TechNation Magazine January 2021 by MD Publishing

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Vol. 12

ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

JANUARY 2021

S AV I N G L I V E S T H R O U G H Q U I C K A C T I O N

18 Department of the Month Mercy Ships Biomedcial Department

26 MD Expo Tampa

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39 Tools of the Trade

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CONTENTS

FEATURED

S AV I N G L I V E S T H R O U G H Q U I C K A C T I O N

HE ROUNDTABLE: T ULTRASOUND In this issue of TechNation, ultrasound experts from within the HTM community share their insights regarding what to look for when purchasing an ultrasound system and more. Next month’s Roundtable article: CMMS

HTM HEROES: SAVING LIVES THROUGH QUICK ACTION ‘Heroes Work Here’ yard signs are visible at many health care facilities throughout the nation and have been since the COVID-19 pandemic hit the United States. Many in the communities those health care facilities serve think of the doctors and nurses who provide care. In this cover story, we look at the HTM heroes who serve a critically important role in making that care possible. ext month’s Feature article: N HTM’s Role During Cyber-Attack

TechNation (Vol. 12, Issue #1) January 2021 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to TechNation at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. 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. ©2021

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

JANUARY 2021

TECHNATION

CONTENTS

INSIDE Departments

PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Jayme McKelvey Megan Cabot

ART DEPARTMENT Jonathan Riley Karlee Gower Amanda Purser EDITORIAL

John Wallace Erin Register

CONTRIBUTORS

Roger Bowles Jenifer Brown K. Richard Douglas Jim Fedele Joe Fishel Manny Roman Cindy Stephens Steven J. Yelton

DIGITAL SERVICES

Cindy Galindo Kennedy Krieg

CIRCULATION

Lisa Lisle

WEBINARS

Jennifer Godwin

HTMJOBS.COM

Kristen Register

ACCOUNTING

Diane Costea

EDITORIAL BOARD

Jim Fedele, CBET, Senior Director of Clinical Engineering, UPMC Carol Davis-Smith, CCE, FACCE, AAMIF, Owner/ President of Carol Davis-Smith & Associates, LLC David Francoeur, CBET, CHTM, Senior Vice President Marketing and Sales, Tech Know Associates - TKA Jennifer DeFrancesco, DHA, MS, CHTM, System Director, Clinical Engineering, Crothall Healthcare Rob Bundick, Director HTM & Biomedical Engineering, ProHealth Care

P.12 SPOTLIGHT p.12 Professional of the Month: Keith A. Todd, CBET p.14 Department of the Month: Mercy Ships Biomedical Department p.18 Association of the Month: The Clinical Engineering Association of Illinois P.20 INDUSTRY UPDATES p.20 News and Notes: Updates from the HTM Industry p.26 MD Expo Tampa Recap p.28 AAMI Update p.30 ECRI Update p.33 Ribbon Cutting: CURE Biomedical p.35 Welcome to TechNation P.36 p.36 p.39 p.40 p.42

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

P.56 EXPERT ADVICE p.56 Career Center p.58 20/20 Imaging Insights, sponsored by Innovatus Imaging p.60 Cybersecurity p.62 The Future p.64 A Medical Device Cybersecurity Success Story, sponsored by Nuvolo P.68 BREAKROOM p.68 Did You Know? p.70 The Vault p.72 MD Expo Scrapbook p.76 MedWrench: Bulletin Board p.86 Flashback p.82 Service Index p.85 Alphabetical Index Like us on Facebook, www.facebook.com/TechNationMag

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SPOTLIGHT

PROFESSIONAL OF THE MONTH Keith A. Todd, CBET BY K. RICHARD DOUGLAS

he military can lead to a lifelong profession and sometimes it can be the catalyst to meet your future spouse. Sometimes, it can be both.

Keith A. Todd, CBET, is a biomedical equipment support specialist in the biomedical engineering department at the Alvin C. York VA Medical Center in Murfreesboro, Tennessee. “I first learned of the biomed field while stationed in Korea. I volunteered to go to Korea and was serving in the 2nd Infantry Division Long Range Surveillance Detachment. I was up for re-enlistment and wanted to change my military occupational specialty. I was airborne infantry and wanted to get some specialized training in the medical field but was not sure what area,” Todd says. He had entered the U.S. Army out of college with a bachelor’s degree in biology and knew his biology degree would be of use while training in a medical-related field. “Before I went to a four -year college, I completed an industrial electricity program after graduating high school and then worked for two years as an industrial electrician in a steel manufacturing plant. Something that could combine the biology studies and the training and work experience of the electrical field would be perfect; but what could that be?” Todd wondered at the time. Todd’s squad leader’s wife, during his time in Korea, was a biomed. She told

TECHNATION

JANUARY 2021

Keith A. Todd, CBET, works on medical equipment at the Alvin C. York VA Medical Center in Murfreesboro, TN. him specifically what she did in her biomed work and he was more than interested. “I then discussed this with the re-enlistment NCO and re-enlisted for Biomed Equipment Repair Technician. After completing my time in Korea, I transitioned back to the states, took leave and then reported to Sheppard Air Force Base in Wichita Falls, Texas for biomed school,” he says. Todd completed the DOD Biomed Training course and, being airborne qualified, was sent right back to Fort Bragg where he was prior to being in Korea. “The airborne wings act as a magnet, and seems to keep you at, or at least bring you back to Fort Bragg; but this time it was not just myself returning. While

going through the biomed training at Sheppard Air Force Base, I met my wife. We were the same age and she was a reservist also going through the DOD biomed school. Aside from her being from the northeast and myself from the southeastern United States; we had much in common,” Todd says. He says that the two of them spent a lot of their free time together and, after a few months, discussed marriage. “She was about six weeks ahead of me in the school and, after graduating, she had to go back to her unit. This was the late October, early November time frame. We then arranged for her to come back to Wichita Falls two days before Thanksgiving,” Todd says. “On that Wednesday before Thanksgiving, we had scheduled with the Justice

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SPOTLIGHT

Keith A. Todd, CBET, tests equipment Keith A. Todd, CBET, previously worked in Alaska of the Peace to have a marriage ceremony. During my lunch break on that day, we went to the courthouse and had a quick marriage ceremony,” he adds. Todd says that they had a great Thanksgiving that year. “Not much furniture, secondhand pots and pans, a one-bedroom section of a divided old house I was renting but lots of fun and great memories,” he remembers. Todd worked in a couple of different biomed positions while in the Army when a position opened up at the base hospital at Womack Army Medical Center. “I was re-assigned when the position came open. About two and half years later, my wife became pregnant and she left the military. Two years later, she was pregnant again. I decided that due to family considerations, I should pursue a civilian biomed career. I did not re-enlist,” he explains. Todd says that when his re-enlistment finished, the family moved to Anchorage, Alaska. “While in Alaska, I worked as a biomed for Hill-Rom, the Alaska Native Medical Center and for Siemens Healthcare servicing lab equipment,” he says. FROM THE COLD NORTH TO THE VOLUNTEER STATE Over the years, Todd has garnered more experience and training, both on-the-job and through formal training coursework. “I very much enjoy working with laboratory equipment and while working at the Alaska Native Medical Center, was sent to RSTI and completed the four phases of radiological service training. I enjoy working on

X-ray equipment as well. Most of all, I like the variety of working in multiple clinics and areas. You get to work on a large variety of equipment and systems. To me that keeps things interesting,” he says. Todd has experienced a few challenges along the way. “There were many challenges working in Alaska. The cold, traveling the vastness of the state to service medical equipment, getting parts and supplies, and even the time difference from the east coast when needing to talk to equipment manufacturers was often an issue,” he says. At his current position, he says that he had to help stand up a COVID-19 wing of the hospital. He and colleagues are currently standing up a new outpatient facility in Chattanooga. On the recognition front, Todd has received three Director’s Awards for outstanding service while working at the VA. When not involved in biomed duties, Todd can be found enjoying outdoor activities like hunting, fishing, hiking and camping. Faith and country are important foundations for this HTM professional. “I have a deep love and appreciation for our country. I believe that our freedoms and liberties were granted to us by God almighty. Many citizens and those obtaining citizenship have sacrificed greatly for our country. We should be mindful of this and teach our children, not omitting any of it, while acknowledging God’s grace and mercy,” Todd says. The veterans in Murfreesboro are in good hands with a fellow vet looking out for the medical equipment they depend on.

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FAVORITE PART OF BEING A BIOMED:

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WHAT’S ON MY BENCH?

• A fan to keep cool. I don’t like heat! • Water • A calendar • Vendor contact info • Snacks

JANUARY 2021

TECHNATION

SPOTLIGHT Senior Biomed Technician Guido Kortleven cleans a microscope in the OR while Denise Ngum observes as part of a mentoring program onboard the Africa Mercy.

DEPARTMENT OF THE MONTH Mercy Ships Biomedical Department BY K. RICHARD DOUGLAS

here may be one biomed opportunity that is more unique and unusual than most others. It is to work on a hospital ship and adjust to the inimitable peculiarities and challenges that such a role requires of the biomed. With the challenges come rewards.

The Mercy Ships organization assembles volunteers who hail from around the world. This includes the ship’s maritime crew, teachers, health care professionals, electricians, IS professionals, galley staff, photographers, accountants and HTM professionals. Every year, the permanent staff of the Mercy Ships organization is joined by 1,300 volunteers from over 50 nations. These volunteers stay with the ship for anywhere from two weeks to two years. The organization looks for commitments of at least six months for most positions. Most of the work is in sub-Saharan western Africa. The ship visits ports where it can dock for extended periods. The organization operates two floating hospital ships: the Africa Mercy and, the

TECHNATION

JANUARY 2021

newest ship, the Global Mercy. The Africa Mercy has been serving patients for several years and the Global Mercy is nearing completion. The organization’s mission states, “We follow the 2,000-year-old model of Jesus, bringing hope and healing to the forgotten poor.” The group brings the capacity for much-needed surgeries to people who would otherwise not have access to that life-changing opportunity. The organization has had a positive impact on the lives of tens of thousands. Mercy Ships also trains health care workers, allowing Africa to add to its workforce of capable health professionals. Mercy Ships provides surgery in the following specialties: maxillofacial, head and neck, general, orthopedic, reconstructive plastics, pediatrics, ophthalmic and women’s health. The Africa Mercy includes five operating theatres, recovery, intensive care and low dependency wards – totaling 80 patient beds. It has an onboard surgical capacity for 7,000 interventions per year. Medical equipment includes a CT scan, X-ray, laboratory services and

equipment for remote diagnosis. For data transmission, the ship offers an onboard satellite communication system which can transmit diagnoses and other data. The organization’s newest and largest hospital ship is the Global Mercy, which will see service in the near future. The 174-meter, 37,000-ton ship will have six operating rooms and house over 600 volunteers from around the globe representing many disciplines including surgeons, maritime crew, cooks, teachers, electricians, the host staff and more. The ship will also feature a 682-seat auditorium, student academy, gymnasium, pool, café, shop and library – all of which have been designed to accommodate up to 950 crew onboard when docked in port. SHIP-BASED BIOMEDS Where there is medical equipment, there are biomeds. With no realistic access to OEM service providers, the Mercy Ships organization depends on biomed volunteers to plan an important role on their ships. “For the Africa Mercy, we have a team of one biomedical technician and one

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SPOTLIGHT senior biomedical technician. The biomed team is responsible for commissioning new medical equipment, preventive and corrective maintenance of this equipment, user support and the team also provides input for selecting new equipment,” says Senior Biomedical Technician Guido Kortleven. He says that the team is responsible for the hospital on board and the off-ship facilities where medical equipment is used (like dental clinic and eye tent). “We have also one ‘Medical Capacity Building Project Manager – Biomed,’ who is responsible for the training of local biomed in country,” Kortleven says. He says that soon, another team will be added for the Global Mercy. “This team has two biomedical technicians and one senior biomedical technician. The scope will be the same as for the team on the Africa Mercy,” he says. “We also have support for two people on the International Support Center who are responsible for procurement and projects (like the new ship),” Kortleven adds. Working on a ship, away from suppliers, can present some challenges and that results in some stories of achievement. “Because of the remote locations where the ship is operating, we have no or very limited access to support from service companies. Therefore, the ship has no service contracts for the medical equipment. We have some companies coming to the ship to perform preventive maintenance while it is in the Canaries for

the annual maintenance, but they are not managed by a service contract,” Kortleven says. Kortleven says that every day there is a unique story on board of the Africa Mercy. “There are so many stories to tell,” he says. “A few years ago, our biomeds on board had to replace the tube of the CT scanner. It took over a week to get it airfreighted to the ship. Within four hours after it arrived, the biomed had the tube replaced and we were able to perform diagnostic activities again,” Kortleven says. “Last year, we had an issue with the water quality in the country where we were. The system which produces DI water for the instrument cleaning had some issues (not enough filter media, some parts were reversed). Together with the hard water we encountered the problem was that halfway through the field service, the filter material was depleted,” Kortleven says. He says this required the biomeds to troubleshoot a system they didn’t have much experience with. “Because of this, we ordered a water quality meter, did some calculations and wrote some instructions. In the future we are better able to predict when the filter material is depleted, so now we can work pro-actively instead of reactively,” Kortleven adds. He says that there are some special projects that are unique to a hospital ship and the eventual challenge of staffing

biomeds for the larger ship, once it is ready to be put into service. “Our special projects are, for example, the commissioning of new equipment (replacement of washers in the CSSD department is different on a ship than in a land-base hospital),” Kortleven explains. “Also, a very big and special project is the commissioning of the Global Mercy. We need 15 biomeds for a period of three months or more,” he adds. WHY VOLUNTEER FOR MERCY SHIPS? The organization states it best. “Each year, 16.9 million people die due to lack of access to surgical care. Mercy Ships is on a mission to help the people behind this staggering statistic,” the Mercy Ships website states. “With 50 percent of the world’s population living near a coast, our hospital ships are able to provide a safe surgical environment that can reach the most people along the shores of Africa’s developing nations. By providing life-saving surgery and life-changing medical training, we help strengthen Africa’s fragile health care systems while leaving a lasting legacy,” the organization explains. Some of the requirements Mercy Ships looks for in a biomed volunteer include: • a minimum six-month commitment • echnical or academic training satisfactory for the position (electronics, biomedical, clinical or electronic engineering) • two years’ experience as a biomedical technician; preferably as a Certified Biomedical Equipment Technician (CBET) • written and verbal fluency in English and flexibility and sensitivity to language and cultural diversity. For biomeds who are willing to take on the challenge of a unique experience, the rewards are great. Helping to bring life-changing surgery to people in remote parts of the world is a noble calling and a tremendous application of HTM skills.

The Global Mercy ship is seen while still under construction. EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

For information about how to volunteer with Mercy Ships, visit https://opportunities.mercyships.org/opportunities-listings/?fwp_sectors=hospital-support-services.

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SPOTLIGHT

ASSOCIATION OF THE MONTH The Clinical Engineering Association of Illinois (CEAI) BY K. RICHARD DOUGLAS

llinois is the state that gave the nation Abraham Lincoln and the John Deere tractor. It was the first state to ratify the 13th Amendment to the Constitution and one of the nation’s first McDonald’s restaurants was in Des Plaines, Illinois.

Starting in 2006, the state also became home to the Clinical Engineering Association of Illinois (CEAI). “The ‘grassroots’ meetings began in 2005 along with the development/ authoring of the state association’s articles of incorporation and association by-laws,” says CEAI former President Al Moretti. In 2007, the inaugural year, the association’s first official officers were elected and quarterly chapter meetings were held with educational topics/ themes to serve the membership base. The group had humble beginnings and came about after a meal at an Illinois restaurant. “Three local HTM leaders met for

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JANUARY 2021

lunch on Taylor Street (Francesca’s) in the fall of 2005 to chat around the formation of a ‘new’ association that would be pillared on promoting education, the biomedical/clinical engineering profession (i.e. HTM) and fostering the next generations of our HTM industry,” Moretti says. “These three HTM leaders embarked on getting the word out to the local masses as to the concepts and the first ‘grassroots’ meeting in October 2005 was held with over 35-plus attendees. These three local HTM founders were Al Moretti, Joe Bandra and Robert Shue,” he adds. In the last 14 years, the CEAI has established a noteworthy history. The group’s current officers include President Leslie McGovern, Vice President Steve Hernandez, Secretary Rachel Homier and Treasurer Greg Czajka. “Over $25,000 has been awarded in CEAI scholarships to aid future HTM professionals in their undergraduate studies quest,” McGovern says.

She says that the CEAI has had more than 10 highly successful annual conferences attended by, not only local membership, but attendees from numerous states across the country. “There have been five elected CEAI officer administrations continuing the lead forward and projecting the HTM vision to its membership and the industry across the country,” McGovern says. McGovern also says that there has been a solid networking base among CEAI member’s – past and present – who yearn to share comradery, knowledge, resources and experiences She adds that CEAI is “one of the most revered and admired HTM associations in the country.” A HISTORY OF PRODUCTIVE CONFERENCES The association addresses topics important to the biomed community. “While education is still very important to our organization, we’ve expanded into current events – especially around right-to-repair and other

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SPOTLIGHT

The Clinical Engineering Association of Illinois (CEAI) held a panel discussion at its 2019 annual conference.

political hot topics – bringing in new blood to the industry and sharing career opportunities. We believe that an organization like ours needs to do more than host educational sessions to stay relevant and continue our growth,” McGovern explains. The current pandemic has placed restrictions on nearly all group activities, including CEAI’s annual conference plans for 2020. The group does have a history of hosting a successful conference dating back a dozen years. “Apart from this year, due to COVID-19, the CEAI and its officers have organized an annual conference for the past 12 years. It is traditionally held at Drury Lane in Oak Brook, Illinois. The event spans two days and includes a variety of educational sessions, a lunch featuring a speaker or panel of speakers and a vendor expo. The educational sessions have been focused on topics includes biomedical, radiology, networking and leadership, among others,” McGovern says. She says that former keynote speakers have included industry leaders, AAMI leaders, educators and local HTM professionals. “The conference helps our local professionals network with peers, vendors and leaders in the industry,” McGovern adds. In addition to the annual conference, CEAI hosts quarterly meetings which are about an hour long. “Normally our meetings are in person and sponsored at a vendor location. We do this to be good partners to the many vendors who have helped CEAI over the

years with their continued support. We spend a quarter of the meeting covering CEAI business updates, discussing any job openings and other CEAI related topics. Then, we let our vendors use the remaining time to educate members on new products and/or services. Due to COVID-19, we have held virtual meetings and have had good turnout surprisingly; we weren’t sure how it would be received,” McGovern says. The association also has enriched the lives of biomeds in training through its scholarship program. “We have given approximately 25 recipients scholarships ranging from $1,000 to $2,500 since 2012,” McGovern says. Despite not having a current relationship with a local technical school, McGovern says that the group does “love our student members and professors.” “All HTM students are encouraged to attend our meetings and get involved. They also only pay $20 for one year of membership which includes the annual two-day conference, chapter meetings and complimentary food,” she adds. “Due to COVID-19 and Illinois restrictions we had to cancel the 2020 conference. We are really hoping we can hold the August 2021 conference. Our theme will be ‘Refueling the HTM Pipeline.’ We are really trying to promote awareness of the HTM field in Illinois through a variety of ways,” McGovern says. She says that CEAI is planning some new sessions that they haven’t had before. “We will have a leadership develop-

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

ment course and a network training course. Also new to 2021, we will be collaborating with TechNation and AAMI to boost conference attendance and educational offerings,” McGovern says. One of the many great benefits an association like CEAI brings to the local biomed community is the ability to help with networking and highlighting local job opportunities within the profession. With the exodus of many baby-boom generation biomeds, this is more important than ever. “CEAI has a portion dedicated on our website to advertise open HTM positions. We also discuss open positions at every meeting and encourage students to come to the meetings to network and meet prospective employers,” McGovern explains. She says that the group is also using AAMI’s “HTM In A Box” tool. “We will have a contest for how many schools our members can visit between hospitals and invite students who may be interested in HTM to the annual two-day conference with a special session designed just for them. We hope we can virtualize some of these meetings for now and then resume in-person meetings once the threat of COVID-19 subsides,” McGovern says. Here’s hoping for new HTM professionals in Illinois and a return to in-person annual conferences. The CEAI has achieved a lot in a short time and the future of the profession looks hopeful in the Land of Lincoln.

JANUARY 2021

TECHNATION

INDUSTRY UPDATES

NEWS & NOTES

Updates from the HTM Industry

AAMI PRESIDENT, CEO RETIRES Rob Jensen, the president and CEO of AAMI, has announced his retirement from AAMI to focus on his family roles and responsibilities. Since 2016, Jensen has led AAMI through many significant transitions and advancements. Among them, the AAMI Center for Excellence opened in 2018 as a world-class training and meeting center to support education and standards development functions. Together with AAMI staff, Jensen led a strategic transformation to change AAMI’s internal culture to one focused on data-driven decision making, comprehensive strategic and operational planning, and financial and data integrity. He spearheaded efforts to increase AAMI’s profile globally and to create a new AAMI fellowship program. Investments in technology and enterprise systems were the foundation for AAMI’s seamless transition to remote work in early 2020 that positioned the organization to adapt and remain financially sustainable into the future. “Rob has been a pleasure to work with and has taken AAMI to new heights,” said Steve Yelton, chair of the AAMI Board of Directors. “We can’t thank him enough for his leadership, his efforts to forge new strategic initiatives and his keen ability to innovate and modernize AAMI’s infrastructure and programs.” On behalf of the AAMI Executive Committee, Yelton announced that Steve Campbell – AAMI’s chief operating officer who has been with the organization for 20 years – will serve as acting president and CEO. “Steve offers great stability to AAMI. He has outstanding personal skills to work collaboratively with members and

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staff and has the vision and practical mindset to tackle challenges and seize on opportunities,” said Yelton. “Working with the management team and board, AAMI is in great hands to move forward and to continue to grow and serve the health care community.” The AAMI staff and board congratulated Jensen on his retirement. In other news, AAMI has Rob Jensen developed a new guide for HTM departments looking to establish biomedical equipment technician (BMET) training programs or internships. “This document is available in the nick of time,” said Danielle McGeary, vice president of HTM at AAMI. “While it is difficult to transition to start or alter a training program even at the best of times, COVID-19 has put many hospitals’ hands-on training, internship and volunteer programs on hold. HTM leaders are making the best of this situation, using the pause to rethink their programs. Now, there’s a training guide to help these programs start up better than ever.” The HTM Training Guide for BMET Students, Interns, and Volunteers is available for purchase in the AAMI store. It is free to all AAMI members and students (who are also eligible for a free AAMI membership). •

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MEDIGATE ANNOUNCES CLINICAL SECURITY OPERATIONS CENTER SOLUTION WITH SPLUNK Medigate, a leader in IoT and medical device security and asset management for health care, has announced a Clinical Security Operations Center (SOC) solution to help Splunk users at health care organizations accurately identify and quickly respond to all threats from connected medical and IoT devices on the network. The Clinical SOC helps users of Splunk Enterprise and Splunk Cloud to detect, manage and respond to cybersecurity events in a clinical context so health care organizations can better understand what the findings mean for their institution. The tailored app allows Splunkbase to consume Medigate’s data, leveraging Splunk’s advanced visualization, analytics and reporting capabilities. The data, fed into Splunk’s Data-to-Everything Platform, enables sophisticated investigations, responses and remediation activities. As a result, health care institutions can easily derive specific insights based on Medigate clinical-focused IoT data. The custom handling of data and built-in dashboards simply present vital asset and events data in an easy-to-comprehend visual. “Data is the lifeblood of every health care organization, yet much Ad_new.ai of this data is being shared over a growing network 1 12/6/2019 10:16:03 AM

of IoT and medical devices – where each device could be used as a network access point for cyber criminals. Protecting this patient data and achieving superior network security is essential for every health care organization as we have seen an increase in the number of attacks in the past several months,” said Jonathan Langer, CEO and cofounder of Medigate. “Our partnership with Splunk is simplifying the process to locate devices, analyze their use and alert IT to solve any potential threats so health care institutions can automatically protect this sensitive information.” Medigate’s solution addresses patient safety and privacy by automatically locating, identifying and managing the security posture of all devices connected to the network, in addition to powering clinical engineering with the device data they’ve never had available before to manage their fleet of medical devices. Medigate has continued its growth by demonstrating how comprehensive device data leads to new ROI and cost savings in health care delivery organizations around the world, from the largest health systems to specialty hospitals. • For more information, visit medigate.io.

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REPORT: MEDICAL EQUIPMENT MAINTENANCE MARKET TO EXPERIENCE TREMENDOUS GROWTH Based on a MarketsandMarkets report the medical equipment maintenance market is expected to grow from $28.97 billion in 2018 to $47.49 billion by 2023. This forecast predicts an compound annual growth rate (CAGR) of 10.4% during the forecast period. The growth of this market is mainly driven by growth in associated equipment markets, rising focus on preventive medical equipment maintenance, adoption of innovative funding mechanisms and the growing purchase of

refurbished medical equipment. Some of the prominent key players are GE Healthcare, Koninklijke Philips N.V., Siemens Healthineers, Toshiba Medical Systems Europe, Drägerwerk AG & Co. KGaA, Aramark, BC Technical Inc., Alliance Medical Group, Althea Group and more. The independent service organization (ISO) segment is expected to grow at the highest CAGR in the medical equipment maintenance market during the forecast period, according to the report.

VERSION 8 OF ITS HEMS CMMS SOFTWARE RELEASED With the release of Version 8 of the HEMS Computerized Maintenance Management System (CMMS), EQ2 LLC has focused on new functionality and user interfaces that hospital clients have requested. Clinical engineering, facilities/support services, imaging, IT and supply chain department users have all contributed to make the new HEMS release even more effective and easier to use. Some new features available in Version 8 include: • First-of-its-kind Call Center/ Dispatch Board with automatic multi-level escalation based on time elapsed, location, problem, shift, etc. • Compliance and AEM guided directly by regulatory standards • Easy visibility into recalls and network security risks

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• The power of analytics in the user’s hands • Advanced filtering and display of information on demand – empowering the user to prioritize required activity • On-demand PM creation • Bulk work order creation with two clicks • Link by location to Environmental Zones • Transparency of Service Areas – detailed information from any service area on one screen based on access rights • New Interfaces/Integrations for Lawson and Peoplesoft. Version 8 is available to new customers and all existing users through an upgrade program. • For more information, call 888-312-4367 or visit eq2llc.com/contact/.

Based on the type of service provider, the medical equipment maintenance market is segmented into original equipment manufacturers (OEMs), independent service organizations (ISOs) and in-house maintenance. In 2017, the ISOs segment is expected to grow at the highest CAGR during the forecast period market, primarily due to their advantages, such as better expertise in handling different brands of equipment as opposed to OEMs and the lower cost of services. •

GLASSBEAM, RENOVO SOLUTIONS EXPAND CLINSIGHTS SOLUTION Glassbeam Inc. and Renovo Solutions have announced the expansion of their partnership to a large customer base of Renovo Solutions. This partnership will allow health care providers to leverage the full power of Glassbeam Clinsights application suite to intelligently optimize service and utilization programs across a heterogeneous fleet of medical equipment comprising of different modalities and manufacturers, while significantly improving patient care and customer satisfaction. Renovo Solutions needed a technology platform to enable early detection of the machine and part failures while also uncovering deeper insights to advise its customers on improving machine utilization. Glassbeam Clinsights solutions now make it easier than ever to automate Renovo Solution’s medical equipment service processes and empower its national workforce. The solution brings the full power of proactive and predictive maintenance for its clinical engineering and biomedical teams tasked with intelligently managing and servicing multi-modality medical equipment from a single pane of glass. •

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RENEW BIOMEDICAL TO EXPAND OPERATIONS Tennessee Gov. Bill Lee, Department of Economic and Community Development Commissioner Bob Rolfe and ReNew Biomedical Services LLC officials announced that the biomedical equipment service provider is expanding operations in Jackson, Tennessee. The project represents an investment of $1 million and the creation of 43 jobs over the next five years. “The addition of these high-quality jobs in Madison County will make a difference both for the employees and our collective efforts to fight COVID-19. These technical jobs equip

health care workers with the equipment they need to operate effectively, and I thank ReNew Biomedical Services for their continued investment in Tennessee,” Gov. Bill Lee said. ReNew Biomedical Co-Owner Jill Taylor said the talented population and a need for more healthcare technology management professionals is among the reasons for the expansion. ReNew Biomedical Services is a medical equipment maintenance and repair service company accommodating HTM professionals and emergency medical technicians in the United States.

The company has operated in Jackson for six years and currently employs 19 people. As part of the expansion, ReNew will build a new training facility where the company will train biomedical equipment technicians to handle the needs of the medical equipment industry, specifically focusing on equipment such as defibrillators, EKGs, vital signs monitors, IV pumps, AEDs and ventilators. The Renew Biomedical Training Academy of Jackson, Tennessee was scheduled to open in the final quarter of 2020. •

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PARTSSOURCE PROVIDES ON-DEMAND SERVICE PROVIDERS PartsSource, an evidence-based marketplace for medical equipment products and services, has introduced the industry-first PartsSource On-Site Service solution. The solution is designed to help ensure vital medical equipment is continuously operational and available for patient care. The solution empowers hospitals, for the first time, to solve equipment downtime issues with online access to an expansive pool of curated and credentialed repair and maintenance technicians, now available through the company’s evidence-based marketplace, PartsSource.com. PartsSource developed the network of over 1,000 pre-qualified service professionals by working with industry-leading engineers within its supply chain network and partnering with original equipment manufacturers (OEMs) and independent service

providers (ISOs). Using the evidence-based PartsSource procurement platform, it can now take as little as 60 seconds to schedule expert service for imaging and biomedical equipment from reliable professionals who can deliver a broad range of services 24 hours a day, year-round. Services include sameday or next-day repair and preventive maintenance for imaging equipment including CT, MR, X-ray, C-Arm and cath/angio as well as general biomedical equipment such as beds, patient monitoring and respiratory equipment, or ongoing support for large installation projects. • For more information, visit partssource.com/onsiteservice.

PATIENT PROCEDURES DELAYED AS OEMS BLOCK OTHERS FROM REPAIRING EQUIPMENT Nearly 70 percent of more than 200 medical repair professionals surveyed by U.S. PIRG Education Fund, U.S. PIRG’s sister organization, say that their hospital has had to “delay a patient procedure because [they] were waiting on a manufacturer service representative to fix a device.” Time can be of the essence for many medical procedures, so these delays undermine the quality of care. While many hospitals had issues with the timeliness of proprietary equipment repair before the COVID-19 pandemic spread widely in March, the coronavirus has exacerbated the issue by restricting travel and outside access to medical facilities. Meanwhile, medical device manufacturers regularly refuse to provide on-site repair professionals with necessary materials such as service manuals, access keys and spare parts to complete repairs on their own. “By restricting access to repair, manufacturers can endanger patients who might not get access to critical procedures when they need them,” said Anne Marie Green, associate with U.S.

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PIRG’s Right to Repair campaign. “A lot is said about how manufacturer repair restrictions run up the cost of health care, but they can also result in patient care being delayed by weeks or months. That’s absurd and unacceptable.” Hospitals typically have in-house repair technicians, known as biomeds, who are qualified to service medical equipment. Because they are on-site, hospital biomeds can service equipment quicker, with less downtime. “It is always life or death in the hospital. I have been brought into the hospital in the middle of night and told ‘If you don’t get the device up and running in an hour or two, that patient will die,’ ” said Nader Hammoud, who is with the California Medical Instrumentation Association and manages a biomedical engineering team in a California hospital. “Putting patients first means manufacturers must cooperate with the hospital biomedical staff, and make access keys and service materials available.” Manufacturers tend to charge

significantly more for repair service, and profit from restricting the repair of their devices to their authorized technicians. Many of the equipment companies defend this practice by claiming that these restrictions are done to prevent safety issues. But these restrictions cause safety issues of their own. U.S. PIRG Education Fund released a report in July detailing the difficulties manufacturers impose on hospitals when it comes to repair. Out of the 222 biomeds surveyed, nearly half said they had been denied access to “critical repair information” by manufacturers since the beginning of the COVID-19 pandemic in March. One based in Texas said the hospital was “at the whim of a vendor who says they’re not coming in because of COVID-19. And we have equipment down and we have patients that still keep coming, and it was tumultuous.” “If medical equipment manufacturers truly prioritized patient care, they would empower hospitals to repair the equipment they own,” said Green.

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BC GROUP ANNOUNCES NEW SPO2 SIMULATOR BC Group International Inc., a manufacturer of test equipment for the medical industry, has introduced a new BC Biomedical product. Ken O’Day, vice president sales and marketing for BC Group said, “The new FSX-1101 Pulse Oximetry Simulator is the only SPO2 Simulator with a lifetime warranty.” (Lifetime limited warranty requires product registration and return to factory for annual calibration.) This is the most advanced pulse oximeter simulator on the market at $1,495. The FSX-1101 is a digital SPO2 simulator with many features. It is small and light weight, yet powerful. It has a bright, 2.4-inch color touchscreen that, coupled with an intuitive menu structure, allows easy access and viewing of all setup and function parameters. To make testing your SPO2 monitor easier and faster, the FSX-1101 has a set of factory presets. Need to do a more specific evaluation? There is a manual mode that allows individual control over each parameter only limited by the specific values that are available. The FSX-1101 is at the top of its class in performance and specifications. SPO2 (in %) is selectable from six values with 2% accuracy. Heart Rate (in BPM) is selectable from 10 values with 1% accuracy. Three Perfusion Index values are also available. The FSX-1101 can be connected to a BC Biomedical NIBP-1000 Series, PS-2100 Series or PS-2200 Series Patient Simulator via the auxiliary port (by using the provided cable). This allows for a synchronized SPO2 and ECG simulation for your monitors. The FSX-1101 can be powered by its two internal AA batteries or using the provided cable from the auxiliary port on your BC Biomedical Patient Simulators, any USB port or the provided universal AC adapter. In battery powered operation, the battery life is 10 hours of full operation with full backlight intensity. • For more information, visit bcgroupstore.com.

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300+ HTM PROS ATTEND MD EXPO TAMPA MD Publishing Provides Much Appreciated In-person Conference

D Expo Tampa drew 361 healthcare technology management (HTM) professionals making it the largest in-person event of 2020 for parent company MD Publishing. The MD Expo built on the success of HTM Mixers in Denver and Milwaukee with a third HTM Mixer set for Nashville on December 9-10.

MD Publishing President and Founder John Krieg was pleasantly surprised by the large turnout in Tampa. He said MD Expo Tampa experienced “much bigger turnout than I expected because of COVID-19.” He also said that several HTM professional thanked him and the MD expo staff for hosting the conference. “They were very appreciative,” Krieg said. MD Publishing Vice President Kristin Leavoy was encouraged by the turnout. “The MD Expo Tampa event proved once again that it is possible to hold an in-person event and a safe and clean format. Our goal was to create an environment where industry professionals could come together safely to do business and I think we succeeded,” Leavoy said. “We as event coordinators, as well as our vendor partners, are having to adjust our expectations as to what a ‘successful event’ looks like. No more is it an exhibit

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Steve Maull of Maull Biomedical presents on contrast injectors.

hall with attendees packed shoulder to shoulder because that environment is no longer safe,” she added. “If we can provide education and access to vendors in a socially-distant environment, then that provides everyone the opportunity to conduct business safely.” MD Expo Tampa started with educational sessions and a Welcome Reception. Thanks to support from the Florida Biomedical Society (FBS) and sponsors — including Select Biomedical, USOC Bio-Medical Services, Avante Health Solutions, Innovatus Imaging, AIV, HTMjobs.com, RPI, AllParts

Medical and MedWrench – members of the HTM community were able to further their education and network with peers while also learning about products and solutions available to assist them with their jobs. Attendees shared positive feedback after the first day of education and while enjoying a beverage at the Welcome Reception sponsored by Select Biomedical. The second day featured more educational sessions, an exhibit hall with companies sharing their solutions capped off by a Happy Hour sponsored

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by AIV. Attendees, exhibitors and presenters all shared positive feedback regarding MD Expo Tampa. “We had a lot of traffic yesterday,” Amy Hobbs from USOC Bio-Medical Services said as the exhibit hall opened on Day 2 of MD Expo Tampa. “Sunday was fantastic. We’ve had a lot of good attendees at this MD Expo. There was not a time that we were not busy.” DR Flower from Beta Biomed said he had “some very nice conversations” with attendees during exhibit hall hours. He added that the opportunity to attend an in-person event was amazing. “It’s been quite important for businesses and just as human beings we want to interact,” Flower said. “I think it’s very good for biomeds to get together.” “It is the backbone of our industry to be able to come together and interact,” he added. MD Expo impressed American MedMart CEO Matthew Lau. “It’s been a real good conference. We

are a new company, so to be able to get the word out about who we are has been phenomenal,” Lau said. “I was expecting more people to approach us for jobs, but we’ve made more contacts with other vendors which is fabulous for us.” Young Professionals (YP) were invited to a special event at MD Expo. The YP at MD was held at a nearby bar and grill where young HTM professionals gathered to network and share ideas. “Our second annual Young Professionals at MD Expo Networking Event was a huge success. We love that we are building a community in the HTM field where our future leaders can build relationships and network together,” MD Publishing Senior Account Executive Megan Cabot said. Attendees and presenters also reported great appreciation for the opportunity to attend MD Expo Tampa. Larry Fennigkoh, adjunct professor, biomedical engineering at the Milwaukee School of Engineering, praised the event and the previous HTM Mixer in Milwaukee.

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Dean Moore from AdventHealth Tampa said this was his first MD Expo. “It’s good to go out and network with other professionals,” Moore said. “The training (at MD Expo) is good.” Charles Hardenstein, a biomed from Colorado, travelled to Tampa for the MD expo. “It’s a great show. Thank you for having it,” he said. Lowell Pitman from Holston Valley Medical Center in Tennessee said the conference exceeded his expectations. He said that he felt safe attending during the COVID-19 pandemic especially with all of the safety measures in place by the organizers and the host hotel. “I can tell y’all put a lot of energy into planning and making it safe,” Pitmann said.

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AAMI UPDATE BY AAMI

Interns, and Volunteers,” is meant to give new and prospective HTM professionals, who are actively learning in the hospital, a broad overview of everything the profession entails. The guide comes with a “cheat sheet” of common HTM acronyms and includes an extensive competency checklist, allowing managers to scale what their program will cover to fit the length of an internship or to accommodate for a trainee’s professional background. It is free to all AAMI members and students (who are also eligible for a free AAMI membership). For more information, visit bit.ly/3nPFmlr.

AAMI FELLOW PROGRAM OPENS 2021 NOMINATION PROCESS The AAMI Fellow Program, which recognizes individuals who have provided substantial service and contributions to AAMI and to the health technology field, is now seeking applicants for 2021. “2020 has been a difficult year, but it was also one where many health technology professionals rose to the occasion,” said Sabrina Reilly, vice president of membership at AAMI. “We’re recognizing professionals who have proven their commitment to AAMI’s mission of leading global collaboration in the development, management, and use of safe and effective health technology.” Individuals who attain AAMI Fellow status are distinguished for the depth and breadth of their accomplishments in six areas: professional experience, education, presentations and publications, professional participation, certification, technical contributions, awards/honors, and community service – as well as the quality of their processional statement and two letters of recommendation. Prospective AAMI Fellows may self-nominate online at bit.ly/35UERAz by 5 p.m. ET, Friday, January 22, 2021. All Fellows receive an AAMI Fellow certificate and a commemorative pin, as well as recognition at the 2021 AAMI Exchange (June 4-7 in Charlotte, North Carolina), in AAMI publications and on social media. NEW GUIDE STANDARDIZES HEALTHCARE TECHNOLOGY MANAGEMENT TRAINING Healthcare technology management (HTM) is a growing field brimming with opportunity. To keep pace with needs for new talent, the Association for the Advancement of Medical Instrumentation (AAMI) has developed a new guide for HTM departments looking to establish biomedical equipment technician (BMET) training programs or internships. The guide, “HTM Training Guide for BMET Students,

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AAMI SEEKS 2021 NOMINATIONS FOR AWARDS PROGRAMS Do you know a health technology innovator, safety advocate or revolutionary? How about a standards leader or humanitarian? You can make sure that your deserving peers are recognized for their achievements by nominating them for an AAMI or AAMI Foundation award. Nominations are due January 11, 2021. “It has been a particularly difficult year for all corners of health care. We have seen that even when challenged, health technology professionals remain dedicated to advancing the effectiveness of the field and overall patient safety,” said MaryJane Thomas, director of membership development at AAMI. “Once again, we’ll be honoring health technology’s finest through AAMI and AAMI Foundation’s awards program. I encourage you to nominate colleagues who have inspired you this year with their dedication and innovation.” The winners will receive a monetary prize, a plaque commemorating their achievements and recognition at the 2021 AAMI Exchange, June 4-7 in Charlotte, North Carolina. There are several types of awards: • AAMI & Becton Dickinson’s Patient Safety Award recognizes outstanding achievements by health care

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•

professionals who have made a significant advancement toward the improvement of patient safety. AAMI’s HTM Leadership Award recognizes individual excellence, achievement and leadership in the HTM profession. AAMI & GE Healthcare’s BMET of the Year Award recognizes a biomedical equipment technician’s individual dedication, achievement and excellence in the field of HTM. AAMI’s Young Professional Award presented annually to a professional, under the age of 35, who exhibits exemplary professional accomplishments and a commitment to the health care profession. The Spirit of AAMI Award recognizes the outstanding contributions of an AAMI member in volunteer efforts within the association. AAMI’s HTM Association of the Year Award recognizes an HTM association that distinguishes itself during the course of the year through outstanding society operations and meetings as well as a commitment to elevating the HTM profession at the local level. The AAMI Foundation’s Laufman-Greatbatch Award is AAMI’s most prestigious award. Named after two pioneers in the field – Harold Laufman, MD, and Wilson Greatbatch, Ph.D., – this highly regarded award honors an individual or group that has made a unique and significant contribution to the advancement of healthcare technology and systems, service, patient care or patient safety.

• The AAMI Foundation & ACCE’s Robert L. Morris Humanitarian Award honoring the late humanitarian Robert Morris – recognizes individuals or organizations whose humanitarian efforts have applied healthcare technology to improving global human conditions. • The AAMI Foundation & Institute for Technology in Health Care Clinical Solution Award honors a healthcare technology professional (individual or group) that has applied innovative clinical engineering practices or principles to solve one or more significant clinical patient care problems or challenges facing a patient population, community or group. • The AAMI Foundation & TRIMEDX John D. Hughes Iconoclast Award recognizes an individual who pushes the boundaries of the HTM professional and demonstrates individual excellence, achievement and leadership. Additional awards programs with January 11 submission deadlines: • The AAMI Foundation Michael J. Miller Scholarship Program for students aspiring to become biomedical equipment technicians, clinical engineers and health systems engineers. • Standards Developer Award is awarded for major contribution(s) to the development or revision of a specific standard. This award is given to up to five people annually. • AAMI Technical Committee Award is awarded to an AAMI technical committee to recognize outstanding committee efforts.

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ECRI UPDATE

Award-Winning Health Technology Management Initiatives

s 2020 drew to a close, ECRI had some good news to share. The independent nonprofit organization announced the winners of its annual Health Devices Achievement Award competition. Top honors were shared by two organizations from Vancouver, British Columbia, Canada: Lower Mainland Biomedical Engineering, which is part of the Provincial Health Services Authority, and Vancouver Coastal Health. The organizations were honored for their joint effort to identify the root cause of overinfusions involving a commonly used brand of infusion pump – an effort that had a global impact on patient safety.

Two additional organizations earned recognition as finalists for the Award (listed alphabetically): Memorial Healthcare System (Miramar, Florida) and NewYork-Presbyterian Queens (Flushing, New York). Key details from the projects are outlined below. The Health Devices Achievement Award competition gives ECRI a chance to shine a light on health care professionals’ innovative efforts to improve patient safety, reduce costs or otherwise facilitate better strategic management of health technology. INVESTIGATING OVERINFUSIONS Through persistence and sound investigative practices, a team representing two health care organizations in British Columbia, Canada, identified the cause of potentially fatal overinfusions involving a brand of infusion pump used throughout the province. Staff from Lower Mainland Biomedical Engineering and Vancouver Coastal Health joined forces to investigate dozens of

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Scans of infusion tubing showing a tubing set with uniform wall thickness (top) and one with the tubing wall thicker on one side than the other (bottom). overinfusion events in health care facilities across British Columbia. After months of examining possible causes, communicating with concerned staff, and searching for evidence, the investigation team had a breakthrough: Nurses identified incidents of unintentional medication flow and followed the procedures outlined by the team to secure the equipment. A collaborative examination of the infusion system – a process that involved the investigation team, the infusion pump manufacturer and ECRI – revealed that the infusion tubing was a contributing factor toward the uncontrolled flow. By scanning the incident tubing with a micro-CT scanner, the investigation team discovered that the tubing was not concentric. That is, the tubing wall was thicker on one side of the lumen than the other. As a result, when the tubing was oriented a specific way within the pump, the increased wall thickness on one side could prevent the pump from fully occluding the tubing, thus allow-

ing flow. When the tubing was oriented in other ways, however, the pump could fully occlude the tubing, as intended. This discovery eventually led to a global recall affecting hundreds of millions of tubing sets. It also may help explain years of unexplained over-deliveries of medications with this brand of infusion pump. “What started as an effort to solve a problem within the Canadian health system ultimately helped improve patient safety everywhere,” says Brendan Gribbons, PEng, MEng, CCE, regional engineering team manager, Lower Mainland Biomedical Engineering. “It’s an honor for Vancouver Coastal Health and Lower Mainland Biomedical Engineering staff to be recognized by ECRI for the team’s persistence and great investigative work.” ADDRESSING WEIGHT-BASED MEDICATION ERRORS Motivated to reduce weight-based

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Vancouver General Hospital (Image courtesy of Vancouver Coastal Health) medication dosing errors, Memorial Healthcare System sought a technological solution to the problem – namely, a means to integrate its scales with the electronic medical record (EMR). An integration solution that could allow data to be captured directly from the scales and sent to the EMR would largely eliminate the human component from the weight-documentation process, thus enhancing patient safety. The organization learned, however, that this wouldn’t be a simple plug-andplay exercise. “When we first started working with the integration vendor, we found the intended workflow to be cumbersome for end users,” explains Lisa Lanigan, RN, clinical systems supervisor at Memorial Healthcare System. “It became important to collaborate with the vendor to develop a smoother process, which would help get staff buy-in.” Those efforts paid off. Clinicians have responded positively to the new system, leading to more accurate documentation of patient weights, resulting in more efficient and safer patient care throughout the health system. The project – which ECRI judged to be a finalist for the 2020 award – illustrates that a focused change, targeted at the right problem

and well executed, can have a significant impact. TRANSFORMING PHARMACY COMPOUNDING PRACTICE For years, NewYork-Presbyterian Queens has been on the path to building a state-of-the-art pharmacy, working to close gaps that could lead to medication errors. Through the addition of technology and increased automation, the facility had made great strides in decreasing the chances of a dispensing error. The one area where technology was lacking, however, was for the sterile compounding process. The pharmacy team determined that implementing a gravimetric-based IV workflow management system (IVWMS) – a system that provides step-by-step workflow guidance, as well as documentation of every compounding step – could help close the gap. By taking a thoughtful approach to change management and adhering to a well-conceived implementation plan, the department transformed pharmacy practice in a manner that led to workflow standardization improvements, more efficient and compliant IV room medication management, and production of reliable and accurate compounded

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medications for patients. “The gravimetric IVWMS produced useful data – providing metrics that the pharmacy could use to improve inventory and time management. That led to cost savings that quickly paid for the technology,” notes Katharine Cimmino, PharmD, BCSCP, Senior Pharmacist IV Compounding/Research at NewYork-Presbyterian Queens. The department’s efforts earned the facility recognition as a finalist in ECRI’s competition. “Pharmacy can be an ‘out of sight, out of mind area’ in the hospital,” adds Cimmino. “Because patients don’t come into the department, people may not recognize how important pharmacy is to the medication process. It’s nice to get recognition for the great work being done to increase patient safety.” For more information about each project, visit www.ecri.org/health-devices-award-winners. Additionally, if your organization has engaged in a health technology management project that deserves recognition, ECRI wants to hear about it. To learn more about how to apply for consideration, visit https://www.ecri.org/ health-devices-achievement-award. You can also contact ECRI by telephone at 610-825-6000, ext. 5891, or by email at clientservices@ecri.org.

JANUARY 2021

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INDUSTRY UPDATES

RIBBON CUTTING CURE Biomedical BY ERIN REGISTER

ccording to CEO Bill Lesch, CURE Biomedical was not a planned thing. “It was more of an idea that came to life from years of eye-opening observation,” added Lesch. “I wanted to steer away from the rigid ‘this is what we service’ approach and provide solutions based on needs.”

In the late 1990’s, Lesch’s neighbor hired him to clean medical equipment at his company while Lesch was studying to be a pathologist. “I found it fascinating, and medical technology quickly became my passion,” Lesch stated. “I was lucky enough to have Kurt Sutton, a biomed at the company, as my teacher. He’s a brilliant fellow with a big heart; a great mentor that taught me so much, from electronic theory to customer perception and everything between.” After several college courses, biomed hospital positions, field service, business development and sales jobs, Lesch ended up at a small Northern Nevada hospital. He found himself wearing several hats from biomed manager and emergency preparedness coordinator to facilities manager. There, he felt that he was ready to do something different. “My non-conforming nature and a broader vision for this business made for some difficult times within previous organizations of employment. I was never allowed the necessary elasticity for proper customer customization. I’ve realized that sometimes it doesn’t matter how good the plan is, you must be able to adapt and

Bill Lesch CEO adjust; every customer and their needs are different and unique. Cure Biomedical has been able to successfully apply this concept in our company’s work culture,” Lesch said. Q: WHAT IS THE MAIN FOCUS OF CURE BIOMEDICAL? A: Our main focus is always the customer, and we always adapt to their needs. Regarding application, Cure Biomedical is only three years old, and we are continually learning in an ever changing technological world. Thus far, our focus has primarily been on hospital in-house biomed support. We are currently working on expanding specialty divisions within CURE Biomedical, from cybersecurity and device integration to a wide variety of operating room devices, with more on the horizon. Q: WHAT ARE SOME OF THE SERVICES CURE BIOMEDICAL OFFERS? A: We have a device deployment team utilized by several institutions for expansion projects. We often find ourselves

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working with and as project managers in heavy communication between hospital leadership, OEMs, clinical technology departments, IT and other third-party organizations helping to orchestrate projects both small and large. In addition to tech work, we provide assistance during acquisitions of capital equipment, working with institutions to ensure the devices they are investing in are the right choice. We provide a stern voice and wide range of knowledge in support of the best possible acquisition. This includes contracted services as well. Q: HOW DOES CURE BIOMEDICAL STAND OUT IN THE MEDICAL EQUIPMENT FIELD? A: We enjoy working with our customers and are always in constant communication during a project or ongoing task. We provide transparency, almost to a fault. Our ability to adapt and grow with the customer is not restricted by the rigidity we see embedded in some organizations. We do what we say and do our best to always leave the customer operational, sometimes at our expense. And, our logo is bright fire red! Q: DO YOU HAVE ANY SPECIFIC GOALS THAT YOU WANT CURE BIOMEDICAL TO ACHIEVE IN THE NEAR FUTURE? A: We have a small team of 15 great employees. We are growing faster than we could have ever imagined. Within the next 5 years, I’d like to see CURE Biomedical become an employee-owned organization with multiple specialty service divisions continuing to help our current customers and developing new relationships with future customers. For more information, visit www.cure-us.com.

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TECHNATION

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SEE Recognized for high-intenOUR AD sity, perfect-white, light PG. 2 output, Cermax is trusted by medical OEMs and is used in over 90% of hospitals worldwide for critical illumination in endoscopy, James T. Clements, M.S. headlamps, and microsurgical procedures. Product We offer the broadest array of design Manager options available, including UV- and Cermax®, IR-enhanced designs. Excelitas With our state-of-the-art manufacturTechnologies ing facility in Batam Indonesia, we are ideally positioned to continue the Cermax heritage of innovation, high-quality and high-performance that enables medical OEMs to fulfill their most demanding requirements. • For more information, visit www.excelitas.com.

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BIOMED 101

The True Cost of Ordering a Bad Medical Imaging Part BY JEREMY PROBST

veryone loves a bargain, but the old saying, “you get what you pay for,” rings true in medical imaging just as it does for anyone making important purchases.

As the impact of the COVID-19 pandemic continues to take shape, hospitals and imaging clinics are being forced to make budget cuts in many areas, including technology. Investment bank Cowen surveyed hospital administrators in mid-2020 and found that 70% said they had redirected capital budget toward COVID-19 spending. For medical imaging departments, that often translates into keeping older systems in operation longer rather than spending on new equipment. Keeping imaging equipment running is crucial to meeting patient needs and supporting a health care facility’s bottom line. If you’re involved with sourcing and purchasing medical imaging replacement parts, you may be under pressure to reduce costs. While there’s nothing wrong with exploring your options, be sure to consider the big picture. FINANCIAL STATE OF MEDICAL IMAGING IN 2020 In 2019, medical imaging revenue experienced growth of 1.5%. That trajectory took a sharp downturn in 2020. According to research from Omdia, the market declined 4.6% last year.

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JANUARY 2021

Even though COVID-19 sparked increased demand for mobile digital radiology and CT scans, the latter of which showed 5% revenue growth in 2020, all other modalities saw declines. In fact, Omdia’s research indicated an expected 18% dip in MRI revenues. To remedy the downturn in revenue, many facilities are choosing to extend the life of existing imaging systems through ongoing preventive maintenance and servicing. It’s an ideal way to continue scanning patients versus spending thousands on expensive new equipment. As OEMs introduce updated models, they may claim that older systems have reached end-of-life and stop providing replacement parts under a service contract. To avoid costly downtime, imaging departments need to feel confident that the parts they purchase will arrive in working order. REPERCUSSIONS OF A DOA REPLACEMENT PART When a medical imaging replacement part shows up “dead on arrival” (DOA), it makes no difference if the vendor sends a different part for no additional charge. The health care facility will likely incur costs stretching far beyond the price of the part. Just a few hours of imaging equipment downtime can mean the loss of tens-of-thousands of dollars. So, it’s easy to picture the impact of waiting days for a working replacement part to arrive and get installed.

Jeremy Probst

President and CEO of Technical Prospects

Imagine an engineer identifies a faulty X-ray tube in a CT system. The engineer receives quotes on a replacement tube from a few different vendors. The difference in the price of the cheapest part and those from other sellers is several hundred dollars, and the least expensive option is chosen. When the tube arrives and is installed, it doesn’t work. The DOA replacement part means someone will need to contact the vendor, explain the situation, and get a different part as soon as possible. But shipping another part will take at least an entire day. Let’s say the price of a CT scan at this clinic is $1,700, which is about average. If that CT scanner was scheduled for use with one patient per hour over a 24-hour period, that equates to a potential loss of more than $40,000. The cost of servicing the system twice adds up as well. If the work can’t be done in-house, the clinic may need to pay for handling fees, travel, lodging and potentially more. There are also salaries being paid to CT technicians who are unable to do their jobs while the system is down. Plus, if the downtime erodes patient trust, they may choose to seek treatment at a competing clinic. Was saving hundreds of dollars on a faulty part worth the hassle and tens-of-thousands of lost revenue?

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HALLMARKS OF A RELIABLE PARTNER When choosing a partner to provide replacement parts, medical imaging departments should first look at the company’s DOA rate and ask questions about how they approach quality control and assurance. When replacement parts are harvested from a machine, are they rigorously tested? Do refurbished parts get plugged into live machines to ensure proper functionality? Is the organization using a state-of-the-art enterprise resource planning (ERP) system to track inventory and shipments? Will the parts you order be properly packaged to avoid damage during transit? A reliable partner provides customers with information about the remaining life expectancy of parts. They should also offer exceptional customer service and technical expertise to help with troubleshooting. These things may add to the total cost of a replacement part − but receiving a quality part that reduces system downtime should be the priority. Taking extra steps for the sake of quality management pays off in the long run. While medical imaging revenue is expected to bounce back in 2021, that optimistic outlook assumes we’ll have a handle on the pandemic. The future is still uncertain, which makes the value of a trustworthy partner even more apparent.

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Jeremy Probst is the president and CEO of Technical Prospects. He has more than 19 years of experience in the medical imaging and engineering field.

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TECHNATION

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TOOLS OF THE TRADE Healthmark Industries Cable Continuity Tester

ealthmark Industries has added the Cable Continuity Tester to its ProSys Instrument Care product line. Designed to test the quality of monopolar and bipolar cords, the Cable Continuity Tester is user- friendly and portable. For the desired test, simply position the “ON” switch to bipolar or monopolar. If the green light remains illuminated, then the cable passed testing. If the light flickers or doesn’t illuminate, this indicates the cable failed testing. Each Cable Continuity Tester comes with a 9V battery and a carrying case. For more information, visit www.hmark.com.

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JANUARY 2021

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WEBINAR WEDNESDAY

2020 Sessions Deliver HTM Knowledge STAFF REPORT

he 2020 TechNation Webinar Wednesday Series continues to build on previous success. “Zoom meeting” became a part of everyday conversation along with “virtual classroom” and “virtual student” last year. As even more people began to realize the benefits of remote (a.k.a. virtual) learning the TechNation series set new.

MEDICAL DEVICE CYBERSECURITY INSIGHTS The Webinar Wednesday presentation “Medical Device Cybersecurity: Building an ROI-Based Business Case” was sponsored by Ordr. It was eligible for 1 credit from the ACI. This 60-minute webinar featured Ordr Director of Healthcare Product Development Ben Stock. As the pace of innovation increases in health care organizations, so does the growth of connected IoT and IoMT devices on the network. These devices aren’t always designed with security in mind. They introduce a new attack surface and any downtime impacts patient safety. As every health care organization prioritizes the need for visibility and security of these devices, the key consideration is “How to quantify the ROI” of a medical device cybersecurity project. Stock discussed the top use cases for companies in medical device cybersecurity and shared real-world case studies where organizations are seeing value in medical device cybersecurity deployments. He also discussed considerations for a medical device cybersecurity project and building an ROI-based business case in an organization.

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Attendees provided feedback via a survey that included the question, “What did you like most about today’s webinar?” “The tie in to HTM and the concerns related to IOT security,” is what Site Manager S. Wright liked about the presentation. “Even though we have an in-house IT department it is very nice to learn more about the inter workings of the hospital systems and how to keep them safe. I also enjoyed learning more about where and how the information goes,” Senior Biomed Tech G. Haungs said. InfoSec Engineer V. Nguyen said what he liked the most was “the overview of IoMTs and how to leverage technology to secure them.” TRIO DISCUSSES HOSPITAL SERVICES TRANSFORMATION The presentation “Parkland Health Transforms Hospital Services” was presented by Justin Mahan and Mark Cooper of Parkland Health along with Heidi Horn of Nuvolo. It was eligible for 1 credit from the ACI. This 60-minute webinar, sponsored by Nuvolo, featured a discussion regarding the steps Parkland Health & Hospital System has taken to become “the foundation for a healthy Dallas.” The health care system has one main 900-bed hospital and additional clinics and surgery centers throughout their metroplex, plus satellite locations like doctor’s offices and acute response clinics. The webinar just missed the century mark with 99 attendees for the live

presentation. However, more HTM and health care professionals have since viewed a recording of the presentation online. Attendees provided fantastic feedback via a post-webinar survey that included the question, “What did you like most about today’s webinar?” “I really thought the different dashboards would be very useful and help a team that is spread out communicate more efficiently,” commented S. Davis, CBET. “Great job on customizing the software to meet the hospital’s needs” said D. Braeutigam, president/consultant. “Practical examples that show the advantage of using this database,” said S. Sirois, BMET III. “Seeing some of the functionality of the newer CMMS that is available,” HTM Director J. Anderson added. OVERVIEW OF CT PRINCIPLES The session “Getting to Know Your CAT! An Engineering Overview of Computed Tomography Principles” was presented by Sam Darweesh. It was sponsored by Technical Prospects and eligible for 1 credit from the ACI. Darweesh is an experienced CT and MRI senior engineer at Technical Prospects. He has been in the medical imaging industry for 20-plus years working with industry-leading CT and MRI manufacturers, as well as major independent service organizations (ISOs) worldwide. He has provided expert recommendations to teams of engineers in North and South America; was responsible for major strategic projects on CT and MRI systems

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worldwide; and is an adjunct professor of medical imaging. His webinar provided attendees the opportunity to learn, or brush up on, an overview of CT principles. About 100 people tuned in for the live presentation and a recording of the webinar is available online for on-demand viewing. Attendees shared feedback via a post-webinar survey that included the question, “What did you like most about today’s webinar?” “Very good historical perspective of CT development,” said D. Motherway, CBET III. “The speaker was knowledgeable, and the presentation content was fluent and sequential,” shared Biomedical Engineer M. Bakkour. “I really enjoyed learning the history around these units,” said D. Vogel, Biomed 3. IOMT CYBERSECURITY INSIGHTS Jon Benedict, PMP for TRIMEDX, and Stephan Goldberg, vice president, sales engineering for Medigate, co-presented “Expect More from Your IoMT Cybersecurity” webinar. The webinar was eligible for 1 credit from the ACI. The presentation discussed how one can be less reactive and more proactive when it comes to managing and protecting IoMT. The webinar provided more information and demonstrated how to automate vulnerability detection and document compensating controls to appropriately address risks; expedite OEM-validated software patching to keep devices up to date; deliver audit capabilities across the entire remediation ecosystem to streamline compliance efforts; and uncover the savings gap between captured asset utilization rates and inventory capacities to improve asset allocations and use. The webinar drew 80 live attendees with many more expected to view the

presentation via the on-demand option. Attendees of the live presentation shared feedback via a post-webinar survey that included the question, “What did you like most about today’s webinar?” “Many questions I had concerning the process of vulnerability analysis and threat mitigation were answered. The demo of the Medigate dashboard interface was very eye opening and I think they have a very good product moving forward,” Cyber Intel Analyst J. Gallagher said. “They presented a well-structured overview of the potential issues and concerns regarding cybersecurity of medical devices on the hospital network,” shared S. Rountree, BMET3. “For the first time in a security presentation, the presenter actually talked about what the actual vulnerabilities are. I’ve been to several conferences and this has been the first time anyone actually mentioned port scanning,” said A. Whyte, owner/BMET. For more information about the Webinar Wednesday Series, including recordings of previous sessions and a calendar of upcoming presentations, visit WebinarWednesday.Live.

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SHOP TALK POWERED BY

SIEMENS ACUSON X150

I am getting a self-diagnostic check signal cable no signal error on a Siemens Acuson X150. I have checked the cables to the unit. The only one disconnected is one that the staff report not using and plugging it in does not clear the error. I have rebooted the unit and still have the same error. Siemens is not providing tech support on this unit. Is there a service manual available? Does anyone know how to clear this error?

It could be power supply issue. Verify AC/DC power supply LEDs located on the back of the system. If DC/DC power supply is bad, then the DC LEDs are solid amber (yellow orange). The system might have over current or over voltage or over temp. Same as the AC LEDs.

I am having the same mistake ‘’self-diagnosis, check signal cable.’’ There is no problem for DC/DC power and AC/DC power. “Self-diagnostic control cable no signal” gives this error. Can you help please?

The issue you are having is with the BE board and RM board. These boards are the main computer of the system and are failing to start. You will want to repalce both parts. For serial numbers less then 307998, use parts 10131804 and 10349420. For serial numbers greater then 307999, use 10349464 and 10349439. FUJIFILM FCR GO

I just purchased a Fujifilm FCR Go for my small animal veterinary practice (dogs and cats exclusively) with 15 kw, 250 ma power. I was wondering if I can install a higher wattage tube head. The one used on the FCR Go 2, for example, or similar. Is that possible? Has

anyone done something similar? Is it worth such an upgrade? Thank you in advance for your answers.

I would not recommend that you do that. You should check the service manual.

MINDRAY BC-3200

My machine gives the error, “Background abnormal and WBC clog” and then states “remanding …” I checked and it has been maintained and calibrated. I cleaned all valves and reset the software. I am asking for troubleshooting help.

It needs to be cleaned with a WBC bath using cleaner (hypochlorite). And, you need to check the volumetric metering board, vacuum value and pressure value.

Never calibrate a machine with faults. For the Mindray, you only calibrate when the background is good, and results are consistent but not correct. For the problem you have, it could be that the valve connects the RBC volumetric tube. Check, clean and/or replace. Check the volumetric tube to see if the flow is within count time.

One of the problems is also usually the fact that your reagents are in poor condition. You know that after changing the reagents you must adjust the dates. I suggest you keep washing the equipment, analyzing tests with hypochlorite or 70% alcohol.

Check to see if your WBC chamber of anode or cathode line is open. If it is, you have to replace the chamber or if you have the best biomedical technician, he can manage to get it to work.

SHOP TALK

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

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ROUNDTABLE

ROUNDTABLE Ultrasound

he ultrasound market is projected to reach $8.2 billion by 2025 which is an increase from $6.1 billion in 2020, according to a recent MarketsandMarkets report. Ongoing technological advancements in the field of diagnostic and therapeutic ultrasound imaging, availability of medical reimbursements for diagnostic ultrasound procedures in mature markets and the growing applications of emerging ultrasound techniques (such as Doppler ultrasound in vascular imaging and 3D/4D ultrasound in oncology) are driving the growth of ultrasound market.

TechNation contacted several companies and experts within the industry to find out more about these devices. Those who responded shared their insights regarding what to look for when purchasing an ultrasound system and more. Participants include Philips AllParts Medical’s Joni Charles; Avante Health Solutions Manager of Clinical Applications W. Todd Dennis, BS, RVT, RDCS; Summit Imaging CEO Larry Nguyen; Ampronix Director of Business Development and Marketing Michael Thomas; and Innovatus Imaging Vice President of Sales and Marketing Matt Tomory.

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DENNIS: Image quality is always a primary concern. You cannot diagnose what you cannot see. Ease of use and workflow tools are of great importance with the throughput demands being placed on sonographers today.

Joni Charles Philips AllParts Medical Q: WHAT SHOULD HEALTH CARE FACILITIES LOOK FOR WHEN PURCHASING AN ULTRASOUND SYSTEM? CHARLES: Top of my list is always image quality. Don’t let the bells and whistles distract you from the actual imaging capabilities of the unit. Second on my list would be versatility – how many different things can I do with this unit? The more things I can use it for, the more cost-effective it becomes. Thirdly, I would look at the serviceability of the unit. How much of the service can I perform in-house as opposed to using the manufacturer or third-party to service.

NGUYEN: It is highly recommended when purchasing an ultrasound system to assess the total cost of ownership, this includes the service and maintenance of the equipment. A strategy that many health care facilities employ are internal healthcare technology management departments. This provides the capability to service and maintain the equipment with immediacy and avoid elongated downtime to reduce costs and improve patient access. THOMAS: First and foremost, they need to determine if a console or portable version would best suit their requirements. Next, start researching options such as 3D,4D probes and software that would be the optimal choice within their budget. Due to ease of use and cost savings, we are starting to see an increased shift toward the use of portable ultrasounds. TOMORY: First and foremost, does the system meet the present and possible future needs of the user(s)? As an ultrasound transducer designer and

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ROUNDTABLE

manufacturer, we develop end user requirement specifications (URS) for new device manufacturing to ensure products are built to meet user needs. The same process should be used for purchasing new ultrasound systems – ensure user needs/functionality are met by the new equipment. Also, field upgrades are typically much more expensive, sometimes prohibitively so, than having the system built with capabilities so what are the current and possible future needs? Almost as important is serviceability or cost of ownership – will the system and probes be serviceable by third parties as well as the OEM? Check with your provider on availability of support in the event you choose to self-support or veer away from the OEM. Q: WHAT ARE SOME OF THE LATEST FEATURES FACILITIES SHOULD CONSIDER WHEN PURCHASING ULTRASOUND DEVICES? CHARLES: Any features that make the patient data more secure. DENNIS: This depends a great deal on the department purchasing the system. LED monitors are able to be seen well in full light; Shear Wave Elastography for liver, breast, prostate, musculoskeletal and other exams.; on-board batteries for quick movement from room to room; self-diagnostics for transducers; Microvascular Flow Doppler and Contrast Enhanced Ultrasound capability are a few. NGUYEN: Recently the advancements in ultrasound can be found in both crystal density along with new wireless technology. By increasing crystal density systems users are able to image at higher resolutions and also create 3D images without the need for moving parts. Adding wireless and battery technology has enabled new bedside quick-use transducers to be used with systems as simple as a tablet.

will rely on a trained sonographer using contemporary technology. Q: HOW DO YOU THINK THAT THESE ADVANCEMENTS WILL AFFECT TROUBLESHOOTING AND SERVICEABILITY? CHARLES: A lot of the newer systems with Windows 10-based software are not accessible from a third-party service software service standpoint. These are also the systems that have the better patient security software. W. Todd Dennis, BS, RVT, RDCS Avante Health Solutions

THOMAS: We are noticing the release of wireless Wi-Fi ultrasound probes. This is an incredible advancement as there are no actual wires being connected to the probes or tablets, which can be very helpful depending on your area of focus, such as veterinary clinics. Also, 4D ultrasound scans still seem to be an industry leader, especially for Millennials, as they want to utilize the latest technology. Additionally, newer ultrasound machines are becoming a lot more quiet when running. TOMORY: Multi-dimensional imaging, matrix array probes and various Dopplers are maturing as technologies and are commonplace today. The newest feature is Artificial Intelligence which can supplement diagnoses, be used for vessel detection or anatomy/ pathology recognition. I have read articles where the long-term vision is “ultrasound for everybody” where the system directs, reads and diagnoses exams. As someone in the business for 34 years (and married to a sonographer) I believe this is very far off. Sonography is highly specialized and dependent on the technologist to find and capture subtle pathology or physiological nuances through individually unique acoustic windows. If it is me or a loved one, I

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DENNIS: New advancements bring additional complexity and potentially more service issues, so a quality service organization is a key to maintaining equipment uptime. Third-party service organizations have been adapting to equipment advancements for years and will continue to do so. NGUYEN: With these new compact high-density transducers, the risk from impact damage and misuse increases, these transducers require a closer eye for care before repairable damage occurs. A great strategy is to be vigilant on issues that might just seem cosmetic, a simple crack on the housing of a transducer can be quickly repaired. If ignored, these minor faults can eventually cause significant damage that would force a costly replacement. THOMAS: Some ultrasound manufacturers are now creating apps that can be downloaded on any handheld device, which would then become the software for the ultrasound system. This would reduce the need for units being serviced utilizing the app interface as manufacturers can send an update to the device to address common issues. Before this, most units would need to be sent into a service center for further diagnosis. TOMORY: When I began on the venerable Acuson 128, there were 80 circuit boards, seven power supplies and miles

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ROUNDTABLE

of wiring within ultrasound systems and the diagnostics were contained in EEPROMS on a scan converter board and accessed through a password tied to your employee number. Today, the vast majority of work is performed with a computer and very complex software. Diagnostics are very sophisticated, can be accessed remotely and typically require the OEM or OEM permission to access. The days of being a hardware engineer are waning and software is increasingly the issue with today’s malfunctions. Access to system software, diagnostics and passwords for installation and repair is key – can you negotiate for this or enter into a cooperative agreement with the OEM? The Right to Repair issue has become more prominent due to COVID-19 and it will be interesting to see how this evolves/resolves for third parties and the clinical engineering community. Q: WITH TECHNOLOGY ADVANCING SO QUICKLY, DO YOU THINK THAT IT’S POSSIBLE FOR A SINGLE SERVICE PROVIDER TO ADDRESS SYSTEMS AND PROBES? CHARLES: I believe it takes a good network of providers. At APM, we work together with many other ISOs to take care of every end user.

medical device and is just as sophisticated, if not more, than the system itself. The technology between the two is completely different and continues to diverge. Innovatus has a full FDA-registered acoustic lab to not only manufacture finished transducers for several OEMs but to test and validate materials, processes and components acoustically, electrically, mechanically and chemically to ensure a safe and effective repair for devices which perform as the OEM intended. Larry Nguyen Summit Imaging

diagnostic image. Often, image quality anomalies may look identical whether it’s a probe failure or system failure. To provide support to the HTM industry, it is imperative the independent service organizations be able to assist in resolving the ultrasound equipment failure and not operate in a vacuum that is limited to only a section of the ultrasound technology.

DENNIS: Any service provider must maintain proficiency in whatever equipment they are tasked with servicing. While complexity certainly adds challenges, a quality organization can overcome these challenges.

THOMAS: There are many variables to consider when servicing and repairing ultrasound machines. One is the availability of parts as some manufacturers limit the number of service centers they will sell parts to. Another variable would be downtime. Some facilities are not able to have any downtime and would require a loaner to be sent to them prior to sending in their unit for evaluation.

NGUYEN: Absolutely yes. In fact, we believe it’s critical for an independent service organization that supports ultrasound equipment to support both the systems and probes. Ultrasound technology requires these two components working together to provide a

TOMORY: As systems have gotten more complex so too have transducers so much so that increasingly more health care providers are splitting ultrasound into two categories – one is system support and the other is probes. Many do not realize a transducer is a Class 2

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Q: CAN YOU TELL READERS A LITTLE ABOUT THE GROWTH OF POINT-OF-CARE ULTRASOUND? CHARLES: It seems to have exploded in the last five years. Because of point-ofcare systems, ultrasound is being utilized in many areas of patient care (like therapy and interventional radiology); not just in diagnostic care. And, with the ability to buy a probe and put an app on a phone it can easily continue to flourish. It has allowed providers that would otherwise not be able to access ultrasound, to use it in new and expanding ways. DENNIS: Point-of-care ultrasound (POCUS) is rapidly expanding in multiple directions. You have handheld ultrasound systems that are gaining popularity as a screening device at the bedside. Systems that are primarily touchscreen are expanding into the acute care settings like the ED and ICU where infection control is a primary concern. Then you have small, extremely portable but very powerful cart-based systems replacing small laptop systems in areas like MSK ultrasound where first-generation users are demanding more capability. POCUS is bringing ultrasound to many specialties that have not used ultra-

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in cost and ease of use. The global POC market is projected to double over the next decade as the modern miracle that is diagnostic ultrasound is used to diagnose disease faster, less invasively and less costly than other imaging modalities. They still have not caught up to console-based systems in terms of image quality and sensitivity but perform well when used as intended.

Michael Thomas Ampronix

sound in the past. These new users are still learning and quality and accuracy of results is widely varied. POCUS is here to stay and organizations are beginning to put policies in place to regulate the use of ultrasound and monitor the accuracy of results. NGUYEN: AI-driven POCUS ultrasound is an incredible diagnostic tool to use during patient transport for EMTs and for medical staff in the use of bladder scanning and vein finding. This sector of ultrasound is growing as the general use and application is non-invasive and a great imaging tool for obvious failures. However, the resolution performance and applications are limited relative to traditional ultrasound systems. THOMAS: I feel POCUS has come along way. We are seeing portable ultrasounds become smaller and lighter. This will allow for more seamless utilization compared to heavier previous models. TOMORY: Point-of-care ultrasound continues to expand at a rapid rate due to the advanced capabilities, reduction

Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING ULTRASOUND DEVICES?

to try and purchase a system with all of the features dependent on what the facility can afford. If they are not able to buy a new system, consider purchasing a refurbished system which, in most cases, still will come with a comparable warranty as a new system would. In regards to choosing a service provider, make sure to ask if the provider has serviced or repaired your specific ultrasound/probe before as this will help reduce future complications that might arise.

CHARLES: Always look at more than one manufacturerâ&#x20AC;&#x2122;s systems before making a purchase. My minimum would be three different manufacturer demos. DENNIS: Purchase a system that will meet your needs in three to five years, not just today. Image quality is the single most important feature of your system. Refurbished equipment can be a very cost-effective option depending on your needs. A capable service organization is key since a broken ultrasound system makes a great paperweight. NGUYEN: Consider taking ultrasound service in-house to reduce equipment downtime. With HTM on-site, response times to faulty equipment is immediate and enables health care facilities to service the equipment with turnaround times far quicker than any other service model. This increases patient access, minimizes operational interruptions and can significantly reduce total cost of ownership. THOMAS: I would encourage readers to do their due diligence on what options they want in an ultrasound system. Most facilities use the same ultrasound systems for 5-plus years, so it is essential

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Matt Tomory Innovatus Imaging

TOMORY: As mentioned earlier, this technology continues to advance and system service is more software engineering so when purchasing new equipment, long-term support post warranty is a strong consideration. Can you get access to the software itself? What permissions are needed to load/reload software? Diagnostics? Regarding transducers, as technology advances so too must the technology behind transducer repairs. There is a huge difference between getting probes working again and restoring them to OEM form, fit and function.

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S AV I N G L I V E S T H R O U G H Q U I C K A C T I O N

BY K. RICHARD DOUGLAS

TECHNATION

JANUARY 2021

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n 1918, there was no such thing as a flu shot. The Spanish flu raged across the planet that year without hindrance. Those who contracted the disease could not be treated with a therapeutic because there were no antivirals at the time. A flu vaccine was not available in the U.S. until the 1940s.

The Spanish flu pandemic killed as much as three percent of the world’s population, including 675,000 Americans. World War I lasted from 1914 to 1918. More U.S. soldiers died in 1918 from the Spanish flu than died in the entire war. Not only was there no vaccine or therapeutics to fight the Spanish flu, but for those who worked in hospitals, there wasn’t the availability of PPE as we know it today. Compounding the problems for hospitals; the demands of the war created a shortage of physicians and other health care workers. In the midst of the 2020 coronavirus pandemic, medical advances have helped physicians and researchers to more quickly understand this viral illness, yet because it is a new (novel) virus, it remains a vexing challenge. A highly transmissible and deadly virus, that was first identified in the Wuhan Province of China, has proven that it can challenge any medical advances made since the 1918 pandemic.

HTM heroes in 2020 included biomedical engineers from Hoag Health Network hospitals in California. The SARS-CoV-2 virus was first thought to be a more common virus causing pneumonia in patients. Physicians quickly learned that this new virus was both more deadly and more contagious than more common viruses like the flu virus. As time went on, it became apparent to doctors and researchers that the new coronavirus not only caused pneumonia, but would block the alveoli in the lungs reducing the oxygen exchange in the lungs and the amount of oxygen traveling to organs. The new virus would also attack the heart, brain, liver and other organs in many patients leading to widespread inflammation and

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oxygen starvation. It can cause acute respiratory distress syndrome (ARDS). As the immune system reacts to the virus’s attack, an over-reaction called a cytokine storm is possible. For the most severely ill patients, the virus would cause multiple organ failure. Doctors were frustrated because

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few effective therapeutics were identified early on and the mortality rates in some places, like northern Italy, were extremely high. A patient on a ventilator requires monitoring and care from several clinicians, so the demands put on staffing, along with clinical staff members who have become ill themselves, has made mitigation and treatment of the illness more difficult at many facilities. The experience of the last major pandemic to hit the U.S. in 1918, which had real consequences and a substantial death toll, has been of

little comfort to the biomed community. The experience of being thrown into a health care crisis, unlike anything seen in 102 years, requires tenacity, vigilance, empathy and ingenuity. It has been in the face of this global emergency that HTM professionals have risen to the occasion and provided expertise and services that have saved lives and brought a degree of relief to their clinical colleagues. CRITICAL EQUIPMENT AND ENOUGH BEDS HTM professionals have been faced with several similar challenges from

McLaren Clinical Engineering Services (MCES) provided support for the creation of a makeshift hospital in downtown Detroit at TCF Center, formerly known as Cobo Center.

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the very onset of the crisis. The first was a need for specific equipment that was critical to the survival of the sickest patients. In most cases, the existing inventories of these devices were wholly inadequate. Inventories were designed to accommodate the normal demands, or even a regional epidemic, but not a worldwide pandemic. As part of the CARES Act, signed into law in March, 2020, the FDA was able to take steps to broaden access to diagnostic, therapeutic and protective medical devices by issuing Emergency Use Authorizations (EUAs) and dispensing a device shortage list. Ventilators were the first devices that physicians demanded in abundance because SARS-CoV-2 was believed to be mostly a respiratory disease that had the potential to cause bilateral pneumonia. About five percent of COVID-19 patients require a ventilator. State health departments and the federal government focused much of their efforts on these devices in response to the pleas of doctors. The needs of any given hospital have been in constant flux, much of it based on how many mild, moderate, severe andÂ critical COVID-19 patientsÂ are being treated on any given day. This requires surge planning that addresses any equipment needs forecast. Device availability has not been the only area where biomeds have contributed to prepare their facilities for the influx of COVID-19 patients. There has also been the critical demand for special COVID-19 beds or rooms that had to be erected or stood-up quickly. In some cases, this was merely an extension of an existing ICU and, in others, a retrofitting of a department with other safeguards and monitoring equipment was required and in other cases, a completely separate temporary unit had to be constructed. Expanding hospital surge capacity

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meant cancelling elective surgeries to free up existing beds. Many of these expansion sites, or CMS Hospitals Without Walls, allowed hospitals to construct additional capacity while CMS relaxed “certain conditions of participation (CoPs) and provider-based rules for hospital operations to maximize hospitals ability to focus on patient care,” according to the agency. Addressing a surge of COVID-19 patients has also required needed equipment. Invasive and non-invasive ventilators, along with consumables, accessories and spare parts, are a minimum requirement. An oxygen source is also required. The supply of accessories and consumables has to be adequately maintained. With invasive ventilators, there is also a requirement for well-trained staff to maintain this equipment, as well as professionals capable of intubation. Both continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) devices were also identified early on as important devices to have on hand for COVID-19 patients who might not require a ventilator. The other challenge has been the highly infectious or transmissible nature of the SARS-CoV2 virus. Not only were supplies of PPE in short supply during the early days of the pandemic, but the extra precautions to keep all staff safe, while monitoring patients, required additional precautions. In many cases, to preserve the supply of PPE and to help protect clinicians, it was necessary to separate the monitoring equipment from the immediate vicinity of the patient. Biomeds sprang into action to distance ventilator monitors from patient beds. PREPARING THE FACILITY The need for a greater supply of ventilators has been a principal challenge for biomeds. Additionally, the need to install more monitoring capability has been another universal

" We had a daily huddle with all sites to define local needs. We then transferred devices between sites including lifesaving ventilators." -Samantha Jacques requirement in surge preparation. “During the COVID-19 pandemic at my facility, we had to quickly install additional patient monitors in an area that was converted to a COVID-only unit. Landon Fields, a Medical Systems Engineering Technologist II from our team stepped in to quickly install, configure, and test additional monitors and central stations allowing the nurses to constantly monitor the COVID patients,” says Ryan Harris, CBET, director of healthcare technology management at Texoma Medical Center in Denison, Texas. Harris says that whenever COVID-19 required their patient care strategies to change, Landon was there at every turn to support the nursing staff in their equipment needs. “Landon has also been very busy with keeping our ventilators in working condition during this pandemic by quickly repairing any that have problems. He has done an excellent job ensuring that the respiratory therapists have the equipment that they need during a time when having adequate ventilators is essential,” Harris says. In Michigan, a large effort by a major health care system tackled the logistics and transport of critical equipment to address the COVID-surge needs in the community. “Many sites such as McLaren Flint (Jeff Semple), McLaren Macomb (Scott Scandalito), McLaren Oakland (Tom Tesolin) and McLaren Northern Michigan (Bob Turk) all jumped to their emergency plans and their teams moved equipment such as monitors, beds, pumps and many other devices from closed sites such as outpatient surgery to expand the capability of inpatient units and build COVID-19 units,” says Samantha Jacques, Ph.D., FACHE, vice

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president at McLaren Clinical Engineering Services (MCES), at McLaren Health in Grand Blanc, Michigan. Jacques says that her team set up a command center at their corporate clinical engineering building, where new purchases were unboxed and installed. “All staff, including Gary Woods, who is our medical device integration specialist, unboxed and set up items such as high flow oxygen setups which were then dispersed to all our sites,” she says. “We had a daily huddle with all sites to define local needs. We then transferred devices between sites including life-saving ventilators. Zella David, manager at McLaren Bay, drove ventilators from her site to other sites that were in need,” Jacques adds. She says that Rick McCloy, the manager at McLaren Lansing, was responsible for testing utilization of ventilators for more than one patient. “Although this option was never used, as it was a worst-case scenario, he defined the disposables and processes needed to use anesthesia machines to be used as well as how to modify a ventilator to be used on more than one patient,” Jacques says. STANDING UP TEMPORARY UNITS Capacity has been a challenge during the pandemic and biomed teams have been an invaluable resource to allow health care facilities to expand that capacity on short notice. “In the earliest days of the pandemic we were called upon to provide equipment solutions and guidance on how to leverage our available resources to create surge capacity. Called upon to provide monitoring for our COVID cohort unit, they were able to redeploy a deinstalled telemetry system within 48

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hours. Again, utilizing disused monitoring equipment they created a 15-bed monitored unit in a space that was repurposed in record time,” says Bob Meninno, director of biomedical engineering at Hoag Memorial Hospital Presbyterian Hospital in Newport Beach, California. In places like Michigan and New York, facilities that were not designed to house medical patients had to be quickly transformed and retrofitted to address surge capacity. “Detroit was a hot spot, so in addition to getting our hospitals ready, we also provided our clinical engineer, Pam Shuck, to a coalition of health care workers and emergency personnel who stood up the TCF center – an arena where the national guard and other emergency personnel built an additional care site. Pam was the only clinical engineer on the project and led the national guard staff in the acquisition and deployment of equipment as well as helped define some of the workflows for the clinical staff. She worked tirelessly more than 10 hours a day for weeks to prepare this site amid uncertainty and ambiguity,” Jacques says. FACING UNIQUE CHALLENGES Nations, governments and public health agencies, all attempt to prepare for pandemics and other public health emergencies. They provide guidance with suggestions for mitigating a pandemic. But, when the scope of the emergency is so pervasive that it overwhelms hospital ICU capacity, then health care professionals have to improvise and address challenges themselves. That has been the case with many HTM departments. “Our efforts and responsibilities have not abated past the initial preparedness push. The chronic lack of parts support continues. We have since secured dedicated warehouse space to allow us to stockpile both equipment and associated maintenance parts to buffer against the challenges,” Meninno says.

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“We have been building our medical device resources, and in some cases, retaining older equipment we might otherwise have sold to avoid the abuses we had sometimes encountered when trying to obtain used equipment. Our contribution to the Hoag COVID Playbook has set forth a strategy to continuously improve on our independence from manufacturer support,” Meninno adds. He says that his team, as part of this effort, has been building technical

training into its capital process. “Decisions on purchases are heavily weighted in favor of manufactures who choose to support us. We have maintained our compliance and quality measures despite our own staffing levels being impacted for a variety of reasons related to the pandemic,” Meninno says. Another aspect of dealing with the coronavirus pandemic has been additional attention to protocols already in place in all hospitals. The concerns with disinfection become intensified

Medical Systems Engineering Technologist II Landon Fields, from the HTM team at Texoma Medical Center in Denison, Texas, helped to quickly install, configure and test additional medical equipment during the COVID-19 pandemic.

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when the pathogen in question cannot be addressed with antibiotics or other therapeutics. “One of the things we have focused on, and continue to emphasize, is the disinfection of all medical equipment before it comes into the HTM department. Each of the techs has a disinfection station on their repair carts and there is a stop line before coming into the shop,” says Sterling Brown, CBET, unit director of healthcare technology management at Iredell Health System in Statesville, North Carolina. “Although we assume that the clinical staff is wiping down/disinfecting equipment after it is discharged from a patient or prior to it being sent to the HTM department for servicing, we, as a matter of precaution wipe down every piece before we touch it or before it is allowed into the shop,” Brown adds. He says that all of the techs have been fit tested for the N95 respirator

availability with resourceful ingenuity. “The biomed team at BSW McKinney played an important role in helping the facility early during the pandemic. The first major role we played was repurposing and relocating equipment to be used in different departments and figuring out ways to make bedside monitors portable when all vendors were out of supplies. We converted old Welch Allyn BP roll stands, we had in storage, into roll stands for X2 modules and other patient monitors we previously did not have roll stands for,” says James Swandol, MBA, CBET, manager of healthcare technology management at Baylor Scott and White (BSW) McKinney. He said that his team was also tasked to come up with a solution for patients to be able to speak to their families and physicians. “We ended up mounting iPads onto roll stands so that patients could FaceTime family members from their

" It seemed like every day we were being tasked to come up with a solution to problems; huge shout out to the technicians who answered all calls to action to make sure we kept patients’ treatment and safety first." -James Swandol and the powered air-purifying respirator (PAPR) so that they are protected if they are required to enter a COVID-positive patient room (and it happens on occasion). “We vet all vendors that require access to the facility and we ensure they are temperature tested and have the proper PPE before entrance is allowed,” Brown says. In Texas, one biomed team that is part of a large health care system, addressed the concern of equipment

room, and through different applications, the physicians could take advantage of telemedicine,” Swandol says. Swandol says that gearing up for the surge was tough on the team. “Ventilators were high priority on the list, during the first month we had a local college offer us loaner ventilators, which the team coordinated transportation of the equipment, and arranged for the equipment to be serviced by vendors. Since then, system solutions have been created to help every facility

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in our Baylor Scott and White system receive ventilators when they need them,” he says. “When confronted with one vendor’s inability to provide parts, the team set about manufacturing required battery packs to support our transport ventilators. With the wealth of equipment-specific training our team possesses, we continued to provide support to the front line without requiring direct support for the OEMs, many of whom could not provide onsite support,” Meninno says. Not only are patients and clinicians grateful for the valiant and persistent effort HTM professionals have made at their facilities, but HTM leadership has been reminded of their team’s important role. “The biomedical engineering staff has been a truly wonderful resource for our organization. No one member shines above the rest, but rather they all excel together. I could not be prouder of them all,” Meninno says. “It seemed like every day we were being tasked to come up with a solution to problems; huge shout out to the technicians who answered all calls to action to make sure we kept patients’ treatment and safety first,” Swandol says. “It was a huge team effort and because of it no patient who needed a ventilator anywhere within the system didn’t have one,” Jacques says. “To celebrate that effort, the Chamber of Commerce in Flint and Genesee County has named me as on the ‘20 in 20’ – the 20 people making a difference in our community during 2020. This is a huge honor and a great way to celebrate the clinical engineering field,” Jacques adds. TechNation says thank you to the HTM heroes who have answered the call and saved countless lives when their skills and resourcefulness were needed most. The many victories during this pandemic can be attributed to your dedicated service.

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