexity of owning and maintaining medical equipment, streamline operating workflows and free clinicians to spend more time with patients. Agiliti represents our shared team belief that every interaction has the power to change a life – a promise demonstrated in our everyday approach to serving customers and their patients.” UHS was originally founded in Minneapolis in 1939 as the ABC Oxygen Tent Rental Company, and subsequently renamed Universal Hospital Services Inc. in 1969. Today, the company delivers services that include on-demand medical equipment rental, biomedical equipment repair, testing and maintenance, and the full-service onsite management of equipment within health care facilities. “The name Agiliti celebrates our 80-year history of round-the-clock service to health care providers, powered by a nationwide logistics and repair network of highly trained technicians who rapidly respond to customer needs with an integrated solution for the management and maintenance of medical equipment,” Leonard said. “With Agiliti, providers are assured the patient-ready technology and equipment they need, when and where needed, with the confidence it is maintained to the highest industry standard.” •

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AAMI UPDATE NEW FEATURES, EDUCATION SESSIONS AWAIT FIRST AAMI EXCHANGE ATTENDEES

Expect changes in both substance and style as AAMI launches the AAMI Exchange, June 7-10 in Cleveland, Ohio. The education program at the Exchange, which is the name for the reimagined AAMI Annual Conference & Expo, reflects the association’s commitment to connecting all its stakeholders, including biomedical equipment technicians, clinical engineers, cybersecurity and sterilization experts, hospital administrators and managers, and the industry’s leading service and solution providers. “The 2019 education program will deliver an immersive and interactive learning environment for professionals in a variety of health technology-related fields at all experience levels,” said Sherrie Schulte, CAE, AAMI’s senior director of certification and meetings. “We received more proposals than ever before, so the Program Committee was able to create a schedule of sessions that not only reflects the diversity of our community but also provides the cutting-edge solutions and forward-thinking insights attendees need to meet the challenges they encounter on a daily basis and those they will face in the future.” The approximately 90 sessions on the schedule will be divided into education tracks that include healthcare technology management (HTM), cybersecurity, artificial intelligence and virtual reality, professional development, data analytics, sterilization and reprocessing, global perspectives, and meeting regulatory/accreditation requirements. Here is just a taste of what is in store: Securing Medical Devices in a Hospital Environment The past decade has seen an intertwined evolution of medical device security threats, regulatory and customer requirements, and industry-leading practices. This session will explore key trends and detail a programmatic approach that healthcare delivery organizations can take to secure connected medical devices and reduce risks to both patient safety and information security. Data Analytics, Artificial Intelligence, Predictive Modeling, and HTM Data analytics, artificial intelligence, big data, machine

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FEBRUARY 2019

learning, and predictive modeling are major buzzwords in healthcare. This session will explore uses for predictive modeling, including how HTM and clinical engineering departments can predict device breakdown and intervene before patient care is disrupted. Big Data Insights on Capital Equipment from 500 Million Work Orders With connected devices and modern maintenance tracking software, the amount of valuable asset data is increasing rapidly. This session will help professionals with purchasing power make better decisions on capital equipment. Tools available to HTM professionals will be examined, helping attendees choose the best equipment and maintenance programs and make critical replace-or-repair decisions with confidence. Device Integration Fundamentals and Troubleshooting Skills This session will explore the fundamentals of device integration and describe how data flows from medical devices into the electronic health record, including an explanation of how middleware software or monitoring gateways use HL7 messages in that process. For a complete list of education sessions, visit www.aami.org/ AAMIExchange. Register by March 20 and save! AAMI LAUNCHES FREE HTM WEBINAR PROGRAM With the rapid pace of change for technology both inside and outside hospital walls, there is more pressure than ever on healthcare technology management (HTM) professionals to learn new skills and adapt to the evolving environment. To stay ahead of the curve when it comes to the convergence of information technology (IT) and HTM, AAMI has launched a free webinar program that will run throughout 2019. The first webinars in this series include: Developing an HTM Specific Cybersecurity Framework, Part 2: Feb. 5, 2-3 p.m. ET; Part 3: April 16, 2-3 p.m. ET Many HTM professionals are unfamiliar with the framework necessary to incorporate good security practices into their service operations. Mayo Clinic has begun to bridge this divide by standing up an HTM Cybersecurity Team focused

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INDUSTRY UPDATES solely on developing a National Institute of Standards and Technology (NIST)-based cybersecurity program. This three-part series will provide insight into the Mayo Clinic’s approach and explore how to develop an HTM cybersecurity program. Bluetooth in the Healthcare Setting, Feb. 19, 2-3 p.m. ET Bluetooth wireless technology is widely used in hospitals, from IT platforms to implanted medical devices. Bluetoothenabled technology also is brought into hospitals in the form of smartphones, headsets, and gaming devices. This webinar will provide a high-level overview of the technology and key features of interest for HTM professionals. Using LinkedIn to Market Yourself and Your Organization, March 13, 2-3 p.m. ET The world of LinkedIn can be confusing and daunting. This webinar will provide tips and tricks to better use LinkedIn to market yourself and/or your organization to the professional world. All webinars are approved for one continuing education unit (CEU) by the AAMI Credentials Institute with the exception of the LinkedIn webinar, which is worth 0.5 CEUs. More webinars will be scheduled throughout the year. For more information and to register, visit www.aami.org/events.

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FEBRUARY 2019

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INDUSTRY UPDATES

BY ECRI

ECRI UPDATE

Continued Use of ‘Flying Lead’ Bipolar Electrosurgical Cables Could Result in Misconnections and Patient Burns

atient burns resulting from the misconnection of a “flying lead” bipolar electrosurgical cable should be a thing of the past. For decades, ECRI Institute and other organizations have warned about the misconnection and burn risk. In addition, safety and standards organizations have long recommended that flying lead cables be phased out; and bipolar cables that prevent such misconnections are commonly available.

Nevertheless, flying lead cables remain in use, and ECRI Institute continues to receive reports of misconnections resulting in patient injuries. What do you need to know about the hazard, and what steps can you take to prevent patient harm? THE HAZARD “Flying lead” bipolar electrosurgical cables are bifurcated at the plug end with two separate connectors. Each connector is intended to be inserted into one of the two bipolar electrode jacks on general-purpose electrosurgical units (ESUs). However, the physical separation of these connectors— because they have flying leads—allows them to be inappropriately inserted into the wrong electrode jacks on the ESU (see the figure on p.29). When a bipolar electrode is wrongly connected to the monopolar jacks on an ESU, the generator may, under certain circumstances (as detailed below), activate without intervention from the surgeon. This unintended activation will deliver monopolar output current through the bipolar electrode to the monopolar return electrode in contact with the patient. Further, the monopolar output may be an inappropriate waveform and/or power setting for the intended bipolar procedure. Such inadvertent ESU activation can lead to unintentional patient burns or other injury (e.g., bowel perforation). AMID WARNINGS, USE OF FLYING LEADS CONTINUES The misconnection risk associated with flying lead cables has

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FEBRUARY 2019

been understood for decades. Safety and standards organizations have long made the dangers clear: • T he flying lead cable design has been warned against in recognized device standards as far back as 1993. • A NSI/AAMI/IEC 60601-2-2:2017—and versions dating back to 2006—specifically prohibits flying lead cables because of the possibility of misconnection of a bipolar accessory to a monopolar output, which could lead to patient injury. • Since 2014, ECRI Institute has recommended that facilities phase out flying lead cables. (See the organization’s November 2014 Health Devices Alerts Hazard Report, “ECRI Institute Recommends Phasing Out Flying Lead Bipolar Electrosurgical Cords.”) Nevertheless, flying lead cables remain available, and ECRI Institute continues to receive reports of misconnections resulting in patient injuries. In response, last year the organization took a stronger stance, recommending that healthcare facilities entirely discontinue the use of flying lead cables. (See the May 2018 Health Devices Alerts Hazard Report, “ECRI Institute Recommends Discontinuing Purchase and Use of Flying Lead Bipolar Electrosurgical Cords.”) Cost is one reason that, despite the risk, healthcare facilities may persist in the use of bipolar electrodes with flying lead bipolar cables. ECRI Institute PriceGuide data confirms that bipolar cables with molded plugs can be 2% to 16% more expensive than electrodes with flying lead cables, depending on the supplier. However, analyses of purchase costs don’t factor in the expense of an adverse incident. The cost of a single burn-related claim may significantly outweigh the added expense of molded plugs; burn litigation payouts can be in the hundreds of thousands of dollars. Another reason that flying lead cables remain available is the continued use of some older, specialized bipolar ESUs that require the use of these cables. Such units (e.g., surgeon-preference generators for neurological applications) do not feature the standard bipolar-jack spacing found on most modern ESUs.

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INDUSTRY UPDATES

Figure. Left image: Incorrect connection. The separate connectors at the ends of the “flying lead” bipolar electrosurgical cable should never be inserted into two of the ESU’s monopolar electrode jacks. The connectors should instead be inserted into the two bipolar electrode jacks (bottom left of the unit). Center and right images: Molded monopolar and bipolar electrode cable plugs are designed to prevent misconnections.

HOW MISCONNECTIONS – AND INADVERTENT ACTIVATIONS – CAN HAPPEN As illustrated in the figure, monopolar/bipolar ESUs include differently configured output sockets for each type of electrode: Monopolar output sockets have three unevenly spaced banana jacks in a straight horizontal line to accommodate the three banana pins of the molded monopolar electrode cable plug. (One jack is for the active electrosurgical current and the other jacks are for switching between cut and coagulation modes when the surgeon presses the appropriate button on the active electrode pencil.) The fixed, uneven spacing of the pins prevents this molded plug from being installed upside down or in the bipolar output socket. The bipolar output socket, on the other hand, has two banana jacks in a horizontal line that accommodate two bipolar electrode banana pins; these may be from a molded bipolar electrode cable plug or from flying lead cables. Because the banana pins on flying lead cables have no orientation or spacing constraints, they can be easily inserted into any two of the three monopolar jacks. Further, because many ESUs have two monopolar sockets, the potential for misconnection remains even if one of the monopolar sockets is occupied by a molded electrode cable plug. When one of the banana pins of a bipolar flying lead cable is mistakenly plugged into one of the cut or coagulation mode jacks and the other is plugged into the active current jack, monopolar current may be delivered through the bipolar instrument when its tips touch or when it closes around tissue with a low enough impedance to conduct the electrosurgical current. In these circumstances, if a return electrode is plugged into the generator and in contact with the patient, as is typical for monopolar operation, the ESU will detect a completed monopolar patient circuit and may inadvertently activate.

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

ECRI INSTITUTE RECOMMENDATIONS The surest way to prevent this problem is to discard disposable and reusable bipolar electrodes with flying lead cables and replace them only with bipolar electrode cables that have a molded plug. These cables cannot be plugged into monopolar output sockets. ECRI Institute recognizes that in very limited circumstances, the above recommendation may not be feasible. That is, some facilities may still own older, specialized bipolar ESUs that require the use of flying lead cables. If your facility uses these units: Segregate them and their flying lead cables from any monopolar or monopolar/bipolar general-purpose ESUs so that their cables cannot be accidentally misconnected. Do not use these specialty bipolar units if there is an alternative energy source that can perform the same function. Plan for the replacement and retirement of units that require flying lead cables. After retiring the units, discard any reusable or disposable flying lead cables that have been purchased for use with them. Regardless of the type of ESU used, always be aware of the specific tones and indicators associated with activation of particular ESU outputs (e.g., cut, coag, bipolar). For additional details, refer to ECRI Institute’s full report at bit.ly/ FlyingLead. The organization has made the report available to the public as part of its effort to keep the healthcare community informed about this potential hazard. To learn more about Health Devices membership, contact ECRI Institute by telephone at (610) 825-6000, ext. 5891, or by email at clientservices@ecri.org.

FEBRUARY 2019

TECHNATION

THE BENCH

BY FERNANDO MARTINEZ AND BOB CHAPUT

BIOMED 101

Cybersecurity is an Important Topic BY FERNANDO MARTINEZ AND BOB CHAPUT

he cyber threat landscape for hospitals and other health care organizations is changing. Health care organizations continue to be the subject of attacks by hackers seeking access to patient data for resale on the black market. Even more ominous are the increasing instances of ransomware attacks, where cybercriminals shut down hospital operations by encrypting all of the hospital’s data until a ransom is paid.

Texas is no exception. In the past 12 months, the Office for Civil Rights (OCR), in the U.S. Department of Health and Human Services, opened investigations on 21 Texas health care organizations for data breaches affecting more than 437,000 individuals. In addition, the number of ransomware attacks hitting health care providers throughout the state have been on the rise. The Texas Hospital Association (THA) recognizes the need to be proactive in the face of evolving cybersecurity threats. To that end, THA hosted the first annual Texas Health Care Security and Technology Conference in April 2018 in Austin, Texas. The conference was designed to bring together health care information security experts from across Texas and beyond to share best practices in planning for and responding to cyber threats. Traditional approaches to cyber risk are becoming less effective. The new era of cybersecurity requires hospitals and health care organizations to approach cyber risk with new tools, new strategies and, most importantly, a new risk identification focus. Three important facts about cybersecurity underscore how the health care industry’s approach to cybersecurity has been transformed in the last few years:

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

CYBERSECURITY IS NOW A TEAM SPORT Not long ago, cybersecurity was an obscure function relegated to the computer nerds in the information technology (IT) department. Not anymore. Cyber risk management is now an enterprise-wide risk management issue. The spread of ransomware and other equally destructive malware threats means that an organization’s entire business operation may be at risk. Patient safety has become an issue as well. This is why interdepartmental cooperation has become so important. Cyber risk management is an issue that should involve not only the IT department, but also operations, quality, security, clinical, engineering, compliance, finance, legal, risk management – literally every department in the organization. Each has a role to play in identifying and mitigating cybersecurity threats. Likewise, every individual associated with the organization – from the chief executive officer to the volunteer who works part-time at the information desk – needs to be engaged with cyber risk management. It only takes one person – one employee who clicks on a phishing email, or one volunteer who uses the word “password” for their password into the system – to expose an entire hospital network to a cyberattack. BOARDS HAVE TO BE ON BOARD An organization’s board of trustees does not have to understand the difference between WannaCry and SamSam (two types of ransomware attacks), but they do need to understand what is at stake. Data breaches can (and have) lead to fines, penalties, legal costs, class settlements and reputational damage running to tens of millions of dollars. Patient safety is also a serious issue. A hospital shut-down due to a ransomware attack, or hackers accessing Internet-connected medical devices, could

threaten patient lives. Board members need to understand the scope, likelihood and potential impacts of cybersecurity attacks. Only then will they have the information they need to make informed decisions about budgeting resources to mitigate those risks. COMPLIANCE IS NECESSARY, BUT NOT SUFFICIENT Many health care organizations focus on compliance with the security and privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA). Although it is very important to have HIPAA-compliant security measures in place, compliance is only one small part of a much bigger information risk management picture. A comprehensive risk management program includes an enterprise-wide analysis of all information assets and exposures. Furthermore, a comprehensive program entails adopting a risk management framework, such as the NIST Cybersecurity Framework, implementing a rigorous process, and adhering to a continuous process improvement mindset. Because the cybersecurity landscape continues to change and evolve, a “once-and-done” process or a simple compliance checklist, is not sufficient to protect an organization. These are just a few of the topics that were addressed at THA’s inaugural Texas Health Care Security and Technology Conference. For more information about the conference, visit https://www.tha.org/techconference Fernando Martinez, Ph.D., is the senior vice president and chief digital officer of Texas Hospital Association and president/CEO of the Texas Hospital Association Foundation. Bob Chaput is founder and CEO of Clearwater Compliance.

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STAFF REPORTS

SHOP TALK you help me solve Error 328 for a Q:Can Sakura Tissue-Tek DRS-601?

To clean and lubricate the linear bearing and\or shaft for Z-axis (up/down) movement failure. Turn the power off, and then see if you can move it up and down smoothly. 1. Obstruction in up/down movement. 2. Problem with the linear bearing and/or shaft. Clean and lubricate it, and then move it up and down (with power off). 3. Problem with cable and/or motor. 4. Problem with optical detector for motion.

First, with power off, push the Z stage down all the way. Clean the upper part of the shaft with paper towels or gauze, and then with PT or gauze moistened with alcohol. Then, lift the Z stage all the way up, and then clean the bottom part of the shaft the same way. Note that there are grooves in the shaft (there are either 3 or 4, I can’t recall). Clean these carefully, perhaps cotton-tipped applicators would be best to get them clean. Then, use a good quality grease (Superlube or a silicone grease) to wipe onto the shaft, alternately moving the Z stage up or down. Force some similar oil into the grooves (Superlube oil if you used Superlube grease or silicone oil if you used silicone grease). Then, move the Z stage up and down repeatedly, to see if it begins to feel smooth. Then try it with power on, to see if it can move without binding and generating errors. Try this repeatedly if you still have problems. If that doesn’t solve it, there may be an additional, more involved procedure.

If Z axis movement is still stiff, after doing the above: The Z axis bracket is clamped around the linear bearing. Remove one machine screw, and then separate, in

order to slide the bearing out of the clamping bracket. Do it carefully, but it will take quite a bit of effort. You will find there are three small holes in the side of the linear bearing. Squeeze oil (of the same base you have been using) into those holes. Fill them up and then move the linear bearing up and down. Then, fill them again. Keep working the linear bearing and filling the holes to see if it will free up motion in the Z axis. If you can free it up, then fill the holes again and slide the bracket clamp back onto the linear bearing. Ensure that the basket hanger is aligned parallel to reservoirs and reinstall screw.

First, linear bearings don’t necessarily last forever, especially if they haven’t been properly maintained. This stainer is probably 20 years old, or more. Second, I would take the bearing out of the bracket/clamp. That way you can get a feel for how much resistance there is when it is just the linear bearing, without the cables and motor and other bearings. Identify the source of the resistance. Third, if it is the bearing, you might try to force some solvent through the holes to clean out the bearing. If you do this, it would probably be best not to move it much until relubricated. Then, I would force in low viscosity silicone oil, and work the bearing up and down. If you can free it up, follow with a higher viscosity silicone oil, and then silicone grease on the shaft. Fourth, I don’t know if it is possible to remove the bearing from the shaft or whether the ball bearings will fall out if you do. If nothing else helps, it might be worth trying to see if you can. It might be possible to replace the individual ball bearings within the bearing assembly, if they are corroded or damaged.

SHOP TALK

is compiled from MedWrench.com. Go to www.MedWrench.com community threads to find out how you can join and be part of the discussion.

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FEBRUARY 2019

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luke Biomedical introduces the ESA614 Electrical Safety Analyzer, an all-in-one solution that combines a multimeter, safety analyzer and ECG simulator in a single safety test instrument. The small, lightweight analyzer features pre-set, on-board automated testing templates that ensure accurate testing of compliance to ANSI/AAMI ES1:1993 and NFPA 99 U.S. electrical safety standards. The ESA614 features a streamlined push-button interface that allows quick access to highly comprehensive functions and features, and an intuitive interface that guides users through tests. Its large display gives clear indications of available functions, set-up criteria, device-under-test receptacle conditions and test results. For more information, visit www.flukebiomedical.com/esa614.

TECHNATION

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WEBINAR WEDNESDAY COMPLETES SUCCESSFUL 2018 CAMPAIGN STAFF REPORT

he final Webinar Wednesday of 2018 featured a presentation sponsored by PartsSource. The webinar “An HTM Evolution: Merging, Managing and Standardizing Operations” was a popular presentation to close out 2018 with 231 attendees eligible to earn 1 CE credit from the ACI.

The attendance for the live presentation mirrored the average attendance for webinars in 2018. The total number of attendees in 2018 was 6,304 for an average 225 attendees per session. The webinar featured Doug Kirsop, system HTM director for OhioHealth. In the current health care environment, health systems are consolidating through mergers, which increases the number of acute and non-acute systems in their portfolio. OhioHealth has been very active in the mid-Ohio region, and Kirsop has been tasked with integrating new facilities and merging and onboarding HTM departments at those facilities. During the session, he provided his team’s operational plan to create a cohesive HTM consortium throughout the entire system. Attendees were able to learn the mindset and leadership approach for a multi-site integration and how to apply key learnings for standardizing and optimizing HTM operations. They also discovered where they should look for hidden costs and drag on their organization, and ideas on how to fix them. Positive reviews flowed in via a

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post-webinar survey in which attendees shared what they liked about the presentation. “Doug had some good points we could relate to. I am one to ‘pick the low-hanging fruit.’ I look at and repair things that are out of our scope of work just to keep the flow going in the OR. I’ve mounted, tightened and repaired my fair share of items maintenance should’ve taken care of. I bypass the help desk when the GI Provation PC is down and call the PC support people directly because they can’t function without it,” said D. Felack, BMET. “I feel like Doug hit on all of the issues I deal with day to day. We are a two-person department with several off-site facilities that we maintain and we are adding two more in 2019 without increasing our staff,” Biomed Manager P. Jenkins said. “Enjoyed today’s seminar. Host brought some valuable insight to the webinar. He mentioned things like accepting change, being prepared and attending meetings that you might not feel necessary. Those small things will often end up benefiting you in the future,” Clinical Engineering Manager P. Brown said. IOMT WEBINAR IMPRESSES ATTENDEES The webinar “Best Practices for Deploying an IoMT Cybersecurity Strategy” shared valuable insights with HTM professionals who were eligible to receive 1 CE credit from the ACI for participation in the live presentation. The 60-minute webinar featured

CyberMDX CTO Motti Sorani. Attendees were taught that the familiar crawl, walk, run mantra for managing any organizational or technological change fits well – allowing for a gradual progression of medical devices cybersecurity posture from building an assets inventory up to preventing cyber attacks. Sorani also discussed how the strategy, designed to minimize organizational burden, uses prioritization and incremental steps as success keys. More than 200 people attended the live presentation and more have watched a recording online. The session received positive reviews as did the overall webinar series. “The webinar was very informative and opened our eyes to many issues that could potentially affect our organization,” said J. Walker, supervisor of operations for clinical engineering. “As security is past due to be an important issue in medical equipment, this was a very useful webinar for biomed and the future direction of the industry,” shared Senior Biomed R. Faut. “This Webinar Wednesday has validated a point that I have been trying to make to administration,” said M. Kersaint, clinical engineering manager. “Very interesting presentation, this opened my eyes to the trick that is out there and what we have to do to keep medical devices safe. Loved the video showing how easy it is for a hacker to control a syringe pump,” said A.

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Unsworth, BMET. The Webinar Wednesday series also received praise following the final presentations of 2018. “The Webinar Wednesday series is a must for all leaders within HTM, as the unification and synergies created by these presentations will surely help the HTM field flourish. The presenters do a great job of providing a tour guide while orating the key decisions and subsequent actions they have embraced to help adapt and succeed in an ever-changing clinical equipment and healthcare technology management environment,” shared G. Joyner, systems clinical engineering manager. “This continuing education support via webinars is fantastic. Thank you TechNation team,” said M. Moore, engineering technician. “The Webinar Wednesday series is a beneficial resource for providing introductory information for a whole variety of topics and aspects of the HTM environment. There are subjects that will interest all players in the HTM community,” said T. Nirsche, performance improvement manager. “It is difficult to choose a favorite event, however the information provided from each webinar is very valuable. I have shared Webinar Wednesday with seven CBET technicians and they are learning how valuable these events are. I always look forward to the next Wednesday event. I also have gone back to previous events that I found very helpful. I realize how much work and time it must take to get someone to put a webinar together. I have so much gratitude. Please keep the series going,” said Senior Biomedical Technician B. Hayes. For information about Webinar Wednesday, including a calendar with upcoming webinars scheduled and recordings of previous sessions, visit WebinarWednesday.Live.

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ROUNDTABLE Ultrasound Probes

In this month’s installment of the popular Roundtable article we look at ultrasound – specifically ultrasound probes and transducers. We asked several experts from throughout the industry to participate and below we share some of their insights regarding these valuable diagnostic imaging tools. Participating in the Roundtable forum are Avante Ultrasound Manager Stephen Goodbar, Summit Imaging CEO Larry Nguyen and Innovatus Imaging Vice President of the Ultrasound Center of Excellence Matt Tomory. Q: WHAT ARE SOME OF THE NEWEST ULTRASOUND SOFTWARE APPLICATIONS HEATH CARE FACILITIES SHOULD CONSIDER?

Stephen Goodbar, Avante Ultrasound Goodbar: I don’t know that I would pinpoint a new application/software, but a fundamental shift in the way that ultrasound imaging is approached. In the past, equipment such as CT and MRI have been the default imaging choice for certain types of studies. The advancements in image quality via single crystal transducers, matrix arrays and ultrasound processing power has allowed ultrasound to be a viable alternative. This option is a more cost-effective solution that allows for immediate results and ultrasound exams can be done without the need for special rooms or facilities to accommodate the machine.

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Nguyen: There are many new applications of ultrasound being developed as a result of the rapid improvements in image quality for non-invasive scanning. We see two movements in ultrasound technology driven by software enhancements that are improving diagnostic capability. First, there are advancements to scan areas of the body traditionally scanned with other imaging technologies. Second, point-ofcare scanning and applications have been rapidly growing, allowing ultrasound to be quickly mobilized to a patient with simplicity in operation and quick diagnosis. Both are fantastic improvements to health care. Tomory: There is a lot of activity on artificial intelligence and how it can improve diagnoses, patient management and throughput and imaging equipment management. One of the first iterations of AI I remember was when Acuson introduced Auto DGC on the Sequoia platform in the late 1990s. This allowed the system to determine optimal gain settings to ensure image uniformity. Today, AI is being used to interrogate patient medical records for relevant information prior to an exam. This enables clinicians to augment a current exam by having a more comprehensive dataset of patient history, prior exams, pharmacy information, lab results, etc. Research is being performed on the impact of AI on image interpretation/diagnoses, and how it can potentially supplement physicians’ interpretations in the future.

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ROUNDTABLE

Q: HOW IS THE INCREASING USE OF ULTRASOUND IMPACTING THE MAINTENANCE OF ULTRASOUND PROBES AND TRANSDUCERS? Goodbar: Increased use equals increased processing and disinfection between patients which ultimately leads to more wear and tear. This is especially true with endo-cavity and transesophageal probes which require high-level disinfection. Utilizing the proper disinfection procedures and performing electrical safety testing is extremely important to increasing usable life and mitigating the cost of transducer repair and replacement. Larry Nguyen, Summit Imaging Nguyen: The increasing frequency of ultrasound use expands the number of potential failures for both ultrasound transducers and system parts. It is essential to process and identify potential ultrasound transducer failures quickly, as the longer a hardware problem goes undiagnosed, the opportunity of cost-saving repairs decreases, increasing the alternative of costly replacements. Tomory: Ultrasound is an ever-expanding modality and organizations are increasingly looking for ways to reduce costs and extend the life of probes. It is critical for facilities to keep their fleet in optimal condition and when repairs are needed, to have those repairs performed properly, assuring the processes, materials used and verifications meet the highest standards possible. Also, proper care is critical to probe longevity. There are many different cleaners and disinfectants on the market to choose from, yet they are not equal as some can cause serious damage although they may seem innocent. The usage of improper chemicals or proper chemicals improperly is one of the most common causes of probe performance and appearance degradation, so it is imperative the OEM-recommended chemicals are used and directions for usage are followed.

Q: WHAT ARE THE PROS AND CONS OF BUYING BRAND NEW VERSUS BUYING REFURBISHED PROBES/TRANSDUCERS? Goodbar: Purchasing a refurbished probe can come with a few unknown variables such as an unknown age and remaining usable life. It’s important to use a trusted source that has quality processes in place to ensure you are getting a quality product. Buying new can come at a much higher price, while purchasing refurbished from a reputable dealer can give you a probe that should function like new with a better warranty and also at a better price.

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STAFF REPORT

Nguyen: Whether refurbished or new transducers are being used, there should be no negative impact to performance or safety of the devices when serviced or repaired. Refurbished transducers will help reduce health care facilities’ costs while maintaining high-quality patient care. However, sometimes health care facilities unknowingly assume risk by using transducers with counterfeit parts or components that have been previously installed by unqualified organizations. It is important to eradicate this risk by choosing ultrasound repair suppliers that have the quality management system and infrastructure in place to prevent the use of invalidated parts and components to preserve the performance and safety of the equipment health care facilities expect. Matt Tomory, Innovatus Imaging Tomory: New probes are built to OEM specifications with OEM materials and come with a great warranty, but also a premium price tag. A repaired probe can be substantially less expensive and come with a comparable warranty. If buying used, you should be sure to know who repaired it and the processes/materials used. Did the organization who sold the probe repair it? How was performance verified against the OEM? For patient safety, longevity and performance, a probe must be restored to an OEM’s original intentions for form, fit and function and the organization performing the repair must have the expertise, processes, materials, data and certifications to demonstrate that a probe performs as the OEM intended.

Q: WHAT CRITERIA SHOULD BE USED TO COMPARE AND SELECT A PROBE/ TRANSDUCER REPAIR PROVIDER WHETHER IN-HOUSE, ISO OR OEM? Goodbar: Reputation is important. Can the vendor or repair facility deliver on what they say they can? I recommend looking for those repair facilities that hold ISO certifications or show evidence of a solid quality management system. Transparency and willingness to bring customers in for site visits and external audits. An example of some criteria around the quality of the sales transactions could be detailed repair quotes accessible through mobile devices, root cause information that can be used to prevent future avoidable transducer failures and loaner availability. Nguyen: The most important criteria to use in selecting an ultrasound transducer repair supplier is to ensure the supplier is not installing or distributing counterfeit parts that hide inside the OEM marked casings. We regularly see counterfeit parts, and our health care facility customers often complain about the decreased lifespan, increased failures and inaccuracies with the equipment. When customers understand the risks, they typically

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ROUNDTABLE

remove these inferior devices and replace them with equipment from trusted partners. Tomory: A probe is a sophisticated, Class II medical device with a tremendous amount of acoustic and materials science and technology integrated into the design and construction. As an OEM made the original probe, the complex part for an ISO is to determine how to restore the probe to OEM form, fit and function. Repair service providers with an ISO 13485:2016 certification specific to medical devices, have a much more solid foundation for repairs than those without. To achieve optimal quality in repairs, this certification is a bare minimum customers should look for when choosing a repair provider. Having a medical device manufacturing background and philosophy is another distinction that can set providers apart. Companies with a manufacturing mindset tend to look at each device from a holistic perspective which drives everything associated with the repair to a higher standard.

Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING ULTRASOUND PROBES/ TRANSDUCERS? Goodbar: “Knowing is half the battle,” applies to truly knowing your suppliers and being educated on the equipment in your charge. Vendors that make the investment to become ISO

certified, perform material biocompatibility testing, provide care and handling training and have a strong track record should be on your short list of trusted partners. Education of clinicians and HTM professionals on the proper care and maintenance of ultrasound probes directly affects the life cycle of the probes, ensures up-time and lowers your operating cost. Nguyen: There is a legal and proper way to repair and service ultrasound probes, and often decisions are made without the insight into quality of product. While all probes may look the same on the outside, counterfeit parts could be hiding underneath OEM casings. Choose ultrasound repair organizations that guarantee you will be receiving a validated OEM product. This can be done by verifying the supplier’s ISO 13485:2016 certified Quality Management System, as well as visiting the supplier’s facilities to better understand their commitment to quality. Look for evidence that supports inspection criteria and quality controls to recognize potential counterfeit parts inside these important medical devices. Tomory: There is a massive difference between being able to get a probe working again and restoring it to perform as the OEM intended. If you, your organization and, ultimately, your patients, are trusting an organization to repair your probes, arrange a visit and see for yourself exactly how and why they deserve to serve you. There is a difference with highly qualified, holistic-minded organizations which is readily apparent upon a visit.

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LOOKING BEYOND CE CREDITS BY K. RICHARD DOUGLAS

The late Vince Lombardi once said; “The price of success is hard work, dedication to the job at hand, and the determination that whether we win or lose, we have applied the best of ourselves to the task at hand.” While the coach was talking about football, and life in general, the effort involved in career development can’t be ruled out. It takes hard work and determination to get ahead in a career and to accumulate more knowledge in the process. The process in most positions includes continuing education, training, reading and research. Career advancement can be strategically planned out by taking several proactive steps and methodically working a plan. Getting involved in professional organizations, finding a knowledgeable mentor and networking all play a role. 44

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Experts suggest setting goals with well-defined timelines. They also suggest talking to the boss to determine what opportunities exist. Also, while meeting with a manager, seek out feedback and get the perspective of peers. It can be useful to query your peers about your strengths and weaknesses. Managers can benefit by asking for honest feedback from employees about these same attributes. For the HTM professional, it can also include attending classes taught by ISOs, OEM classes and professional conferences. All contribute toward practical, hands-on knowledge that can make the HTM professional more valuable to their employer. These are the skills that help take a BMET I to a BMET II and eventually to a BMET III. It is this knowledge that produces a lead biomed and, eventually, a manager and director. This increased knowledge can lead to a more specialized expertise in areas of critical demand. That specialized expertise provides the biomed with more potential for career growth. A prime example of this has grown out of the need for network knowledge in recent years. The HTM professional with some IT-focused certifications is well-positioned. What should the path to career advancement look like? It includes introspection, lifelong learning and goal setting. Sometimes career advancement comes out of finding and filling a need. “From my personal experience, I started out in our department as a student going through my B.S. in biomedical engineering technology, growing quickly into an entry level biomed role,” says Anthony McCabe, MBOE, MBA, BS, LSSBB, associate director of the Wexner Medical Center Department of Clinical Engineering. “Once I got into that role, it was finding the areas that were of a potential that nobody else wanted to do or had the education to help out. Seeing that projects were something that we did as a clinical engineering department, I also found a gap that nobody had any formal

“ Learn about something new, take the initiative and highlight your efforts through the work you are able to do to support the need. There are educational sessions being held all over the place that are free, that help you hone your own skills.” – Anthony McCabe

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education in that arena, so I went after my MBA with a concentration in project management,” McCabe says. He says that this helped him advance his career even more and rise up through the ranks, leading projects, and eventually leading to a linear accelerator engineer position. “Wanting to do even more for the department in operations, and for the entirety of our medical system, I went after my masters of business operational excellence and also received a Black Belt certification in Lean Six Sigma and completing a capstone project that saved our organization millions on service agreement costs over multiple years through standardization and reduction of variability within the processes,” McCabe adds. Finding a need, and growing into that need, makes a person valuable to the organization and helps with career progression. McCabe says that while he doesn’t advocate for people to get a degree just for the sake of getting a degree, he thinks the process of continuing education is to focus on a true gap that you see in the workforce and chase after that. “I see a lot of people go for the degrees or certifications that everyone seems to have these days, without a real purpose behind it. Making that situation worse, the individual may take on enormous amounts of personal debt, and then don’t ever get the opportunity to go

further beyond that point all just because that piece of paper alone doesn’t practically set them apart,” he says. McCabe says that career advancement can come about by discovering the gaps that exist in your current organization, or in the field in general, and doing something to help make yourself stand out among your peers. “Learn about something new, take the initiative and highlight your efforts through the work you are able to do to support the need. There are educational sessions being held all over the place that are free, that help you hone your own skills on top of the big items, such as for public speaking, Microsoft Office programs, networking, etcetera,” he says. “I think alone, separately, these things don’t make you stand out a whole lot, but when you keep adding them to your repertoire, they all lead up to someone that helps lead that pathway to success,” he adds.

Leaderships’ Perspective It is not only in the HTM professional’s best interests to investigate methods for career advancement but in leadership’s best interests as well. Clinical engineering managers and directors have taken strategic steps to ensure career progression and job satisfaction for their staffs. “Career advancement planning is an integral part of employee morale,

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employee retention and succession planning. Without a good employee career advancement plan in place, not only will employee satisfaction suffer, but employee turnover will increase,” says Walter Barrionuevo, CHTM, CMLSO, director of clinical engineering for BayCare Health System. Barrionuevo says that his department has taken steps to assist the clinical engineering team members in achieving career goals. “We begin this process by annually discussing career goals and aspirations with each team member. We also created a job matrix which shows which skills/tasks are required for each job level. This assists the team member in identifying what skills/tasks are necessary for each specific job description and identify areas that still need improvement,” he says. “The other area that was identified was the need for a new job description that bridges the gap from a Biomed III to a diagnostic imaging engineer/field services. We created a new job description which provides a path for biomedical technicians to move in to and obtain the necessary training and experience to ultimately fulfill the role of a diagnostic imaging engineer,” Barrionuevo adds. Training and education, along with more meaningful hands-on experience, help biomeds further their knowledge and advance their careers. “We cannot allow a BMET I to only fix low level/low risk repairs such as suction regulators. We need to get our less-experienced staff engaged very early in learning all aspects of healthcare technology management and the technology that drives it. We must not let ourselves fall into the trap of tradition, relegating junior technicians to menial tasks because that’s what we were relegated to,” says George Reed, director of clinical engineering at WakeMed Health and Hospitals in Raleigh, North Carolina. “We need to allow junior BMETs to either assist in or manage more complex device repairs that traditionally are only

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assigned to their more experienced staff. We are seeing more and more of our junior technicians entering the field with a bachelor’s degree in areas of STEM (science, technology, engineering, and mathematics). Department leadership should recognize the value of these skills along with computer network-based education as the future of HTM,” Reed adds.

Management’s Plan to Help with Careers The many avenues available for training can be based on areas of interest. “OEM and third-party training are important avenues for us to continue to develop staff. We will train more than

This individual approach by leadership to developing the careers of biomeds is shared by Andrea Brainard, CBET, director of healthcare technology management at Children’s Health in Dallas, Texas. “I believe each situation is different, and in my experience, I’ve found it’s better to evaluate each team member and his or her accomplishments in context. In other words, there is no ‘cookie cutter’ approach to advancement, and I wouldn’t place labels or assign a specific set of milestones a team member should reach to get to the next level,” she says. Brainard says that in the past, there

“ I look for team members who are proactive in their day-to-day activities, forward thinkers, ambitious, and have the desire to do the work it takes to grow into the next level roles.” – Andrea Brainard one person in certain modalities and will train additional in some cases. Conferences provide opportunities to introduce our staff to new technologies and different career paths in addition to developing their current skills,” says Dan Blaisdell, biomedical engineering supervisor for ProHealth Care in Waukesha, Wisconsin. “Staff members, who show interest in areas outside their normal role, attend conferences and basic training to help them gauge their interest. Training will continue if the staff member continues to show interest and aptitude. This process allows staff members to transition into new positions with a better understanding of their new role and a solid foundation of skills,” Blaisdell says.

was a mindset that you had to “do your time” in order to graduate to the next level. Motivated biomeds often can have a leg-up on those with less determination. “I never liked that approach because some team members may have greater longevity in a role, but they may not be prepared to take the next step. They may be content in their current role and wish to stay where they are, and that is OK. A team member’s career path is often contingent on his or her desire and willingness to advance. Experience is always important, but so is a person’s drive and job competencies,” Brainard says. “As such, I look for team members who are proactive in their day-to-day activities, forward thinkers, ambitious, and have the desire to do the work it

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takes to grow into the next level roles. To me, these indicators far outweigh how long you’ve been doing the job and how many OEM or ISO classes you’ve taken. Trained biomed technicians should be able to work on almost anything without the excuse of ‘I haven’t been to the service school,’” Brainard adds. This effort to develop oneself beyond the textbook skills is one that impresses Jim Fedele, CBET, senior program director of clinical engineering, BioTronics for UPMC in Williamsport, Pennsylvania. “In my opinion, it takes preparation in the form of OEM training, knowledge of current industry issues and self-development outside of technical training. Now that I have been a manager for a long time, I am most impressed with technicians that do more than attend OEM training,” Fedele says. His best impression is derived from the technicians that pursue selfdevelopment to improve the intangible aspects of their skills. “For instance, skills like leadership, customer service, decision making and listening, these are all attributes that make a technician more valuable and will help propel them in their career. Many times, I have met 20-year technicians that have only attend OEM training that was organized by their employer and have done nothing on their own to improve themselves,” Fedele adds. McCabe says that career advancement can come about by discovering the gaps that exist in your current organization, or in the field in general, and doing something to help make yourself stand out among your peers. Blaisdell says that ProHealth Care developed career paths for staff members that allows them to advance through technical, operational and leadership careers. Some positions can be entered into directly depending upon the abilities, experience or attitude. They offer a diagram that illustrates career paths for employees. “Additionally, entry into leadership

“ For instance, skills like leadership, customer service, decision making and listening, these are all attributes that make a technician more valuable and will help propel them in their career.” – Jim Fedele

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path was not indicated because there are numerous possibilities to enter from the other paths, and the connectors would start to get confusing,” he says. “I do have a training plan for each employee. It lists the training I would like to see them have and also their requests. The plan continues out two to three years and is reviewed periodically with each employee. This is very fluid and often changes based upon department need,” Blaisdell says. That proactive, ambitious approach that Brainard alluded to is the advice that McCabe suggests for a BMET I as a launching point for growth. “My experience is to get involved in every opportunity as a BMET I to get that strong foundation, and take advantage of any trainings formally approved through management as possible. Always ask for the basics to be provided, but try to find one spectrum to excel in,” he suggests. “Help management by identifying an area that may be under contract or an area that isn’t well structured for support, and propose a solution in the form of researching the training needed to get you there and packaging that together for management,” McCabe says. “Doing this legwork may not only make you stick out as a candidate, but makes their job easier to review things and approve rather than try to pull all of that info together and pick someone whom may not be you,” he adds. He says that this is a good approach to get to BMET II, and then from there it gets a little more complicated to move up to that BMET III role.

“There are still those similar opportunities, but it’s adding those additional tools to your belt that help you reach those goals. Taking a leadership role to help with operational efficiencies is always a great way to go,” he adds. McCabe says that certifications and education can help also if they are justified to bridge the next gap and show your worth. He says that biomeds who can improve processes and eliminate obstacles to those processes make themselves valuable to management. “For me it was implementing more lean principles and foundations into the clinical engineering department, as it made management look better by improving our numbers, it made the other technicians’ lives easier by creation of standards and workflows that cut out waste and allowed them to get more work done to focus on other things like projects and improving other areas of the department,” McCabe says. Getting from BMET I to any level in the HTM universe comes about by taking control of your career and making yourself a valuable asset to your organization. “For me personally, I have always worked to make my boss’s job easier; if that meant taking on a project, or running a PM list for the team or organizing a team activity I would do it. Some might say that is ‘kissing up,’ but in the end, it helped me learn and expand my knowledge base, which then led to promotions,” Fedele says. Be proactive and don’t forget to make the boss’s job easier.

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EXPERT ADVICE

JENNIFER BROWN

CAREER CENTER

Seeing the Forest for the Trees BY JENIFER BROWN

JENIFER BROWN CEO and Founder of Health Tech Talent Management

feel this old cliché remains very timely in this day and age! Where candidates oftentimes seem unable to really see or visualize the entire “forest” of an opportunity due to perhaps the large tree (normally the dollar offer amount) in front of them.

In our industry today there is, thankfully, a high demand for skilled biomed technicians, imaging engineers and management-level employees. Because of this demand, hiring managers and/or employers have steadily increased salaries over the past several years to attract candidates to leave their current employment or from going to other opportunities. Due to this, I have seen many candidates going after the immediate high dollar rather than the opportunity with more career growth! My advice to candidates is always to be sure to review all of the components in regarding or comparing offers. Not just the salary dollar amount of the offer. Make sure to obtain the full comprehensive benefits package for comparative cost of out-of-pocket

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

medical, dental and/or vision insurance coverage for you and your family, if pertaining. Plus, there are many other benefits that can equate to dollars when comparing offers. For example, the employer’s matching percentage to a 401k or IRA which provides financial dollars for your future! Some employers even offer tuition assistance or reimbursement programs for you to obtain a new degree. Many even offer a bonus and/or raise in salary base if you obtain your CBET or for Management HTM certification. Also, there are organizations that offer a performance-based annual (sometimes quarterly) bonuses in addition to your salary base. Most importantly; ask yourself if this position offers any future career advancement or training. If not, and you accept due to “the dollars,” then you may be in a scenario of looking again in a year or two! The list can go on, but it is up to you to request and review all of the details when receiving offers so are you making the right decision for your current state as well as for your future!

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in the middle, where the bar seems to be two pieces that drop down in the center. Philips IU22 or IE33 ultrasound Other hard stops will just bend. Either case weiV ro retsigeR ot 4877.922.338.1 llaC // machine tends to fall into one of four is a clear indication of a failed articulation enilnOPM, eluimage dehcSartifact, dna xedhard nI esdown ruoC ITSR eht categories: arm. It may not seem like much, especially or mechanical problem. Each of these if the arm still holds its position, but this events requires the expertise of a imaging hard stop prevents the pistons in the arm T7731-9service 0-39 .ON professional. .GER HO FO ETATSMany | ITSR 8times, 102© additionfrom being destroyed by keeping the arm’s al service issues are found while running movement range within limits. Philips iU22/iE33 control panel articulation arm routine checks during service calls. Most of If the hard stop is good but the these issues point to a clearly defined probcontrol panel still moves while pushing lem, but some are less obvious and require down, then the arm is still bad. There are some extra testing. A particular issue that two adjustments to the articulation arm, you should always be on the lookout for is but both only increase or decrease the TROPcan PUSItry TSR# a failed, and possibly leaking, piston in the tension on the brake cable. You control panel articulation arm. decreasing the tension to see if that will allow the arm to stay locked, but chances are this will not do anything. Increasing Hard Stop The the tension just makes it easier for the Mpotential OC.EGdamage NAHCcaused XE-ITby SRbroken articulation arm is high. Why? It’s just brake to release, so that isn’t the solution mechanical, right? Yes, but that arm control panel to a comfortable working either. If the brake is not holding, it ® G Narm A H C Xmeans E I Tthe S Rpistons are failing. This failure houses two pistons. When defective, height. When raised or lowered,Ethe those pistons can leak into the front-end should stop at a consistent height and hold will eventually lead to the arm dropping card cage and cause electrical mayhem its position. You should not be able to push faster than normal, and will eventually eniLmake lluF ruOcause pohSthe dnahard enilnstop O egtonabreak. hcxE ITSR tisiV // anywhere from the scan-head to the down (reasonably) on the handle and t n e m p i u q E denwoof -erthe P fo select board, to any of the front-end it move down. To prevent a complete failure boards. As an imaging professional, you If you’re able to move the articulation control panel articulation arm, stay P ,ecivreand S dwatch nameDfor -nO ruOclues tuobwhile A ksA // would not even know that the fluid is arm handle, it’s time to confirm if the arm stravigilant these leaking because the arm is concealed by is bad by checking the mechanical hardnoitcnujservicing noC ni trultrasound oppuS hceTsystems dna sninoitthe allafield. tsnI all of the cosmetic covers. stop. The hard stop is located just under Catching the problem early can be the sesahcruP straP htiw The only way to detect // EaNdefective IL N O SU W OLthe L Oarm F / /nearest the control panel, and you difference between a cheap and easy fix or articulation arm is to see the clues the will need to remove the front-end cover straP fo yrotanlong, evnI gcostly nidnaand pxEstressful yltnatsnrepair. oC a sseccA // machine is giving you. Where are these and the “beard” to access it. When you eitiladoMJoe dnaLopez srerisutacImaging afunaMService tsoMProfessional rof kcotS ni clues? They are in the movement of the look at the hard stop, it should be a ssolid arm itself. The function of the control bar with two screws on the left and right for Avante Ultrasound. For 24/7 technical mE ro 0074or.9visit 43.044 llaC // panel articulation arm is to allow the sides of the arm. I have seen many of these support, calllia 800-958-9986 sonographer to raise and/or lower the stops broken. The most common break issliateD www.avantehs.com/ultrasound lluF rof moc.egnahcxE-ITSR@selaS

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THE OTHER SIDE

Micromanagement – Style to get things done or recipe for poor results? BY JIM FEDELE

n my 29 years as an employee, supervisor and manager I have had many “bosses” all with their own style and “hot buttons.” As I reflect on what I liked and disliked about them, micromanagement seems to be the area that was the biggest challenge for me. I would like to discuss how micromanagement affects employees and ultimately the overall operation. Some would argue that there is a time and place for micromanaging, I personally have not found too much success in the practice over the long haul.

Early on in my management career, micromanaging was all I knew to get things done. My rationale was, I was selected to be a manager because I had excelled at getting things done. I felt I knew how to get results and my systems would certainly carry us to greatness. For a little while it did actually work, but soon my world seemed to collapse around me and I was left wondering why. Nothing could have prepared me for the feeling of betrayal I experienced the first time I discovered one of my employees not doing what they were supposed to do. After all, they were my loyal coworkers; I was just one of them not too long ago. It seemed that not everyone felt my way was the best way to get things done. In an effort to make corrections, I started to micromanage every aspect of their work. I did not expect the push back from my “friends” and I became stressed out. I did not achieve any of my goals. Our

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performance was not getting better. Nobody seemed happy. It was during this time that I got a new boss to report to who was also a micromanager. I remember feeling very angry about this new person. I could not get passed the thought that this person wasn’t in my department every day, how can he know anything about my job? I felt like quitting. That is when it hit me, if I felt like this about my boss, most certainly my techs had similar feelings for me. Luckily, I had a good support group to lean on and I got help to combat my issues. What I learned was to focus on outcomes, clear and defined outcomes. I let the techs workout their own schedules and how they wanted to work. I just provided them with absolutes and goals, like coverage times and quality indicators; I left the how up to them. It is not easy to trust and give up control of things that are important. I think to be successful at not micromanaging, there has to be a fundamental paradigm shift for one to be completely free of it (micromanaging). You must see your employees as people who want to do a great job and who want to have fulfilling positive lives. When I think of our employees from this angle it allows me to focus on the “why” and instead of the “who.” I think when we focus on why things aren’t going the way we plan, instead of solely on who isn’t getting it done, we identify true root causes to issues. How would you ever know there is a system problem or a process problem if all you did was focus on the person not getting it done?

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

One great advantage of not micromanaging your people is it does allow the manager time to focus on special projects and more strategic issues. By getting out of the daily activity a manager can work on developing his people, networking with customers or projects that can benefit the entire organization at a higher level. My favorite line is, “You only have two types of employees; those who are committed and those who are compliant.” Micromanagement almost always cultivates compliant employees (those employees that do just enough to stay employed) because they do not feel empowered to do things their way and improve their own work practices. Fortunately for me, the leadership team I get to work with today is not made up of micromanagers. They empower me to do what I need to do to run a great program. They give me the guard rails I need to keep me out of trouble, but ultimately I am free to run the daily activity as I see fit. In turn, I have given my employees the flexibility to manage their workloads on their own with limited interference from me. 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 MANNY ROMAN

ROMAN REVIEW The Misinterpretation Dance BY MANNY ROMAN

recently had the dubious opportunity to be an observer in a learning experience regarding the misinterpretation of someone’s intent. Without going into details regarding this observed encounter, I will say that I was an innocent bystander in a discussion where an individual assigned bad intent to a speaker’s words and actions. As an observer, I did not have the same impression of these words and actions.

I called this a learning experience because it caused me to wonder how the offended party could have such a differing conclusion than I. Of course, I then proceeded to analyze and to generate my own conclusions as to the reasons for the difference. I will share this with anyone still reading this. First I will quote my father, “Every head is a different world.” This means that everyone has a head full of their own judgments, biases, beliefs, quirks, perception of reality, bucket of knowledge, delusions and much more. We all look at everything we see, hear and touch through different colored glasses. It should be a wonder that we can get along at all. We project our version of the truth, reality, facts and moral code onto the presenting individual. This will certainly cause a mismatch and the ensuing misinterpretation of their intent. Search previous TechNation articles or the Internet for “The Ladder of Inference” for a very interesting description of how we arrive at conclusions.

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So when someone projects a group of verbal and nonverbal communication in our direction, it is seldom received and interpreted as intended. Interpretation and assigning of intent is largely based on our own experiences and all the stuff that resides in our head as previously mentioned. How we assign intent can be based on our present attitude in general and our attitude toward the presenter. We also use past experiences of similar situations to assign meaning and intent. I have written about the science that presents the amygdala in our brain as the gatekeeper of emotions. Its main job is to ascertain if a situation presents a threat and to protect us from it. If we get even a hint that the presenter has bad intentions, we will expand that hint into a threat. The freeze-flee-fight emotional response is brought forward in all threatening situations. We then freeze by not listening any further, flee by extricating ourselves from the situation or fight back with an argument. I once came across something termed the curse of knowledge. It speaks on the fact that it is very difficult for us to comprehend how someone else does not know what we know. How can they not understand us when we clearly projected the message? This is the other side of this discussion. The person whose intent was misinterpreted cannot believe that the other person got it so wrong. I quietly observed the two individuals mentioned at the beginning performing the back and forth misinterpretation dance. I was in awe of how each additional bit of information

MANNY ROMAN, CRES AMSP Business Operation Manager

fueled the rising anger and frustration. It was clear that the situation was becoming an accusation sword fight. I used my great and many talents to redirect the discussion to a gentler and kinder form of communication. I pointed out some of the things that I mentioned above. They became confused enough to arrive at a decision to continue their dance once I exited the premises. Now I will provide some recommendations for avoiding the misinterpretation dance. Communication is key. Good communication requires active listening as well as a more careful selection of the verbal and nonverbal cues used for the message. Good communication requires that the what, the why and the expected result be clearly communicated. It requires that the receiving individual be given the opportunity to provide feedback. In fact, feedback should be solicited to ensure understanding. One great way to provide feedback is to say, “Wait, I want to make sure I understand.” Then proceed with your interpretation and negotiate together for the truth. Good communication also requires the acceptance of the different worlds in each other’s heads. It requires an acceptance that we each bring a bucketful of impediments to the communication. One final caution: Sharpen your sword. Just because you are paranoid does not mean they are not out to get you.

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P P

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

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

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

P P P

P P

P P P

Diagnostic Imaging Avante Health Solutions avantehs.com •

Avante Ultrasound avantehs.com/ultrasound • 800-958-9986

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

Endoscopy Healthmark Industries

HMARK.COM • 800-521-6224

P P

Computed Tomography Altima Diagnostic Imaging Solutions

CMMS Nuvolo

Celing Lifts

Biomedical ALCO Sales & Service Co.

sebiomedical.com/ • 828-396-6010 www.swbiomed.com/ • 800-880-7231

Batteries PartsSource

www.seaward-groupusa.com • 813-886-2775

Southeastern Biomedical, Inc

Association AAMI

Rigel Medical, Seaward Group

Cardiology

Asset Management ISS Solutions

TRAINING

www.ambickford.com • 800-795-3062

SERVICE

A.M. Bickford

PARTS

Anesthesia

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

AD PAGE

Company Info

Multimedical Systems www.multimedicalsystems.com • 888-532-8056

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

11 75

P P

Fetal Monitoring Multimedical Systems www.multimedicalsystems.com • 888-532-8056

FEBRUARY 2019

TECHNATION

TRAINING

www.brcsrepair.com • 844-656-9418

P P

General

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

Soma Technolgoy, Inc

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

Hand Switches

www.somatechnology.com • 1-800-438-7662

www.inrayparts.com • 417-597-4702

P P

Imaging

www.ampronix.com • 800-400-7972

BMES www.bmesco.com • 888-828-2637

Health Tech Talent Management, Inc. www.HealthTechTM.com • 757-563-0448

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

Infusion Pumps AIV aiv-inc.com • 888-656-0755

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

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

Multimedical Systems www.multimedicalsystems.com • 888-532-8056

P P

Infusion Therapy AIV aiv-inc.com • 888-656-0755

Elite Biomedical Solutions elitebiomedicalsolutions.com • 855-291-6702

FOBI www.FOBI.us • 888-231-3624

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

RepairMED www.repairmed.net • 855-813-8100

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

Soma Technolgoy, Inc www.somatechnology.com • 1-800-438-7662

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

P P

27 27

Altima Diagnostic Imaging Solutions www.altimadis.com • 844-548-4540

Innovatus Imaging www.innovatusimaging.com • 844-687-5100

PartsSource www.partssource.com/shop • 877-497-6412

www.ozarkbiomedical.com • 800-457-7576

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

Webinar Wednesday

FOBI www.FOBI.us • 888-231-3624

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

AIV aiv-inc.com • 888-656-0755

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

Avante Health Solutions

P P

www.betabiomed.com/ • 800-315-7551

BETA Biomed Services Biomedical Repair & Consulting Services, Inc. BMES www.bmesco.com • 888-828-2637

Master Medical Equipment

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

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

4 61

P P P P P

masterfitmedical.com • 866-468-9558

PartsSource www.partssource.com/shop • 877-497-6412

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

FEBRUARY 2019

P P

8 17

P P P

67 74

P P

Patient Monitoring

Mammography

PACS

avantehs.com •

P P

Oxygen Blender

Online Resource

www.brcsrepair.com • 844-656-9418

Ozark Biomedical

MRI

Labratory

MRI

www.1technation.com/webinars • 800-906-3373

Monitors/CRTs Ampronix, Inc.

inRayParts.com

TECHNATION

SERVICE

Monitors

Biomedical Repair & Consulting Services, Inc.

PARTS

Gas Monitors

Company Info

AD PAGE

TRAINING

SERVICE

PARTS

AD PAGE

Company Info

P P

WWW.1TECHNATION.COM

SERVICE INDEX CONTINUED

www.usocmedical.com • 855-888-8762

P P

Patient Monitors Avante Patient Monitoring avantehs.com/monitoring • 800-449-5328

Doctors Equipment Repair www.doctorsequipmentrepair.com • 458-205-8438

P P

www.inrayparts.com • 417-597-4702

P P

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

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

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

Soma Technolgoy, Inc www.somatechnology.com • 1-800-438-7662

www.adel-lawrence.com • 866-252-5621

Health Tech Talent Management, Inc. www.HealthTechTM.com • 757-563-0448

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

4 61 43

P P P P P P

aiv-inc.com • 888-656-0755

67 57 64

avantehs.com •

Elite Biomedical Solutions elitebiomedicalsolutions.com • 855-291-6703

www.alcosales.com • 800-323-4282

Avante Patient Monitoring avantehs.com/monitoring • 800-449-5328

Avante Ultrasound avantehs.com/ultrasound • 800-958-9986

www.ambickford.com • 800-795-3062

FOBI

Nuvolo

Healthmark Industries

P P

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

Avante Patient Monitoring avantehs.com/monitoring • 800-449-5328

Biomedical Repair & Consulting Services, Inc. BMES www.bmesco.com • 888-828-2637

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

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

RepairMED

www.swbiomed.com/ • 800-880-7231

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

P P

Test Equipment 64

www.ambickford.com • 800-795-3062

BC Group International, Inc

P P

www.BCGroupStore.com • 314-638-3800

P P

www.prnwebsite.com • 508-679-6185

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

A.M. Bickford 50

Surgical

Southwestern Biomedical Electronics, Inc. 2

P P

Software

www.repairmed.net • 855-813-8100

Repair ALCO Sales & Service Co.

A.M. Bickford

www.multimedicalsystems.com • 888-532-8056

Respiratory

Multimedical Systems

Rental/Leasing Avante Health Solutions

Engineering Services

www.brcsrepair.com • 844-656-9418

Refurbish AIV

elitebiomedicalsolutions.com • 855-291-6701

HMARK.COM • 800-521-6224

Recruiting Adel Lawrence Associates

Elite Biomedical Solutions

eam.nuvolo.com/clinical • 844-468-8656

IBC

Replacement Parts

www.FOBI.us • 888-231-3624

P P

ISSsolutions.com • 800-752-2290

www.eng-services.com • 888-364-7782x11

Portable X-ray inRayParts.com

ISS Solutions

TRAINING

USOC Bio-Medical Services

P P

elitebiomedicalsolutions.com • 855-291-6701

SERVICE

www.swbiomed.com/ • 800-880-7231

Elite Biomedical Solutions

PARTS

Southwestern Biomedical Electronics, Inc.

P P

Company Info

AD PAGE

sebiomedical.com/ • 828-396-6010

TRAINING

Southeastern Biomedical, Inc

SERVICE

www.repairmed.net • 855-813-8100

PARTS

RepairMED

AD PAGE

Company Info

PRN/ Physician’s Resource Network

P P

FEBRUARY 2019

TECHNATION

SERVICE INDEX CONTINUED

www.seaward-groupusa.com • 813-886-2775

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

TRAINING

Rigel Medical, Seaward Group

SERVICE

www.pronktech.com • 800-609-9802

PARTS

Pronk Technologies, Inc.

AD PAGE

Company Info

Continue your free subscription of TechNation magazine!

3 67

P P

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

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

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

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

Advancing the Biomedical/HTM Professional

67 42

SUBSCRIBE TODAY!

Tubes/Bulbs PartsSource www.partssource.com/shop • 877-497-6412

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

P P P

P P

APRIL

1tech

natio

n.com

Ultrasound

1techn

P P

ISSsolutions.com • 800-752-2290

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

Summit Imaging www.mysummitimaging.com • 866-586-3744

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

64 25 76 41, 73

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Mag

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www.rsti-training.com • 800-229-7784

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

FEBRUARY 2019

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ISS Solutions

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www.innovatusimaging.com • 844-687-5100

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Innovatus Imaging

OT S E

16 WH O WI A R 22 E C MA LL OM IN TA ING 26 IN T

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avantehs.com/ultrasound • 800-958-9986

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Req ues ted

ATS Laboratories

Vol. 9

Service

Add ress

www.ampronix.com • 800-400-7972

2018

NAL ESSIO PROF HTM

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www.1technation.com/subscribe WWW.1TECHNATION.COM

ALPHABETICAL INDEX

DOCTORS

A.M. Bickford…………………………

inRayParts.com………………………

AAMI…………………………………

InterMed Group………………………

Adel Lawrence Associates……………

Interpower…………………………… IBC

AIV……………………………………

ISS Solutions…………………………

ALCO Sales & Service Co.……………

Master Medical Equipment…………

Altima Diagnostic Imaging Solutions…

Maull Biomedical Training……………

Ampronix, Inc.…………………………… 4

Medical Equipment Doctor, INC.……

ATS Laboratories………………………

Multimedical Systems………………

Avante Health Solutions………………… 2

MW Imaging…………………………

Avante Patient Monitoring……………

Nuvolo…………………………………

Avante Ultrasound……………………

Ozark Biomedical……………………

BC Group International, Inc………… BC

PartsSource…………………………

BETA Biomed Services………………

PRN/ Physician's Resource Network… 75

Biomedical Repair & Consulting

Pronk Technologies, Inc. ……………… 5

Services, Inc.…………………………

RepairMED……………………………

BMES…………………………………

Rigel Medical, Seaward Group………… 3

Crothall Healthcare Technology Solutions…67

RSTI……………………………………

D.A. Surgical…………………………

Select BioMedical……………………

Doctors Equipment Repair……………

Soma Technolgoy, Inc………………

ECRI Institute…………………………

Southeastern Biomedical, Inc………

Elite Biomedical Solutions……………

Southwestern Biomedical Electronics, Inc.…16

Engineering Services…………………… 6

Stephens International Recruiting Inc.… 64

FOBI…………………………………

Summit Imaging………………………

Health Tech Talent Management, Inc.… 57

Tri-Imaging Solutions…………………

Healthmark Industries………………

Trisonics…………………………… 41, 73

iMed Biomedical………………………

USOC Bio-Medical Services…………… 7

Injector Support and Service…………

Webinar Wednesday…………………

Equipment Repair

Depot repair services for portable patient ceiling lifts.

Supported brands and models • Molift Nomad and Air • Ergolet Luna (458)-205-8438 www.doctorsequipmentrepair.com

Innovatus Imaging……………………… 8

ADVANCING THE BIOMEDICAL/HTM PROFESSIONAL

FEBRUARY 2019

TECHNATION

BREAKROOM

PARTING SHOT

“Don’t keep forever on the public road, going only where others have gone and following one after the other like a flock of sheep. Leave the beaten track occasionally and dive into the woods.” – Alexander Graham Bell

TECHNATION

FEBRUARY 2019

WWW.1TECHNATION.COM

The Interpower Solution

The Interpower Solution for North American Hospital-Grade Replacement Cords: If you just need one, order just one. We have no minimum order or dollar amount requirements, which empowers you to order just what you need—whether it’s 1, 5, 100, or more. Interpower manufactured hospital-grade cords are made in Iowa and are electrically tested for safety. They carry UL and CSA approvals. We offer both replacement cords and special orders. Value-added options, such as labeling and packaging, are available upon request. For example, you can mark your cords with labels that contain your specific information, such as identifying a certain location (e.g. Operating Room 1, ER 2, etc.). With your cords specially labeled, hopefully they will stay in the correct location. And if you need to replace one, you only have to order one. Interpower offers a wide selection of clear, black, and gray North American hospital-grade plugs on power cords, cord sets, and replacement cords.

• Made in Iowa, U.S.A. • No minimum order or dollar requirements • Same day shipments on in-stock products • 1-week U.S. manufacturing lead-time on non-stock Interpower products • Lock in your price with blanket or scheduled orders • Free technical support available

Secure Your Connection

Interpower connector locks can help prevent accidental power interruption.

Before you select your connector components, you should consult the appropriate medical equipment standards for connection security requirements.

Contact Customer Service for more information. sales@interpower.com

Order Online! www.interpower.com

Business Hours: 7 a.m.–6 p.m. Central Time

IPA-3400 Infusion Pump Analyzer

Now Patented

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

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

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

Screenshots from the IPA-3400

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

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