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Vol. 10
JUNE 2019
ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL
TRUST THE
PROCESS TIPS TO HELP YOU MAKE BUYING DECISIONS
14 Company Showcase
Elite Biomedical Solutions
20 Company Showcase
SPBS, Inc.
Company Showcase 26 Agiliti Roundtable 54 Cybersecurity
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CONTENTS
FEATURED
54
ROUNDTABLE: CYBERSECURITY ybersecurity continues to be an C important and hot topic in health care, especially in the HTM community. TechNation quizzed some industry experts about cybersecurity in search of information to help readers. Next month’s Roundtable article: Ultrasound Systems
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TRUST THE PROCESS: TIPS TO HELP YOU MAKE BUYING DECISIONS
Biomeds understand what clinicians requires of equipment and have a sense of what makes that device work, why it will continue to work or break down and how much trouble and cost goes into maintaining it. We asked HTM experts for tips and how they acquired knowledge to make good purchasing decisions. ext month’s Feature article: N What’s the Standard: Follow up on the latest TJC developments
TechNation (Vol. 10, Issue #6) June 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
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
JUNE 2019
TECHNATION
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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
CIRCULATION
Lisa Lisle 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
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Proud supporters of
P.12 SPOTLIGHT p.12 Professional of the Month: Carlos Rodriguez, MBA, CBET p.14 Company Showcase: Elite Biomedical Solutions p.18 Department of the Month: Yavapai Regional Medical Center Biomedical Engineering Department p.20 Company Showcase: SPBS Inc. p.24 Biomed Adventures: Providing the Right Tool for the Job p.26 Company Showcase: Agiliti P.30 p.30 p.34 p.35 p.36 p.38 p.40
INDUSTRY UPDATES News & Notes Ribbon Cutting: Insight HTM Welcome to the TechNation Community MD Expo Keynote Informs Hundreds AAMI Update ECRI Update
P.45 p.45 p.46 p.48 p.51
THE BENCH Biomed 101 Webinar Wednesday Shop Talk Tools of the Trade
P.69 EXPERT ADVICE p.69 Career Center p.70 20/20 Imaging Insights p.73 Cybersecurity p.74 Addressing TJC’s Most-Cited Standards p.76 The Other Side p.78 Roman Review P.82 BREAKROOM p.82 Did You Know? p.84 The Vault p.86 MedWrench: Where is Ben C? p.91 Trick Out Your Biomed Cart p.92 MD Expo Houston Scrapbook p.96 Service Index p.101 Alphabetical Index p.102 Flashback Like us on Facebook www.facebook.com/TechNationMag Follow us on Twitter twitter.com/TechNationMag WWW.1TECHNATION.COM
Technology that powers healthcare. Sodexo CTM powers lifesaving technologies at some of the nation’s leading hospitals and health systems. They trust Sodexo because of our advanced training and resources, and our global network of technicians sets the standard for reliable and precise service. We never stand still, continuing to invest in our people so they have the skills and knowledge to support those who save lives every day. This is a truly life-changing career for professionals like you.
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SPOTLIGHT
PROFESSIONAL OF THE MONTH Carlos Rodriguez, MBA, CBET: Finding Solutions in Western Arizona BY K. RICHARD DOUGLAS
I
t gets hot in Bullhead City, Arizona. The temperature in the city, which is located across the Colorado River from Nevada, in western Arizona, can be 112 degrees in the summer. Thankfully, for those who like to escape to the water, there is some relief and enjoyment.
One resident who enjoys the region’s water recreation areas is also the local medical center’s director of biomedical engineering. Carlos Rodriguez, MBA, CBET, works at the Western Arizona Regional Medical Center in Bullhead City. Western Arizona Regional Medical Center is a 139-bed acute care facility serving the greater Bullhead City community. It is staffed by 571 health care professionals and offers the area’s largest intensive care unit. Although Rodriquez came from a medical family, he took a different route when entering the health care field. “Coming from a family already in the health care field, my father used to be a physician and my mother a nurse and due to the necessity to make a change in my life, I decided to enroll in a field where I could fix medical equipment,” he says. “Initially, I was looking for something to be completed quick, like an associate’s, but I ended up in a university and completed a full bachelor’s degree in biomedical engineering. Now I have the bachelor’s, an MBA and AAMI CBET 12
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certification,” Rodriguez says. Rodriquez’s biomed education came as a combination of formal schooling and on-the-job training with a dash of mentoring. “For education, I attended Devry University in Phoenix, Arizona and I just completed the internship time required by the school; it was just a couple of months that I completed in Banner Estrella Medical Center focused on Carefusion/ Alaris pumps and beds,” he says. “I was lucky, because in my first job at Western Arizona Regional Medical Center, I was hired for a team of two biomeds with a lot of experience and knowledge and I spent two years back to back with one of them (Frank Evans). He was the one who decided to hire me. He saw my resume, full of education, and he didn’t care about extensive experience and hired a smart guy full of knowledge ready to be trained,” he says. Over the past seven years, Rodriguez has held positions at the Phoenix location and at his current facility. “My first position was biomed technician internship in Banner Estrella from March to May of 2012. My second position was biomedical engineering at Western Arizona Regional Medical Center from December of 2012 to June of 2016. I stayed in this position for almost four years, but at the same time, I started to do tasks that belonged to the biomedical supervisor position. Finally, I was promoted as a biomedical engineering director in June of 2016 and
I’m still in this position today,” Rodriguez says. MAKING GOOD CHOICES Rodriguez reflects on the role of the HTM professional and remembers a couple of first-hand challenges with new technology. “As HTMs, either technicians or leaders, we face challenges every day. When we talk about broken equipment, [it] could be something as simple as a broken bedside monitor that can potentially close a room or a broken anesthesia machine than can cancel procedures for patients; a bigger challenge could be a problem with the water system used in the SPD department that can stop the OR department,” he says. Rodriguez says that additionally, they evaluate a lot of special projects. “For example, now we are in the process of buying new pumps for infusions. The input from the HTM department is critical because we are the ones who said if the old device is no longer supportable – no parts and/or service is available – and at the same time we need to identify in advance how the new equipment will be supported. In this case, we need a lot of coordination/ communication with clinical department to made the project successful. At the same time, we are evaluating to replace our current patient monitor system, bedside monitors and telemetry, and we need to evaluate different technologies or vendors in the market before we make a WWW.1TECHNATION.COM
SPOTLIGHT
FAVORITE BOOK “The Secret”
FAVORITE MOVIE “Good Will Hunting”
FAVORITE FOOD Seafood
HIDDEN TALENT Good with tools
FAVORITE PART OF BEING A BIOMED Find solution for problems
WHAT’S ON MY BENCH? • AAMI A Practicum for Healthcare Technology • Coffee cup • Flashlights • Cellphone • Laptop • TechNation magazine
Top: Carlos Rodriguez can repair various medical devices. Bottom: Carlos Rodriguez is seen with the pillars of excellence at the Western Arizona Regional Medical Center.
final decision,” Rodriguez says. He says that the main challenge is being the technology manager for medical equipment/systems to ensure patient safety. “A year ago, with coordination with pharmacy and clinical nurse leaders, I made the recommendation to our administration to replace the infusion system equipment and now we are ready to go live in early May,” Rodriguez says. “Several years ago, the anesthesia machines were replaced. I was in charge of completing the coordination with several vendors to try their units until we found the perfect model that met each and every one of our needs. I supervised
the whole process until the in-service (training) was completed,” he adds. When living in a hot climate, a good escape is to find a source of water and jump in. “I love summer weather here in Bullhead City. We have a beautiful river and lake, so I spend a lot of time swimming,” Rodriguez says. He is talking about Lake Mohave and Big Bend Park on the Nevada side of the river. Lake Mohave is located north of the sister-cities of Laughlin, Nevada and Bullhead City. Along with the Colorado River, the bodies of water provide an escape from the summer heat. “I’m married with three children; my
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
wife is Yesenia Rodriguez (cosmetologist), my older daughter is Ingrid Rodriguez (15 years old), Alexander (12) and Damian (10),” he says. What is Rodriguez’s approach as an HTM professional? “I’m the type of person that presents solutions; not problems. I think that if you do something, anything, whether a simple repair or a major project, it has to be done right the first time. Completing tasks both quickly and efficiently is key in everything I do,” he says. The solution to keeping medical equipment running is to have a competent biomed like Rodriguez. The solution to 112 degrees is a quick dip in the lake. JUNE 2019
TECHNATION
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SPOTLIGHT
SPECIAL ADVERTISING SECTION
PATIENT SAFETY IS OUR FOCUS
A
s a family owned and operated business, we know and value the importance of family. There have been days where our loved ones have depended on an Elite Biomedical Solutions’ part. Therefore, every replacement part, replacement assembly, production process and repair service are performed with the highest level of detail. Elite has worked diligently to build the diverse and skilled team we have today. Our experienced team works every day to ensure patient safety is met. We work hard, so your loved one is treated with Elite care. Learn how we focus upon patient safety daily.
HOW: MANUFACTURING CONTROL A major decision for Elite was to bring manufacturing in house! We are proud to say we use 100% USA manufactured plastic replacement parts and that we
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manufacture these parts in our corporate facility. This provides to you (our customer), Elite’s protection and guarantee of a high-quality replacement part. For an error-proof process, Elite manufacturing implements principles of poka-yoke. This can be as simple as pre-counting the number of labels for a specific product lot to setting alarms on the injection mold press that alert the operator of any variances in parameters. Elite regularly evaluates their processes for improvement. We are firm believers in continual improvement at Elite. It is an ongoing effort to advance our processes, products and services in order to execute the best solution. Our team works closely in collaboration to share ideas and brainstorm improvements. Through the plan, do, check, act (PDCA) cycle, these ideas or solutions are tried and tested. If proven effective, they are then implemented.
HOW: DESIGN CONTROL Throughout the entire process of product development, we follow a strict set of guidelines. This is accomplished by establishing a detailed Project Plan from the collaboration of department Design Reviews. The reviews foster input and discussion on the product design and the areas with special consideration. Documentation is created and maintained for each Design Review. Every product process is validated through an IQ, OQ and PQ process to ensure that the respective process will yield a product that meets the predetermined requirements. This is true regardless of how complicated or simple the process is. Prior to releasing a product for sale, a test protocol is created and performed to ensure that Elite parts perform to the same level as OEM. Each product is composed of numerous parts that are either
WWW.1TECHNATION.COM
SPOTLIGHT
fastened together or included in assembly. A detailed set of assembly steps are created and validated to guarantee the assembly is correct and contains all components. HOW: QMS-RISK MANAGEMENT Elite Biomedical Solutions takes a risk management approach for our products and services. The risk management process includes many steps such as identifying the risk; assessing the likelihood of the risk occurring; impact of this risk; implementing risk mitigation strategies; and monitoring the effectiveness of the risk management controls. The results of the risk management process allow Elite to anticipate any error and minimize the impact. The best result of an effective risk management process is prevention. Elite completes a risk evaluation. This allows us to determine the significance of the risk and decide to accept, minimize or prevent. During risk evaluation, each is evaluated for probability (likelihood) of it happening and the consequences. These two factors help determine if something is high, medium or low risk. By performing a risk evaluation, Elite can focus on any and all risks that impact patient safety. After risks are evaluated and prioritized, we decide to either accept, reduce or eliminate the risk. Risks may be reduced or eliminated by introducing new gauging, new fixture equipment, poka-yokes or by changing the production/assembly process. Once the Elite team evaluates the risk mitigation plan, these plans are put in place.
Risk Management is not a one-time exercise. Continuous monitoring and review are crucial for effective risk management.
Patient safety continues to drive, challenge and propel Elite to produce the best solutions and service in the health care industry.
HOW: ISO CERTIFICATIONS AND FDA REGISTERED Elite Biomedical Solutions is a registered ISO 13485:2016 and ISO 9001:2015 company. Annual audits are completed by an outside ANABaccredited Registrar. Just as important as the Registrar audit, is the ongoing internal auditing plan. Elite has several internal auditors who also audit our processes. These audits are completed to ensure conformance to the ISO standards and operating procedures. Elite is also FDA registered and
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
complies with 21CFR820, Quality System Regulation. LOOKING FORWARD Patient safety continues to drive, challenge and propel Elite to produce the best solutions and service in the health care industry. And, we are just getting started. Be sure to follow along as we continue to develop and produce new Elite products. 2019 is a big year for product launches. You won’t want to miss this. For more information, visit elitebiomedicalsolutions.com.
JUNE 2019
TECHNATION
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SPOTLIGHT
DEPARTMENT OF THE MONTH Yavapai Regional Medical Center Biomedical Engineering Department BY K. RICHARD DOUGLAS
T
he town square is as American as apple pie. Put a courthouse in the center of it, and surround it with a beautiful park, and it becomes the quintessential small-town gathering place. This is just part of the splendor of Prescott, Arizona; a town with an impressive granite courthouse and a green, tree-filled grassy park, known as the plaza, at its core. Surrounded by restaurants and shops, it’s a place to relax and people-watch.
Nestled among tall ponderosa pine trees, its location in Yavapai County is only 125 miles from the Grand Canyon and 60 miles from Sedona. The plaza is considered one of the top 10 public spaces in the U.S. The local hospital is impressive as well.
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Yavapai Regional Medical Center is the region’s leading not-for-profit health care provider. With its related facilities, it provides medical care and other resources to an area of 5,500 square miles and covers the communities of Prescott, Prescott Valley, Chino Valley, Dewey, Humboldt, Mayer, Paulden, Bagdad, Yarnell, Kirkland, Skull Valley and Crown King. “Yavapai Regional Medical Center (YRMC), located 90-minutes north of Phoenix in north-central Arizona, was incorporated in 1942. What started as a simple, community hospital in the old Jefferson School building on Marina Street is today a state-of-the-art health care system with two acute care hospitals, a nationally renowned heart program, a network of primary and specialty care clinics, outpatient health and wellness centers, cardiac diagnostic
centers, and outpatient medical imaging centers,” says Dennis Wells, CBET, director of biomedical engineering. In addition to Wells, the team is made up of senior biomedical engineering technicians Bob Wilkinson, CBET; Bruce Thornbrugh, CBET; Anthony Parlin and Chris Elley. The department is responsible for 5,780 devices between two medical center campuses and 28 medical clinics. In the near future, the department will transition its name to Healthcare Technology Management. The team members have areas of specialization, which allows for keeping much of the service in-house. Bob Wilkinson specializes in OR anesthesia and ventilators. Bruce Thornbrugh specializes in OR anesthesia and ventilators. Chris Elley specializes in CT
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SPOTLIGHT imaging and Anthony Parlin works in general biomed. Besides working on equipment at Yavapai Regional Medical Center West, which is in the heart of Prescott, the team also has duties at Yavapai Regional Medical Center East, which is east, and slightly north, of the downtown Prescott area. The East location is a 72-bed acute care hospital built in 2006, while the West location is a 134-bed facility. The group also maintains a good working relationship with the information systems (IS) department. “Biomed and our IS department work hand-in-hand, whether it is ensuring a device is mapped to an EMR or working together to ensure a device’s electronic footprint works within our environment,” Wells says. SERVING THE COMMUNITY The biomed team members do not limit their service to their clinical colleagues, and the patients that visit the hospitals and clinics. They also serve the greater local community.
“The slogan for Prescott, or ‘Prescutt’ as referred to by people born and raised here, is ‘Everybody’s Home Town.’ Our biomedical team plays a significant role in the delivery of YRMC’s health care mission and is vital to the hospital communities we serve. YRMC is a sole community provider and is the only source of not-forprofit acute care services to the region,” Wells says. He says that the local community truly depends on YRMC and the support of the biomedical team. “A prime example is YRMC’s ‘Partners for Healthy Students Program,’ which provides free health care to underserved children in the region. This is one of many programs we support. At the heart of this grant-funded program is a state-of-theart mobile clinic. Biomed not only maintains all of the equipment onboard; we were consulted as the medical
“Our biomedical team plays a significant role in the delivery of YRMC’s health care mission and is vital to the hospital communities we serve.” - Dennis Wells, CBET equipment experts on what would be needed to provide quality health care. The expert collaboration between clinicians and the biomed department ensures we have healthy, well-cared-for children in our community,” Wells says. Prescott is a beautiful community and has been rated as one of the best places to retire, as well as to raise a family. Its first-class health care is further bolstered by a dedicated biomed staff that supports the community as much as they manage their equipment inventory.
Left Page: Members of the Yavapai Regional Medical Center Biomedical Engineering Department (from left to right) Chris Elley, Mark Hastings, Bruce Thornbrugh, Carol Alston-Dixon, Bob Wilkinson, Jose Villimar, Dennis Wells (Director), Above: Bob Wilkinson, CBET, works on a device. Right: Bruce Thornbrugh, CBET, tests a piece of equipment.
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SPOTLIGHT
SPECIAL ADVERTISING SECTION
Q&A WITH SPBS INC.
F
ounded in 1979, SPBS Inc. has been in business for 40 years. Texas has been its home-base of operations, but it has grown through the decades and has expanded operations into Arizona, New Mexico, Mississippi, Alabama, Louisiana, Georgia, Oklahoma, Missouri, Colorado, New Jersey and New York.
TechNation interviewed SPBS Inc. CEO Jeff Daugherty and Vice President of Sales and Marketing James Blandi to find out more about the company. Q: CAN YOU TELL US A LITTLE MORE ABOUT THE RECENT GROWTH OF SPBS? A: Most recently, we have acquired an imaging company in New York, further expanding our footprint in the tri-state area. As a 100% employee-owned company (the only one in the HTM vertical) we pride ourselves on engaged staff which directly relates to a superior customer experience. Q: WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION? A: That we’re an ESOP. Every time a client sees us, they’re dealing with an owner. Happier team members equals happier clients! As a result of this paradigm, we are driven by client and employee satisfaction and retention. Many of our technicians and engineers are former military. Additionally, all of our technicians maintain some combination of OEM certification, AAMI certifications, degrees and OTJ training. Our state-of-the-art CMMS platform provides us and our clients greater visibility into their asset management performance. Our clients have direct visibility and quick access into historical data, reporting and verification which better prepares them for regulatory inspections and audits. This provides SPBS a platform to provide life cycle
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asset management and alternative equipment management programs. In addition to the numerous training options and support provided to our employee-owners through company sponsored OEM training, tuition reimbursement and cross-training, SPBS also looks to develop talent from within. We have established career ladders and training programs that support our staff at every level to move up within the company. Q: WHAT ARE SOME CHALLENGES SPBS RECENTLY OVERCAME? A: As with other companies in the industry, we are not immune to the labor market shortage and the impact of the anticipated retirement exodus from the HTM industry. As such, we have experienced turnover and difficulties staffing in certain markets. Fortunately, we have the ESOP on our side as a compelling attraction and retention
tool. As an employee-owned company, we offer a benefit that serves the employees over the long-run. SPBS commits to investing in our employeeowners and educating current and potential employees about this amazing opportunity. Additionally, we have reviewed and refreshed our hiring process; thus, ensuring candidates entering into employment with the company maintain basic skills sets as well as cultural fit. We’ve discovered this significantly reduces turnover and provides a more cohesive team. Q: WHAT PRODUCT OR SERVICE THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW? A: SPBS is a true asset manager. We customize and design flexible asset program solutions. Additionally, with our recent acquisition, SPBS has
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SPOTLIGHT
SPBS has worked dutifully to expand its service streams to ensure full facility coverage for our clients. JEFF DAUGHERTY CEO
increased its imaging equipment coverage for our prospective and current clients. We are excited to roll-out this additional service stream in a larger capacity. Q: WHAT IS ON THE HORIZON FOR YOUR COMPANY? A: Growth! SPBS has worked dutifully to expand its service streams to ensure full facility coverage for our clients. During the last year, we have expanded into two additional states and we, the employee-owners, look forward to our ever-growing footprint across the U.S. Q: CAN YOU SHARE A COMPANY SUCCESS STORY? A: A client serviced out of our Irving field service office recently underwent an inspection and audit with the DNV with less than a 24-hours’ notice. Our branch manager’s presence was requested at the meeting, as well as several department heads and the administrative office. We started with a walk through of reports which started
with the hospital as a whole and moved all the way through to the individual devices and finished up with a walk through of our inspection policies and procedures. DNV asked about our equipment certifications and asked us to prove that each device tested had a valid piece of test equipment on them. Review of our reports and procedures had a clear chain of what and how we did it on each and every piece of equipment allowing us to move quickly through all the questions the inspector could throw at us. When it came to running equipment tracers, our manager simply typed in the control number into the search bar and ran through all our inventory, schedule and PM checklists in less than a minute each. In all, we spent 15 minutes on this before the inspecting agent ran out of his standard questions. He then moved from his paper to a more theoretical stance asking us how we planned to improve this year. We spent the next 45 minutes discussing random topics and had clearly “passed.”
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
JAMES BLANDI Vice President of Sales and Marketing
After our segment was completed, the QA officer gave the comment, “So that is how that is supposed to go.” We curiously asked her to explain and she mentioned that the sister hospital in Houston had spent three hours discussing biomedical policies and procedures and had multiple follow-up findings when their other provider had fallen far short. This is just one of many stories in which SPBS has consistently been able to provide accurate and reliable service and reporting for our clients; which has only paved a smooth road for our clients when facing audits and inspections from regulatory bodies. Q: WHAT IS YOUR COMPANY’S MISSION? A: As an employee-owned organization, it is our mission to deliver more than basic repair and maintenance of clinical equipment. We deliver responsive support, high-quality and cost-effective service and solutions tailored to our client’s needs. For more information, visit SPBS.com.
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Making our customers heroes™
Lowering Healthcare Facilities’ Total Cost of Ownership
ISO 13485:2003 Certified
Quality Management System
P: 866-586-3744 E: info@mysummitimaging.com W: mysummitimaging.com YouTube.com/SummitImaging
SPOTLIGHT
BIOMED ADVENTURES Providing the Right Tool for the Job BY K. RICHARD DOUGLAS
T
here have been many stories of HTM professionals who have stepped up and helped colleagues in developing countries with knowledge, parts, equipment or funding. It’s not only a trait of what has made many highly developed counties great, but it is a particularly endearing quality of many in the biomed profession.
With the tools and ability to better the lives of people in many underserved communities around the world, some members of the biomed community have volunteered their time, fundraising skills or biomed skills to improve the conditions of fellow biomeds, patients and clinicians around the world. One of those biomeds, Bill Gentles, Ph.D., CCE, was recently recognized by AAMI as the recipient of their AAMI Foundation and ACCE’s Robert L. Morris Humanitarian Award. Gentles, a Canadian semi-retired biomed living in Toronto, spends his time these days doing “some consulting work conducting accident investigations in situations where a patient has been injured and a medical device is suspected of contributing to the accident.” In the AAMI nomination, it states that Gentles was “a positive role model” with “a passion and dedication” for both humanitarian and clinical engineering (CE) efforts around the world. Gentles, who has 50 years of experience in the healthcare technology management (HTM) field, has been the leader of the Canadian Medical and Biological Engineering Society’s “Tools for Techs” project since 2017, which has provided crowdsourced cash grants to frontline HTM professionals in Ghana, Mongolia, Tanzania and Rwanda to 24
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purchase badly needed tools so they can be more effective in their roles.” AAMI pointed out that Gentles also “has administered the INFRATECH International Email Discussion Group on CE/HTM.” The “Tools for Tech” concept is an interesting approach to putting useful and working tools in the hands of biomeds in developing regions to allow them to most effectively do their jobs. Gentles explains how the concept came about.
but with very limited resources, and very few tools,” Gentles explains. He says that one of the projects of the committee was to start a fund to buy tools for biomeds in low-resource countries. “This idea arose out of my work in many low-resource countries, where I was struck by the difficult conditions the biomeds were working under. I have done volunteer work in Ghana, Ecuador, Chile, Nicaragua and Kosovo. The society generously provided some seed funding,
“A few years ago, I proposed to the executive that we should set up an International Outreach Committee to assist biomeds in low-resource countries, who are facing many of the same problems we do in Canada, but with very limited resources, and very few tools.” –Bill Gentles, Ph.D., CCE THE RIGHT TOOL FOR THE JOB One of the best uses of the Internet is the concept of crowdsourcing. It allows a person or an organization to put out a call to raise funds for a good cause. The funds can accumulate through the combined resources of dozens or hundreds or thousands or millions of donors who contribute online. Gentles employed this modern approach as a catalyst for putting much-needed tools in the hands of biomeds in developing regions. “I have been active in the Canadian Medical and Biological Engineering Society (CMBES) for many years, including a stint as president. A few years ago, I proposed to the executive that we should set up an International Outreach Committee to assist biomeds in lowresource countries, who are facing many of the same problems we do in Canada,
which we used to award our first tools grant, set up a website (www.tools4techs. ca) and start looking into how to raise additional funds,” Gentles says. Gentles says that there are many websites that will help you with crowdsourcing campaigns (e.g. gofundme.com), however many of them require a time-limited campaign with a specific funding target for the campaign. They also typically charge a percentage of funds raised. “We found one such website that returned all funds pledged to the campaign, and asked donors to chip in a little extra to support the website. A fundraising campaign on this site does not need to have an end date,” he says. “The website is chuffed.org. We started our campaign on this website in January 2018, with a goal of raising $5,000. In the first year, we got close to WWW.1TECHNATION.COM
SPOTLIGHT
Above: Bill Gentles is seen with the Ghana workshop faculty Top Right: Bill Gentles holds a Mongolian Eagle. Right: Mongolian Tools for Techs Recipient Sugarmaa is seen with tools provided through grants. 50 percent of that goal, and awarded three more tools grants. The grants started out as an amount of $300 (Canadian dollars), which is about $250 U.S. dollars,” Gentles adds. He explains that to apply for a grant, an applicant must fill out a brief application form and then send some brief video clips describing their workplace and their need for tools. “To save on shipping costs and customs duties, we provide cash grants to the recipients, so that they can buy tools in the local marketplace. This gets the biggest bang for the buck, and assures us that the applicant is getting things that they really need. We ask the recipient to then send us a video showing the tools they have purchased, as well as copies of all receipts,” Gentles says. He says that they publicize the campaign among the community of biomeds in Canada and the USA. There is a link to the fundraising website on the tools4techs.ca website. Donors can make a donation with a credit card. The website transfers funds raised to a CMBES bank account on a monthly basis.
CONNECTING BIOMEDS FOR SHARED KNOWLEDGE Gentles has also administered the INFRATECH International Email Discussion Group on CE/HTM sponsored by the World Health Organization and the Pan-American Health Organization for nearly 20 years. “The INFRATECH email discussion group is an informal gathering of over 400 persons around the world who are interested in issues of clinical engineering and health technology management in low-resource countries,” he says. “I am the moderator of the list. It goes through periods of very little activity, then periodically someone will raise an issue that many people have opinions on, and a lively discussion ensues. HTM professionals, working in low-resource countries, will sometimes use the group to post a question about policies or regulations, and others from around the world will share their knowledge and opinions,” Gentles adds. He says that as an example, there was a recent discussion about the
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
practicality of refilling the canisters in oxygen concentrators with zeolite, rather than buying replacement canisters, which are quite expensive. “Although the discussion didn’t result in a solution, much useful information about oxygen concentrators was shared,” he says. Gentles reveals that his wife says he has failed three times at retirement. “My longest job was director of biomedical engineering at Sunnybrook Hospital in Toronto. I worked in that position for 28 years. Sunnybrook is a large teaching hospital affiliated with the University of Toronto Medical School. It has a trauma unit, open heart surgery, and a large neurosurgery program, as well as the usual tertiary care services,” he says. The humanitarian award is welldeserved and a dollar figure cannot be put on the very real benefit that those tools and knowledge do to save lives every day. JUNE 2019
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SPOTLIGHT
SPECIAL ADVERTISING SECTION
Q&A WITH AGILITI T
echNation interviewed Agiliti President Kevin Ketzel to learn more about the company and how they support Healthcare Technology Management (HTM) teams.
Q: CAN YOU SHARE SOME INFORMATION ABOUT AGILITI? A: Every day, we work side-by-side with clinicians, biomeds, supply chain experts and healthcare executives in over 7,000 healthcare facilities across the country. In every hospital, we see our customers looking for new ways to lower their cost of care while improving patient safety and outcomes. Facilities like to hone in on medical equipment to solve these challenges. Typically, the main focus is on getting the best purchase, rental or service price for the equipment. What we don’t see is a focus on the entire end-to-end equipment management process, and the impact it can have on things like utilization, equipment availability, technician productivity and the cost burden of
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maintaining equipment over its lifecycle. These inefficient processes can cost hospitals millions of dollars and tens of thousands of wasted hours. At Agiliti, our focus is on working closely with our customers to recapture wasted cost and time by rethinking equipment workflows – and establishing how much equipment they actually need to meet patient volumes. When done right, they need a lot less equipment than they own today. The key to this is partnering with HTM teams – who are often understaffed and overburdened with non-value-added work – to reduce the cost of service through flexible clinical engineering programs. At the same time, we work with supply chain teams to improve utilization of the equipment they own and align their equipment mix with patient volumes. This ultimately frees up nurses to spend more time with patients by ensuring they can quickly access essential equipment – exactly when it’s needed. Combined, this process cuts out waste and variation in the equipment management process, resulting in lower
overall costs and more efficient operations. Q: WHAT IS THE BIGGEST THING THAT MAKES AGILITI DIFFERENT THAN OTHER INDEPENDENT SERVICE ORGANIZATIONS (ISOs)? A: Success in this industry is all about people – talented, committed and experienced teammates who function as an extension of the staff in the hospitals we serve. Biomed talent, for example, is becoming harder for hospitals to identify, hire and retain. Yet, HTM teams are being asked to do more than ever. They’re not just repairing devices. They’re making critical technology recommendations, managing capital service plans and integrating softwareenabled devices. To help our customers address these challenges, we’ve developed a workforce of highly trained, experienced biomed professionals and made them readily accessible in our 86 local service centers across the U.S. Our local market availability ensures that our customers have quick access to the technical talent they need.
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SPOTLIGHT
Q: WHAT ELSE MAKES AGILITI A VALUABLE PARTNER FOR HTM TEAMS? A: With many customers, we support multiple departments involved in the equipment management process. This visibility allows us to see entire workflows and identify where both economic and operational improvements can be made. As a result, we can offer our customers a comprehensive view of their equipment-related spend, including capital, rental and maintenance. In addition, our commitment to quality is core to our identity as a company. Our Quality Management System drives our processes — and we hold ourselves accountable to the highest standard in our industry – ISO 13485:2016. This is a significant advantage for healthcare facilities looking to reduce risk, reduce delays and improve patient satisfaction metrics. Lastly, we maintain OEM neutrality and have active partnerships with more than 200 manufacturers. These relationships give us exceptional purchasing power and an ability to stock parts in advance, which significantly reduces equipment downtime.
Q: WHAT DO YOU SEE ON THE HORIZON FOR THE CLINICAL ENGINEERING MARKET? A: We see a couple of trends taking shape in the market. The first focuses on HTM talent management and shortage. We’re working to grow our HTM staff and continually expand our portfolio of offerings. We believe HTM departments will be looking for innovative ways to fill talent and labor gaps. Second is the role that HTM teams are playing in the facility – and how increasingly important it is for them to be part of the broader strategy and mission. When HTM teams are connected with the other departments – and intricately tied to patient outcomes – the equipment management process runs more efficiently, and facilities drive out wasteful spending and reduce delays. To do this effectively, many are evaluating how they manage different equipment types and rethinking their approach to managing staff and leveraging outside service partners. Q: CAN YOU SHARE A RECENT EXAMPLE OF WHERE YOU DELIVERED CUSTOMER VALUE? A: Recently, we partnered with an academic medical center to provide
in-house clinical engineering support. When we began the engagement, we took a hard look at the mix of resources and budget being used to service equipment. We immediately identified opportunities to measurably reduce service costs and reallocate their technicians to focus on higher-value work. We worked closely with the customer to develop a unique service program that was the right fit for their in-house team. The path we took was a hybrid model. First, we contracted with them to provide dedicated technical support for high-volume equipment types (ex. infusion devices, ventilators, beds). We fully manage the service for these devices in their facility so their in-house team could focus on higher-value equipment. Next, we made sure they had on-demand access to local technicians of all levels to meet variable service demands – so they could be covered for nearly any type of backlog. Within months, the customer told us that the flexible program design and our implementation had exceeded their expectations. They very quickly saw increased equipment uptime, as well as improved PM and recall compliance. Most importantly, they met their financial goals, and their technicians were able to spend more time focused on high-value work and other strategic projects.
ABOUT AGILITI:
Agiliti – formerly known as Universal Hospital Services (UHS) – began operating in 1939 as a small medical equipment rental company in Minneapolis. Today, Agiliti employs more than 3,000 medical equipment management experts and serves virtually every hospital in the U.S. LEARN MORE AT agilitihealth.com
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More devices. More service requirements. Never-ending service queues.
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To see our full service portfolio, visit agilitihealth.com/service Contact a local Agiliti team member today at 800.847.7368.
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The manufacturer is the holder of their respective names and trademarks; not to be taken as an endorsement/affiliation of iMed Biomedical, Inc.
INDUSTRY UPDATES
NEWS & NOTES
Updates from the HTM Industry STAFF REPORTS
DIAGNOSTIC ERRORS, TEST RESULTS TOP PATIENT SAFETY LIST ECRI Institute names diagnostic errors and improper management of test results in electronic health records (EHRs) among the most serious patient safety challenges facing health care leaders in 2019. Released in conjunction with National Patient Safety Awareness week, ECRI’s Top 10 Patient Safety Concerns for 2019 raises the profile of safety issues that pose risks to patients and health care providers. “Medical errors are the third leading cause of death in the country,” says Marcus Schabacker, MD, PhD, president and CEO, ECRI Institute. “This guidance can help health care leaders and clinicians save lives.” Diagnostic errors and managing test results remain in the top spot two years in a row. While many health care providers rely on EHRs to help with clinical decision support and tracking test results, technology is just one tool in the diagnostic process, according to William Marella, executive director of operations and analytics, ECRI Institute Patient Safety Organization (PSO). “We have to recognize the limits of current technology and ensure that we have processes in place to close the loop on diagnostic tests,” says Marella. “This safety issue cuts across acute and ambulatory settings, requiring teamwork across the health system.” ECRI Institute’s 2019 list of concerns addresses systemic issues facing health systems, such as behavioral health concerns, clinician burnout and skills development. Mobile health technology, number four on the list, opens up a world of opportunities by transporting health care to the home, but also presents potential risks. The report also highlights ongoing clinical issues with infections from peripheral IV lines, sepsis and anti-microbial stewardship. In the outpatient setting, at least 30 percent of antibiotic use is unnecessary. ECRI’s list of patient safety concerns does not necessarily represent the issues that occur most frequently or are most severe. It identifies new risks, how existing concerns may be changing because of new technology or care delivery models, and persistent issues that need renewed attention or that might have additional solutions. Topics are selected each year by a broad multi-disciplinary team of patient safety analysts, infection preventionists and clinicians at ECRI Institute. They identify safety concerns based on member inquiries, root cause analyses and adverse events submitted to ECRI’sPSO. ECRI Institute PSO has received more than 2.7 million event reports and reviewed hundreds of root-cause analyses since 2009. Health care organizations can use ECRI Institute’s 2019 Top 10 Patient Safety Concerns for Healthcare Organizations to identify priorities and create corrective action plans. The Executive Brief is available to download for free. The comprehensive report, available to ECRI Institute members, includes many actionable resources. • FOR MORE INFORMATION about working with ECRI Institute PSO, e-mail pso@ecri.org or visit www.ecri.org/solutions/pso 30
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RELINK MEDICAL ACQUIRES OF DMSOLUTIONS LLC relink Medical has completed the acquisition of DMSolutions LLC, a growth services firm focused on driving top-line revenue through strategic partnerships and alliances. DMSolutions LLC Founder and CEO David Sluka recently joined the reLink Medical team as senior vice president of sales. “reLink Medical believes this acquisition will further strengthen its equipment disposition and trade in desk channel presence with both the original equipment manufacturer (OEM) and national independent service organization (ISO) communities. DMSolutions’ focus on building strategies relative to strengthening relationships with the OEM and corporate clients, combined with proven sales process development and improvement, will further accelerate our continued growth in the area of end-of-life clinical asset management. David brings a tremendous amount of experience and knowledge of the medical device marketplace to us and we look forward to learning from him,” relink Medical Founder and Executive Chairman A. Ray Dalton said.
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INDUSTRY UPDATES
NEW AAMI AWARD TO HONOR HTM ‘ICONOCLASTS’ Sometimes, the best way to improve a field is to break the rules. That’s why AAMI and TRIMEDX have partnered to create a new annual award that will honor former AAMI Board Member John Daniel Hughes Jr., a healthcare technology management (HTM) leader known for his sense of humor and willingness to challenge the status quo. Hughes passed away in 2018 after a long bout with cancer. The AAMI & TRIMEDX John D. Hughes Iconoclast Award will recognize individuals who push the boundaries of the HTM profession and demonstrate individual excellence, achievement and leadership. “There are so many people who simply ‘go with the flow’ because either it is easier, or they just don’t think that change is possible. The award winner should be someone who is comfortable challenging the norm,” said Larry Hertzler, senior vice president at TRIMEDX and a longtime friend of Hughes. Candidates for the AAMI & TRIMEDX John D. Hughes Iconoclast Award must demonstrate: • A dedication to achievement in the HTM field. • Significant contribution(s) to an important issue or issues facing their organization and/or the industry as a whole that push the general thinking or position currently in place.
• L eadership and a professional commitment to the field by writing articles for industry publications, participating in committees and speaking at industry events. Candidates should also demonstrate: • T he ability to professionally challenge a commonly held perspective or position that results in moving an HTM program forward. • L eadership in promoting the profession to the C-suite, clinicians, prospective students and other health care professionals. • Evidence of HTM leadership and excellence in the workplace through, for example, contributions to management improvements, patient care, cost savings or improvement in the use or impact of technology. • L eadership contribution to national, state or local HTM organizations. • I nvolvement in standards development through organizations such as AAMI, NFPA or The Joint Commission, or an individual’s own organization. • Substantial professional contributions to AAMI. The winner will receive a $1,000 check and a plaque during a special ceremony at the AAMI Exchange.
Doctor is Renting Renting instead of buying medical equipment makes good business sense on so many levels. Our rental programs provide patient-ready solutions for your facility at a fraction of the cost of purchasing. If you're considering renting any type medical equipment, get in touch and we'll put together an end-to-end comprehensive rental program for you.
The Doctor is in, and Renting. Renting@MedicalEquipDoc.com
2749 East Regal Park Drive • Anaheim, California 92806 • 800-285-9918 • medicalequipdoc.com
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INDUSTRY UPDATES
ORGANIZATIONS TO CREATE ACADEMIC HEALTH CARE SYSTEM MEDICAL EQUIPMENT SALES AND SERVICE
customer service. “With our singular dedication to quality, value and meeting customer needs, we at Southeastern Biomedical have been providing a broad range of equipmentrelated services since 1996,” Co-owner Boyd Campbell says. “Southeastern Biomedical Associates is owned and operated by Boyd Campbell and myself. We are both certified biomedical technicians. We are ‘Biomeds helping Biomeds™,’ ” Co-owner Greg Johnson adds. “Our mission is to provide health care facilities with a viable option to acquire and maintain medical equipment in a costeffective manner, while delivering superior quality. Our business is operated upon the belief that patient safety is the utmost priority.” “We provide key services that help medical facilities deliver the highest quality, efficiency and cost-effective technology management, leading to superior patient safety and care,” the company’s website states. Southeastern Biomedical Associates is proud to be the exclusive channel partner for Fluke Biomedical providing quality biomedical test devices and coverage to eight states in the southeast U.S.
Atrium Health, Wake Forest Baptist Health and Wake Forest University announced the signing of a Memorandum of Understanding to create a next-generation academic health care system. This enables three health care organizations to invest in the health and well-being of people throughout the region, as well as contribute ground-breaking research and innovation to the world. Included in the announcement are plans to build on the excellence of Wake Forest School of Medicine and develop a second state-of-the-art campus in Charlotte, North Carolina. By signing a Memorandum of Understanding, the organizations have agreed to start a period of exclusive negotiations, with the goal of entering into a final agreement later this year. With a shared vision to further transform medical education, expand patient-centered research and innovation currently in place in Winston-Salem, North Carolina, and empower the next generation of clinical excellence, the three organizations are embracing the opportunity to revolutionize how people become and stay healthy, ultimately enriching countless lives and communities throughout North Carolina, the Southeast region and the nation.
FOR MORE INFORMATION, visit sebiomedical.com.
FOR MORE INFORMATION, visit BestCareforAll.org.
SOUTHEASTERN BIOMEDICAL ASSOCIATES INC. IS AN AUTHORIZED FLUKE BIOMEDICAL SERVICE CENTER In its ongoing quest to provide the highest quality products and an elite level of service, Southeastern Biomedical Associates Inc. is now an authorized Fluke Biomedical Service Center for most of the southern United States. As of March 8, Southeastern Biomedical is certified as an authorized Service Partner for Fluke Biomedical Instruments. The certification applies specifically to the following products (calibration and repairs): Electrical safety analyzers, Defibrillator analyzers, Patient simulators, Electrosurgery analyzers, Infusion device analyzers and SpO2 simulators. Fluke Authorized Service is offered in the following states: Virginia, North Carolina, South Carolina, Georgia, Florida, West Virginia, Tennessee, Arkansas, Texas, Oklahoma and Louisiana. Additionally, the company maintains two ISO certifications. Having ISO 9001:2015 for the overall business and ISO/ IEC 17025:2017 specifically for the calibration lab, Southeastern Biomedical is well positioned to provide customers with the highest quality test equipment calibration services available on the market today. Southeastern Biomedical maintains a professionally trained calibration staff who are qualified, courteous and eager to provide the best service aimed at completely satisfying customers’ calibration needs. These accomplishments mirror the company’s focus on quality, value and
MEDIGATE EXPANDS MEDICAL DEVICE SECURITY AND ASSET MANAGEMENT PLATFORM Medigate has announced its expansion to clinical IoT and general IoT devices. Medigate now enables accurate and comprehensive device discovery, contextual and behavioral anomaly detection as well as clinical policy enforcement for Health Delivery Organizations’ (HDO) entire clinical networks. “As HDOs race to secure IoT devices connecting to their hospital’s network, our distinctive approach to identifying and securing medical devices provides us with a unique seat at the 32
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table,” said Jonathan Langer, CEO of Medigate. “Our understanding of proprietary protocols provides hospitals with granular visibility, contextual anomaly detection and clinical policy enforcement so CISOs, IT, security and BioMed departments have the tools they each need to ensure patients, PHI and the network remain safe.” FOR MORE INFORMATION, visit medigate.io WWW.1TECHNATION.COM
INDUSTRY UPDATES
ECRI INSTITUTE OPENS INTERNATIONAL MEDICAL DEVICE EVALUATION CENTER ECRI Institute is launching its first medical device evaluation laboratory outside the United States. The ECRI International Research Centre will conduct rigorous, hands-on testing and evaluation of devices to help medical professionals make informed decisions that improve patient safety. The independent lab, located in Selangor, Malaysia, will evaluate medical devices used across all care settings in Europe and Asia. “This research will help us better understand the safety and effectiveness of medical devices used around the world,” says Marcus Schabacker, MD, PhD, president and CEO, ECRI Institute. “That’s important to our international members as well as to foreign ministries of health.” Devices used internationally will be evaluated in Malaysia with the same independent, rigorous protocols ECRI Institute has upheld for more than 50 years. ECRI Institute’s experienced team trained Malaysian engineers to ensure accuracy, consistency and quality control.
The international evaluation program will assess performance, workflow, maintenance, safety and human factors usability for all technologies under review. The first devices to be evaluated include large-volume infusion pumps, surgical lights, point-of-care blood gas analyzers, portable ultrasound machines, continuous positive airway pressure (CPAP) units and digital radiography systems. “The establishment of this research facility opens up many possibilities for the future,” says Eric Woo, regional director of ECRI Institute’s Asia-Pacific office, “including possible collaborations with government regulators. Other plans include using the lab for training programs and for accident investigations involving medical devices.” ECRI Institute established its Asia-Pacific office more than 20 years ago to support healthcare technology decision making and patient safety throughout the region. FOR MORE INFORMATION, e-mail asiapacific@ecri.org
Doctor is Buying Medical equipment and disposition is the cornerstone of our business. We purchase medical equipment that is no longer being used from hospitals, surgery centers and third-party providers, offering comprehensive documentation and full disclosure of how the equipment is to be distributed.
The Doctor is in, and Buying. Buying@MedicalEquipDoc.com
2749 East Regal Park Drive • Anaheim, California 92806 • 800-285-9918 • medicalequipdoc.com
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RIBBON CUTTING Insight HTM
R
ay Marden and Jared Wilson formed Insight HTM on October 26, in part to ensure a continuation of services to some clients of their employer that would not be picked up in a new agreement.
On November 8, still an employee of Feather River Hospital, Wilson’s world changed drastically. Wilson and everyone in his family lost their homes in the Camp Fire. The fire also consumed the hospital he served. It was then that Marden found out he had chosen his partner well! “His calm was astonishing,” Marden explained. “He never lost hope or his composure, he was never harsh and has yet to complain, though I know his losses were great. It never occurred to him to quit. Since the fire, we have built a company intended to help ambulatory surgery centers and other smaller healthcare delivery organizations (HDOs) develop HTM programs that they own and understand.” TechNation found out more about Insight HTM through a question-andanswer session. Q: WHAT IS THE MAIN FOCUS OF INSIGHT HTM? A: The main focus of Insight HTM is to meet the small HDO market where it is and fill in the missing HTM components. We want to ensure that every facility has access to peace of mind when survey time comes, regardless of which accrediting agency they use. We are planning on being a 34
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resource for our fellows in the business as well. We will be producing videos on current topics, offering training to techs and prospective managers, as well as consulting with test equipment and CMMS providers to help them bring the future of HTM to life in an affordable way for smaller HDOs. Q: WHAT SERVICES DOES INSIGHT HTM OFFER? A: Insight HTM offers management support to lead technicians at small hospitals who are looking to take a more professional and proactive approach to HTM. We offer preventative maintenance and repair services using a distributed team of experts. We also offer HTM program development services to surgery centers, critical access hospitals and urgent care facilities, as well as assisting major health care systems with projects, such as device integration, deployment or something as simple as vacation coverage, for short-staffed departments. Our experts are all experienced technicians, and our crew has over 65 years of combined experience, most having military and private sector experience. Q: HOW DOES INSIGHT HTM STAND OUT IN THE MEDICAL EQUIPMENT FIELD? A: We stand out because we did not come into the market as new competitors. We are coming to the market with a new vision. We think we have discovered something that has been missing in our industry: namely, professional,
INSIGHT HTM, LLC Contact: Ray Marden Phone: 541-318-1619 Email: experts@insighthtm.com
accountable HTM services in the small HDO market. We believe that there is an amazing opportunity at hand to improve our footprint in the industry by making these departments affordable and relevant from a business perspective. Q: DO YOU HAVE ANY SPECIFIC GOALS THAT YOU WANT INSIGHT HTM TO ACHIEVE IN THE NEAR FUTURE? A: Insight HTM considers all of the problems facing HTM to be opportunities, thus training and attrition are the first non-operational industry opportunities that we are considering. We are beginning to develop our Insight Community of Experts by building a platform to capture the education and assistance of our retiring colleagues. This will provide newer technicians direct access to trained modality experts and support those retired experts with a small stream of income. We are also working with industry leaders to develop new, affordable and relevant training opportunities for HTM professionals. WWW.1TECHNATION.COM
INDUSTRY UPDATES SEE OUR AD PG. 94
NEW ADVERTISER:
WELCOME TO THE
TECHNATION COMMUNITY! BRANDYWINE IMAGING INC. TELL US ABOUT YOUR COMPANY: Brandywine Imaging, Inc. was established in 1980 to provide a responsive and dependable service and a source for consumables to satisfy our customers’ needs; a dependable source of livelihood for our employees and to contribute to the stability and well being of the community in which we are located.
Bill Laird Brandywine Imaging Inc.
WHAT IS ONE QUALITY THAT DIFFERENTIATES YOUR COMPANY? Brandywine Imaging Inc. has been in business for nearly 40 years. Our service team has over 100 years of experience in both the x-ray and film processing fields. We pride ourself on quick response time to our customers service needs. Over 95% of service calls have a technician on site the same day. We sell and support many of the latest digital advancements in medical imaging. Our web site includes many of the systems we offer. In addition, we offer installs and de-installs. We are a founding member of the AMSP (Association of Medical Service Provider’s) and have members across the country that maybe able to help.
Doctor is Selling Selling medical equipment is a centerpiece of our business. We purchase medical equipment that is no longer being used from hospitals, surgery centers and third-party providers. We then offer it for resale at significant savings and provide comprehensive support documentation on everything we sell.
The Doctor is in, and Selling. Selling@MedicalEquipDoc.com
2749 East Regal Park Drive • Anaheim, California 92806 • 800-285-9918 • medicalequipdoc.com
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
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MD EXPO KEYNOTE INFORMS HUNDREDS T
he ongoing discussion of the “FDA Report on the Quality, Safety, and Effectiveness of Servicing of Medical Devices” (FDA Report on Device Servicing) created in accordance with section 710 of the FDA Reauthorization Act of 2017 (FDARA) continues to be a hot topic in the Healthcare Technology Management community.
Therefore, it is no surprise that the MD Expo keynote address “Updates to Regulatory Affairs and Opportunities” included debate with what some attendees described as “heated exchanges” among panelists. The session, sponsored by Medigate, provided HTM professionals with valuable information. The panel discussion included stakeholders from a variety of backgrounds, including G. Wayne Moore, CEO, Acertara Laboratories; Dave Francoeur, senior director, brand and quality, Sodexo CTM; Rob Kerwin, general counsel, IAMERS; Kelly Proctor, physical environment
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Sector Lead, DNV-GL Healthcare; and Peter Weems, senior director, strategic operations and policy, Medical Imaging and Technology Alliance (MITA). The panel discussion was moderated by Christopher G. Nowak, CBET, CHP, CSCS, senior director, HTM, UHS of Delaware Inc. The FDA Report on Device Servicing discussed the continued quality, safety and effectiveness of servicing of medical devices by original equipment manufacturers and thirdparty entities. The report was informed by feedback and comments from an open docket and a public workshop held in 2016, among other information. Based on the available information, the FDA stated the current available evidence is not sufficient to conclude whether or not there is a widespread public health concern related to servicing of medical devices that would justify imposing burdensome regulatory requirements. The FDA Report on Device Servicing also included several actions the FDA intends on pursuing.
Among those actions are continued discussion, defining whether activities are servicing or remanufacturing and the creation of “Collaborative Communities.” In response to a December 2018 workshop, MITA was among several individuals and organizations to answer the FDA’s call for comments. “In both the May 2018 ‘Report on the Quality, Safety, and Effectiveness of Servicing of Medical Devices’ as well as the December 2018 workshop, the Agency made clear that it would like to encourage the development of and participation in ‘Collaborative Communities’ as vehicles for public and private stakeholders to ‘proactively work together to solve both shared problems and problems unique to other members in an environment of trust and openness, where participants feel safe and respected to communicate their concerns.’ In this instance, the Agency believes ‘there may be value in the creation of a public-private forum, such as a Collaborative Community, to address
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“ IT’S NOT REALLY OEM VERSUS NON-OEM. IT REALLY SHOULDN’T MATTER. WHATEVER IS BEST FOR PATIENT SAFETY IS WHAT IS IMPORTANT. WHATEVER IS REQUIRED, GET THE JOB DONE.” - DAVE FRANCOEUR the challenges associated with delivering high quality, safe, and effective servicing of medical devices.’ The Agency also states its willingness to facilitate the creation of such a community, pending sufficient interest from stakeholders,” MITA states in its comments to the FDA. During the MD Expo keynote address, Weems said he does not expect the “Collaborative Community” to form quickly. “We are still trying to figure out what is going to happen with this Collaborative Community,” Weems said. “It is probably going to take a long time. Not months, but years.” Kerwin shared the next FDA meeting will likely address a “largely shared understanding of QMS (Quality Management System).” He also said he still sees issues regarding service keys, access to manuals and technical drawings. Kerwin added that a July 2019 FDA meeting on the right to repair is a “chance to address the elephant in the room.” Moore said he hopes to see progress as the FDA also looks to define servicing and remanufacturing in an effort to move the discussion forward. The process will shine a light on service and remanufacturing and a look at the differences between the two, Moore explained. “I am hoping for, and looking for, more cooperation at looking at what is servicing and what is remanufacturing,” Moore said. “This does not apply to biomeds in hospitals, but to third-parties.”
Francoeur replied that the FDA has not yet decided and that the definitions could be applied to in-house biomedical teams as well as third-party service providers. “Until it gets clearly defined it could cause us all angst and anxiety,” Francoeur said. Moore concurred. “The FDA has left a lot of gray area in any definition. We need a clear definition,” Moore said. Proctor said better definitions will empower his accrediting organization to better serve health care delivery organizations and promote patient safety. “We enforce rules, but when the rules are gray it’s difficult,” Proctor said. Panel members seemed to agree that progress is being thwarted by a lack of confidence in what are seen as competing interests. Kerwin and Weems both said a lack of trust continues to be a roadblock, especially between device manufacturers and third-party service organizations. “There is a lot of trust that needs to be built,” Weems said. “There is a lack of trust because of competitors. We (MITA) published a white paper on remanufacturing and one thing that became clear is that nothing is clear.” When asked to predict the future, panelists echoed a desire to continue to focus on patient safety. “Particularly through this Collaborative Community, we will come to see how much we agree. We are all here because we care about patient safety,” Weems said. “I’d
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love to see a standard that is multistakeholder and defines quality.” In regards to access to service keys and product manuals, Weems said “our member companies make available what is required by contract or regulation.” He added that MITA has thousands of member companies and that they each think about that differently. Francoeur inserted that competition should not get in the way of what is important. And, he added that it should not be about the “financial impact.” “It’s not really OEM versus non-OEM. It really shouldn’t matter,” Francoeur said. “Whatever is best for patient safety is what is important. Whatever is required, get the job done.” The panel wrapped up the discussion by fielding questions and comments from the meeting room packed with more than 200 attendees. In closing, Francoeur added that it is time to plow forward with the FDA on this issue and create a solution. He insisted that this is not something that can be kicked down the road and left for future generations to encounter. “We need to break down walls. We need to guide and direct instead of getting run over,” he said about working with the FDA and a Collaborative Community of stakeholders. “Let’s change the language and perspective and get to the other side.” “It’s more than getting it done, but getting it done right,” Francoeur said.
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AAMI UPDATE BY AAMI
AAMI HONORS HEALTHCARE TECHNOLOGY’S BEST AND BRIGHTEST An impressive lineup of healthcare technology experts and innovators, along with clinicians, patient safety champions, standards volunteers, young professionals and students received an AAMI award or scholarship at this year’s AAMI Exchange, the name for the association’s growing and revamped annual conference and expo. The honors recognize the leadership, dedication and contributions these individuals have made to the association and their wider professional community. AAMI President and CEO Robert Jensen said the winners represent the best in health technology. “Collectively and individually, these professionals are helping advance the cause of safe and effective health technology,” Jensen said. “They push all of us to aim higher and find innovative solutions to the challenges we face. It is AAMI’s great pleasure to honor and thank them for their achievements and extraordinary work.” The 2019 AAMI award winners were: • The AAMI Foundation’s Laufman-Greatbatch Award: Lawana Bryan, Carol Means, Tim Rausch, Tina Hayes, Penny Robertson and Christina Van Den Handel, Northeast Georgia Health System • The AAMI Foundation & ACCE’s Robert L. Morris Humanitarian Award: William Gentles, BT Medical Technology Consulting • The AAMI Foundation & Institute for Technology in Health Care’s Clinical Solution Award: JoAnne Phillips, Virtua Health System • AAMI & Becton Dickinson’s Patient Safety Award: Shelly Crisler and Katrina Jacobs, Department of Veterans Affairs • AAMI’s HTM Leadership Award: Heidi Horn, SSM Health • AAMI & GE Healthcare’s BMET of the Year Award: Jovito “Jojo” Gonzales, Kaiser Permanente Hospital • AAMI’s Young Professional Award: Benjamin Esslinger, Franciscan Alliance • The Spirit of AAMI Award: Paul W. Kelley, Washington Hospital Healthcare System • AAMI HTM Association of the Year Award: Colorado Association of Biomedical Equipment Technicians • Standards Developer Award: Bruce S. Alpert, University of Tennessee Health Science Center (retired); Richard Dart, Marshfield Clinic Research Foundation; Nupur Jain, Intuitive Surgical; John Murray, Food and Drug Administration (retired); Rose Seavey, Seavey Healthcare Consulting, LLC • AAMI Technical Committee Award: AAMI’s ECG Committee • AAMI Foundation Scholarship: Lauryn Carr, Mississippi State University; Rebecca Halmich, University of 38
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Connecticut; Anas Mahmoud, Texas State Technical College; Moses Suherman, Southern California Institute of Technology; Angie Thai, University of Washington; Bianca Wyman, University of Connecticut • Bright Ideas Award (selected by AAMI’s Technology Management Council): The biomedical engineering technology program at St. Philips College in San Antonio, TX During a special ceremony at the AAMI Exchange, three ‘best of’ articles published in AAMI’s peer-reviewed journal, BI&T, were also honored: • Best Article: “A Rational Approach to Efficient Equipment Maintenance, Part 1: A Simple, Basic AEM Program” by Malcolm Ridgway, retired; Matthew Baretich, Baretich Engineering; Matthew Clark, Advocate Health; Stephen Grimes, Strategic Health Care Technology Associates; Bhaskar Iduri, Renovo Solutions; Michael W. Lane, University of Vermont; Alan Lipschultz, HealthCare Technology Consulting; and Nancy Lum, Massachusetts General Hospital • Best Research Paper: “Frequency and Duration of Infusion Pump Alarms: Establishing National Benchmarks” by Rachel R. Vitoux, Catherine Schuster, Kevin R. Glover, and Mark Dekker from B. Braun Medical Inc. • Best Commentary: “Keeping Track of All the Moving Pieces” by Symantec’s Axel Wirth For more information about the AAMI Awards Program visit at www.aami.org/awards.
NEW AAMI PODCAST FOCUSES ON ROLE OF STANDARDS IN AI REGULATION The expanded use of artificial intelligence (AI) and machine learning (ML) technologies in health care poses a challenge for regulators, but a new regulatory paradigm isn’t what is needed, according to the most recent episode of AAMI’s award-winning podcast. “There tends to be a lot of mystery around AI, like it’s out of a science fiction movie,” Pat Baird, head of global software standards at Philips, explained during episode 29 of the AAMI Podcast. “But the good practices needed for AI development are already very similar to existing good practices.” For example, a standard designed for handling animal tissues can be applied to the controls needed to ensure that AI data is high quality and comes from a reliable source. The standard also provides principles for testing the tissue – or in this case AI data – to ensure that it’s valid. And, just like physical items, data needs to be stored properly. “These are all concepts that we’re already familiar with, but we never thought of applying them to AI,” Baird said. WWW.1TECHNATION.COM
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ECRI UPDATE
2019 Top 10 Patient Safety Concerns
O
rganizations across the continuum of care are striving to become high-reliability organizations, and part of being highly reliable means staying vigilant and identifying problems proactively. ECRI Institute’s annual top 10 list helps organizations identify looming patient safety challenges and offers resources for addressing them. Below is a brief excerpt.
#1 DIAGNOSTIC STEWARDSHIP AND TEST RESULT MANAGEMENT USING EHRS When diagnoses and test results are not properly communicated or followed up, the potential exists to cause serious patient harm or death. Providers have begun relying on the electronic health record (EHR) to help with clinical decision support, to track test results, and to flag issues. However, the EHR is only part of the solution. Three key components – the diagnosis, the treatment plan, and the follow-up plan – must be clearly communicated in the EHR. To help “close the loop,” providers must not only fully utilize an EHR designed to meet their practices’ unique needs, but also recognize the importance of clear communication, both among caregivers and between caregivers and patients. #2 ANTIMICROBIAL STEWARDSHIP IN PHYSICIAN PRACTICES AND AGING SERVICES The health care system needs to combat antibiotic resistance before the situation gets worse. As antibiotic resistance increases, treatment options can be limited. Perhaps the most significant challenge facing antibiotic stewardship is managing patient expectations in all care settings. Unnecessary antibiotic administration puts patients at unnecessary risk of adverse drug reaction, and the broadest concern is that overprescribing leads to antimicrobial resistance.
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#3 BURNOUT AND ITS IMPACT ON PATIENT SAFETY Burnout affects physicians (including trainees), nurses, allied health care providers and organizational leaders alike. Studies show that burnout has a consistent negative relationship with safety and quality. If burnout is to be addressed effectively, organizations must listen to providers’ concerns about workload, performance criteria, and suboptimal resource allocation and fix these problems at a system level. Moving to a safety culture that rewards and recognizes a job well done is necessary.
#6 DETECTING CHANGES IN A PATIENT’S CONDITION Failure to detect changes in a patient’s condition is an ongoing patient safety concern across the continuum of care. Problems can arise within a care unit and during transitions of care within a facility and from one facility to another. Technology can alert caregivers to a patient’s changing condition, but it must be used appropriately. Staff must be trained in how to operate the equipment and understand the organization’s policies and their responsibilities for responding to alarms.
#4 PATIENT SAFETY CONCERNS INVOLVING MOBILE HEALTH Risks of mobile health technology include lack of regulation of new technologies, barriers to ensuring that providers are accurately receiving the data a device collects, and the possibility that a patient is not using the technology correctly or is not using it at all. Many devices are released without U.S. Food and Drug Administration testing. Health care organizations must ensure the safety and validity of any device they recommend to a patient and be certain the device will work when the patient leaves the health care facility.
#7 DEVELOPING AND MAINTAINING SKILLS Patient harm can occur if staff are uncomfortable using medical equipment or performing a procedure, or are unaccustomed to an organization or care area’s processes. ECRI Institute has received reports of adverse events occurring because a health care professional was unfamiliar with equipment, such as infusion pumps and robotic-assisted surgical systems, or lacked competence with procedures and processes, ranging from Foley catheter insertion to management of a hemorrhaging patient after childbirth.
#5 REDUCING DISCOMFORT WITH BEHAVIORAL HEALTH The fear of working with individuals with behavioral health needs can lead providers and staff to behave in ways that fail to meet patients’ needs or even escalate situations, with consequences for patients and staff. In many health care settings, behavioral and physical health are siloed. All providers and staff need communication skills. Options to improve these skills include certified training, training led by internal experts or consultants, community behavioral health first-aid workshops or a combination of modalities.
#8 EARLY RECOGNITION OF SEPSIS ACROSS THE CONTINUUM Sepsis can be difficult to detect, but early recognition is vital because sepsis can quickly turn deadly. Health care workers throughout the continuum of care must be able to recognize sepsis. Simulation and skills practice can help workers recognize sepsis and communicate their concerns. To facilitate timely diagnosis and management, health care organizations across the continuum should have protocols for response when sepsis is suspected, much as they do for chest pain. Organizations may use checklists, tools or algorithms to support the response.
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#9 INFECTIONS FROM PERIPHERALLY INSERTED IV LINES Peripheral intravenous (PIV) catheters are commonly used items in health care. Often, PIVs are inserted upon admission as a matter of course, in case the patient needs IV therapy at a later point. However, PIVs can expose patients to a significant risk of infection – one that is underreported, under-recognized, and often ignored. Increased awareness of PIV-catheterrelated infections, coupled with routine active surveillance and follow-up reporting, can help reduce the risk.
organization leadership in engaging with patient safety priorities. Foundational principles of continuous communication up and down the chain of command, clear organizational structure, consistent committee configuration, and universal strategic planning and implementation can help the organization reduce inconsistencies and embed a strong focus on patient safety. As health systems grow and expand across the continuum, it is beneficial to leverage the protections that a patient safety organization (PSO) affords to all affiliated providers within the health system.
#10 STANDARDIZING SAFETY EFFORTS ACROSS LARGE HEALTH SYSTEMS Regardless of organization size, the goal is to institute structures that effectively allow patient safety leaders to support
ABOUT THE LIST In selecting this year’s list, ECRI Institute relied both on data regarding events from our PSO database of more than 2.8 million event reports, as well as expert
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judgment. This list identifies concerns that might be high priorities for a range of reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models, and persistent issues that need focused attention or pose new opportunities for intervention. We recommend that providers across the continuum use this list as a starting point for conducting patient safety discussions and setting priorities. Download the executive brief at
www.ecri.org/patientsafetytop10. The full report is available to members of many of ECRI Institute’s patient safety programs. If you would like more information, call (610) 825-6000, ext. 5891, or clientservices@ecri.org.
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BIOMED 101
Cloud Computing More Common in HTM BY INHEL REKIK
C
loud computing is currently very on trend and represents an important shift in the way businesses think about IT resources. It’s not uncommon today for HTM departments to purchase a cloud-based medical solution. An example can be a cloud-based image archiving system or imaging processing software used in conjunction with a CT scanner, MRI or a Gamma Camera to assist in the diagnosis of certain diseases. The cloud component can be simply sending usage statistics to request authorization to use the software or sending the images for additional processing before they are retrieved back. HTM may also encounter a completely cloud-based solution such as some of the modern asset management systems and image archiving systems.
So, what should an HTM know about cloud solutions? What security concerns should they be aware of in today’s environment? NIST defines cloud computing as “a model of enabling convenient, ondemand network access to a shared pool of configurable computing resources (eg. networks, servers, storage, applications and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction.” From an IT standpoint, cloud computing offers a host of advantages with the main ones being flexibility, optimization of resources and faster cycle of innovation. Organizations typically only use 10% to 20% of their computing resources. A cloud architecture makes it easy for organizations to scale up or down on the resources used and liberate those
that are not being used. This leads to quicker deployment of applications and the need for fewer on-premise servers as well as solution testing without significant capital investments. And, let’s not forget the seamless infrastructure refresh without needing to invest any additional funds. Cloud computing can be provided either as public hosting for several unrelated organizations or private hosting for large ones wanting more control. Not to confuse private cloud with virtualization – cloud carries some assumptions about architecture, workload manageability, provisioning automation and user self-service. Different types of cloud services provided include: Infrastructure as a Service (IaaS); Platform as a Service (PaaS); and Software as a Service (SaaS). Cloud computing shifts the computing cost from capital (CAPEX) to operating (OPEX). As an IT-savvy HTM, you will need to know that some cloud-based software or SaaS solutions can be capitalized if they meet the following criteria: you can get a hold of the software during the hosting period and you can install it in your environment or have another party host it in your behalf. I will always recommend engaging your finance department as early as possible in the process. Even though cloud computing reduces the number of the on-premise servers an organization needs to have, and the headcount needed to maintain servers, it doesn’t always lead to cost savings. Depending on how often the service is used and the workload you need, it might be more cost effective to own the infrastructure. Public clouds carry a host of security concerns. There is a loss of
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Inhel Rekik Director of health technology security at MedStar Health in Columbia, MD.
control over sensitive data. Does the cloud provider encrypt the data? Do they have a backup of the data? Where are they storing the data? For organizations that store data across states or countries there are several law and regulations that must be considered. Breach notification law can be different between jurisdictions. If the data is involved in a criminal case, the country and state where it is stored dictates the level of control the government has on it. Business data can be held hostage of an investigation. Availability of audit logs may also be limited or nonexistent from the cloud provider – which makes the actual level of security difficult to assess. To mitigate some of these risk, some provisions can be added to the service level agreement with a cloud service provider such as: client right to audit, indemnity clauses to mitigate impacts caused by the cloud service provider, requirements for Incident Response Planning (IRP) and Business Continuity Planning (BCP), integrity and confidentiality of business data. When selecting a cloud solution, get your IT security team involved in the selection process so you can make an informed decision. It’s clear that cloud solutions are going to be more prevalent in health care delivery organizations. INHEL REKIK, MS, is the director of health technology security at MedStar Health in Columbia, Maryland.
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WEBINARS
Webinar Series Delivers Knowledge, ACI Credits BY JOHN WALLACE
T
he Webinar Wednesday presentation “Troubleshooting Today’s X-Ray Systems” was sponsored by Technical Prospects and presented by John DiPasquale, a technical trainer and support specialist with the company. Participation in the webinar was eligible for 1 credit from the ACI.
DiPasquale provided valuable knowledge as he discussed what makes up the two primary subsystems of a X-ray system. He also discussed what it takes to successfully troubleshoot these subsystems – the generator systems and the imaging systems. During the webinar, DiPasquale discussed the five basic systems that make up the generator subsystem with diagrams and his experienced insights. He also touched on the three systems within the imaging systems. After sharing knowledge about the basics, DiPasquale talked about troubleshooting today’s X-ray systems. He shared some general information and thoughts and then broke down radiographic and fluoroscopic before talking about preventative maintenance. The session concluded with an informative question-and-answer session. This was a popular webinar from the start with the highest number of registrants so far this year. It also received the highest rating with a score of 4.3 on a 5-point scale. The webinar also received positive feedback via a post-webinar survey. “Really good logical breakdown of general X-ray troubleshooting strategy
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(generator versus imaging chain). I make system back-ups compulsively so I was really excited to hear the recommendations with regard to that,” said R. Marek, Imaging Specialist. “I enjoyed the real-world advice for working with these modern machines. Was nice to get real world experience to help you in your day job versus a sales pitch for a product,” said K. Saager, Field Service Engineer. “The background information was very helpful in the presentation. It was a refresher of the circuitry and helped in providing the basis for troubleshooting. The different types of imaging were presented for an all-around exposure to problems and quality of the machines,” said Clinical Engineer H. Martin, CBET. “I’ve been repairing X-ray for about 35 years and I liked the fact the he talked very fluently through the material as well as gave basic hints on how to diagnose issues,” shared T. Cassell, Senior Imaging Engineer. “As someone new to X-ray equipment maintenance, it was great to hear from an expert and learn tips on how to best troubleshoot specific issues and highlight common troubleshooting tips that may not always be taken in usual troubleshooting,” said D. Nitinthorn, TCF Biomedical Engineer. “I enjoyed how the presenter (John) took something so complex and broke it down to much simpler methods of troubleshooting. I found the presentation very well presented in a logical layout. His method of teaching captivated me. I personally do not service imaging equipment due to a facility buyout, but I previously had service training on GE
ultrasound machines. Working in a cardiovascular hospital and medical for 33 years I have witnessed the technology changes he mentioned. Great presentation,” said B. Hayes, CBET Site Lead. “John provided a great overview of X-ray systems and typical troubleshooting techniques. I have a vague understanding of X-ray systems and get involved in repairs from time to time. This will absolutely enhance my abilities going forward. Great job and thanks,” said L. Shelman, Biomedical Equip Tech III (CBET). “Mr. DiPasquale was very clear, very direct, spoke in a simple, very understandable way. He obviously gets what it means to be a technician in the field. Tips were excellent. Excellent educator. (I don’t think they’re too common.) Thank you very much. Very enjoyable,” said R. Resnicoff, Senior Clinical Engineering Technician. WEBINAR DELIVERS CYBERSECURITY INSIGHTS The Webinar Wednesday presentation “Adding Medical Device Cyber Security To Your CMMS System” was sponsored by Nuvolo. It included insights regarding a hot topic in the HTM industry – cybersecurity. It was presented by Nuvolo Vice President of Product Marketing Ben Person and was eligible for 1 credit from the ACI. He shared his experience regarding the different ways innovative HTM organizations are managing medical device cybersecurity in a CMMS System. Person discussed today’s business challenge, process improvement areas, and cybersecurity approaches. He also looked
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at the transition from the current to future state of IT in the health care environment and provided an insightful demonstration. The webinar concluded with a question-and-answer session in which Person shared his knowledge with attendees regarding specific concerns. About 200 people attended the live webinar presentation and more have viewed a recording of the webinar on YouTube and other outlets. A survey sent to attendees collected positive feedback for the presentation and the Webinar Wednesday series. “Great content! Cybersecurity is a great topic to keep at the forefront of HTM. Patient safety has changed with regulations and now cybersecurity is pushing the envelope even more. Keep bringing these types of interesting and relevant topics to the webinars,” said L. Clifford, Area Manager. “A hot topic for all in HTM! Nice job,” reported M. Dowd, Senior Director of Biomedical Engineering. “I am new to the hospital’s cybersecurity team and this information is invaluable to discover and move ahead in my role as lone biomed guy and adding equipment to network,” said M. Pritchett, CBET. “This was one of your best webinars I have attended regarding new information. Learned a lot,” Biomed H. Kim said. “I appreciate the effort placed into preparing presentations. When I can learn something that can improve my performance or stimulate new ideas the presentation is real bonus. Thanks for continuing to provide great content and information for free,” said L. Shelman, CBET. “This was my first webinar with you folks and it was very informative, thank you for providing me this opportunity to listen and learn,” said G. Woods, Clinical Engineering IT Specialist. “I am always excited when the subject and work schedule allow me to take time for Webinar Wednesdays. It has always proven to be well worth the
time I set aside,” said D. O’Keefe, Lead Technician Clinical Engineering. “Webinar Wednesday is a great way to learn about companies in our industry and ways to solve issues that arise in our ever-changing field,” shared M. Ramono, Clinical Engineering Technician. “Webinar your Wednesdays and increase your knowledge,” said R. Slater, Medical Electronics Technician. EXPERTS SHARES X-RAY PM, REPAIR INSIGHTS Webinar Wednesday delivered insights for HTM professionals with the presentation “Controlling the Clock in X-ray Preventative Maintenance” by RTI Electronics AB Global Product Manager Fredrik Brorson. Attendees were also eligible to pick up 1 credit from the ACI. In the webinar, Brorson discussed how HTM professionals can be more efficient and productive in maintaining and repairing X-ray assets in today’s highly regulated environment. He discussed the effect tight budgets are having on health care facilities and the pressure it places on imaging service departments to maximize the uptime of imaging equipment. He talked about the desire for a faster response and shorter service time in today’s health care environment. In regards to the efficient servicing of imaging equipment, Brorson suggested the utilization of the best resources available. He said key elements to consider are a fast response time, intimate knowledge of the equipment history, the physical environment of the device, in-depth technical knowledge and more. He also discussed what he termed “OEM Protectionism” and how to bypass some restrictions. Brorson then discussed servicing X-ray equipment/QA and calibration as he shared insights and tips. He talked about leveraging the experience and knowledge of in-house HTM professionals in regards to diagnostic imaging devices. He also covered how big data will play a role in the future.
EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL
The webinar concluded with a question-and-answer session. More than 200 people attended the live webinar and more have watched it online. At the conclusion of the live presentation, a survey sent to attendees captured positive feedback. “Informative webinar. This one was more on point and relative to the future of this facility,” said R. McInally, CBET. “This was a good seminar. Very insightful and informative. The speaker is very knowledgeable and his presentation was clear and concise,” shared K. Ongchango, CBET. “Was an informative experience with many useful takeaways,” S. Honeywell, Operations & Quality Manager, said. “This was a very informative webinar. This is a great tool and skill for in-house trained biomed professionals to assist in keeping equipment up, assisting with diagnostics, reducing downtime and cost. Thank you for having this presentation,” said B. Hayes, CBET. “Thank you so much for taking time to deliver the presented information. I always love learning even though it may not apply to my role now but could be beneficial in the future,” said J. Ekalo, CBET. “This webinar is useful for field service and in-house technicians who work on X-ray equipment frequently. It does not apply to all facilities, but it is good to know what tools are out there for the industry,” M. Calderon, BMET, said. As Medical Electronics Technician R. Slated said, “Upgrade your knowledge with Webinar Wednesdays!” FOR MORE INFORMATION about Webinar Wednesday, including upcoming presentations and a video library of previous sessions, visit WebinarWednesday.Live. THANK YOU!
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THE BENCH
SHOP TALK GE HEALTHCARE OEC 9800 PLUS I have a problem with 9800 Plus. Loading stops at the fifth arrow. After checking the PC in the monitor stand, I found that the hard disk drive can’t boot. I think its a deficit hard disk. Any ideas or help please?
Q: A:
Check your bios battery on the SBC. It should be greater than 3VDC. Could be your hard drive as well. From the service manual, generator object tasks initialize. If boot-up fails on this arrow, check communications between Workstation and C-Arm. Check the ARCNet. Verify that Workstation completely boots.
WELCH ALLYN SPOT VITAL SIGNS One of our Welch Allyn Spot Vital Signs displays a E42 error. The battery indicator is always empty as if the battery was low, even when it’s not. I found that disconnecting the connector to the compressor and valve removes the error and then the battery voltage displays properly. Can anyone help me with that?
Q:
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E42 error happens when the date and time are missing. Disconnect the battery for 5 minutes, then reconnect and go into service mode and enter the correct date and time.
A:
A:
A:
A:
Stopped boot on 5 arrows means communication problems. Check the main cable between Workstation and C-arm. Sounds like you have pins on the lemo connector that are pulled back. Take the dog house off and check the pins on the back of the lemo connector. You might be able to get lucky and pull out the tabs on the pin. If not, just replace the lemo connector.
Did you check if the battery voltage was actually low? Is it possible the battery was completely dead causing the date/time to be lost? This is from Welch Allyn’s website, “E42” error may mean you need to reset the date and time on Spot Vital Signs Device. To clear the E42 error code: Power the Spot Vital Signs off, wait five seconds, and power on. If the error code reappears, then power the Spot
Vital Signs off and disconnect the battery for five minutes. Reconnect the battery and power on. After disconnecting the battery for a few minutes, you must program the date and time screen. To reset the date and time: 1. Turn the Spot Vital Signs off. 2. P ress and hold the Power and Blood Pressure Start/Stop buttons. (If an E38 appears in the display, press C to clear). The device enters the Internal Configuration Mode and displays the software version. 3. Press the Mode button to cycle through the Internal Configuration menu until you see the Date/Time menu option displayed on the screen. 4. U se the Next Patient/Clear/Cancel or Blood Pressure Start/Stop buttons to change the Date/Time setting. 5. Press the Mode button once to save the change and press the Power button to exit the Internal Configuration Mode.
SHOP TALK
is compiled from MedWrench.com. Go toMedWrench.com community threads to find out how you can join and be part of the discussion.
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ROUNDTABLE Cybersecurity
C
ybersecurity continues to be an important and hot topic in health care, especially in the HTM community. TechNation quizzed some industry experts and educators about cybersecurity in search of information and tips to help readers.
Participating in the roundtable discussion on cybersecurity are Medigate Co-founder and CEO Jonathan Langer, Cynerio CEO and Founder Leon Lerman, Clearwater Chief Risk Officer and Senior Vice President of Professoinal Services Jon Moore, CyberMDX Vice President of Business Development Safi Oranski, Nuvolo Vice President of Product Marketing Ben Person, Texas State Technical College-Waco Associate Professor of Biomedical Equipment Technology Garrett Seeley and Extreme Networks Director of Healthcare Solutions Bob Zemke. Q: WHAT IS THE BASIC INFORMATION BIOMEDS NEED TO START A CYBERSECURITY PROGRAM?
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LANGER: As purchasers of medical devices ultimately connecting to a hospital’s network, biomeds need to understand the risks associated with connecting to the network. They can’t go it alone anymore. They can’t be experts in understanding how to secure them, so biomeds need to coordinate with IT and IS (information security) teams from the outset, outlining requirements, clear roles and responsibilities for each group to take ownership of and drive forward. The uniqueness of the devices, the sheer volume of different types of devices and the complexity of clinical networks is daunting. The ability to find and secure devices, from MRIs to glucose meters and to alert a hospital of anomalies requires security that understands clinical networks. LERMAN: The most important thing is to have visibility into where the medical devices are and what their role is within medical workflows and clinical processes. This needs to include all the connections such as gateways, nurse
stations, interface engine servers, terminal servers, printers and other middleware. There also needs to be special consideration regarding how critical the device is for patient care. For example, if an MRI machine services an entire region it needs more protection that one of several ultrasound machines. Keeping a physical inventory isn’t a one-time activity but something that needs to be done on an ongoing basis as devices are moved, retired or are added to the network. MOORE: If you want to create a cybersecurity program it should be built on a recognized framework and it should consider how security can be imbedded throughout the device lifecycle. A good place to start is with the following documents: • Framework for Improving Critical Infrastructure Cybersecurity Version 1.01 by the National Institute of Standards and Technology • Content of Premarket Submissions for Management of Cybersecurity in Medical Devices – Draft Guidance for
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are those devices life sustaining, do they transmit or store ePHI and what is the risk to the hospital if those devices become unavailable or compromised. When it comes to cybersecurity there is no silver bullet and both process and technology need to be looked at in order to build a mature cybersecurity program for your medical devices.
Jonathan Langer Medigate
Industry and Food and Drug Administration Staff • Postmarket Management of Cybersecurity in Medical Devices – Guidance for Industry and Food and Drug Administration Staff ORANSKI: Biomedical professionals have a lot on their plate but in order to successfully achieve the many tasks they have, they must gain visibility into all of the devices on their network in order to embark on a cybersecurity journey. The first step is to automatically identify and categorize every connected device (you can’t protect what you don’t know you’ve got). This inventory will provide the foundation for an informed cybersecurity and enterprise risk management strategy. PERSON: When considering implementing a cybersecurity program, biomeds should first get an understanding of the level of maturity of their asset inventory in their CMMS system. Most hospitals I speak with have challenges understanding what assets they have and also if they are connected to the network or not. Once biomeds have a trusted inventory in their CMMS and they know which devices are connected to their network they need to look at what asset details need to be tracked in order to understand the level of risk those devices pose from a cybersecurity perspective. For example,
SEELEY: Cybersecurity is about risk management. The most basic tools are exactly what we use to mitigate risk to/for other equipment. We have to ask questions and log critical information to figure out the cyber risk of each item. Log things such as the operating system version and update history. Understand the connectivity of the device: Does it use a firewall? Does it need VPN access? Do you have to use remote desktop or can it be disabled? Does it use a web browser as an interface? If so, which one and what are the updates? Does it use Java, ASP, Flash or any other script languages? We need to study each piece of equipment to find its potential vulnerabilities. Most of this is persistently asking the right questions during capital equipment purchases or from the OEM. ZEMKE: Before starting a cybersecurity program, it’s important to accept that all the connected medical devices in their environment most likely carry significant risk to the organization since they were implemented years before many of the current security risks existed. I would start with reading IEC 8000-1 Application of risk management for IT-networks incorporating medical devices. The report is a great first starting point and includes instructions on how to create an organizational framework for the identification, assessment, onboarding and remediation of connected medical devices.
complicated and life-altering devices connecting to the facility’s network. At the foundation is a need for a tool that digitizes and automates accurate and comprehensive inventorying of every device connected to the network. That is the baseline of what biomeds, security and IT need to implement the most sophisticated medical device security solution. The second component is clinically contextual anomaly detection capabilities in order the detect anomalies in device communications behaviors based on manufacturer protocols, not just network traffic. These enable rule-based, clinically driven security policies.
Leon Lerman Cynerio
Q: WHAT ARE SOME TECHNOLOGIES BIOMEDS CAN USE TO ENHANCE A FACILITY’S CYBERSECURITY MEASURES?
LERMAN: Technology can be used to automatically identify medical devices and all the relevant information to create a physical map of the entire medical device ecosystem. Tools can be used to help assess and score each device’s relative risk level and to record recommended actions to protect patient data and safety. All the communications that go in and out of the medical device ecosystem can be recorded and then modeled using machine learning technology so that suspicious device behavior can be detected and the necessary corrective actions can be taken.
LANGER: Biomeds have the disadvantage of needing to secure the most
MOORE: One of the first problems we encounter when helping organizations
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with security of medical devices is uncertainty about the number, type and location of devices. Traditional scanning for devices on networks is problematic as it might cause a device to fail. This has resulted in the invention of new passive scanning tools that use machine learning to identify unique devices on the network. These tools will also identify vulnerabilities in the medical devices, anomalous behavior and, if the right supporting technology is in place, segment suspect devices into separate networks to limit the damage they might cause. CyberMDX, Zingbox and Cloudpost are manufacturers of this type of technology.
Network Connected and the IP Address, MAC Address, Software Version, Firmware Version, Hostname, Common Platform Enumeration (CPE) operating system identity, ePHI details, Life Sustaining and many other details. The CMMS system should also have a cybersecurity module to enable automation from the external cybersecurity products that perform network discovery, vulnerability management, and automate notifications and work order creation in the event of a cybersecurity exploit event. CMMS systems like Nuvolo have those capabilities natively included and can integrate with modern medical device cybersecurity products like Asimily, Zingbox, Medigate, Ordr (CloudPost), CyberMDX and many others. SEELEY: There is no substitute for familiarity with networking. People say that the A+ and Network+ CompTIA exams are good, but they are a start. It is helpful to also understand material from Cisco CCENT
Jon Moore Clearwater
ORANSKI: Biomed professionals must deploy cybersecurity tools that are specialized for health care. General security solutions aren’t sufficient; they were not built to understand the unique attributes, communication protocols and data workflows of a health care environment. Solutions that detect and prevent attacks from connected devices and clinical assets also benefit colleagues who work with biomed engineers. PERSON: When considering tools that biomeds should look at there are two main areas of focus that should be considered. The first is making sure you have a modern CMMS system that has the ability to track the information needed for a cybersecurity program. Those details include if the device is 56
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ZEMKE: Before I make suggestions on products, I want to stress that technology alone doesn’t solve our problems. Many organizations operate with a false sense of security – they’ve invested in security products but done so without an accompanying operational strategy. Tools are what I consider the enabling component of strong process and procedures. That being said, I find that it is critical to have the following capabilities: Network Access Control, Management, Analytics, and Location. Q: HOW CAN BIOMEDS PROTECT PATIENT INFORMATION AND PREVENT HIPAA VIOLATIONS? LANGER: Here again, providing the comprehensive and accurate device inventory while coordinating and working closely with IT and IS provides a holistic security approach from individual device to network security. It gives IT and IS the information they need to segment their networks, create policies based on the device’s function and quarantine or shut
down those behaving outside of the policy parameters. Partnering device security with best-in-breed solutions enables a comprehensive approach to protecting patient information and remaining HIPAA compliant while mitigating attacks like ransomware and disruptions of service. LERMAN: Each device that stores patient data needs to be analyzed based on the possibility that sensitive information can be leaked. For instance, a Picture Archiving and Communication System (PACS) would have a high privacy ranking. Based on the ranking system those devices that need immediate attention can be identified and managed accordingly. MOORE: The first thing is to identify any systems and/or devices where electronic protected health information (ePHI) is created, received, transmitted and/or stored. Next, would be to conduct a risk analysis of those systems and devices. To the extent an identified risk exceeds your organization’s risk appetite, the risk should be treated. Treating risks consists of either avoiding, mitigating, transferring or accepting the risk. Avoiding the risk means to stop doing whatever is causing it. For example, decommissioning the system/device associated with the risk. Mitigating the risk is done by implementing compensating security controls like a configuration policy or software patch. Risk can be treated by transferring the risk typically through insurance however that only transfers the cost if the risk becomes a reality. An organization cannot transfer its compliance responsibility. In some cases, an organization might choose to accept a risk above its threshold. For example, perhaps the device causing the risk is particularly expensive to replace or can’t be replaced at all and there are insufficient compensating controls available. In that case, the organization should be sure to document its decision to accept the risk making sure that it is reasonable under the circumstances. ORANSKI: Cybersecurity technology can be enlisted to pull double duty and not WWW.1TECHNATION.COM
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compromising the email of an employee or theft of equipment. Change passwords to email often and watch out for vulnerable hardware.
Safi Oranski CyberMDX
only protect against a ransomware attack, but also assist with compliance. Health care cybersecurity solutions are uniquely positioned to support HIPAA requirements, as AI-assisted network traffic monitoring can identify assets containing ePHI and confirm that ePHI stored on medical devices has not been tampered with as it moves across the network (ensuring integrity), while built-in threat prevention techniques ensure the availability of that information to authorized parties only (ensuring confidentiality). PERSON: One of the first steps in protecting patient information and preventing HIPPA violations is knowing which medical devices contain, transmit and store HIPPA ePHI data. These devices should be easily identified in a CMMS so that additional precautions and protections can be implemented in managing these devices. Protections like data encryption, secure passwords when accessing the devices, firewalls, white listing along with training biomeds on how to handle devices that have ePHI. These devices should also have an automated notification and workflow as part of the decommissioning process for the device to ensure that device data is wiped before disposing of the equipment. SEELEY: Know how attacks occur. Preventable attacks involve
ZEMKE: The IEC 8000-1 Application of risk management for IT-networks incorporating medical devices, referenced earlier, suggests that we audit all devices to understand if they transmit or store any patient data. Start fresh, and assume nothing went through a thorough assessment before. From there, install behavior monitoring with network analytics. This allows you to understand what is talking to the devices and where the data is flowing. I consider connected medical devices in a hospital to be the same as children in a sandbox. When you are watching them they behave (most of the time), but turn your back and they start misbehaving, talking to strangers and spreading viruses. Q: WHEN IT COMES TO OLDER EQUIPMENT, WHAT STEPS CAN BE TAKEN TO PREVENT CYBERSECURITY ISSUES? LANGER: Older equipment is tricky. In addition to finding the equipment, outdated operating systems and software can leave a hospital vulnerable. A cybersecurity solution that finds and identifies all of the equipment connected to the network is the first step to preventing cybersecurity issues. If you don’t know what’s connected to the network, you have no idea what the vulnerabilities are. If the tool used to identify the devices builds their profile from the manufacturer’s protocols, it will know the status of the OS and software versions and can send alerts when new CVEs or patches are available. LERMAN: It’s important to make sure that all equipment is running the latest version of software including the most recent patches. If equipment is more vulnerable you need to provide compensating steps, like segmenting high-risk equipment from the rest of the network so that it only communicates
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with the devices that are absolutely necessary to add another layer of protection. MOORE: There are some real limits on what one can do with older equipment. The one thing that can be done is to place the device on its own network segment. This can be done either through traditional physical or logical methods or by using technology that supports virtual local area networks (VLANs). ORANSKI: Medical devices are often connected to legacy infrastructure that’s been developed over many years. A patchwork of systems, networks and components using different operating systems, communication protocols and data stores is complicated and difficult to maintain. As a first step, hospitals must deploy a dedicated medical device cybersecurity solution that will identify vulnerable, out-of-date or otherwise insecure configurations that exist. We often come across medical assets that are left unpatched for years, even though a firmware update is indeed available. Additional steps include automatic context aware policies that can be enforced selectively based on the relevant vulnerability or threat. PERSON: When it comes to older equipment that is no longer supported by the OEM and the operating system is vulnerable to cyber attacks most hospitals look to place the device behind a firewall or white list the specific IP addresses that the device needs to communicate with and the specific network ports. Biomeds should also consider replacement for these types of devices as part of their capital planning. With modern CMMS systems you can track the acquisition cost of the device, depreciation, total cost of service, device availability and other areas to determine if a medical device has reached the end of its usable life and if the device is costing more to maintain then purchasing a new one that does not have the same level of cybersecurity threat. SEELEY: This brings up the argument of
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clinicians that they are the first and often only line of defense. Hackers look for the easiest way in and it’s almost always an unwitting employee.
Ben Person Nuvolo bolt-on versus imbedded security. Bolt-on security is making an older system work. We can use things such as firewall appliances to make sure that there is a firewall with port security between a medical device and the rest of the network. This is OK, but ultimately this should be something the device itself can do. The most logical thing is to upgrade or replace the system. We have to use the OEM as a resource at this point. ZEMKE: The risk with medical devices is that they have a life cycle well beyond typical IT systems. Add to the fact that they often have rigorous code certifications means that they are not able to keep up with tomorrow’s cyber threats. The key, then, is to have a functional process in place to keep all older devices isolated from internal and external threats. Security dongles like Extreme’s Defender for IoT product act as individual VPN/firewalls for older medical devices, and are a good approach to retrofit and defend. Q: WHAT TRAINING/EDUCATION DO CLINICIANS NEED TO PREVENT CYBERSECURITY ATTACKS? LANGER: Cybersecurity education in every department should be constant and consistent. Whether advising clinicians to practice good security hygiene or alerting them to the latest phishing scam, it’s important to regularly remind
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LERMAN: It’s important that all data input devices are used only for the purpose for which they are intended. Health care providers shouldn’t plan their vacations or shop on eBay using hospital computers since browsers tend to be riddled with viruses. It’s important that every new medical device is inspected with the IT team before it’s added to the network and that service level agreements with vendors include procedures for keeping software versions up to date. MOORE: In addition to the security awareness training that is provided to everyone in the organization, clinicians need to have a heightened awareness of anomalous behavior by medical devices. Dr. Christian Demeff, an emergency room physician and hacker from UC San Diego, has done some work around simulation of compromised medical devices in a clinical setting. During these simulations, very few, if any, participating clinicians recognized the compromised device as such. ORANSKI: For health care providers, insiders pose a bigger threat than outside actors – providing a case in point for the need to better incorporate cyber hygiene education into medical device user training. A lot of the training undertaken by the clinical engineering team can be condensed and re-packaged for delivery to clinical staff and other users with a focus on cybersecurity awareness and threat detection. Staff training needs to cover general cybersecurity protection, such as the basics of password management, how to spot and what to do when encountering malicious websites or emails, social engineering, etc. It might seem obvious, but staff needs to understand that they should only use connected medical assets for their intended purpose and not, as we commonly see, to surf the web. They
must understand that clicking on the wrong link can trigger a malicious script that may ultimately compromise the delivery of care. Sometimes subtle changes in device behavior patterns can indicate malfunction or worse – tampering. PERSON: When looking at training that the hospital staff and clinicians themselves need it needs to start with cybersecurity awareness. One area the hospital staff needs to be trained on is best practices in password management. Also, they need to get training on how to avoid malicious websites, malicious emails, social engineering and other targeted attacks that could compromise a device or impact the delivery of care for the hospital. Hospital staff should also receive training to not plug in their cellphones or personal devices to the USB ports on the medical devices. The most important thing to implement with the hospital staff is a standard operating procedure (SOP) for educating the hospital staff as part of the onboarding process and ongoing cybersecurity awareness program.
Garrett Seeley Texas State Technical College-Waco
SEELEY: Know about hardware risks due to loss, know about social engineering to get access and do not click unknown pop-ups. And, do not charge a cellphone with a USB port on a medical device. Consider disabling front USB on a medical device, if possible. In general,
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good behavior for computer security includes watching out for suspicious emails or phishing. Often, hackers pretend to be someone else to try to get valuable information from someone. Remember to be suspicious about unknown phone calls or emails. Never click on things sent through email unless you expected it. Keep off of suspicious or unscrupulous websites. ZEMKE: The first thing clinicians need to understand is that every device is a computer, even if it doesn’t have a screen or keyboard. That helps set the groundwork for education around best practices and why biomed needs their cooperation. Another is to share real world examples about various incidents that have taken place recently that impacted patient care, such as WannaCry. Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW? LANGER: I can’t stress enough that protecting hospitals, health care systems and, ultimately, their patients requires a level of security not always necessary in other industries. • Cursory identification of a device (IP address, MAC address, make, model) is not enough to create meaningful security policies. • It’s critical to have biomeds, IT and IS involved in the IoT/device security solution procurement process. For example, if IT and IS own the budget and drive the process without biomed, they are more likely to purchase an IoT solution that can’t address the unique needs of medical devices. • The only way to achieve the highest level of security for medical devices is to understand a manufacturer’s protocols and clinical workflows. There is no substitute for that. LERMAN: As part of the digital revolution we are seeing the introduction of thousands and hundreds of thousands of connected medical devices, such as patient monitors, IV pumps, MRI machines, infusions pumps, ventilators that are connected to the internal hospitals
network. Now that devices are more connected and vulnerable, biomeds have a significant role to play to keep patients safe and their sensitive data secure. MOORE: Cybersecurity is no longer an IT issue, it is a patient safety issue. We are completely dependent on technology to operate our organizations, deliver care and keep patients alive. Up to now, the health care industry’s focus has been primarily on the confidentiality of information. We see stories of hacked records, OCR fines and class-action lawsuits. There are, however, two other pieces of the information security triad; integrity and availability. If the integrity of the information we rely on to treat patients is compromised and/or the technology and the information it creates is not available to provide care at all, well then we have a whole different and likely much more urgent problem than identitfying theft and medical insurance fraud. ORANSKI: In today’s health care environment, biomed professionals are at a disadvantage when it comes to cyber vulnerabilities and risks that they are presented with on a daily basis. Cyber criminals need to get it right just once, while biomed teams need to get it right 24/7/365. As a result, they must deploy an automatic, real-time cybersecurity solution that was built for a health care environment. A generic IoT security solution that addresses the cybersecurity needs of manufacturing, retail and financial institutions can not address the unique requirements associated with operating and protecting medical devices. PERSON: When implementing a cybersecurity program, a hospital needs to look at process and technology to address all aspects of cybersecurity threats. Consider from a process perspective the entire life-cycle of the medical device including how the medical devices are purchased, on-boarded, maintained and disposed. Consider implementing a modern CMMS system that supports the details
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and process automation to handle a cybersecurity program. Lastly, look at modern medical device cybersecurity products that can discover, monitor and protect the hospital from cybersecurity threats. SEELEY: Cybersecurity and cyber attacks are not as bad as people may think. Most devices are actually specialized with little to no actual risk. However, times are changing. As the field evolves, so should we. We need to stay on top of potential threats. This is actually us being proactive. Do not fear this, but be aware that there have been some incidences. Do your best to limit the problems on your end using proper risk management techniques. Remember, you are good at that!
Bob Zemke Extreme Networks
ZEMKE: I am a strong advocate for education and self-reflection. We have been connecting medical devices in health care for decades, well before “IoT” was a cool term. With that realization, we have to accept that the security landscape has changed, the risks have increased and our assumptions on what adequate security is need to evolve. Digital health care is very real in today’s clinical workflows, and with that our dependency on security will require continued education and changes to how we safely and effectively deliver services.
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TRUST THE
PROCESS TIPS TO HELP YOU MAKE BUYING DECISIONS
BY K. RICHARD DOUGLAS
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A
sk any two people, or any 10 people, what is most important to them when purchasing a new car. Some will tell you the color, some want that 630-watt stereo system, others like certain wheels or technology. Then, there is that one person who looks at cost of ownership or historic reliability. That person may also want to know about the length of the warranty, the cost of replacement parts and the cost of insurance.
While some people are satisfied that a new vehicle will get them from point A to point B and do it in style, the practical buyer is taking a deeper dive into which vehicle makes the most sense on a number of levels. Some buyers will pour over the Consumer Reports surveys on reliability and problem areas while others are oblivious to this information. Yet, with a large purchase, every consideration helps find the best value and greatest peace of mind. It’s not much of a stretch to relate these varying approaches to the purchase of medical equipment. “Will it provide a clean image of the liver is a much different question than what are the availability of replacement parts?” “Will it provide the accurate amount of medication or nutrients into a patient’s body versus what is its long-term reliability?” The biomed understands what the clinician requires of the equipment, but the biomed also has a keen sense of what makes that device work, why it will continue to work or break down and how much trouble and cost goes into maintaining it. Most anything worth knowing something about proves to be more complicated and involved than it seems at first appearance. Making purchasing decisions about medical equipment is a good example. We asked some experts for tips and considerations that can go a long way to making good decisions. We also asked them how they acquired the
knowledge to make good purchasing decisions. And, for the newer members of the HTM team, we asked them what advice they would offer when it comes to purchasing decisions. These relate to the purchase of capital equipment with a longer life-cycle, a larger price tag and it may require modifications to the facility for installation. Input from the HTM professional is also contingent upon the confidence of clinical colleagues and hospital leadership. HTM may be in the best position to recommend equipment replacement decisions, knowing the condition of the existing assets better than anyone else.
those considerations and why these HTM professionals have a seat at the table. “I developed a good relationship with my supply chain director, and he started to request my insight on future equipment purchases. About two years ago, HTM became an approving authority within our internal capital purchasing application for all medical equipment purchases. Before a purchase order can be issued, the HTM department must approve the request. This has allowed us to weigh in on all equipment purchasing decisions, secure service manuals, and develop a proactive service strategy for the equipment we purchase,” says Ryan Harris, CBET, HTM director at
“ I developed a good relationship with my supply chain director, and he started to request my insight on future equipment purchases. About two years ago, HTM became an approving authority within our internal capital purchasing application for all medical equipment purchases.” – Ryan Harris THE ROAD TO DECISION MAKER With the unique perspective that HTM brings to equipment selection and negotiation, the myriad considerations that HTM professionals are aware of can bring important considerations to the table. Someone, representing the HTM department has to have a seat at the table in these decisions and that person must have a roadmap to determine what constitutes the right choice from the HTM perspective. Here are some of
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Texoma Medical Center in Denison, Texas. “We put out a capital recommendations report each year to help executive leadership make the ultimate decision. This report includes obsolete equipment, equipment that is beyond useful life, equipment that has become expensive to maintain, or our involvement with clinical staff to replace lost or additional equipment that is needed to support increased volumes,” says Matt Royal, CHSP, CHFSP, CHEP,
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ARTICLE CONTRIBUTORS
Joshua Virnoche, MBA, CHTM, CBET, director of clinical engineering at JPS Health Network
Matt Royal CHSP, CHFSP, CHEP, CHTM, CLSO-M, CHC, CHFM, CBET, director of biomedical engineering for Eskenazi Health
CHTM, CLSO-M, CHC, CHFM, CBET, director of biomedical engineering for Eskenazi Health in Indianapolis, Indiana. Royal says that he also meets with clinical leadership to discuss capital and how HTM can support those requests. “With the great information we can provide from a CMMS, this is often the justification they can use to help them get what they need. Eventually, they’ve trusted the capital requests go through me and executive leadership has me help them prioritize the capital that is approved. Some capital request processes in health care can be a popularity contest. The information we provide from HTM removes those politics and makes it a more educated decision for executive leadership,” Royal says. Joshua Virnoche, MBA, CHTM, CBET, director of clinical engineering at JPS Health Network in Fort Worth, Texas, says that he is not necessarily a decision maker as it relates to capital purchases, but instead, part of the decision process. “To be honest, I kind of weaseled my way into the process. Every opportunity I got, I made mention that we (clinical engineering/HTM) needed to be involved in what type of equipment we bring in. I approached it from both sides in regard to service contracts and in-house service. If we are servicing it in house, we need to a) either know that we are already trained on the equipment and can support it, or b) prepare our staff to support it in-house with a training
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Ryan Harris CBET, HTM director at Texoma Medical Center in Denison, Texas
budget and proactively getting training,” he says. “If the equipment needs to have a service contract on that, I need to know preemptively so that I can get a POS quote, or shop other vendors for coverage, and have that all lined up before the warranty is up. Continuously reiterating this, plus having the executive support to bring me into the conversation was incredibly important. If I didn’t make it important to me, nobody else was going to make it important to them, to include me in the conversation,” Virnoche says. Gary Barkov, MS, director of healthcare technology management/ clinical engineering support services at Advocate Aurora Health in Downers Grove, Illinois says that his team “doesn’t struggle with being at the table” because his team “manages the entire technology life cycle.” “System-wide equipment procurement and capital planning activities fall under HTM through their direct management of clinical technology replacement capital and the medical technology acquisition and planning (TAP) department,” he says. “The AAH clinical engineering leadership team and TAP collaborate with key stakeholders to objectively establish medical equipment standards, forecast replacement needs, analyze utilization, prioritize and allocate funding, and optimize procurement in order to have the right technology in the right place at the best value,” Barkov adds. Tony Cody says that he is very
Tony Cody Tech Management/ENTECH director in the clinical engineering department at Banner Health
grateful that his health system technology management department has built such a strong relationship with the organization and the individual hospital leadership. Cody is tech management/ ENTECH director in the clinical engineering department at Banner Health in Greeley, Colorado. “Although it was a TJC standard (EC.02.04.01 EP 1) for a long time that the hospital must solicit input from individuals that operate and service equipment when it selects and acquires medical equipment, the ‘selecting input’ could vary substantially,” says Cody. “The Banner Health Technology Management Department has earned the trust of the corporation and the health care facilities by delivering excellent service and consistently showing the measurable value of our input. When I joined this team, the hard work was essentially complete. My job is to continue delivering great service, give thorough evaluations of equipment purchases, research equipment standards, be financially responsible and help devise a comprehensive equipment replacement strategy. If I was starting from ground zero then my first step would to be to deliver great service and results in the areas of responsibility, they have already entrusted to me,” Cody says. Bill McFarland, senior director of materials management at Cambridge Health Alliance in Malden, Massachusetts, says that he has always worked hard to understand “the importance of high touch/high tech in health care.”
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“It starts with realizing that it all begins with the patient. For a patient to receive truly supportive patient care, the caregiver needs the time and best tools to deliver care in a safe and efficient manner. With patient care always as the guide, I have tried to work with caregivers to find the safest, most user friendly and economic devices and equipment. It is not
“There may be a device setting to change or an upgrade that we can implement to make their jobs easier. If you can become a resource that they trust for insight and knowledge about the equipment, you will find that they will begin to truly value the opinions of the HTM department and include us in the conversations about selecting future
“If I was starting from ground zero and trying to gain influence with biomedical purchasing decisions then my first step would be to deliver great service and results in the areas of responsibilities, they have already entrusted to me.” – Tony Cody easy since each patient’s need can be very specific, but the devices and/or equipment may not be practical or economically feasible to invest in. It is something that is a struggle every day,” he says. ADVICE FOR THE ROOKIES With their accumulated knowledge and years of providing input into equipmentbuying decisions, senior HTM professionals have some advice for the more junior colleagues regarding the process and gaining trust. “My advice for a person starting out in the HTM industry who wants to have authority on equipment purchasing decisions would be to prove your value to the clinical staff and hospital leadership. It is important that you elevate your HTM program beyond break/fix capabilities. Get involved with nursing and seek out opportunities to help them improve patient care through the use of the equipment that we manage. Bring ideas to them about equipment use that they may not be aware of,” Harris says.
equipment,” Harris adds. Some of the advice lends itself to the role of a good biomed as much as a good source for buying decisions. “Be your own advocate. Nobody is going to just assume you need to be there, you need to make sure everyone knows you need to be there. Once you’re involved everyone will understand how much you bring to the table and will begin to ask your insight and opinions. Persistence is key, persistence will allow you to show your expertise,” Virnoche says. Royal suggests meeting with customers on a regular basis. “Implement structure on how you do everything. The regular customer meeting builds a trusting relationship because often we are the bearers of bad news when it comes to broken equipment. This news if often much easier when a relationship is established,” he says. Barkov suggests that the newer HTM professional can learn about purchasing decision making if they “hang close to
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experienced techs and assist with vendor installations. Ask to attend any equipment planning meetings,” he says. “If I was starting from ground zero and trying to gain influence with biomedical purchasing decisions then my first step would be to deliver great service and results in the areas of responsibilities, they have already entrusted to me. When an opportunity presented itself that could save the facility financially or help them provide a better standard of care then I would already have one foot in the door,” Cody says. “I would present my suggestions to the purchasing decision maker in a clear and concise manner. The most important thing is to exceed their expectations at every opportunity and always in their best interest. If you do this consistently then they will trust you as a subject matter expert and your influence will grow,” Cody adds. McFarland echoes this advice with some general suggestions that will set the newer HTM professional apart as a trusted source. “I would have three pieces of advice; invest in your people skills; every day you will be confronted with the question: How can we make this happen? You can’t do it alone and you need to be able to work with people on both sides of the table to get it done on a daily basis,” says McFarland. And with regard to negotiations; “Think win-win. You need to listen to the other side and try to figure out what they need. You both need to know that you walked away from the deal feeling like you got what you needed,” he says. “Be creative; it is very easy to fall into mental ruts which you will need to climb out of,” McFarland adds. With HTM at the purchasing decision table, there is a better chance that equipment decisions will consider all factors and prove to be the best choice throughout the device’s life cycle with regards to costs and uptime. Building trust with other stakeholders is part of bringing HTM to the table to begin with.
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Are CBD-Oil Products Worth the Career Risk? BY JENIFER BROWN
A
n issue that continues to come up is, what happens when a potential employee takes a drug test and fails because they used a CBD-oil product?
I feel compelled to address this because I know firsthand of instances where candidates did not obtain a position because of a failed drug test. They failed the drug test because they had used CBD oil for health and/or medical reasons believing it to be perfectly legal. CBD (cannabidiol) is one of many active chemical compounds in the cannabis plant and has become legal in most states. It is not subject to the same drug laws as medical marijuana. Since it’s a dietary supplement, you can find it online, in health food stores and even in some pharmacies and retail stores. An increase in the number of people using CBD oil, as it becomes more common and more acceptable, makes many people believe that it will not impact the pursuit of a new job or their current employment. However, some HTM professionals who used CBD oil have tested positive via a drug screening because of the presence of THC – the psychoactive component of marijuana. This test result happened even though CBD oil and CBD-oil products are labeled as THC-free. As it turns out, depending on the source of the cannabis that is used to produce the CBD oil, some products
contain trace amounts of THC (including low-quality isolates and full-spectrum tinctures). While some CBD oils claim to be isolates, they may be full spectrum oils that actually contain more cannabinoids (such as THC) than they claim. It is worth noting that the medical industry has a zero-tolerance policy when it comes to drugs. This is even the case in states where marijuana is legal! Many health care organizations do an extensive 10-panel level drug screening when considering a new hire instead of the 5-Panel level test. However, it does not really matter because even the 5-panel screening can detect THC traces from some CBD-oil products. This is an issue that even the FDA continues to research as it considers policies. On April 2, FDA Commissioner Scott Gottlieb issued a statement on new steps to advance the agency’s continued evaluation of potential regulatory pathways for cannabis-containing and cannabis-derived products. The FDA has a webpage with questions to frequently asked questions on this topic that states: “Over the past decade, there has been a growing interest in the development of therapies and other consumer products derived from cannabis and its components, including cannabidiol (CBD). FDA recognizes the potential opportunities that cannabis or cannabis-derived compounds may offer and acknowledges the significant interest in these
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CEO and Founder of Health Tech Talent Management possibilities. However, FDA is aware that some companies are marketing products containing cannabis and cannabis-derived compounds in ways that violate the Federal Food, Drug and Cosmetic Act (FD&C Act) and that may put the health and safety of consumers at risk. The agency is committed to protecting the public health while also taking steps to improve the efficiency of regulatory pathways for the lawful marketing of appropriate cannabis and cannabis-derived products.” In closing, it is important to do your research before taking any over-thecounter or prescription medications. Ask your doctor about treatment options and know the risk and benefits of each. And, when it comes to CBD oil and CBD-oil products do your homework as a CBD-free product may provide similar results without the risk of missing out on a new job.
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20/20 IMAGING INSIGHTS Little Process Checks Can Deliver Big Uptime and ROI BY TED LUCIDI, CBET
W
hen it comes to imaging devices, little things go a long way. And not always in the right direction. A little slip of the hands could cause trauma to a TEE probe, and according to years of data from first-hand experience and researching common failures, trauma is one of the leading reasons for costly repair services. In fact, many believe that “biting” is one of the primary causes of traumatic damage, yet research conducted by our Centers of Excellence show that poor transportation practices and poor set-up practices are a much higher cause. Additionally, the process of disinfecting a transducer with traumatic damage, such as a hole in the bending rubber or crack in the distal tip, is one of the primary causes of irreparable catastrophic damage.
Research also shows that many of the little things that lead to big repairs are easily avoidable by training staff in key processes for handling, cleaning and storing. Repairs and replacements can add up fast. Consider the following typical costs you could incur: • Exchange through an OEM may range from $12,000 to $50,000 • Exchange through the third-party market may range from $5,000 to $40,000 • Cost of repair may range from less
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than $500 to about $10,000 By implementing best practices and training staff on proper execution, facilities of all sizes can drastically reduce their cost of operations and ownership for TEE and other types of probes. For example, our clinical experts pioneered TEE care and handling assessments as a means to assist customers with failure prevention. Our pilot customer “owned 10-TEE transducers, yet experienced 28 catastrophic failures stemming from trauma and gross fluid invasion in a single year.” By modifying key steps in crossfunctional processes, this customer achieved the following results: • 50% failure rate reduction in year 1 • Additional 31% failure rate reduction in year 2 • Translated into a 44% cost reduction for a 3-year trend • Resulted in increased customer satisfaction As a 20-year veteran within the clinical environment, 15 years within probe and coil repair and 18 years of teaching biomedical engineering technology at Penn State University, I’ve developed an 18-point process guide to help facilities avoid those little “slip ups” that can take your TEE probe down and escalate your budget with costly, often avoidable, repairs. Here are a few of the steps that have
TED LUCIDI INNOVATUS IMAGING helped cut costs and failures in half: DETERMINE A BENCHMARK AND STARTING POINT: • Compare existing processes with industry best practices • Monitor and observe how staff behavior aligns with these best practices • Consult an outside partner, with expertise in process analysis, to “observe” (as sometimes insiders don’t see what others see) • Review observations to determine weaknesses, strengths and resources needed to achieve goals DEVELOP A PLAN: • Define what processes should be modified and the managers able to implement change • Determine who is responsible for assuring staff compliance • Establish goals and how to measure team success
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ACT, MONITOR AND REPEAT: • Educate end-users regarding best practices • Integrate as many best practices as possible • Monitor compliance frequently REPORT AND ANALYZE: • Use worksheets, controls and other tools to empower employees to self-report or suggest improvements • Capture photographic evidence • Highlight good practices and identify areas for improvement The money saved by eliminating several catastrophic failures with the above steps can often justify the expense of one employee to fully manage this process. With over 20 plus years, I’ve noticed that following these tips can potentially save facilities 50% or more in TEE probe maintenance costs, regardless of size and patient volume. For more suggestions or to set up a time for my 18-point Process Analysis for your facility, email me at ted.lucidi@innovatusimaging.com. TED LUCIDI, CBET, is a Customer Experience and Clinical Insights specialist at Innovatus Imaging.
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CYBERSECURITY BY JOSEPH E. FISHEL, CBET, MBA
T
he following questions are often asked by senior leadership and the IS department of the biomed/ clinical engineering department. Where are you in biomedical or clinical engineering with your cyber plan? Do you have one? Many don’t know where to start as much of this is uncharted ground and every facility is different or has its nuances. We have to look at what is happening today and also at what is changing in the industry as well as in our own facility? What changes are being planned for your network in the future and how will it affect your medical devices? This can often be two ways. The first is securing the devices on the network and providing protection. The second is securing the network so that only qualified devices are allowed on the network. Medical equipment may not meet the standards that IS has planned, so identifying changing parameters is critical.
First, you need to identify where you are in your enterprise with your IT/IS team in what are they are doing presently for protection and detection. Are they looking to make changes to the existing network or are they looking to move to a new platform? What security steps will be changing? Will they be going to a higher level of security verification? Finding out the exact standards is very important. If they are moving to a PEAP/SHA2 requirement, your next step is to determine what equipment will meet that standard and what equipment won’t. As you start gathering information it helps to create fields in your CMMS to track what you have and be able to document changes or updates. Then, look to see if equipment that will not meet the standard can be modified. For example, a device that is
not compatible could become compatible with a new network card. This makes it easier to track compliancy. You will need to create fields in your CMMS to document this along with other fields. As you start identifying the fields you need to record keep in mind that there are everyday settings that need to be documented on how the device is set up. There are fields that will be used to filter the different ways a device is connected for mitigation and remediation for network protection. Sometimes fields need to be added that become very valuable when an attack is identified. Being able to identify quickly which devices are vulnerable to that particular attack is critical. So, while it may seem to be labor intensive to collect this information it will save you from going on an Easter egg hunt and having to look at every device to see if it is affected. As you identify devices that won’t meet the standards, start talking to manufacturers about the new standards and see if the devices can be upgraded. Make sure that the new standards are made available to your purchasing department and have the IS requirements updated. The sooner you start implementing the changes to new equipment purchase the sooner you start meeting a higher level of cybersecurity. If your current vendor can’t meet the new standards, then it’s time to go shopping. There are vendors out there still selling devices that have embedded XP which is no longer supported by Microsoft. Some of the fields or categories you may want to consider for your cybersecurity plan could include: MAC address, IP address, Type of IP address Static/DHCP, Wired or Wireless, Operating System Manufacturer, Version
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Joseph E. Fishel, CBET, MBA HTM Manager for Sutter Health eQuip Services of Operating System, Service Patch Level, Patch level, MFR of Network Card, DNS Server Address, Gateway Address, Host Name/AE Title, Application Level, Firmware Level, Send to Destination Info, Query Info, PHI status (this can be a multitude of fields). Does the device have PHI on it? There are 18 critical PHI fields that you may want to identify should a device go missing and you can identify what fields it is capable of. Do you want to know which ones are available on each device? Does the device support PEAP? Will the device support SHA 2? Does the device have auxiliary connections? What are they and how many? Does the device support antivirus? What vendor of antivirus do they support or work with? Can the device be patched remotely at any time? Can the device be patched remotely, but requires someone to be in front of the machine to turn it off and on? Does the unit require onsite manual patching? As you can see, the information that can be gathered will set you up for dealing with the future. If you can identify some types of information, either at the model level or at the device level, you should probably collect it for the present or future use. Remember it’s your program and what you put into it early on will help you later. JOSEPH E. FISHEL, CBET, MBA, is a Healthcare Technology Systems Manager for Sutter Health eQuip Services.
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Addressing TJC’s
MOST-CITED STANDARDS with Modern Software Solutions BY BEN PERSON
W
hen we think of the Joint Commission (TJC) audits, we often focus on the more exotic aspects of the health care environment like advanced clinical or diagnostic equipment, but a recent analysis suggests it’s the less flashy elements of the Environment of Care that are responsible for a substantial portion of typical Joint Commission audit citations.
TAKING CARE OF THE BASICS According to a 2019 strategiesfornursemanagers.com article, the Top 10 Most-Cited Joint Commission Standards are: 1. EC.02.06.01 (maintenance of a safe environment), 56% 2. EC.02.05.01 (management of utility system risks), 53% 3. IC.02.02.01 (reduction of infection risk from equipment, devices and supplies), 52% 4. LS.02.01.20 (maintenance of egress integrity), 50% 5. RC.01.01.01 (maintenance of accurate, complete medical records for all patients), 49% 6. EC.02.03.05 (maintenance of fire safety equipment and building features), 48% 7. LS.02.01.10 (minimization of fire, smoke and heat damage via building and fire protection features), 46% 8. LS.02.01.30 (building features 74
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provided and maintained to protect from fire and smoke hazards), 43% 9. LS.02.01.35 (fire extinguishment features provided and maintained), 43% 10. EC.02.02.01 (management of hazardous materials and waste risks), 36% Tellingly, of the 10, all but two (#5 and #10) are the direct responsibility of hospital facilities management teams. You read that correctly: the team tasked with responding to clogged toilet calls is also responsible for 8 of the top 10 Joint Commission issue areas. While we tend to focus on the higher-profile clinical engineering teams and the critical work they do to maintain the safety of the equipment directly impacting patient care, the supporting facilities assets like air handlers, filters, doors and fire safety equipment – however seemingly pedestrian or mundane – are just as important to Joint Commission auditors concerned about the overall Environment of Care. MODERNIZING ROUNDS Dissecting each item on the list above is unfortunately beyond the scope of this discussion, but it’s notable that citations in the most common 8 areas can be reduced if the concept of “rounds” can be automated. As the name implies, a facilities team’s “round” is similar to that of a physician. Instead of periodically checking on patients,
Ben Person Nuvolo facilities team members, during their rounds, inspect safety and other equipment, and identify any number of issues that may compromise patient and staff safety, or jeopardize a Joint Commission audit. Facilities teams that have yet to deploy modern software solutions often conduct rounds manually, relying on paper and technician hand-written notes; inefficiencies and errors therefore abound. To illustrate the concept of rounds and how they can impact a Joint Commission audit, let’s consider a typical facilities team effort that requires the round concept: inspection of Exit signs, which could number in the hundreds in a typical health care facility. Using a legacy CMMS or otherwise antiquated maintenance management system, inspecting hundreds of Exit signs might require the generation of WWW.1TECHNATION.COM
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hundreds of individual work orders, and could even mean hundreds of pieces of paper. Modern, cloud-based solutions are delivered with features that eliminate all that, replacing those hundreds of work orders with a single “round”; a single round … with hundreds of tasks. The facilities technician can open that single work order, and make his or her way through each inspection via their mobile device, literally never generating a single piece of paper. Each task – that is, each Exit sign inspection – has a short checklist that the technician completes on their mobile device (e.g. Is the Exit sign lit? Is there any visible damage to the Exit sign?). Modern applications can show the technician how many they’ve completed, how many remain, and even track the amount of time the round is consuming. Since modern software solutions are highly configurable, the round feature can be extended to handle frequent Joint Commission audit deficiencies. Perhaps oxygen tanks are cited as unsecured, for example. A round and associated checklist can be created for a technician to visit rooms in the hospital, identify if an oxygen tank is located there, and if so, if it’s properly secured. If not secured, the technician can create a corrective work order on their mobile device to secure the oxygen tank. As a related aside, a classic Joint Commission audit question that often stumbles health care organizations is: “demonstrate how you create a corrective work order when a technician finds a problem during an inspection or during a preventative maintenance activity.” Modern,
mobile-enabled facilities management solutions have little trouble with this kind of audit request, while organizations using older or manual systems rely on the diligence, notetaking skills and organization of the technician. Needless to say, that’s not the kind of answer that typically impresses auditors. MODERN TECHNOLOGY ENABLES PRO-ACTIVE WORK It’s likely the preponderance of the cited issues listed above are the result of overworked and understaffed facilities technician teams. When organizations are overwhelmed, they have no choice but to prioritize work efforts and, in such environments, proactive inspection activities are likely to fall to the bottom of the list. In one example familiar to the author, a company recently demonstrated a 45% reduction in facilities work order Mean Time to Completion(MTTC) after deploying a modern, cloud-based facilities management software solution. This organization was now able to free precious technician resources to complete work that had gone neglected. As this short discussion suggests, health care organizations subject to Joint Commission certification may find that the benefits of deploying a modern CMMS replacement include a measurable reduction in Joint Commission audit citations.
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BEN PERSON is the vice president of product marketing at Nuvolo, a modern HTM software provider. Nuvolo invites readers to view an on-demand webinar that discusses the Nuvolo HTM solution in detail at nuvolo.com.
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THE OTHER SIDE Performance Evaluations – A Daunting Task BY JIM FEDELE, CBET
I
n my almost 30-year career, I have used many employee evaluation tools and programs. Some were elaborate programs with many elements and actions and some were very basic. I know, as I have had to utilize the more complex tools for my own staff, the outcome has not ever been what I hoped. To be truthful, I do not personally care for the formalized tools and programs but do understand the purpose and what is trying to be accomplished. I know, based on my experience of “evaluating” my own employees, that they struggle with some of the formalized tools and processes that I have been mandated to use.
One does not have to dig too deep to find articles on evaluating employees. Many management books have entire chapters dedicated to employee evaluation. They have many perspectives and all have tips and strategies for evaluating employees. With so much written about evaluating employees it certainly is widely accepted as an important activity. What is the purpose of evaluating employees though? To help them grow professionally? To improve their performance? To reward their performance? To identify training needs? To improve morale? I think all of these apply. However, given the importance of these purposes, it is puzzling to me how many of the tools I have used in the past over-complicate the process. I have worked for small and large companies. What I have found is the larger the company, the more complex the process becomes. When I worked for
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a small company feedback was immediate, when I showed extra initiative I was praised, when I screwed up I was trained, all within minutes of the actions. We did not have a formal process. If I wanted to make more money or work a different job, I was told what skills I needed and how to learn them to improve. We did not have a formal meeting, computer program or even a form to complete. There was just dialog and action. I have to tell you the first time I was exposed to the “formal process” of an evaluation I thought it was ridiculous. I had to fill out a 15-page form, outline goals and objectives, identify training opportunities and then plan how to achieve it all. I certainly agree these are all important activities. I believe that goals and objectives are necessary for the growth of our employees and our businesses. But, asking an employee to help come up with 10 or 15 goals makes their eyes glaze over in loss of interest I think there are many factors working against a simplified, meaningful evaluation. One of the companies I worked for had a large HR department and they worried about litigation incessantly. The document I had to complete for my employees, had many items that were included for regulatory agencies. It seemed like every regulating agency had their hands in the employee evaluation, we had an age specific competency section, job specific competency and a privacy document. All put in place to satisfy some interpretation of a regulation. Given all this “stuff,” if you will, I think the true purpose of an employee evaluation is lost. We should always be asking
Jim Fedele, CBET Senior Program Director, UPMC and BioTronics
ourselves the question, “What am I trying to accomplish?” I think the goal is to grow employees, make them feel appreciated, discover and remove the barriers to their success and understand their definition of success. In my opinion, this cannot be done with an annual meeting and a document. This is done with daily communication and an inherent desire to want your employees to succeed. However, many evaluation tools I have used focused on growing people out of their present position. I guess the thought is that by pushing people to different positions they will achieve more. I tend to disagree with this line of thinking. Most of the techs I have worked with are more interested in being the best possible technician than they are in moving to a different position. The people who want to move up will certainly let you know. We should not force it on everyone. As a manager, my job is to ensure my people are learning every day and developing
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into experts in their respective positions. And then, remove the barriers that impede their idea of success. The evaluation document should be more of a journal than a critique, because the critique should be happening daily. So, what does it all mean? I have received and given many evaluations over the past 30 years. I know for a fact that the more complicated and long the process, the less likely it will be meaningful to the employee. Most times, given how busy everyone is, the process is more “check the box” to get it done, as opposed to accomplishing the lofty goals the document was designed to do. Lack of follow up and substance makes the entire process feel like busy work. I think continuous communication and feedback sets up a better process to help employees achieve more. Employees who need help will do better getting it when they need it not at some later date dictated by some regulation or program. I am not advocating that we not give feedback to our employees, I just feel that giving feedback on a continuous basis at the time it is needed produces better results. Also, good employees will seek out challenges and maintain lines of communication with their manager. The bad employees, well you better be talking to them continuously, or they will never have the opportunity to improve and isn’t improvement what we want? I do not see the employee evaluation going away, all we can do is try to make it meaningful within the barriers imposed and do our best to help our employees understand and then improve.
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ROMAN REVIEW Habits of the Highly Intelligent BY MANNY ROMAN, CRES
I
received an email from Reader’s Digest titled “12 Quirky Habits of People Who Are Smarter Than Everyone Else.” Imagine my surprise to see my picture prominently adorning the heading of the article. Well, it was not there but it should have been. I implement most of the habits on a daily basis.
First the article admits that intelligence is difficult to define, however according to one professor it is the ability “to learn from experience, adapt to new situations, understand and handle abstract concepts, and use the knowledge to manipulate one’s environment.” Multiple research projects have proposed 12 habits that seem to be shared by highly intelligent people. MESSY DESK I nailed this one! Apparently a neat desk encourages conventional thinking with less creativity. The messy desk may be the result of enhanced creativity and focus which pushes cleanliness toward lesser importance. STAYING UP LATE Nailed it! Apparently people who go to bed later have higher IQ’s. They stay up later to take advantage of the reduced distractions. I may not be the guy working on stuff until late night however the studies did not eliminate watching TV from having high intelligence.
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SWEARING Man, I am on a roll! It seems that people who swear have larger vocabularies and verbal fluency. Knowing how and when to swear is part of emotional intelligence. Hit your thumb with a hammer and fluently verbalize to your heart’s content. COLD SHOWERS Imagine that, there is another reason for cold showers. Adapting to the cold water is energizing, decreases tension and fatigue, improves mood and generally enhances brain function and productivity. I’m in a cold shower right now to improve my writing skills.
Manny Roman, CRES AMSP Business Operation Manager
THE SOUND OF CHEWING OK, this one is a stretch. In a study, people who tested high in creativity tended to be unable to filter out irrelevant information. So, it is more difficult to concentrate with all the distractions around. However, these distractions may help to encounter new ideas that can be transformed into creative thoughts. People chewing with their mouths open really bother me. I hope that counts toward high intelligence.
SELF-CRITICISM In a 1999 study, scientists found that “incompetent people couldn’t recognize their own incompetence, which led to inflated self-assessments. This has become known as the Dunning-Kruger effect.” To recognize their incompetence, the incompetent need the very same expertise that they lack. Those with high intelligence realize that most things are complex and there is always a need for additional knowledge. I am a proponent of, “When you think you are done, take an extra step toward excellence.”
DOODLING Doodling apparently helps to process information, problem solving and memory. Doodling may be a good distraction to allow your subconscious to work on a problem. I do this only when on the telephone with important people.
DAYDREAMING I love daydreaming. Daydreaming is the interruption of presence to allow the subconscious to work on a problem while you float away to irrelevance. This is the same effect as doodling except more fun. Hey look, a squirrel.
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THE LEADER
TALKING TO YOURSELF This is a sign of higher thinking, memory and perception skills. You must actually mumble or speak out loud. I talk to me often, but not out loud, I answer out loud however.
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LONER Apparently high IQ people were less happy when they socialized often. We need others but not all the time. We high intelligence people need more quiet time to doodle and daydream. COUCH POTATO Yes! This I can and will do very effectively. Non-thinkers are much more physically active than thinkers. We thinkers do not bore easily with our own company while we ponder the meaning of life as presented on “Game of Thrones.”
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3. There continues to be an increase in the number of women who are joining the HTM ranks. MD Expo Houston provided unique opportunities for this important group of professionals.
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4. The Reverse Expo provided a “speed dating” atmosphere for hospital leaders and companies to get to know more about each other.
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