TechNation Magazine August 2021 by MD Publishing

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ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

AUGUST 2021

BIOMEDS ON A MISSION

HTM VOLUNTEERS MAKE A DIFFERENCE

12 Professional of the

Month Make the Best of Your Time

35 Ribbon Cutting

First Advisory Health

46 Roundtable Address Service Requested MD Publishing 1015 Tyrone Rd., Ste. 120 Tyrone, GA 30290

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Vol. 12

Radiography

73 The Other Side

Celebrating an Industry

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CONTENTS

FEATURED

HE ROUNDTABLE: T RADIOGRAPHY For this month’s roundtable article on radiography, several original equipment manufacturers (OEM) were able to share insights as well as a third-party service.

Next month’s Roundtable article: Equipment Disposition

BIOMEDS ON A MISSION: HTM VOLUNTEERS MAKE A DIFFERENCE The skill set that biomeds possess is desperately needed when medical equipment is the difference between life and death in places that can’t afford to staff enough biomedical professionals. Many HTM professionals have already made a difference by volunteering with nonprofit organizations, but more help is always needed. ext month’s Feature article: N Teamwork: Advantages of Working with Others

TechNation (Vol. 12, Issue #8) August 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

AUGUST 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 Taylor Powers 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

EVENTS

Lisa Lisle

WEBINARS

Jennifer Godwin

HTMJOBS.COM

Kristen Register Sydney Krieg

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: Make the Best of Your Time p.14 Company Showcase: The InterMed Group p.18 Department of the Month: VCU Health Community Memorial Hospital Biomedical Engineering Department p.20 Shifting Gears: Violin Virtuoso with a Multimeter P.25 INDUSTRY UPDATES p.25 News and Notes: Updates from the HTM Industry p.30 AAMI Update p.32 ECRI Update p.35 Ribbon Cutting: First Health Advisory p.36 Welcome to TechNation P.39 p.39 p.41 p.42 p.44

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

P.60 EXPERT ADVICE p.60 Career Center p.62 5 Tricks to Avoid Damage to Your Ultrasound Transducer,sponsored by Avante Health Solutions p.64 Cybersecurity p.68 20/20 Imaging Insights, sponsored by Innovatus Imaging p.70 The Future p.73 The Other Side P.76 BREAKROOM p.76 Did You Know? p.78 The Vault p.80 Where in the World is Ben C.? p.86 HTM Strong p.82 Service Index p.85 Alphabetical Index Like us on Facebook, www.facebook.com/TechNationMag

MD Publishing / TechNation Magazine 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

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AUGUST 2021

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SPOTLIGHT

PROFESSIONAL OF THE MONTH Make the Best of Your Time BY K. RICHARD DOUGLAS

any of the healthcare technology management (HTM) professionals highlighted in the Professional of the Month feature are already well known to their departments, hospitals or even entire health systems. It is less common that they are already familiar to the entire HTM community before being featured.

In the case of Maggie Berkey, CBET, who was recognized with the 2021 AAMI & GE Healthcare BMET of the Year Award and is the visionary behind AAMI’s BMET Apprenticeship Program, an introduction is not necessary. Berkey is a senior BMET in the clinical engineering department at CommonSpirit Health’s Good Samaritan Hospital in Kearney, Nebraska. She is also a member of AAMI’s Technology Management Council (TMC). Long before the national honor, Berkey had been one of those biomeds who took a circuitous route into the profession. “In a roundabout way, I would say it was my mom. She had pushed me to enter into what was, at the time, an up-andcoming male-dominated industry of laser technology. Not long after I started in that career field, the attacks on the twin towers caused mass layoffs that shut down most of the opportunities to thrive,” Berkey remembers. She says that several years later, her husband questioned why they were paying for a degree that she wasn’t even using. “With two electronic-equivalent associate degrees under my belt, my alma mater offered a one-year BMET specific degree. Honestly, I had no idea what I was getting into. Today I look at our industry

TECHNATION

AUGUST 2021

Maggie Berkey, CBET, checks a medical device at Good Samaritan Hospital. as a hidden gem. Unfortunately, being a best kept secret has contributed to the struggle to recruit talent in HTM,” Berkey says. “I graduated from Southeast Technical Institute (STI) in Sioux Falls, South Dakota, which is about an hour away from my hometown. I earned an AAS in laser electro optics technology (LEOT) in 2000, then my AAS in biomed (BMET) in 2009. Both programs have since closed their doors, but not before providing a foundation for my continued and ongoing education,” Berkey adds. MAKE THINGS BETTER Berkey came up with the internship program idea in 2019 and presented it at the AAMI eXchange that year. She saw it through to earning Department of Labor approval. This was just one notable project and challenge of many that she has tackled. “I am fortunate to have been a part of many interesting and unique challenges during my career. One highlight from my career is definitely the BMET apprenticeship, which involved numerous partnerships spanning over the last 11 years,” Berkey says.

She adds that the idea was built from a culmination of experiences starting back at the University of Minnesota Medical Center-Fairview. “I had a good internship experience in technical school, so when I noticed a couple of interns not getting out of the shop much or showing up during projects that pigeon-holed them to an extent, I mentioned it to my first HTM leader, Vickie Snyder. The document that our team created to ensure interns had a variety of experiences was the beginning of what eventually became the foundation of the work process schedule and competency guide for the Department of Labor BMET Apprenticeship,” Berkey explains. She says that during her later years with Fairview, she was tasked with wearing numerous hats, including being a project liaison for the University of Minnesota Clinics and Surgery Center. “The nearly 350,000-square-foot clinic opened in 2016, and I was able to provide input and expertise to make the project a success. Another opportunity for improvement, identified during my tenure with St. Cloud Technical and Community College (SCTCC), was to improve on the

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SPOTLIGHT

Maggie Berkey’s proactive approach to life has gotten her where she is today – a successful HTM professional.

existing curriculum, as well as partner with the St. Cloud State University College of Nursing. We created a collaborative that benefited BMET students and the nursing school alike,” Berkey says. There are details about the project in an article published in the January 2019 issue of the Journal of Clinical Engineering. The story is titled “Creating a Mock Environment for the Real World.” “While writing curriculum for SCTCC, I took the internship guide created at Fairview and built it into a graded expectation metric for BMET students’ internships. After moving west to be closer to our daughter and grandson, a conversation with our district manager propelled the idea of building a tech from scratch while learning on the job,” Berkey adds. Berkey has had many great experiences that have cemented her commitment to the HTM field; it’s past and future. “There have been a few things during my career that I consider noteworthy including ‘winning’ a trip to AAMI’s Future Forum III, where I got to meet some really neat people including George Mills. I remember thinking what a down to earth guy he was, which made me willing to invite him to speak at our local biomed association conference when I served as vice president of the North Central Biomed Association (NCBA),” Berkey says. She says that she also met many other really interesting and “kind souls” like Karen Waninger and Steve Campbell. When not at work, Berkey spends her free time with her children, family and friends. “We have a fairly large and growing family. I have five children and a second grandson coming in July. I feel blessed to have seven siblings and my parents, as well as in-laws, extended, and adopted family to spend holidays and free time with,” Berkey says.

“I enjoy taking walks with my husband and contributing whatever I can to the ongoing success of the HTM field,” she adds. How would Berkey characterize her approach to life? “I am just an average girl that looks for opportunities to make the world around me a little better each day. My number one focus is spending as much time as possible with my family and friends. I know how precious time is; I thank my kids in their 20s for that gift,” she says. She has embraced the concept of being a change agent and taking a proactive approach to improving things. “I used to worry a lot about what people thought of me or what they might think if I threw out an idea that was dumb, but now I understand that if I don’t ask questions, investigate further or try to figure out how to make something better; things will just stay ‘broken.’ I can choose to be the change I want to see or whine and complain about the way things are. Let’s face it, life is pretty interesting when you slow down and enjoy the ride,” Berkey says. With people like Berkey in the HTM profession; there is reason for optimism.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

FAVORITE BOOK:

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FAVORITE MOVIE: “Forrest Gump”

FAVORITE FOOD:

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HIDDEN TALENT: Busting a move

FAVORITE PART OF BEING A BIOMED: The excitement of knowing a new challenge is just around the corner.

WHAT’S ON MY BENCH? • •

•

Coffee - black please My cellphone - I use it all day to capture time frames and notes that help with documentation, I am constantly googling various resources and often text my customers with status updates. I also carry a small pocket purse that holds a handy tool.

AUGUST 2021

TECHNATION

SPOTLIGHT

SPECIAL ADVERTISING SECTION

COMPANY SHOWCASE The InterMed Group: Adding Logical Maintenance to Health Care Physical Maintenance of Medical Devices

he InterMed Group has been at the forefront of healthcare technology management for nearly 30 years; our trailblazing work in medical device and medical equipment cybersecurity has equipped healthcare organizations to face today’s complex security challenges and better prepare for the future.

Given the current cyber climate in the healthcare industry, we are pleased to introduce a cohesive cybersecurity suite of services that cater to the rising demand for strong cyber protections within healthcare. Healthcare technology management (HTM) is not what it used to be; during 2020 we all witnessed a monumental influx in network-based connections; it is no surprise that with the huge shift in how device and patient data is transferred and stored that there has been a dramatic increase in healthcare cybersecurity data breaches. In fact, in less than a year, healthcare breaches in the United States alone jumped a dramatic 55.1% from 2019 to 2020, with approximately 91.2% resulting in theft of personal information; the average facility took approximately 236 days to recover from a breach.1 InterMed understands that with an increasing amount of healthcare technology being connected to or

TECHNATION

AUGUST 2021

Scott Nudelman

InterMed Cyber Security Officer and Vice President of Support Opperations

housing ePHI, there is a growing concern about cybersecurity vulnerabilities that are not, and cannot, be remedied by the majority of HTM providers. “Our holistic approach to ‘cyber hygiene’ is developed to be paired with medical equipment and the unique staffing aspects of each facility, with minimal disruption during implementation,” says InterMed Cyber Security Officer and Vice President of Support Operations Scott Nudelman. WHY PATCH MANAGEMENT IS NOT ENOUGH Most medical device cybersecurity services currently available on the market cover the very basics of healthcare technology; they can

inventory systems, devices, and the equipment, identify the current problems or vulnerabilities of the network, and complete patch management. All of this is important to maintaining your cyber hygiene, but is this enough in today’s world? The answer is simple: no, it is not. Patch management is the process of distributing and applying original equipment manufacturer (OEM) and third-party software (iOS and Windows) updates for medical devices. They are necessary to correct errors and vulnerabilities while providing a more secure healthcare network environment and maintaining certain regulatory compliance. Not all manufacturers are current on patches, or they do not release third-party patches fast enough or at all for older equipment. If a patch is not available, you’re still vulnerable; we work with your IT and security team to ensure other compensating controls are in place when patches are no longer available or not released by the OEM. THE INTERMED DIFFERENCE We have all witnessed a huge influx in network communication and data transferring throughout the last 18 months. Traditional healthcare facility IT departments are not equipped to adapt to the shifting strategies of cyber attackers on medical devices; they lack clearly defined ownership and responsibility of managing alerts and/or patches.

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SPOTLIGHT

InterMed’s offering within its healthcare technology management services provides a scalable and more complete solution that not only enhances their client’s physical maintenance but also transcends the concept of logical maintenance (cybersecurity). This software-agnostic solution ventures beyond standard visibility software, adapting to threats on an ongoing basis taking into consideration organizational specifics and growth. Cybersecurity has become a major heartache for many organizations. InterMed’s services have a measurable and immediate impact within healthcare. This initiative is a great lift for healthcare delivery organizations; the time and resources that go into recovering from breach physically, financially, and in some cases even emotionally, are sizeable yet in most cases avoidable. “Here at InterMed, we understand that our solutions not only change our client’s business, but they also impact lives – which isn’t something we take lightly,” says Nudelman. “At the end of the day, patient safety is the top priority

for everyone in healthcare; it’s our responsibility as healthcare professionals and leaders to ensure we exhaust all efforts possible to keep patients and the equipment they rely on safe.” PROTECTING OUR PARTNERS InterMed’s program combines education, physical inventory assessment and integrated services for prevention, detection, containment and culmination of results. Clinical Asset Defense Engineers (CADE) from InterMed are set in place to provide ongoing service that continues beyond the first engagement. Overlap with InterMed’s highly utilized JumpTeamsTM services will allow for rapid deployment and immediate boots-on-the-ground implementation. Hand-picked JumpTeamsTM technicians, InterMed’s professional biomedical and field service engineers, receive selected training and testing to support the future of the InterMed Group’s cybersecurity services, including but not limited to Security Plus and HCISPP certification.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

“InterMed has grown significantly over the past few years, both in size and in the development of core services. InterMed has taken a leadership role in delivering integrated cyber solutions for our clients regardless of their size. We are eager to use these services in tandem with our key industry partners to provide quantifiable solutions for our clients,” concludes Nudelman. To learn more about the InterMed Group and to inquire about enlisting their HTM services, including their cybersecurity offerings, visit www.intermed1.com or email info@intermed1.com. References 1 Bitglass. Bitglass Healthcare Breach Report 2021 | Hacking and IT Incidents on the Rise. Bitglass, 2021. https://pages. bitglass.com/rs/418-ZAL-815/images/ CDFY21Q1HealthcareBreachReport2021. pdf?aliId=eyJpIjoiOE54NGRRTkhCZDY3aUxGMiIsInQiOiJ0RTZ1QVZXbnFPUGRhZXhVbmhyMmVnPT0ifQ%253D%253D

AUGUST 2021

TECHNATION

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DEPARTMENT OF THE MONTH VCU Health Community Memorial Hospital Biomedical Engineering Department BY K. RICHARD DOUGLAS

n the southern part of central Virginia, near the North Carolina border, sits the town of South Hill. It is billed as the “Gateway to Mecklenburg County.” The town was originally designed in a circular pattern and is one of only three towns in the nation that can make that claim. South Hill got its start as a railroad town in 1889.

South Hill is fortunate to have a 70-bed hospital within its borders. VCU Health Community Memorial Hospital sits just off the main drag in South Hill, partially hidden from the road, but available to residents of the town and the surrounding area. The hospital is a part of the VCU Health System. The system, based in Richmond, has locations covering much of Virginia. The three-member biomedical

TECHNATION

AUGUST 2021

engineering department consists of Biomedical and Facilities Manager Tim Bowers, CHTM; BMET 2 Tyler Quinn and BMET 1 Bryce Kegebein. The team reports to Facility Engineering Director Archie McCartney. “Our department is responsible for all of your standard medical and lab equipment but is also responsible for beds, nurse call, RTLS systems, Ascom phones and even cable TV distribution system (because it is integrated in with nurse call). We basically handle any and all equipment that is directly used for patient care,” Bowers says. In addition to the hospital, the biomed team also manages equipment at The Hundley Center, a 140-bed extended care facility, the Hendricks Center, a rehabilitation center, the Solari Radiation Therapy Center, the CARE Building; nine specialty

clinics, the CMH Behavior Health Center, Clarksville Primary Care and Chase City Primary Care. Bowers handles the day-to-day operations of the department and leads any biomed/IT related projects. Quinn handles life support preventative maintenance (PM) as well as general biomedical equipment. Kegebein maintains general biomedical equipment as well. The department provides the repairs, support and maintenance for all of the facility’s medical equipment. For anything the team does not cover, service contracts are evaluated by biomed to determine the appropriate level of coverage. The contract is then discussed with, and signed off by, the appropriate vice president and is then forwarded to the team’s contracts contact in purchasing to process. The department works well with its

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SPOTLIGHT A three-man biomedical engineering department maintains medical equipment at VCU Health Community Memorial Hospital.

IT colleagues. “We are separate departments here at CMH but have a good, close working relationship with the department. We all work well together to get things done. We keep each other on ‘speed dial,’ ” Bowers says. COVID CREATED AN ENORMOUS PROJECT It is one thing to stand-up a COVID-19 surge unit or isolation unit in an existing area of a hospital and quite another to turn an abandoned hospital into a COVID surge facility. That was a major challenge that the three-member team faced along with colleagues in other departments. The plan to retrofit the old hospital as a precautionary step was announced in March of 2020. “We moved into a new hospital in 2017 and left the old hospital vacant. Once COVID hit, and the numbers in our region began to increase, the health system decided to bring up the old facility as a COVID facility if needed,” Bowers says. He says that the team was given two weeks to turn an abandoned hospital into a fully functioning 130-bed hospital. Because Community Memorial Hospital provides services to patients over a large portion of south-central Virginia and north central North Carolina, the old facility was made available in case the need arose. “To simplify the project, once we were told to move forward, everything shifted into overdrive. We met

with nursing leadership and performed walkthroughs of the facility to determine what were priority-needed items in order to start seeing patients as soon as possible. The biomed team made many calls to contacts in the industry to find out the availability of devices and lead times and would then run purchasing approvals through at a lightning speed process through administration,” Bowers says. He adds that they worked hand-inhand with many departments and volunteers to work out the logistics of getting equipment to the old hospital, assembled, tested and cleaned. Some of the other departments involved included facilities, IT, environmental services and materials management. “We ended up outfitting the facility with 130 beds. Each room needed to be outfitted with beds, IV pumps/poles, suction regulators and O2 regulators. We set up a 10-bed ICU unit that included the same items as a standard patient room to include ventilators and applicable patient monitoring for each room,” Bowers says. He says one of the items that ended up being the most time consuming was the recommissioning of the nurse call system where most of the IT-based hardware had been

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

removed. “The biomed team had to terminate and test a few hundred CAT 5 cables and reinstall any missing hardware. The other item was the testing and configuring of all of the IV pumps received. We ended up setting up an assembly line outside of the shop area and used facilities and security staff to assist with prepping pumps to be tested and configured,” Bowers says. “This was a stressful time for all involved but the biomed team, along with every other department, all worked together seamlessly to accomplish a goal on what we thought would be an impossible task. I wouldn’t trade these guys for anyone,” Bowers adds. He says that in the end, luckily, they never needed to use the building for COVID-19 cases. It was used as a vaccine clinic. Outside of the workplace, all three biomeds are members of the Virginia Biomedical Association. The value of biomedical departments is on display every day, but with the additional challenges of the past year, teams like this one are indispensable. Only now can we say that it is much better to have an extra hospital available and not need it.

AUGUST 2021

TECHNATION

SPOTLIGHT

SHIFTING GEARS

A Look at HTM Professionals Away From Work Violin Virtuoso with a Multimeter BY K. RICHARD DOUGLAS

connection was found many years ago between playing a musical instrument and intelligence. Some studies have found that learning to play a musical instrument has a positive cognitive impact; increasing a person’s intelligence quotient (IQ) by as much as 10 percent.

It may follow, that those who have mastered a musical instrument would be good candidates for most professions. Even a self-taught amateur musician would bring some additional cognitive benefits to the job. What if the musician was a classically trained professional? Many professional musicians become members of symphony orchestras or work as studio musicians, while a small number move on to explore other career opportunities. Don Stanciauskas, a field service technician with Network Imaging Systems in Charlotte, North Carolina, may be one of the most proficient musicians in the biomed/imaging service profession. While Stanciauskas’ customers just see him as their competent imaging tech, his background as an accomplished violinist might surprise them. Stanciauskas remembers that his musical studies started very early and became integrated into his early education.

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Don Stanciauskas can repair imaging equipment and play the violin. “At the age of four, I started so-called prep school for the arts in Lithuania. I started playing violin at the age of five or so. I was considered a prodigy and my father, a musician himself, recognizing my abilities, decided to push me in the musical direction early. I studied violin, piano and general music at the National M.K. Ciurlionis School of Art in Lithuania and graduated at the top of my class in 1990. At the age of 16, I won the national music performance competition,” Stanciauskas says. He says that the school was the top school for music, ballet (now a

separate school) and visual arts at the time, and remains so to this day. “The competition was fierce. Out of 32 kids, starting in the first grade in my class, only five graduated and went on to study music in the Lithuanian Academy of Music and Theater,” Stanciauskas says. He went on to study at the Academy and earned an advanced degree and learned that his place of residence might also change. “I graduated from the Academy with a master’s degree in performance in 1995. A year earlier, I won another national competition. The same year, in 1994, I discovered I won a ‘green card,’ which was a new thing then, a DV-1 lottery devised by the Department of State to foster legal immigration to the U.S.,” Stanciauskas says. While still in Lithuania, Stanciauskas performed with the Lithuanian State Symphony Orchestra. This opportunity allowed him to tour “half the world.” “I believe I visited every single European country thanks to music,” he says. This was only one experience he enjoyed as a professional violinist. He also performed with various chamber ensembles, groups, international youth orchestras and other “fun groups.” “In the States, I played in various

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SPOTLIGHT

Don Stanciauskas plays the violin on stage in 1994. He says his musical talents helped him visit and perform in every European nation.

orchestras in the Southeast: South Carolina Philharmonic, Greenville Symphony, Charleston Symphony, Hilton Head Symphony, Savannah Philharmonic, Augusta Symphony; to name a few,” he says. “The highlight is always performing with the top names in music such as Mstislav Rostropovich, YoYo Ma; even Béla Fleck. The life of a musician is full of wonderful moments,” Stanciauskas says. A STACCATO CAREER SHIFT The big redirection in career came out of a personal challenge he made to himself after arriving in New York in 1995. He continued to spend time with other musicians and continued to perform as a violinist, but it was a radio ad that changed everything. “It is a 180-degree turn in a professional sense. But technology and science were not new to me. My mother was an electronics engineer and she fostered my interest in all things beeping and chirping. I developed a life-long interest in electronics, computers, mechanics

and engineering in general,” Stanciauskas says. He says that he did a stint at Brooklyn College, but it was mostly to satisfy his academic curiosity in various humanitarian and scientific subjects; not to advance to a new career. “After a decade of musical freelancing in the Southeast, I started to consider doing something different. There was a moment where I heard Central Piedmont Community College featured on a local public radio station while driving down I-77. I took an exit and went to admissions office to join their engineering program. After graduating, I made a donation to WFAE Charlotte, they are collecting on my AMEX still,” Stanciauskas adds. The radio ad was a turning point for the professional musician, and he is forever grateful to the radio station for running it. “I am happy to contribute; they need it and it makes me feel good,” he says. Stanciauskas isn’t the only violinist

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in his household. His wife has also been a violinist for many years and teaches the instrument. On the job, Stanciauskas works with CT and MRI medical imaging scanners. When not servicing imaging equipment or taking a bow to strings, Stanciauskas can be found outdoors and spending time with his son. “I am always busy with all kinds of projects – I am an audiophile; I build vacuum tube audio equipment. I also build custom airsoft guns for various clients. My son and I play airsoft almost every weekend. Fishing, beach, mountains – family fun is always on my schedule,” Stanciauskas says. The lure of the chin rest and the vibrato have not completely faded for the one-time virtuoso. “I am starting to miss music and playing though. I have considered rejoining my old friends as my work schedule permits; it would be fun.” MRI repairs by day; Beethoven’s Violin Sonata No. 9 by night.

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Updates from the HTM Industry MON HEALTH SYSTEM WINS AWARD ECRI has announced that the Mon Health System of Morgantown, West Virginia, is the winner of its 15th Health Devices Achievement Award. ECRI presents its annual award to a member facility that has carried out the most exceptional initiative to improve patient safety, reduce costs or otherwise facilitate better strategic management of health technology. “Mon Health’s submission showed how health system leadership can foster an environment that encourages the use of innovative technology solutions to advance patient care,” says Marcus Schabacker, MD, Ph.D., president and chief executive officer, ECRI. “We congratulate Mon Health for striving to meet the needs of their local community and investigating new approaches to improving patient outcomes.” Mon Health System created a pathway for innovation for their physicians, clinicians and engineers by partnering with Intermed Labs at Mon Health. “Establishing a collaboration with a local innovation lab allowed us to provide our clinicians with the framework and infrastructure to develop new ideas to improve patient care,” says Mon Health CEO and President David Goldberg. “For this initiative to succeed, we committed our leadership support and then we got out of the way so the entrepreneurs had full rein to innovate.” The first project through the process sought to improve the options for patients who had experienced fingertip amputation, a common concern among West Virginians. Fingertip amputation often occurs in young and productive populations. Prosthetics can help these patients overcome functional deficits, but obtaining a functional finger augmentation can be difficult for patients in remote or economically disadvantaged regions. The solution was to create a low-cost, easy-to-order, highly functional ﬁngertip manufactured exclusively by 3D printing. “While other 3D-printed augmentations have required signiﬁcant post-production customization and maintenance, our device’s intrinsic joint system makes it essentially maintenance free and is able to be used immediately upon delivery,” says W. Thomas McClellan, MD, plastic reconstructive surgeon and chief executive officer, Intermed Labs at Mon Health. “For patients, it’s as easy as visiting our website, taking a picture of their hand, and ordering the device – similar to a typical e-commerce product.”

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ARMY, AAMI MAKE CERTIFICATION EASIER The U.S. Army is making it easier for medical maintainers to train and affirm their abilities as subject-matter experts in their field. As of April 1, soldiers working as biomedical equipment specialists, known by the military occupational specialty code 68A, can now enroll in several types of job-related training with no out-ofpocket expense. “For many years, soldiers had to request training through their unit and see if the unit would pay for it,” Master Sgt. Wesley Ladlee said. “Now, soldiers can just go in, click a few buttons and they’re funded for their test.” Seeing an opportunity to improve the training process, Sgt. 1st Class Jaime Sanchez worked with the Army’s training partner – the Association for the Advancement of Medical Instrumentation (AAMI) – to secure an agreement to become a recognized vendor through the new ArmyIgnitED credentialing program. “Proficiency in our jobs translates to a quick turnaround time for scheduled services and repairs and keeps all the medical equipment fully functional so we can provide the best casualty care on the battlefield,” said Sanchez, medical equipment branch non-commissioned officer in charge at Reynolds Army Health Clinic in Fort Sill, Oklahoma. The effort was a success and now roughly 1,100 active-duty, reserve and National Guard soldiers can access up to $4,000 worth of training and certification programs each year through AAMI. Ladlee, the Army’s 68A senior enlisted adviser, said the certifications, which are based on industry best practices, make soldiers more competitive in an ever-changing field where technology grows by leaps and bounds in a short amount of time. Available courses include certified biomedical equipment technician (CBET), certified radiology equipment specialist (CRES) and certified healthcare technology manager (CHTM).

AUGUST 2021

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MIDMARK RTLS OFFERS CLOUD-BASED, BLE SOLUTION Midmark RTLS now offers a cloud-based, Bluetooth Low Energy (BLE) asset tracking solution – a combination that can be rapidly deployed across health systems, in both new and existing facilities without time-consuming, resource-intensive projects. “Midmark RTLS Cloud modernizes asset tracking capabilities – it’s simple to install and scale across your health system, supporting your staff with real-time information,” said Susan Martin, vice president, Midmark RTLS. “Our decades of experience with RTLS in health care provide a strong foundation, enabling us to build evidence-based solutions with the latest technology that allow care teams to find the right equipment, quickly and efficiently.” Hospitals today may accept searching for missing equipment and over-purchasing assets as frustrating yet necessary practices. Yet the broader impact – on annual budgets, nurse inefficiency and staff dissatisfaction – can add up to a staggering $7 million per year for the average 300-bed hospital, according to customer interviews. “Supporting front-line caregivers and technicians is an investment that will pay for itself with increased asset

utilization, lowering both capital and operational expenditures on equipment, while also improving care and nursing satisfaction, increasing the time they spend with patients,” said Martin. Because the Midmark RTLS solution is cloud-based, it scales easily to provide asset visibility across the health system, tracking assets that move between facilities. The webbased software, viewable on computers and tablets, was designed with both nurses and biomedical technicians in mind – giving these critical teams location data at their fingertips. Midmark’s new Bluetooth Low Energy (BLE) sensors, which can be combined with the company’s existing wired RTLS hardware, outperform Wi-Fi RTLS in both accuracy and tag battery life, offering near room-level precision (within three meters). The sensors can be deployed within a matter of days, without disruption to patient care. Midmark’s new family of BLE asset tags includes the small footprint Micro BLE Asset Tag that is perfect for smaller mobile devices such as telemetry packs. For more information, visit midmarkRTLS.com.

THE INTERMED GROUP ANNOUNCES CYBER RISK PROGRAM The InterMed Group has created a cybersecurity suite of services. InterMed’s program combines education, physical inventory assessment and integrated services for prevention, detection and containment, and assimilation of results. With an increasing amount of healthcare technology being connected to or housing ePHI there is growing concern about cybersecurity vulnerabilities. InterMed’s approach to “cyber hygiene” is designed to be paired with the medical equipment and staffing aspects of each facility; it has been designed to be implemented with minimal disruption. Scott Nudelman, InterMed’s current chief operating officer, has accepted the role as cyber security officer/vice president support operations effective July 1, 2021. Nudelman will concurrently direct InterMed’s unique JumpTeams services as the new products and rapid deployment capabilities of JumpTeams may frequently intersect

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depending on client needs. Hand-picked JumpTeams technicians will receive selected training and testing, including Security Plus and HCISPP certification. “I am grateful to the InterMed team for this effort, and for this opportunity to pursue a passion I have had for some time. InterMed is taking a leadership role to deliver integrated cyber solutions for our clients regardless of their size. I am eager to use these services in tandem with our key industry partners to provide quantifiable solutions for our clients,” said Nudelman. Rick Staab, CHTM, chief executive officer of The InterMed Group, said, “These services will have a measurable and immediate impact in the health care industry. Scott Nudelman is one of our most valuable leaders, and he has been an amazing COO. Assigning him to this leadership role underscores InterMed’s true commitment to improving medical device cybersecurity and the health care industry.”

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NUVOLO SPONSORS BMET APPRENTICESHIP PROGRAM Nuvolo has partnered with AAMI to support healthcare technology management (HTM) departments who enroll in AAMI’s Biomedical Equipment Technician (BMET) Apprenticeship Program. The program combines online and classroom education with up to 6,000 hours of on-the-job learning time over the course of two years. BMET apprentices participating in the two-year program have the opportunity to earn three industry-recognized credentials: the Certified Associate in Biomedical Technology (CABT), the Certified Biomedical Equipment Technician (CBET), candidate status; and CompTIA IT Fundamentals (ITF+) certification. Upon successful completion of the apprentice-

ship, participants also receive a nationally recognized certificate from AAMI and the U.S. Department of Labor. To help HTM departments pay for the cost of certifying their BMET apprentices, Nuvolo has started the Nuvolo Apprenticeship Certification Program. Here’s how the program works: • The first seven health systems or stand-alone hospitals to enroll in AAMI’s BMET Apprenticeship Program by December 1, 2021 will be automatically eligible to receive up to $725 per apprentice for up to two apprentices. • Hospitals and health systems must officially register their apprentice(s) in AAMI’s BMET Apprenticeship

Program by December 1, 2021. After this date, any remaining sponsorship spots will be offered up to other hospitals or health systems enrolled in the BMET Apprenticeship program. •A total of up to 14 apprentices will have the cost of their certification tests covered by Nuvolo. •N uvolo will donate the funds to AAMI, who then will apply the donated funds as a reimbursement to the eligible participating organizations once the apprentice passes each of the required certification tests by June 30, 2025. • Additional program details can be found at www.nuvolo.com

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CE-TECH PARTNERS WITH CABLES AND SENSORS LLC In a recent letter, CE-Tech introduced a new products partnership with Cables and Sensors LLC. The new partnership is made up of experts in the industry who have built a reputation for delivering quality products below OEM pricing, according to the letter signed by CE-Tech President Scott Long. “This new partnership allows CE-Tech to continue providing value added enhancements while offering affordable quality products to complement our existing services,” Long writes.

For over 30 years, CE-Tech has provided medical device repair services throughout the

southeastern United States. The corporate headquarters are in Jacksonville, Florida with satellite offices centrally located in Florida, Georgia, Alabama and South Carolina. “Our success is based on our customer satisfaction record, which is the cornerstone of our business, providing quality clinical engineering services in a timely fashion at cost-effective prices. We feel that our service programs provide the best value money can buy. Our commitment to deliver cost-effective services while maintaining the highest industry standard, guarantees your satisfaction,” Long adds.

MEDICAL EQUIPMENT DOCTOR ADDS TO STAFF Medical Equipment Doctor, an Anaheim, California company, provides a large array of medical equipment and services to hospitals, clinics and surgery centers. This growing company contributes a portion of its success to hiring great people. Albert Negron, founder and CEO, has announced the addition of five new positions for Medical Equipment Doctor. New positions and hires include Operations Manager Tara Stack, Biomedical Technician Andres Arcos, Sales Representative Alan Rodriguez and Sales Representative Shane Hekhuis. For more information, visit medicalequipdoc.com.

INTERPOWER ANNOUNCES OPTIONAL CORD CLIP Interpower has a new optional cord clip for all of its USA-made 3x18 AWG cords, and the 3x18 VCT-F Japanese cords. The new Interpower Cord Clip is constructed of a glass-reinforced Polypropylene compounded resin for molding consistency and retention. The clips are set at an optimal 4.75 inches behind the plug, and are molded in gray (P/N: 65910020) and black (P/N: 65910010). These cords are perfect for clipping excess cord to prevent tripping and injuries and extend the life of the cord by keeping it away from tools and machinery. This material is not hazardous by OSHA Hazardous Communication Standard 29 CFR 1910.1200 and is not an RCRA hazardous waste compounded resin. Interpower cord clips can be used in a wide range of markets such as industrial, information technology, appliance, medical, food service – anywhere excess cable could pose an issue or a danger. For more information, email info@interpower.com.

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PARTSSOURCE UNVEILS NEW OPERATIONS DASHBOARD PartsSource has expanded its flagship solution, PartsSource Pro with a system-wide Operations Dashboard, unveiled at the 2021 AAMI Exchange REWIRED. The PartsSource Pro Operations Dashboard provides one centralized location to increase efficiency and monitor supply chain approvals, open orders, exchanges, returns and repairs. It also provides access to clinical engineering supply chain activity to support daily planning and make available across the health system with one simple click. Users can also monitor shipping and deliverability and receive exchange reminders to reduce costs and increase quality across the health system “PartsSource is continuously innovating to help me be proactive. This latest innovation gives me visibility across my operation in real-time, the ability to monitor the life cycle of my clinical supplies and to respond with a resilient supply chain – all

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in one place. No other partner offers this level of service or insight,” said Charles Verzi, corporate director HTS, Ballad Health. The Operations Dashboard is the newest PartsSource Pro expansion designed to improve the reliability and resiliency of clients’ medical device supply chains through increased visibility to actionable insights. The feature serves as a client-facing counterpart to the PartsSource Command Center, released during the pandemic to monitor critical Key Performance Indicators along the supply chain, as part of the PartsSource Pro 2021 expanded benefits. The new Operations Dashboard will be available to the 1200+ member hospitals within the PartsSource Pro community this summer. •

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AAMI UPDATE Guest Highlights from AAMI eXchange REWIRED’s ‘Good Morning HTM’

eld entirely online, June 7 to 11, AAMI eXchange REWIRED was a unique online meeting experience. More than just a series of webinars and education sessions, REWIRED kept attendees engaged with a daily livestream hosted by Danielle McGeary, AAMI vice president of HTM, and Robert Burroughs, AAMI senior vice president of education. The duo kicked things off every morning with “Good Morning HTM,” featuring a lineup of short interviews with health technology thought leaders. Here are just two highlights from the many morning show guests:

WITH NEW WI-FI ON THE HORIZON, IS IT TIME FOR NEW DEVICES? “So, we thought it would be wonderful to do some forecasting for what is about to come,” said wireless technology expert Shawn Jackman, founder and CEO of Clinical Mobility. He joined “Good Morning HTM” as a special guest during AAMI eXchange REWIRED on Tuesday. Wi-Fi as we know it previously made a transition from 2.4 GHz bandwidths to 5th generation (5G) capabilities. Now, just on the horizon, is WiFi-6E. Why’s that important? Most of the time, when someone experiencing trouble connecting to a Wi-Fi network, spectrum congestion is

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the problem, Jackman explained. That is, too many devices are trying to connect over the same band of frequencies and compete for space to send data. With WiFi-6E, a new 6 GHz spectrum will introduce lots of new real estate for devices. Confusingly, the “6” refers not to the frequency but to the name of the most advanced wireless standard, called “WiFi-6.” The “E” in Wifi-6E stands for “extended,” as in, an extended number of available bands. “Marketing teams — I don’t envy them!” Jackman laughed. Jackman also mentioned how the 802.11Ax-2021 standard, which encompasses WiFi-6 for 2.4 GHz and 5 GHz, and WiFi-6E for 6 GHz, is already a massive advancement unto itself. “The problem they tried to solve with 802.11Ax is the density issue,” he said. With the 2021 Wi-Fi standard, devices can have “orthogonal frequency division multiple access” (OFDMA) capabilities. This mouthful of syllables means that when a device attempts to send a package of data, it can share that package with other devices that are simultaneously communicating on the network. Instead of networked devices competing for bandwidth, they are efficiently organized, much like a food delivery service picking up orders from

multiple restaurants to then make deliveries in the same area. It sounds like a dream come true for networked hospitals worried about any one device hogging bandwidth and slowing down other devices. However, there’s a catch! “Your legacy devices don’t support it. It’s not a forward compatible technology. So, we’re going to need to buy new devices,” said Jackman. “Is this something that HTM departments should be preparing for?” asked McGeary. “Every time there’s a new infrastructure advancement like Wi-Fi, it’s always better to buy new, compatible devices before you buy into the infrastructure itself,” Jackman replied. This way, he explained, manufacturers will become aware of a demand for the technology and establish support systems for forward-thinking departments as soon as feasibly possible. A SHOCKING ‘SMART’ DEVICE VULNERABILITY DEMONSTRATED Can you imagine having your smart assistant getting hijacked with … light? During AAMI eXchange REWIRED’s Thursday airing of “Good Morning HTM”, The Archimedes Center for Healthcare and Device Security shocked the HTM community with a live demonstration of a worrying vulnerability inherent in many smart devices.

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During the demonstration, University of Michigan doctorate student and Archimedes Center research assistant Connor Bolton aimed a bright green laser at a Google Home smart assistant device. A few seconds later, and seemingly unprompted, the device announced the time to everyone watching the eXchange REWIRED live feed. “Oh wow — there it went!” exclaimed Burroughs. “And you’re doing that with some very inexpensive equipment? I’m definitely keeping my blinds closed from now on!” Bolton explained that he had modulated the light of a $20 laser pointer to carry a specific message — in this case, asking the smart assistant to tell the time. “By varying the intensity of the laser in tune with the voice command we want to give, we’ve essentially embedded audio into the laser beam itself,” he said. The researcher and his colleagues have tested the technique in multiple devices and at varying distances. The team has even managed to command a smart device to open a home’s garage door after shooting the laser from a bell tower, through a window, and into the home. The vulnerability, first revealed by researchers from the University of Michigan and the University of Electro-Communications, Tokyo, raises important security questions even while medical device designers are becoming increasingly interested in the idea of digital health care assistants, “smart” wearables, and networked smart devices in the clinical setting. It also highlights a worrying trend: As the advance of new technologies continues to speed up, it may begin to outpace device security. Fortunately, this is a concern that AAMI and the Archimedes Center have combined their efforts to address in a new collaborative effort. “We’re bringing together health care providers, security experts, device designers … everyone you can think of” to anticipate problems and find the right solutions, said Bill Aerts, executive director at Archimedes Center. The two organizations have connected their membership and partner networks to work on advancing security for life-saving devices.

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ECRI UPDATE

Respiratory Assistance Helmets: A Noninvasive Ventilation Option during COVID-19 … and Beyond?

uring the height of the COVID-19 pandemic, respiratory assistance helmets – sometimes called CPAP hoods, ventilatory assistance helmets or noninvasive ventilation helmets – received considerable attention as an alternative to intubation and the use of a ventilator. ECRI tested several helmet models to gauge their effectiveness for this purpose and to identify considerations for safe use. An open question, however, is whether these products will remain an option once the pandemic recedes.

Ismael Cordero likes to immerse himself in his work. As a long-time biomedical engineer and current senior project engineer in ECRI’s Device Evaluation Group, Cordero has plenty of experience conducting deep dives into medical technologies to assess their value to patient care. But his latest project was a little different. Cordero’s immersion in the technology he was evaluating, respiratory assistance helmets, was quite literal. With the COVID-19 pandemic limiting both his access to products and his options for finding test subjects, Cordero wore each of the models himself as a way to gauge the patient experience and assess CO2 retention levels. Respiratory assistance helmets

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became a hot topic during the height of the COVID-19 pandemic as a potential alternative to intubating patients and putting them on a ventilator. These helmets consist of a clear, flexible vinyl hood that fits over the patient’s head. The hood attaches to (or comes pre-attached to) a neck ring that forms the bottom of the helmet and that seals against the patient’s neck to prevent air from escaping. Ports in the hood allow the inflow of oxygen or air and the outflow of expired gas. Underarm straps that attach to the neck ring maintain the position of the helmet (which rises when pressurized). Patients wearing these helmets are conscious and can conduct many normal activities, such as talking, reading, watching TV or drinking. Respiratory assistance helmets have been used for several decades on patients receiving hyperbaric oxygen therapy. In the last decade or so, their use has been adopted in several countries for providing CPAP and other noninvasive ventilation therapies. This type of use accelerated during the COVID-19 pandemic, since the helmets are less invasive than intubation and can help prevent aerosolized particles from dispersing in the environment. ECRI published its ratings of four models in May 2021. (A fifth model

that ECRI tested was withdrawn before publication.) Most of the tested products performed well in ECRI’s testing and should serve the intended purpose, but the organization did identify important considerations for the safe and effective use of these helmets. CONSIDERATIONS FOR USE ECRI recommends that the use of respiratory assistance helmets be managed and monitored by trained respiratory care professionals, with the aid of respiratory monitoring devices, to prevent problems such as: • Overpressurization – Obstructions and restrictions in the gas flow path can cause the helmet to develop dangerous pressures. Built-in or add-on pressure-limiting devices, along with constant pressure monitoring with alarms, can help prevent this hazard. • CO2 rebreathing – Obstructions and restrictions in the gas flow path or insufficient flow rates can result in an accumulation of expired CO2 in the helmet. Constant monitoring of the CO2 levels at the output of the helmet can help prevent this hazard. The manufacturers should state the minimum flow requirements for the safe use of the helmet. • Leaks – Tears in the neck collar

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ECRI’s Ismael Cordero tested respiratory assistance helmets. One of the helmet models that ECRI evaluated is shown on the test mannequin (background) as it would be worn by a patient.

seal, loose connections, uncapped accessory ports and other conditions can result in leaks, which can reduce the therapeutic pressure levels. Leaks can also lead to aerosolized particles contaminating the environment, which is particularly concerning with infectious diseases and pandemics. Constant PEEP pressure monitoring with alarms can help prevent this hazard. • Asphyxiation – An obstruction of gas flow may lead to asphyxiation. Helmets should either have a built-in anti-asphyxia valve or be fitted with an external anti-asphyxia valve to permit the patient to breathe in gas from outside the helmet. • Unknown treatment pressure levels – Many commercially available PEEP valves are not designed to function accurately with the relatively high constant flow rates used with the helmets. As a result, the set PEEP value may be lower than the actual value. Constant PEEP pressure monitoring with alarms, and the use of PEEP valves that are not flow dependent, can help prevent this hazard. Other complications or hazards

associated with the use of these helmets include: • Claustrophobia – The patient may not tolerate being enclosed in the helmet. • Pressure sores and skin irritation around the neck – The neck collar seal may rub or press too hard on the neck. Correct seal sizing and placement, along with frequent inspection of the skin by caregivers, can help reduce this hazard. • Hearing damage – The gas flow rates inside the closed helmet can produce hazardous noise levels that can lead to hearing loss. The use of a bacterial/viral filter at the gas input and the use of earplugs can help reduce the noise to safer levels. ECRI’s patient experience volunteers all felt the helmets were too noisy when ear plugs weren’t worn. Another key consideration is that the flows needed to operate the helmets for CPAP therapy are relatively high ( >40 LPM) compared to other devices. Thus, Cordero cautions that “the widespread use of these helmets in a hospital needs to be considered in the context of the capacity of the hospital’s oxygen pipeline.”

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OUTLOOK Device approval status will be a relevant consideration affecting the future use of these products. Two of the models that ECRI tested were approved for use during the COVID-19 pandemic through an FDA Emergency Use Authorization (EUA). Two other models have FDA Class 1 approval for the intended use of providing air/oxygen mixes in hyperbaric chambers, but do not have approval for the treatment of respiratory distress or any other respiratory therapy. (The supplier of the fifth model that ECRI tested abandoned its effort to obtain an EUA or other FDA approval.) Whether U.S. hospitals will adopt the routine use of respiratory assistance helmets in normal times is uncertain. But, as Cordero notes, “facilities certainly have another option in their arsenal for treating respiratory distress during pandemics.” Additionally, these products are an option for providing CPAP and other noninvasive respiratory treatments to patients with highly transmissible airborne diseases. One interesting note from ECRI’s testing is that, despite some concerns about the helmets being a little claustrophobic, most of ECRI’s patient experience volunteers preferred the helmets to extended use of a CPAP face mask because the helmets allowed them to talk and read with less obstruction. To Learn More . . . This article is adapted from ECRI’s “Evaluation Background: Respiratory Assistance Helmets” (Device Evaluation 2021 May 12). The complete article—including model-specific test results and product ratings, along with additional guidance for purchasing and using these products—is available to members of ECRI’s Capital Guide, Device Evaluation, and associated programs. To learn more about membership, visit www.ecri.org/solutions/evaluation-and-comparison, or contact ECRI by telephone at (610) 825-6000, ext. 5891, or by e-mail at clientservices@ecri.org.

AUGUST 2021

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First Health Advisory BY ERIN REGISTER

Secondary Logo: available for documentation in which the primary logo is not a good option (based on size/space/etc) • Color_Stacked_Without Tagline

Q: HOW DOES FIRST HEALTH ADVISORY STAND OUT IN THE MEDICAL EQUIPMENT FIELD? irst Health Advisory began A: Our security and risk management 16 years ago to serve the solutions converge the processes, technoltechnology integration needs of ogy and data needed to gain visibility and health systems. ultimately trust in the devices used to • White/Black_Stacked_Without Tagline deliver safe and secure care. In our approach, people still make the biggest “As more and more data was being difference in the success of a program. created out of electronic health records People are the foundation of our solu(EHRs) and specialized ancillary tions, bringing clinical engineering and systems, the need to get accurate HTM know-how to reducing cyber risk the SECONDARY Logo on documents (physical/digital) in which the primary logo does not meet fit/sizehow it fits into information to the right places Use at the while understanding recommendations and in instances in which the primary logo does not fit with the aesthetic or theme of the design. right time became an essential requireQ: WHAT SERVICES DOES FIRST HEALTH patient and enterprise risk. Making sure ment for new initiatives involving the ADVISORY OFFER? all the technical, operational and financial exchange of information,” said First A: As health care entities constantly considerations in developing a security Health Advisory CEO Carter Groome. increase their reliance on devices that are program can provide the best outcome First Health Advisory – Quick Tips “This naturally led to understanding network connected computing devices, and experience for the patient is what we how medical devices were interacting and those devices are operating in a think about every day at First Health with these systems as they became more borderless environment, understanding Advisory. and more digitized and connected to the where your assets are, how they are network. As First Health Advisory behaving, if they are exposing your Q: DO YOU HAVE ANY SPECIFIC GOALS THAT became more aware of the security gaps patients and organization to risk and how YOU WANT YOUR COMPANY TO ACHIEVE IN and vulnerabilities in these devices, to address those challenges is an enterTHE NEAR FUTURE? clinical asset risk and assisting our clients prise undertaking. The responsibility A: As digital assets in the health care understand how best to reduce that risk cannot be ignored, and accountability setting proliferate, including wearable emerged as a prominent service, leading often falls upon the clinical engineering and in-home technologies, the interopus to where our focus is today.” and HTM departments. Our mix of erability of these devices and how TechNation learned more about First experience in the clinical engineering/ security and privacy factor in this Health Advisory in a recent interview HTM, IT, security, network and caregivtransformation will be a major focus with Groome. ing areas allows for a unique solution in for First Health Advisory. We aim to tackling this ever-increasing challenge. help health systems better manage all Q: WHAT IS THE MAIN FOCUS OF FIRST HEALTH First Health Advisory’s core capability is of these assets in a frictionless manner, ADVISORY? understanding how health care organizawhere all of the controls and security A: First Health Advisory specializes in tions can operate more securely and you implement does not impede clinical asset orchestration and risk efficiently. We are different because we innovation, ease of use and the management. We enable safe digital have combined the talent and experience provision of the best care possible in processes and secure practices in managfrom many disciplines in the health care any setting. ing the life cycle of the devices that are setting to tackle a major challenge as one, critical to the continuum of care, promotinnovating through the targeted managed For more information, ing patient safety and operational uptime solutions and collaboration options we visit firsthealthadvisory.com at the core of each engagement. provide.

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CURE BIOMEDICAL Q: TELL US ABOUT YOUR COMPANY CURE Biomedical is a Nevada-based HealthBill Lesch care Technology ManageOperations ment company founded in 2017. We currently work primarily in the Bay Area and are aggressively seeking to expand into new regions. With a focus on building long-term partnerships, we strive to find customer-based solutions for a multitude of HTM challenges. Q: WHAT DIFFERENTIATES YOUR COMPANY FROM OTHERS? At CURE Biomedical, we seek to broaden our expertise to meet the changing demands of the industry. With continuing advancements in information technology, cyber security, and equipment integration, we believe it is essential to provide a holistic approach to HTM, bringing departments together, to achieve a common goal. • For more information, visit cure-us.com.

Join us on our mission whether it’s to solve a similar equipment problem or making the world a better place, in our own small way! • For more information, visit pd1medical.com.

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AUGUST 2021

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BIOMED 101 BY DAVID SCOTT, CBET

ow are you doing? Funny I would ask that. The last year and a half has been a little crazy. Just wondering how you are making it through all of this. I think I can finally start to see the start of getting back to “normal” or at least the “new normal,” whatever that might be.

If you are a certified technician and are trying to get CEUs in this time period the way you do things has changed. There have been many Zoom or online learning sessions. I know GE Healthcare has a virtual learning class available for some of its technical training. In June, AAMI had its very first AAMI Exchange REWIRED. It was entirely online. From all reports I have heard, it went well. My local biomed association (Colorado Association of Biomedical Equipment Technicians or CABMET) has had virtual meetings. I have had perfect attendance! I never did that when it was in person. So maybe some aspects have been better. I don’t have to drive to the meetings. I can log in from home. I do miss seeing all the people that I know and talking to them in person. It’s just not quite the same with an online meeting even though I can see their video feed. I don’t know about you, but I find it difficult to do these sessions. I may be alright with an hour or so, but I can’t imagine an entire day of online classes or meetings. Maybe I am just not used to that? It is better if it is recorded so you can always go back and listen again if you get sidetracked somehow.

I know the TechNation Webinar Wednesdays have been a blessing in these crazy times, not only to get CEUs but to keep up with the “outside world.” It makes it a little easier knowing that everyone is going through the same thing. I have talked to some other health care workers who have to do continuing education for their jobs. X-ray techs are who I have mainly talked with. They have been able to do correspondence classes. They are sent modules to complete and get a certain CEU value from completing each of these courses. Many of them do this even during “normal times.” There is a cost associated with these courses. Just like many things in life – nothing is really “free.” During the COVID-19 shutdown, TechnNation has not shut down as much as some of the others. I have attended MD Expos in Tampa and Dallas. I felt safe and thought proper precautions were taken at each of the MD Expos. August is here, and we are seeing many things return to normal. By now, most people that are going to get the COVID-19 vaccine have already gotten it. Most places no longer require masks. Outdoor events are just like they were before. In August, CABMET is having its first in-person event in over a year. I can’t tell you how excited I am for this. It will be good to have live events back. I will be able to get CEUs toward certification renewal and see people in person. Looking ahead a little bit more is the

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

David Scott CBET

MD Expo Las Vegas (MDExpoShow.com). This is being held the first few days of November. From reports I have seen, Las Vegas is back to normal and open for business. I was watching the local news this morning in Denver, and they had a story on the top places people wanted to visit in the U.S. Denver was number three behind Vegas and Seattle. Vegas was number one! I encourage you to attend the MD Expo in Las Vegas. Get there a little early or stay a little later to do all the normal Vegas stuff. I’ve heard Las Vegas has some crazy Halloween events. Check it out. I think it’s going to be one of the best MD Expos ever! I think it will mark a return to normal that we all have been looking for. The TechNation team always does an excellent job at making everyone feel welcome at these events. If you see me there, please say “Hi.” Until then, keep doing what you do best! DAVID SCOTT, CBET, is a Senior biomedical technician at UCHealth.

AUGUST 2021

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TOOLS OF THE TRADE Global Technology Systems

UPS Systems Replacement Batteries

lobal Technology Systems (GTS) has announced the introduction of a complete line of replacement batteries for APC and TrippLite uninterruptible power supply (UPS) models.

GTS’s UPS replacement batteries are: • Designed for use with APC and TrippLite UPS models • 100% OEM compatible • Shipped fully assembled with new cables, connectors and components • Hot-swappable, user-replaceable, maintenance-free • Significantly lower in cost than the OEM • Assembled in the USA, making them TAA compliant Each GTS UPS replacement battery assembly comes with a best-in-class 24-month warranty, exceeding the industry standard by 12 months. GTS also includes simple installation instructions, as well as information on proper recycling of the used battery. “Virtually every organization must use UPS systems to protect its critical data and operations. Millions of these UPS’s are in operation 24/7,” said Scott Carlson, director of

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

product management and development, GTS. “But over time, the batteries lose their ability to hold a full charge. This can lead to shorter runtimes, costly downtime and data loss. Timely replacement of these batteries is imperative.” “Many organizations don’t realize UPS batteries are replaceable. And those that do, actually replace them randomly and without a plan. They often replace them too late, and spend too much money in the process,” GTS CEO Larry Murray added. “Now we can provide our customers with a single, perfectly matched replacement UPS battery or a plan for timely replacement of thousands of batteries enterprise-wide. And at the same time, we can provide them with important operational and budgetary savings.” For more information, visit gtspower.com or email sales@gtspower.com.

AUGUST 2021

TECHNATION

THE BENCH

WEBINAR WEDNESDAY

Sessions Deliver Valuable Knowledge STAFF REPORT

PROTECTING MEDICAL DEVICES The Webinar Wednesday presentation “Navigating the Challenges of Protecting Medical Devices by Applying a Zero Trust Security Strategy” was eligible for 1 credit from the ACI. In the Cynerio-sponsored webinar, cybersecurity and systems engineer expert Micha Burd, vice president of product management at Cynerio, discussed how biomedical/CE teams and their IT counterparts can tackle the challenges of securing medical and IoT devices quickly and safely with a Zero Trust strategy while ensuring patient safety, data confidentiality and device availability. Burd provided in-depth information regarding the challenges of applying IT security solutions to medical and IoT devices. He also discussed the principles of Zero Trust Security and best practices for applying Zero Trust security in health care environments. Burd also answered questions from attendees. One question was, “Are some medical devices more vulnerable than others? And, how do you determine what to secure first?” “Obviously, there are some medical devices that are more vulnerable. Usually, those devices are devices that are running a legacy operating system, and the reason for that is because there’s no updates for those devices. We don’t have anything to do from the device-level perspective,” Burd said. “The idea of network access control tools is to put compensating controls on this device in order to mitigate the risks.”

TECHNATION

AUGUST 2021

Regarding what to secure first, Burd said, “So remember I spoke about the bottom-up approach and top-down approach. My advice to you is to look around, understand what type of attacks there are in space and then what type of exploits are being used. And understand the relative or the relevant vulnerability of those exploits and start with those.” “Because once you get hit with those kinds of popular malwares, you want to make sure that they are blocked from moving within your network, because you already covered those specific vulnerabilities,” he added. Attendees provided feedback via a survey that included the prompt, “Give us 3 words to describe today’s webinar.” “Appreciated, knowledgeable, enjoyable,” Principal FSE H. Tucker said. “Showed real solutions,” Field Service Specialist 2 J. Velazquez said. “Pertinent, informative, insightful,” Clinical Engineering Manager P. Graham said. CYBERSECURITY REQUIRES TEAMWORK The presentation “Bringing BioMed and Security Together to Take Control of Your Medical Devices” was presented by Rich DeFabritus, a senior director of product marketing. It was eligible for 1 credit from the ACI. It was sponsored by CyberMDX. DeFabritus discussed ways HTM professionals can improve device visibility and leverage centralized management to support a hospital’s initiatives and integrate them into the overall cybersecurity strategy. Biomedical engineers responsible

for healthcare technology management make significant decisions that affect their hospital’s cybersecurity posture. Whether it is procuring new medical devices, managing device end-of-life or connecting devices to the network, they make critical decisions regarding device security, data integrity and patient safety. In this webinar, some of the challenges facing biomedical engineers – from procuring devices that have potential vulnerabilities to lack of device visibility and centralized management – and how to support their initiatives and integrate them into an overall cybersecurity strategy were addressed. The webinar also included a question-and-answer session. One question was, “Do you think cybersecurity teams and biomedical teams are collaborating on life cycle management? And what equipment should they procure or obtain?” “So, I kind of talked a little bit about that during the presentation, and what I would say is, I’m encouraged to see that it’s happening more,” DeFabritus said. “I think this is happening, you know, out of necessity. I think if hospitals are dedicated to the security side of things, you will certainly see it now. Now, I’m going to ramble a little bit. And I don’t want to make the answer too long. But recall that I had mentioned early on that, if you were to look at, you know, there’s 6,200 hospitals in the United States, roughly, you know, maybe 300 have a dedicated security team. The first thing that has to happen is the C-suite or the executives have to take cybersecurity very seriously. They have to

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invest in it. They have to make sure that there’s backing for those teams. And then, when they do have that, I think the biomedical teams and security teams can collaborate a lot better.” “What’s more likely, you’ll see, is it’s like an ad hoc security team that doesn’t really have the backing of the management. And things are a little bit loose,” he added. “But I’m encouraged to say that it’s changing, but maybe not fast enough.” The webinar included 82 attendees for the live presentation. Participants provided feedback via a post-webinar survey that included the question, “What do you like best about the Webinar Wednesday webinar series?” “Very good insights about security. Grateful for the opportunity” Senior BMET S. Rivera said. “The webinars are available to watch from any place that has web access and be able to ask questions, make comments, etc. They are convenient, informative and can gather listeners from around the world,” said P. Bozin, BMET II. “Interesting demonstrations from a variety of product categories,” said C. Baber, BMET. “Sharing of the speakers’ experiences,” Director G. Perry said. SECURITY EVENT RESPONSE AND REMEDIATION The presentation “Response and Remediation of Medical Device and Facilities Security Events” was eligible for 1 credit from the ACI. It was sponsored by Nuvolo. The session was presented by a trio of experts in Keith Whitby, section head healthcare technology management, cybersecurity and operations of Mayo Clinic; Tony Bailey, director of product marketing OT security of Nuvolo; and Benjamin Stock, director of healthcare product management, Ordr. In this 60-minute webinar, the experts focused on why operational technology (OT) security’s top priority

is response and remediation using an intelligence hub made up of device information such as the device owner’s name, what the device is used for, its location and security monitoring information. They covered how this intelligence hub works with a workplace management system to dispatch and track the response across potentially hundreds of devices. It is critical to know everything about medical devices and facilities systems because if a security exploit impacts a device, HTM professionals need to quickly coordinate to dispatch the right person with the right remediation steps. The presentation shared additional information during a question-and-answer session. One question was, “Is Mayo Clinic able to improve their HTM team productivity with the CMS plus IWMS approach that you mentioned earlier?” Whitby answered this question. “I would say absolutely. Everything we do, we do with an eye on maximizing efficiency within our organization,” he said. “Again, I’ll mention that it’s been a very valued partnership with both Ordr and Nuvolo because both organizations are really helping us via the tools that they provide to ensure that we’re able to accomplish this ‘new work’ without a massive increase in the number of staff that we have within our organization.” “To put this into context,” Whitby added. “When we’re talking about the volume of vulnerabilities that have occurred, even over the course of the last year, you know the BlueKeep, DejaBlue, the Ripple20, and on and on and on. All of those vulnerabilities equate to some level of effort or work that needs to happen as it relates to our medical equipment, our fleets or our OT fleets. What we’ve been able to do with the tools that we have is really streamline the amount of time and energy and effort that we’re expending. Number

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

one, matching our fleets to figure out what’s impacted by these particular vulnerabilities, but also to complete the work and to track the work. So, I would say, absolutely we’ve been able to improve our team productivity with the solution that’s been described.” Almost 100 people joined the live presentation with even more watching an on-demand recording of the webinar. Attendees for the live presentation provided feedback via a post-webinar survey that included the question, “How will today’s webinar help you improve in your role?” “It was a good reminder to keep an eye on new equipment that has entered the facility that may pose security risk,” Tech T. Forsch said. “We are looking for a new CMS in the future and I am looking to understand all the options,” Clinical Engineer K. Ferguson said. “It provides another avenue to managing networked medical devices. Until this presentation, it never occurred to me that a parking gate could compromise our hospital network,” Biomedical Manager R. Bueckman said. For information, visit WebinarWednesday.Live. Thank you to our sponsors:

AUGUST 2021

TECHNATION

THE BENCH

SHOP TALK POWERED BY

LUMENIS VERSAPULSE POWERSUITE 80/100W

At first, I had the laser connected to a 220V step up transformer. Sometimes it would turn off due to the step up transformer not having enough power for the laser, but sometimes it would stay on and go through the screens with no issues. I decided not to run the laser until we hooked it up to a True 220v line that we were thinking of hooking it up to. So, the issue that I am having now is that after adding the distilled water to the reservoir due to low level of water, I turned on the machine, and now I’m getting a red screen with a message that says “Casesaver Feature” activated. I clicked continue and it went to the laser control screen, but with limited power. So, I decided to run the true 220V line to our basement to run the machine directly to a 220V line, but when I turned it on, that “Savecase Feature” mode was still popping up. Does anyone know how to disable “Savecase Feature” mode?

The case saver feature does not turn off. The PowerSuites have 4 heads internally that together make 100W of holmium laser. When one or more of the heads is not

functioning efficiently enough, the laser runs at limited power. If the max is 60W @ 40Hz, then 1 head is down. If 30W, then 2 heads are down. Open up the laser and check the rods and mirrors. REPLY: Thanks for the info. What am I looking for when checking the rods and mirrors?

10 minutes until it shuts down randomly. I don’t get any error messages from the device. I am wondering what the problem could be because the seller who sold me the device has no idea. Could it be an overheating problem (I have cleaned the filter and fans, everything is working) or is it the power supply or something else?

Any kind of optical damage. They will appear as spots/ burns. Typically, in order to cause it to go into case saver, the spots will be greater than or equal to 1 mm in diameter. Also, the laser’s burns should be round 4 mm spots. If they are slitted like a cat’s eyes, that could also be an issue. If that is the case, then alignment is required. GE LOGIQ E BT12

I have been using the Logiq e BT12 which I bought refurbished a year ago. A couple of days ago I started having this problem where the machine will shut down randomly after 10 minutes of being on and it will be very hot. I couldn’t try to turn it back on immediately. I have to wait a bit. I take out the battery and put it back in and then it works again but, of course, for only

There are several things that can get hot in a Logiq e. Some of them, like the DC-DC power supply and TMST board, should give a warning before the system just shuts down. We have seen hard drives that run very hot before they fail completely. The fans are critical for cooling the system. There are two fans on the left side near the front of the system and two on the right side in back of the probe connector, and it is possible that one or more of them is not turning.

SHOP TALK

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

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AUGUST 2021

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AUGUST 2021

TECHNATION

ROUNDTABLE

ROUNDTABLE Radiography

or this month’s roundtable article on radiography, several original equipment manufacturers (OEM) were able to share insights, as well as a third-party service provider. Those participating in the discussion are Rob Fabrizio, director of strategic marketing, digital radiography and women’s health, FUJIFILM Medical Systems U.S.A. Inc.; Mark Lothert, MD, head of product management, service business management, Siemens Healthineers; Steve Romocki, worldwide product line manager for radiology systems, Carestream Health; Jason Schneck, president and general manager imaging, U.S. and Canada, GE Healthcare; and Medical Equipment Doctor Operations Manager Tara Stack.

Q: WHAT ARE SOME OF THE NEWEST FEATURES IN RADIOGRAPHY EQUIPMENT THAT FACILITIES SHOULD CONSIDER WHEN PURCHASING EQUIPMENT? FABRIZIO: Medical imaging vendors today are increasingly innovating digital radiography (DR) equipment to maximize workflow efficiency, provide exceptional image quality at low dose for patient safety and improve patient experiences. Facilities looking to purchase new X-ray equipment should be considering all of these factors to

TECHNATION

AUGUST 2021

image quality for all types of images acquired at lower and lower doses. It’s also important that the detectors are as lightweight as possible for easier and safer positioning for technologists and higher durability. Detectors with tapered edges and smooth surfaces help technologists more easily slide them under the patient. Also important, especially in this day and age, is that they come equipped with antibacterial coating for additional patient safety in infection controls. Rob Fabrizio FUJIFILM Medical Systems U.S.A. Inc.

ensure they are driving more accurate diagnosis and better, safer patient outcomes. Today, Fujifilm’s DR detectors are engineered with patented Irradiated Side Sampling (ISS) technology and noise reduction circuitry to reduce noise in ultra-low dose images to improve image quality and detail. The two technologies combined complement each other to perform better with low dose and low penetration exams from the smallest to the largest of patients and anatomy. Additionally, image processing technologies push dose efficiency even further, like Fujifilm’s Virtual Grid and Dynamic Visualization, also help produce exceptional

LOTHERT: Increasingly, automated positioning features that first appeared on premium radiography systems are migrating to mid-tier and value-tier systems. The reason: Health care providers are being asked to do more with less staff, and equipment automation is one way to do that. Also, more 2D and 3D cameras are being incorporated into the tube head. And since artificial intelligence (AI)-based features use these cameras routinely, facilities must ensure that these cameras function optimally. ROMOCKI: There has been tremendous progress in improving and automating workflow to increase productivity and image consistency. Carestream offers new AI-based smart features for our DR rooms that help optimize workflow for

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ROUNDTABLE

radiographers and increase efficiency; and help improve image consistency, patient communication and reduce retakes. DR detector technology also is evolving. Our new Lux 35 Detector is glass-free and lighter weight: weighing around 5 pounds. Its lighter and more ergonomic design makes it easier for radiographers to transport while making rounds and performing bedside exams and is more comfortable for patients. SCHNECK: Many of the newest features across radiography equipment are digital enabled applications and AI embedded into the systems that help standardize and improve clinical workflow. Faster and more consistent imaging that increase the effectiveness of clinical decisions and patient experience across the enterprise. STACK: The goal of medical device technology should always be patient safety driven, especially with radiography equipment. Radiography devices that provide the lowest radiation exposure without compromising image quality should be a priority when considering the purchase of new equipment. Imaging devices that help manage radiation dose can help facilities protect their patients and could provide a competitive edge compared to other health care organizations. Other factors to consider are the overall image quality, speed and efficiency of the equipment, and ease of use for the technicians. I have seen facilities spend a lot of money on radiography equipment that was never put into service because the staff could not figure out or didn’t feel comfortable using the new equipment. The last area to consider before purchasing new equipment is the post service costs and available support after the warranty expires. How much is an annual service contract? Are the parts proprietary to the manufacturer or are parts like the X-ray tube available on a third-party market? Does the manufacturer provide service training

and offer a variety of service agreement levels that include co-op agreements? Can a third-party company support the device? Q: HOW CAN FACILITIES OVERCOME BUDGET CONSTRAINTS WHEN IT COMES TO ACQUIRING RADIOGRAPHY DEVICES? FABRIZIO: DR may be more affordable than one would think. There is a ton of competition in the DR space today, which has helped make it more affordable compared to when they first came to the market. There are plenty of cost-savings benefits that come with new DR. For instance, workflow is faster and detectors are easily shareable so you can do more with less. Another consideration is that many systems such as new RF rooms, C-arms and CT systems, for example, are being designed for multipurpose uses to expand capabilities and maximize return on your investment.

Mark Lothert, MD Siemens Healthineers

LOTHERT: Facilities should clearly identify the standard features they require in any radiography system to satisfy their unique needs. Reducing optional features will lower total system costs. ROMOCKI: Facilities should look for scalable, upgradeable rooms – like our budget-friendly DRX-Compass, that

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will meet their changing needs. The DRX-Compass offers a bridge for health care facilities looking to move from an analog or retrofitted X-ray room to a digital system, and now includes a floor-mount option for sites that are unable to accommodate an overhead tube crane. Shareable detectors can be shared with any DRX equipment allowing facilities to share and move detectors to where they are needed most. Additionally, lower-cost detectors provide an affordable way to upgrade to wireless digital imaging. SCHNECK: There are many new acquisition models that are emerging across the industry to address budget constraints that exist. Software purchased as a subscription model is helping reduce upfront acquisition costs while ensuring technology stays up to date with the most current software applications throughout its life cycle. Some providers are also moving toward managed equipment relationships that spread out capital expenditures over long term relationships with a commitment to keep technology current through upgrades and agreed-upon replacement schedules. STACK: Radiography devices should be profit centers for health care organizations. When you are planning to acquire a new radiological device, a business plan – including the expected ROI – should be established. The business plan should include answers to questions like: Will this device increase the volume of patients daily? Does the new device/technology improve patient outcomes and patient experiences? What is the insurance reimbursement for the procedures that can be performed on this device? Can the facility establish a new clinical program that will give the organization a competitive advantage over competitors? Another area to consider for budget constraints are units on the third-party market that are completely refurbished and still able to be serviced and supported. Some

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third-party organizations provide leasing options that can work in your advantage while your clinical program is being established. Q: WHAT SHOULD ONE LOOK FOR IN AN X-RAY/ RADIOLOGY SERVICE PROVIDER? FABRIZIO: It’s important that providers look to purchase equipment from a trusted vendor with an excellent reputation first and foremost in reliability, and then in service as well. Reliable equipment costs less to maintain and OEM service contracts have become more affordable. FUJIFILM Medical Systems U.S.A. Inc. takes service seriously, our service and applications personnel, our parts division and our Technical Assistance Center (TAC) have achieved certification under the prestigious Service Capability & Performance (SCP) Standards program. SCP Standards quantify the effectiveness of customer service and support and represent best practices in the industry. Every day we strive to deliver worldclass customer service and support, and passing the rigorous requirements necessary to achieve SCP Certification is confirmation that we are succeeding in this mission and achieving high levels of customer satisfaction. It’s also important that a radiology service provider is a one-stop shop for its customers. For instance, our service and our customer’s biomed engineers are factory trained side by side. We stock the most common spare parts and our parts are available for fast overnight shipping. We also offer Active Line Remote Services, a system that is designed to monitor and anticipate system malfunctions before they happen. This valuable functionality can help prevent downtimes, in-person service visits and simplify visits when they are needed by helping identify needed parts before a service engineer is dispatched. LOTHERT: The one-size-fits-all services contract doesn’t always work; facilities should look for flexible service options. An imaging system’s criticality with

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respect to the entire fleet as well as its hours of operation, redundancy level and clinical use influence the choice of service contract. Also, the service provider should offer continuously trained OEM service engineers and ample geographical coverage, as well as be able to escalate issues beyond a 1-800 number. The facility should have access to value-added services such as asset management solutions (for example, system performance information), with potential integration into a hospital’s computer maintenance management system. And lastly, the service provider should offer multiple methods of educating technologists.

than just maintenance and repair. A significant part of providing service is consulting and helping health care organizations with important factors like ACR accreditation. Without ACR accreditation, which proves you have a quality radiology department, your organization will not receive Medicare reimbursement. A service provider should offer programs that will help your organization obtain the maximum profit and provide the best patient care possible from the imaging devices. That includes up-time, parts availability, remote diagnostics, reliable on-site service, regulatory compliance and assistance with accreditation.

ROMOCKI: Look for a supplier that has a robust portfolio of products to choose from and a comprehensive roadmap to bring new capabilities to the market, including the ability to leverage future applications like artificial intelligence. Also ask about standardization of software and equipment. Often, radiologic technologists move among different pieces of equipment within a facility or network of facilities. Having a consistent user interface for mobile and/or room-based imaging systems not only reduces the training required, but also enhances productivity and ease of use. Lastly, ask about their applications training that can help you optimize your use of the product’s features; and service options to keep your equipment running smoothly.

Q: WHAT STEPS CAN BE TAKEN TO FACILITATE FUTURE UPGRADES?

SCHNECK: Depth of resources and capabilities are important when choosing a service partner to ensure any equipment downtime is minimized. Also consider the ability to do remote diagnosis and service of issues. The ability to predict equipment failures and resolve issues by remotely monitoring equipment performance enables a service provider to resolve an issue and prevent a hard-down emergency service event before it occurs.

FABRIZIO: I highly recommend that providers look to purchase from vendors who offer simplified and consistent user interfaces across multiple imaging systems. Whether a provider purchases a DR portable, a retrofit to an existing room or complete X-ray room, the user interface should be the same. This allows for less upfront training and once technologists know how to use one system, they can easily move to the next with little to no training.

STACK: X-ray service providers should be partners and they must provide more

LOTHERT: The facility should not only make sure that continuous soft-

Steve Romocki Carestream Health

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ware-based updates and frequent upgrades are an integral part of their service engagement, but also that options and upgrades (for example, specific computer hardware upgrades) are available outside a contract’s parameters. And, since every system eventually reaches its limits from an upgradability perspective, the facility should ensure that the service provider offers attractive equipment replacement programs. ROMOCKI: The first step for facilities is to identify and incorporate growth scenarios into their long-term planning and design. Additionally, they need to develop projections for their service and uptime requirements based on their facility type, equipment utilization and degree of equipment redundancy. They also need to examine any shifting trends in the demographics and needs of their patient base. The foundation for a future-ready strategy emphasizes modular capital purchases and professional services to reduce risk, and to increase flexibility and adaptability to change. SCHNECK: There are non-obsolescence offerings across the industry that provide for upgrades and updates as part of a contractual commitment. Upgrades can also be offered in parallel with ongoing service agreements or purchased independently. Certain software subscription models ensure operating systems and applications stay current throughout the life of the system. STACK: Upon purchase of any X-ray device, the facility should determine if software upgrades can be purchased outside a service agreement and understand the associated costs. The life expectancy of the device is a factor with upgrades. How long will this device work before upgrades are needed? When examining the reliability of the device, one thing to consider is how many upgrades have been required since the device entered the market. How

many were due to product recalls? Understanding these factors can help determine the reliability of the device and the need for a service agreement.

needs. Also, adopting AI-based product features/technology can help a facility accelerate transformation, while improving diagnoses and patient care. SCHNECK: It is important to evaluate the total life cycle cost and clinical capability of the device when evaluating options. Serviceability, technical training and applications support should be important considerations to evaluate in addition to feedback from clinicians.

Jason Schneck GE Healthcare

Q: WHAT ADVICE WOULD YOU GIVE A BIOMED INVOLVED IN THE PURCHASING OF A FACILITY’S RADIOGRAPHY DEVICES? FABRIZIO: A facility’s biomed should look for products that are reliable and easy for staff to use from vendors that are experienced with integrating with various other vendors’ equipment and enterprise systems. Last but not least, biomeds should look to vendors with consistently reliable equipment, quality training, 24/7 support and fast parts availability. LOTHERT: Consider remote diagnostics and break/fix capabilities to support biomed efforts. Evaluate the ease of ordering OEM spare parts. Consider the quality of the OEM’s training capabilities and whether they offer an enterprise-level approach with a holistic plan to train biomeds beyond radiography. And finally, determine whether asset information can be integrated into the hospital computerized maintenance management system (CMMS). ROMOCKI: To facilitate future upgrades, radiography equipment should be scalable to meet a facility’s changing

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STACK: All medical device purchases should have a failure mode and effects analysis performed before committing to the purchase. How many recalls, adverse events, upgrades and safety alerts has the device had since it was made available on the market. What is the prediction of failure? From a cost perspective, is this unit available on the third-party market and are there parts available? What is the cost of the service agreement and is there technical training available? Can this unit be serviced on a third-party market at a reduced cost? Can a cost-effective service delivery plan be established? Are loaners available to minimize down time? Q: ARE THERE ANY CYBERSECURITY ISSUES HEALTH CARE SYSTEMS SHOULD BE AWARE OF REGARDING RADIOGRAPHY DEVICES? FABRIZIO: In many cases, imaging acquisition workstations can be more isolated from threats by being configured on a closed network and limiting the data communicated. Nevertheless, these systems require all of the same requirements to protect data and access. Controls are built-in for encrypting drives, two-way handshake authentication for device communication, customizable authentications, secured login, auto logoff, audit controls, secure application of patches and updates, health data de-identification, backup and disaster recovery, physical locks and, of course, malware detection and protection.

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LOTHERT: Any product with software components that is connected via a network or through data ports can be vulnerable. The best defense starts with educating users and involved parties as well as restricting user access. Network-based cybersecurity solutions with scanning capabilities and vulnerability assessments as well as product-based virus protection solutions should prevent malicious attacks, although no form of protection is 100 percent guaranteed. ROMOCKI: Cybersecurity is always a priority, and we strongly recommend that customers keep current with upgrades to software. Our ImageView software is built on Windows 10 which offers several cybersecurity advantages such as intrusion detection and prevention, two-factor authentication for secure login options and encrypted Data in Transit ( DIT) for network communication and Data at Rest (DAR) hard drive protection. SCHNECK: The health care industry is one of the most impacted industries from a cybersecurity risk and threat perspective. The average cost of a data breach is now greater than $7 million. As technology in the health care domain continues to grow and more devices become smart-connected-networked devices, the threat of such risk is expected to increase. Radiography devices are not immune to this growing threat and, depending on a number of factors including age of a device, configuration, network topology and more, they can pose a potential cyber risk if they’re not proactively managed from a medical device cybersecurity perspective from the time of onboarding through the device life cycle. STACK: There have been reports in the past about cyber intrusion from nuclear med cameras and IT departments not

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perform a major “forklift upgrade” to acquire new features and functionality. The facility can simply add new features – such as AI-based collimation – on an as-needed basis as they become available, much like an app store.

Tara Stack Medical Equipment Doctor

been factoring in their remote access. Any medical device that is integrated to a computing system, storing electronic health information or software that controls the functions of the device is at risk for cybersecurity issues. Keeping the operating systems updated with the newest vulnerability patch and developing plans to detect abnormal communication traffic between the hardware is a must. Including your radiography equipment in your cybersecurity plan is absolutely essential for the safety and security of your organization. Q: WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT RADIOGRAPHY EQUIPMENT? FABRIZIO: Medical imaging facilities that are looking to purchase new radiology equipment and systems should consider partnering with vendors who are constantly innovating and expanding their product offerings and not just making “me too” products. Partners that focus on what’s important to patient safety, user workflow and accuracy.

ROMOCKI: In addition to hardware, consider the role of software when choosing your X-ray room equipment. Image processing software is evolving considerably through the application of advanced algorithms and AI. So your choice of X-ray room equipment and DR detectors needs to support advanced software to take advantage of innovative imaging applications like options for smart noise cancellation, pneumothorax visualization, dual energy and digital tomosynthesis. Make sure the equipment you choose today can support future advances – otherwise your imaging equipment might become obsolete too quickly. SCHNECK: The radiography equipment market is very dynamic with new digital and AI enabled software applications taking image quality, speed of exams, patient experience and clinical workflows to an entirely new level. STACK: When radiography was first introduced to health care it was considered a miracle. The impact of a well-planned radiology department is crucial to the success and stability of your facility. It is important to understand the new technology available, and to develop care plans based on that technology. If you work in imaging or service imaging equipment and have not been to the RSNA convention, you should plan to experience it. New technology is always on display, and you can witness new miracles about to happen right before your very eyes.

LOTHERT: Some newer radiography systems don’t require the facility to

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COVERSTORY

BIOMEDS ON A MISSION

HTM VOLUNTEERS MAKE A DIFFERENCE BY K. RICHARD DOUGLAS

f the year 2020 is deserving of nothing else; it will go down in modern history as the year that brought focus to the plight of people needing help.

It is a need manifested in many ways. There was widespread demand for addressing the medical needs of people; often serious medical needs. There was the need for personal protection equipment (PPE) and other supplies needed by medical personnel. There was the need to look after those who were isolated, including the mental health of children. Somebody had to address all of these needs in the face of an international pandemic that has impacted the lives of every person on Earth. In addition to the new set of concerns raised by the COVID-19 pandemic, there were the existing health care needs of people in

developing countries that were intensified with the onset of transmission of a dangerous virus. Many charitable organizations already exist to provide specialized medical treatment to people in developing countries, provide medical equipment and expertise or prepare medical equipment for its next chapter. These organizations have a challenging mission in a good year. Throw in the numerous complications that arise from a pandemic, and the response to it, and the effort to help patients and health care providers becomes problematic. Still, they have adopted mitigation measures and pressed on. Some organizations who rely on the talents of biomeds include MedShare, Medical Missions, Operation Smile, MedWish and Mercy Ships; to name a few. Members of the healthcare technology management (HTM) community have already made a difference by volunteering with these organizations and others. The skill set that biomeds possess is desperately needed when medical equipment is the difference between life and death in places that can’t afford to staff enough biomedical professionals. Volunteers should be aware that there are still COVID-19 protocols that exist with most organizations, depending on location. For volunteer opportunities that are U.S.-based, many charitable organizations have mitigation requirements that reflect those of the local municipality. International opportunities require more safeguards because infection rates vary widely depending on the locale. It is best to consult with the charitable organization ahead of time

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and be aware of requirements. BIOMEDS NEEDED Biomeds are needed by charitable organizations to repair, calibrate, inspect and install medical equipment that is often donated. Sometimes, the skills of experienced biomeds are also needed to train local biomeds, who have less experience. “Biomedical technicians ensure that we can bring state-of-the-art medical equipment to even the most rural and remote hospitals,” says Operation Smile’s website. The organization has hosted volunteers from more than 80 countries and works in 34 countries to provide surgeries to children born with a cleft palate or cleft lip. The surgeries that the organization provides can help a child with eating, breathing and speaking. The organization provides care to more than 19,000 children every year. Operation Smile also helps local health care professionals through training and education. Some of the qualifications the organization looks for in biomeds include: a minimum of one-year experience in the operating room or a minimum of three-years’ experience in non-OR setting, hold a related degree and/or certifications (CBET recommended) and registered in specialty (as applicable by country/profession). The June 2020 Professional of the Month, Kenneth Shearer, CBET, CET, provided some insights into volunteering as a biomed with Operation Smile. “I was in charge of all the equipment that we brought. I had to unpack and check all the equipment, set up the OR rooms, manage the gases and pack all the equipment

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back up when we were done. They were long days,” he said. He helped out in all areas from transporting patients to running for supplies. “I helped out wherever I was needed. I even helped the local biomed of the host hospital fix their equipment,” Shearer explained. According to its website, “MedWish International is a not-for-profit organization that saves lives and the environment by repurposing discarded medical supplies and equipment to provide humanitarian aid to people in need.” The organization’s site says that “MedWish repurposes unused medical supplies and equipment, while promoting better health and environmental stewardship.” MedWish works with health care partners in Northeast Ohio to recover usable medical surplus. They are based in Cleveland. Recently, the organization rallied to collect oxygen concentrators to send to India as the country faced a massive COVID-19 surge. Contact them for volunteer opportunities. Like MedWish, MedShare puts unused medical equipment and supplies to good use to help patients in medically underserved areas. The organization’s website states that they are “dedicated to improving the quality of life of people, communities and our planet by sourcing and directly delivering surplus medical supplies and equipment to communities in need around the world.” “We have a need for clinical or biomedical engineers in all the various specialties including servicing and maintaining all medical equipment with mechanical, hydraulic, pneumatic, electronic, digital, optical and radiological principles,” says Eben Amstrong, director of biomedical engineering training and technical services at MedShare in Decatur, Georgia. He says that the organization can use clinical or biomedical engineers who can also perform calibrations and preventive maintenance, inspect

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Sheryl Forward, medical recruiter for Mercy Ships equipment for serviceability, perform operational checkout procedures, troubleshoot and isolate malfunctions, replace and repair defective components, install medical equipment considering power and safety requirements and record all services performed. There are a number of ways that the skill set of an experienced HTM professional can help the organization. “To evaluate equipment for donations as required by World Health Organization (WHO) guidelines. Troubleshoot, repair, service, maintain and inspect the performance of donated medical equipment to ensure accuracy,” Amstrong says. He says that biomeds can also help the organization by converting equipment to the appropriate voltage, temperature, weight, etcetera as required by the receiving country (recipient) and by carrying on safety tests using a safety analyzer to prevent potential hazards and to ascertain to include with each piece of equipment all the necessary accessories/consumables. Amstrong also says that biomeds are needed to prepare, clean and bubble wrap equipment for shipment as well as to help with the international training of end-users and biomedical technicians, along with repairs and installations of donated medical equipment. Medical Missions Foundation’s “mission is to provide surgical and medical care in underserved communities throughout the world and to positively impact the lives of children and their families.” Among the organization’s objectives are to provide surgical and medical care for children and adults and to provide donated medical

Pam Shuck, MS, CCE equipment and supplies to economically depressed areas. Additionally, the not-for-profit provides medical training to local health care providers. There is a need for volunteers in the metro Kansas City area. Visit their website to learn more. VOLUNTEER FOR A FLOATING HOSPITAL Mercy Ships brings us the sad reminder that globally; one child in eight will die before age five. The organization deploys hospital ships to reduce this grim statistic. The organization has launched five hospital ships to accomplish its mission. In the past, it was the Good Samaritan, the Caribbean Mercy and then the Anastasis, that sailed until 2007, which was replaced by the Africa Mercy, which provides medical services today. The newest hospital ship, the Global Mercy, “will be the world’s largest civilian hospital ship, capable of more than doubling our current surgical and training capacity,” according to the organization’s website. The Global Mercy is expected to set sail and be put into service in sub-Saharan Africa in 2022. As an organization that brings important medical services to underserved areas of the world, they use doctors and nurses to perform surgeries on the ships and teach medical professionals on the ground. Mercy Ships primary focus is Africa. This requires medical equipment, and by extension, skilled biomeds. The organization is focused on filling the role of Biomedical Project Assistants currently and then the Biomedical Technician role in the second half of 2022. “In Antwerp, the Biomedical Project Assistants will be key in the final preparations of the equipping phase for

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COVERSTORY our brand-new ship; the Global Mercy. This project is focused on initial setup and deployment. The Biomedical Project Assistants will be responsible for deploying all medical equipment used in the hospital including, but not limited to, radiology, pharmacy, operating rooms, clean core, intensive care units, simulation training rooms, pre- and post-operative rooms, wards, nursing stations, and sterilization decontamination rooms,” says Sheryl Forward, medical recruiter for Mercy Ships. She says that on the African Mercy and Global Mercy in 2022, those filling the biomedical technician role will be a part of the hospital team as they offer specialized surgical care to the people of Senegal. “The biomedical technician will perform preventative maintenance of medical equipment as directed by the senior biomedical technician. They are a vital aspect of the team and are needed to ensure the equipment is working properly so we can provide the highest level of care possible to our patients,” Forward says. As a precaution to prevent the spread of COVID-19, the Mercy Ships organization has to continue to observe mitigation procedures. “Before boarding the vessels in Antwerp or Senegal, there will be a quarantine period at a local hotel. Mercy Ships will cover this cost. At this time, it is mandatory to wear a mask on the ship when not in your cabin. Being vaccinated is encouraged, but not mandatory,” Forward says. “In 2022, we will not be staffed at 100 percent capacity to reduce the number of crew on the ships. Also, we will not be utilizing all the ORs and this is to reduce the number of patients who will be in the wards,” she adds. She says that there is mandatory COVID-19 testing upon arrival; further testing as needed. Those with any additional questions may email questions to med.recruiter.ioc@mercyships.org VOLUNTEERING IN RESPONSE TO COVID-19 Many HTM professionals found

“We have a need for clinical or biomedical engineers in all the various specialties including servicing and maintaining all medical equipment with mechanical, hydraulic, pneumatic, electronic, digital, optical, and radiological principles.” – Eben Amstrong, director of biomedical engineering training and technical services at MedShare in Decatur, Georgia

themselves volunteering last year in roles they could not have imagined six months earlier. Most of the volunteering came out of an immediate need; often because of a scarcity of PPE or standing up a COVID-19 surge unit or helping in other ways. “I am a senior clinical engineer for McLaren Health Care in Michigan. As the pandemic started, I was furloughed from my job, so I immediately started working on fabricating face shields for health care PPE in my newly found spare time,” says Pam Shuck, MS, CCE. She says that although the shields only required a few parts (headband, foam, plastic shield, double sided tape), materials were difficult to obtain because there was such a shortage throughout the entire country. “Prototypes were made and given to clinicians for feedback. But after only one week, I was called on to assist bringing up a 1,000-bed field hospital in Detroit, so I went back to work full time. I worked alongside team members from the Michigan National Guard, Detroit Police, Air National Guard, Civil Air Patrol, Henry Ford Hospital, the Department of Veterans Affairs and dozens of other organizations to turn the large TCF exhibition hall into patient ready beds,” Shuck says. She says that throughout this effort, she and her family were still fabricating and donating face shields to local hospitals, ambulance companies, senior citizen homes and

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doctor’s/dentist’s offices. “I donated a total of 2,500 free face shields during the COVID-19 pandemic. In order to fund all the free face shields, I developed and applied for three patents for musical instrument’s PPE and musicians’ face shields. These were sold to many musicians and school band programs,” Shuck adds. Most biomeds who have had experience with volunteering their time and skills have found great rewards from the experience. The feeling of doing something that makes a real difference in the lives of those who are medically underserved is a rewarding experience. The past year and a half has proven that volunteer experiences and needs can be found closer to home also. The challenges of the COVID-19 pandemic called many biomeds into action in their roles on the job as well as in volunteer roles. HTM skills are needed.

For more information about volunteering visit: Operation Smile: operationsmile.org/medical-volunteer MedWish: medwish.org/give/volunteer-info/ Medical Missions Foundation: medicalmissionsfoundation.org/volunteer/ Mercy Ships: mercyships.org

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CAREER CENTER Why Mentorship is Important BY KATHLEEN FURORE

entorships always have been an important aspect of getting a foot in the door and climbing the career ladder. But many people from underserved communities don’t have the connections often needed to find someone to help them along. Why is mentorship so important, especially to young adults from underrepresented groups? And what are some tips that might help these “next generation” students find mentors no matter the field they’re interested in pursuing?

MENTOR, an organization dedicated to helping students from all walks of life find mentors, explains it this way: “Systemic and growing inequity manifests as gaps in opportunity, networks and access to adult relationships outside of families.” To help fill that gap, the organization has created what it calls “a movement” designed to “fuel the quality and quantity of mentoring relationships for America’s young people and to close the mentoring gap for the one in three young people growing up without this critical support.” Mentoring works in many ways and can serve many functions, notes Kevin Davis, founder and chairman of First Workings, a nonprofit that helps underserved New York City high school students develop workplace readiness skills. “Crucially, mentors can advocate for students from underrepresented communities, while also providing a safe space for students to explain any barriers they face,” Davis says. Mentors also can help students

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“navigate their journey towards what they are most passionate about pursuing,” says Dr. Emma Benn, associate professor of population health science and policy at Icahn School of Medicine at Mount Sinai (ISMMS).

Kathleen Furore Benn also is founder of the Center for Scientific Diversity (CSD) at ISMMS, which is committed to increasing representation and retention of underrepresented students in the biomedical research workforce – and she knows first-hand how important mentoring can be. “It was a medical anthropologist who gave me my first exposure to bioethics and public health as an undergraduate,” Benn recalls. “As a mentor, she exposed me to a field that I had no idea I would even be interested in pursuing, but I started realizing I was very passionate about it. Without this particular mentor, I would not have even considered going into biostatistics, as I had never heard of it.”

There are many opportunities available that students and prospective mentors can tap. A new partnership between CSD and First Workings, for example, exposes high school students from underrepresented groups to careers in science, technology, engineering and medicine (STEM). According to Davis, First Workings connects teens interested in medical and science fields with mentors and internships at the Center. Other organizations include: • T he Global Mentorship Initiative. Created from the Rockefeller Foundation’s Digital Jobs Initiative, this program helps prepare underserved college students for their first career job by partnering with university professors to identify hard-working students who are eager to start their careers. • Mentor Foundation USA. This is another program designed for underserved high school students. The goal of its career mentoring program is “to ensure that students are prepared for post-secondary education, trade schools or entry-level professional success.” Whatever road a student takes toward finding a mentor, creating a LinkedIn account and tapping that network is a good place to start, Davis says. “Students can search for companies and executives in their field of interest and send them invitations to connect,” he says. “Once connected to a potential mentor, students have the opportunity to pitch themselves for a conversation.” In that pitch, Davis says students

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should explain that they are passionate, hard-working and committed but do not have social or familial connections in the field they are interested in, and that they would like advice on how to find an appropriate mentor. “Asking for advice is a more subtle way of asking this new connection to become a mentor themselves,” he explains. “Students should have an elevator pitch on hand, so that they can present themselves in the most concise and compelling way. The more potential mentors the students reach out to, the greater the chance they have of finding one.” And it may take working with multiple mentors at different stages of a career journey, Benn notes. In fact, that is the road that led to her current career. “Once I understood that I wanted to merge my expertise in biostatistics with health disparities research, I was eventually able to find mentors aligned with my interest to assist me with navigating that next stage of my journey,” she says. “I think students should find mentors both within and outside of the fields they intend to pursue as they will be able to both expose them to new fields as well as help them delve deeper into specific areas of a field that excite them the most.”

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Kathleen Furore is a Chicago-based writer and editor who has covered personal finance and other business-related topics for a variety of trade and consumer publications. You can email her your career questions at kfurore@yahoo.com.

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