TechNation Magazine July 2022 by MD Publishing

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Vol. 13

JULY 2022

ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

SECURE NETWORK HTM, IT COLL ABOR ATION V ITAL FOR HOSPITAL S PA G E 5 2

12 16 46 66

Professional of the Month Stephanie Drake

Department of the Month John Muir Health Walnut Creek Medical Center HTM Department

Roundtable CMMS Cybersecurity Medical Device Procurement: Why It’s OK to Be the Bad Guy

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CONTENTS

FEATURED

THE ROUNDTABLE: CMMS TechNation contacted several experts to find out the latest about computerized maintenance management systems (CMMS) in the health care sector.

ext month’s Roundtable article: N Radiography

SECURE NETWORK: HTM, IT COLLABORATION VITAL FOR HOSPITALS The roles of HTM and IT/IS require something of a balancing act. The need for collaboration is vital for the health care facilities they protect and serve.

ext month’s Cover Story article: N Education & Future of Training

TechNation (Vol. 13, Issue #7) July 2022 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. ©2022

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

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TECHNATION

CONTENTS

PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Jayme McKelvey Megan Strand

ART DEPARTMENT

Karlee Gower Taylor Powers Kameryn Johnson

EDITORIAL

John Wallace

CONTRIBUTORS

Roger Bowles K. Richard Douglas Jim Fedele Joie Marhefka Manny Roman Connor Walsh David Witt Steven J. Yelton

DIGITAL SERVICES

Cindy Galindo Kennedy Krieg

EVENTS

Kristin Leavoy

WEBINARS

webinar@mdpublishing.com

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, Service Zone Vice President Midwest Imaging - Siemens Healthineers Jennifer DeFrancesco, DHA, MS, CHTM, System Director, Clinical Engineering, Crothall Healthcare Rob Bundick, Director HTM & Biomedical Engineering, ProHealth Care

INSIDE Departments P.12 p.12 p.14 p.16

SPOTLIGHT Professional of the Month: Stephanie Drake Company Showcase: Phoenix Data Systems Department of the Month: John Muir Health Walnut Creek Medical Center HTM Department p.18 Association of the Month: The Clinical Engineering Association of Illinois p.22 Company Showcase: Nuvolo P.26 p.26 p.31 p.32 p.34 p.36

INDUSTRY UPDATES News & Notes Welcome to TechNation ECRI Update AAMI Update Ribbon Cutting: Siella Medical

P.39 p.39 p.40 p.42 p.44

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

P.58 EXPERT ADVICE p.58 Career Center p.60 20/20 Imaging Insights: Innovatus Imaging p.63 The Future p.64 Sponsored Article: Nuvolo p.66 Cybersecurity p.68 Sponsored Article: Medigate P.72 p.72 p.74 p.76 p.80 p.82 p.90

BREAKROOM Did You Know? The Vault HTMA-SC Scrapbook HTM Jobs MedWrench Bulletin Board HTM Strong

p.86 Service Index p.89 Alphabetical Index

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SPOTLIGHT

PROFESSIONAL OF THE MONTH: STEPHANIE DRAKE The Right Skill Set BY K. RICHARD DOUGLAS

ot everyone who considers providing veterinarian care to horses ends up as a biomed, but biomeds often take an indirect path to the profession.

Some start out intent on taking the clinician route and end up as HTM professionals. Both were the case with Stephanie Drake, clinical engineering manager with Intermountain Medical Center and TOSH facilities at Intermountain Healthcare IMC/ TOSH in Murray, Utah. Drake didn’t know much about biomed at the start of her journey and considers it a fluke that she found biomed. “I wanted to be an equine veterinarian, then joined the Army in 2008 hoping to become a Combat Medic (68W), but there were none available at the time,” she says. A recruiter she spoke with was a biomed (68A) and pointed her in that direction. “I had no idea what I was getting myself into, yet I caught on well, particularly when it came to the hands-on portions of the training. I do not believe I would have done as well as a combat medic as I have as a biomed, both in and out of the

TECHNATION + JULY 2022

military,” Drake says. Training came by way of the military and then more handson experience overseas. “I attended the military’s biomed program at Sheppard AFB in Wichita Falls, Texas from 2008-2009. It was 10 months of both book and hands-on learning from a Gomco suction unit to closet-sized sterilizers,” Drake says. Shortly after completing that program, she got married and was informed that her unit was slated for deployment to Afghanistan. “That started a six-month process of additional training on devices such as would be used in the lab or imaging,” Drake says. Drake’s HTM journey continued in the civilian world after her time in the military. “I was in the Army Reserve as a biomed and reached sergeant (E5) prior to my contract ending. I joined Intermountain Healthcare in August 2012 as a clinical engineer. I serviced the medical group clinics for three years. I transferred to the LDS Hospital, and with my five years there, I reached tech III and team lead before accepting the clinical engineering manager

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SPOTLIGHT

position for the Intermountain Medical Center and TOSH facilities in December 2020,” she says. Drake’s area of specialization includes the GE Aisys anesthesia machine as well as multiple ventilators. “In my most recent role as manager, I have had less time with equipment. I specialize in promoting my team’s development and growth,” she says. MEETING THE CHALLENGE During the pandemic, Drake and her team were called upon to coordinate and quickly expand bed capacity. “In the summer of 2020, we came upon the need to quickly expand our ICU capacity at the LDS hospital. This involved pulling and storing equipment from those previously occupying the floors and commandeering extra patient beds to fill each room,” she says. The project required a push for a patient monitor upgrade in another facility in the system so that the old monitors could fill these rooms. This project required Drake to do research to purchase consumables (cuffs, hoses and finger probes) that could be delivered within a week. “Some of these rooms had to go live with patients before we could install the central monitoring and nurse call system. Nursing had extra sitters available as well as bells in each room. My team escalated the need for each install and was able to get them in with coordination between the vendor and nursing staff to work around and move patients between rooms,” Drake says. Away from her role as a CE manager, Drake enjoys reading and video games when there is time. “For both, I enjoy fantasy with good story lines that I can lose myself in,” she says. She also enjoys staying active,

which includes going to the gym and yard work. “More mowing the lawn than weeding. I like being up and moving about,” Drake says. At home, she enjoys time with her husband of 12 years and three children from one to six-years-old. “When the opportunity arises, I will take home devices apart to try to fix or even just replace the power cord on my dryer. Teaching my kids what the different tools are called, and what they can be used for,” she says. Despite initially thinking she would be healing horses, Drake ended up in her perfect vocation. “I love what I do, both as a tech and as a manager. Even though I ended up in the field by happenstance, I have the mechanical mindset and ability to work with people to do the job and to do it well. Being able to solve problems with machines and people is satisfying work and I get to be called a wizard. The moments that the end-users see how we affect their work, and the appreciation they show, is one of the things that keeps me coming back to the problems,” she says. Drake says that the work that she does would not be nearly as good if not for her husband. “He takes the time to listen to my day and provides amazing insight into what the results could be depending on the direction I choose to go. He also reminds me when it is time to set my work aside and come home. If not for him, I would be a much worse workaholic,” she says. People skills and a mechanical mindset allow this CE manager to check all the boxes while enjoying her work.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

BIOMETRICS FAVORITE BOOK: “The Lightbringer” by Brent Weeks HIDDEN TALENT: “As a teenager I did clogging which included competitions at high schools and the local amusement park, Lagoon.” FAVORITE FOOD: Rice and brown gravy, especially when it has some beef and mushrooms. WHAT’S ON MY BENCH? Pictures of my kids/their handprints, breakfast shake/concoction that is surprisingly tasty, sticky notes, as much as I try to go digital, I always go back to the sticky notes, scrubs so I can jump into the OR at a moment’s notice, water bottle because I am never hydrated enough, and texts from my husband. FAVORITE PART OF BEING A BIOMED? “Training people and seeing their eyes light up when the information clicks. Both awesome and sad that they then tell me I can go away because they’ve ‘got it.’ ”

JULY 2022

TECHNATION

SPECIAL ADVERTISING SECTION

SPOTLIGHT

COMPANY SHOWCASE Phoenix Data Systems Inc.

hoenix Data Systems is a trusted provider of CMMS software. AIMS (Asset Information Management System), the company’s signature software, is used by tens of thousands of HTM professionals around the world. Phoenix was formed in the early days of specialized software based on the urgent need for hospitals to have a computerized maintenance work order system.

In 1984, the first AIMS was delivered to eight Michigan hospitals. Presently, AIMS is used in almost 3,000 hospitals in 22 countries and by an estimated 50,000 to 60,000 users each day. Phoenix’ success is based on a collaborative partnership approach with our customers. Phoenix listens, builds and delivers both quality CMMS software and quality support service. The software is constantly improving with two software releases per year to satisfy customers’ wants/needs and regulatory requirements. Phoenix Data Systems Inc. CEO/ President Ben Mannisto recently shared more information about the trailblazing company. Q: WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION? Mannisto: AIMS was specifically created by health care engineers for health care clients and has been a CMMS system explicitly dedicated to the health care industry for over 35 years. The Phoenix staff has extensive experience with CMMS software implementations, database conversions and

TECHNATION + JULY 2022

complexity of creating a solution for small, individual hospitals to large, multi-site health systems by providing each user the ability to define their preferences for hospital count and breadth of feature and function. AIMS 3 can also interface with almost any third-party application, giving customers the freedom of customizing even further than the numerous optional components. Health care is our only business, and our extensive experience is reflected in the software’s ease of use and creative features and functions.

Ben Mannisto

Q: WHAT ARE SOME CHALLENGES THAT YOUR COMPANY FACED LAST YEAR? Mannisto: Our hospital customers deferred many capital projects in 2020 and early 2021. Once hospitals became less busy with COVID, the deferred business has been reinstituted and Phoenix is enjoying a backlog, the highest in the company’s history. Phoenix’ biggest challenge is to find qualified staff to support the growth.

Q: WHAT PRODUCT OR SERVICE THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW? Mannisto: AIMS 3 is 35 years of hospital technician and management needs combined and optimized in a completely new rebuild of the AIMS platform. AIMS 3 makes the users experience easier and more efficient with meaningful labor savings. A Phoenix subsidiary, Superior Analytics, provides its services to hospitals using any CMMS software. Superior can analyze an HTM department using any of the 15 identified very relative department KPIs. These metrics show a comprehensive HTM department profile indicating where the potential areas of improvements are. The hospital’s ROI for fees to do the analysis are typically 300-500%.

Q: CAN YOU PLEASE EXPLAIN YOUR COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS? Mannisto: Phoenix has approached the

Q: WHAT IS ON THE HORIZON FOR YOUR COMPANY? Mannisto: We expect continued growth with the release of our AIMS 3 software

ongoing customer support. Phoenix’ customer support satisfaction scores in the last three years have been 94% to 97%. Arguably the highest in the CMMS industry.

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SPOTLIGHT

and combined excitement with the services we offer through Superior Analytics. Phoenix and AIMS have numerous future activities and ideas for software expansion that will facilitate making the HTM departments more efficient, more effective and more visible as to where they are doing a good job versus where they can do better. Q: CAN YOU SHARE SOME COMPANY SUCCESS STORIES WITH OUR READERS? Mannisto: Customer needs are the primary force that drives the AIMS product. Phoenix will often design and implement specific solutions for our customers. For example, a 40-hospital group determined that (a) their receipt of products to a central warehouse is important before distribution to the hospitals; and (b) the redistribution of the obsolete equipment must be warehoused to optimize a sale, relocation to another hospital, or donated. Phoenix presently is designing a warehouse optional component to handle all of these needs and a number of other activities. The software will be a major add to the AIMS 3 software and will be phased in by the various sections of the warehouse operations over the next two years.

Q: CAN YOU DESCRIBE YOUR COMPANY’S FACILITY? Mannisto: Phoenix’ corporate office is located in Southfield, Michigan. However, many of our employees enjoy flexible working conditions with the ability to work from home. Q: CAN YOU HIGHLIGHT ANY RECENT CHANGES TO YOUR COMPANY? Mannisto: Management commonly knows that quality work is reflective of the individuals and team experience. Because of the accelerated customer growth of AIMS 3, Phoenix has expanded our team and acquired some very able employees who have extensive experience in health care CMMS. Q: CAN YOU TELL US MORE ABOUT YOUR EMPLOYEES? Mannisto: Phoenix has many key employees. However, it is important to highlight Aaron Peters, the 18-year AIMS product manager. Aaron supervised the team that designed AIMS 3 from the very beginning to its current condition. Aaron works closely with customers and is constantly improving the software through close communication and innovative thinking.

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

AIMS 3 is being well recognized by the HTM community and Phoenix enjoys many new customers because of it. Q: WHAT IS YOUR COMPANY’S MISSION STATEMENT? Mannisto: Phoenix’ mission is to stay current with ever changing health care needs and, where practical, stay ahead of any HTM health care requirements. This commitment to our users’ efficiency and ease of doing business is one of Phoenix’ foundational values. This has helped build Phoenix from a nominal number of customers in 1984 to roughly 3,000 hospitals presently. Phoenix cares about our users’ experience and this shows through our solid, long-term relationships with customers. The average relationship is longer than 20 years, and many of our customers began using AIMS as early as 1984. Many of those early customers have never used any other CMMS. “Choose AIMS 3 and you will never search for another CMMS” Phoenix is committed long term to health care CMMS and nothing else. For more information, visit goaims.com/

JULY 2022

TECHNATION

SPOTLIGHT

DEPARTMENT OF THE MONTH:

John Muir Health Walnut Creek Medical Center HTM Department

BY K. RICHARD DOUGLAS

n the eastern side of the San Francisco Bay, across from San Francisco, is Contra Costa County. The county includes the cities of Walnut Creek, Concord, Brentwood, San Ramon and many others.

Serving the health care needs of the people in this part of the bay area is John Muir Health, a not-for-profit integrated system of hospitals, providers and other services. The system’s Walnut Creek and Concord medical centers have received recognition from U.S. News & World Report, Healthgrades, Newsweek and The Joint Commission. Equipment management for the John Muir Health Walnut Creek Medical Center is handled by its healthcare technology department. The seven-member department includes Manager Nader Hammoud; Quality Coordinator Irene Advencula; Supervisor Carlos Cervera; Engineer II Alexander Koth, CBET; Engineer I Douglas Boggan, CBET; Technician II Tam Vuong, CBET; and Technician II

TECHNATION + JULY 2022

Nagham Haddad, CBET. The team provides life cycle management of all medical devices at Walnut Creek Medical Center, from acquisition, service strategy, maintenance to disposal/replacement. “Service contracts that are designed and set by HTM are managed directly by HTM. John Muir Health has a process called Contracts Review Committee; all contracts must be reviewed and approved by it. HTM sits on that committee on an ad hoc basis,” Hammoud says. Biomed equipment and minor lab equipment are maintained in-house by the department members. Ultrasound is maintained in-house and imaging equipment is 100 percent managed by HTM. The group also handles project management for medical equipment and cybersecurity in partnership with CISO. Hammoud says that they have a clinical systems analysts team that reports to IT, that works closely with HTM. Although a smaller team, the group has expertise in respiratory (vents),

OR/surgery (OR tables, anesthesia, ESU), general biomed (pumps, ECG, defibs) and neonatal (incubators, warmers). MULTIPLE PROJECTS The additional challenges of the last two years have tested the mettle of many biomed departments. The Walnut Creek team displayed its value through a department swap and several other projects. “Like other organizations, COVID was an opportunity to show the importance of the HTM department, by swapping departments to be able to receive high-acuity adult patients, regardless of their previous status,” Hammoud says. “The pediatric department, with 32 beds, had to be switched into a critical care COVID area. For the HTM team, this meant replacing the monitors, and changing the configuration to match adult critical care patient requirements, as well as relocating and repurposing equipment from less critical areas to ensure all services are available,”

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SPOTLIGHT

Hammoud says. He says that the HTM team, having the visibility of all care areas, inside and outside the hospital, were able to source equipment and get the unit ready in 24 hours. “Of course, completing this task in such a short time, means everything else will be impacted, such as PM completion or less critical repairs, as well as all planning and strategic thinking for supporting the hospital in the long run; all had been put on hold,” Hammoud adds. In another case, the biomed team was able to track and identify that low-cost absorbent canisters were failing more often, causing delay to surgeries, as well as cost wise. With the failures, they end up being more costly than the high-cost OEM canisters. Data was presented and a switch back to OEM canisters took place. Although the switch over to the COVID surge unit was unique, the team generally tackles several projects routinely.

“At any time of the year, we are involved in at least three projects. Our latest and biggest project is a systemwide replacement of physiological monitors. The Walnut Creek Campus HTM team is heavily involved and working side by side with other disciplines and the vendor to ensure a successful project,” Hammoud says. Replacement of the physiological monitors across the health system, is a more than $20 million project, involving more than 250 monitors for the Walnut Creek campus. “We work as part of a multi-disciplinary team, including IT, Supply Chain, Clinical, Telecommunication, Epic, Facilities. Being the experts of medical equipment, our expertise and interaction with the medical devices is the key to successful testing and implementation. With one person assigned as biomed project manager for the project, all other members also support the effort as needed,” Hammoud says. Biomed members have worked

on wireless fetal monitoring for labor and delivery, allowing expectant moms to be able to walk around the area and not be confined to a room. Another one of the big projects that the biomed team has taken on is a nurse call system upgrade. “Throughout the years, we have been upgrading the nurse call to be the latest and greatest. With the challenge of Windows 7 obsolescence, we have to replace the last pieces in a big chunk versus in phases. Working closely with the facilities department, I T and the vendors, H TM is planning and identifying the best, most efficient route to complete this project, with the least disruption to patient care and the least cost,” Hammoud says. The seven-member H TM team has accomplished as much as larger departments, especially with the extra requirements of the pandemic. They handle most work in-house and get the job done.

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SPOTLIGHT

ASSOCIATION OF THE MONTH: The Clinical Engineering Association of Illinois

BY K. RICHARD DOUGLAS

llinois is part of the Midwest. It has the fifth largest gross domestic product in the U.S. and ranks sixth in population. Most people recognize its largest city, Chicago, which is the fifth largest city in the U.S.

The state is one of the country’s main transportation hubs, owing to its central location and access to the Great Lakes. Although proximity to Lake Michigan is not as essential to running an association, the state enjoys an active biomed association that provides many benefits to its members. The Clinical Engineering Association of Illinois (CEAI) brings together biomeds from the Chicago area and all parts of the state. “The CEAI grassroots meetings began in 2006 and the association was officially incorporated in 2007,” says association president Greg Czajka. He says that this year marks the group’s 15th anniversary.

TECHNATION + JULY 2022

Czajka says that the CEAI’s beginnings can be traced back to three local HTM leaders who met for lunch on Taylor Street (Francesca’s restaurant) in the fall of 2005 to chat regarding the formation of a new association that would be pillared on promoting education, the biomedical/ clinical engineering profession and fostering the next generations of the HTM industry. “These three HTM leaders embarked on getting the word out to the local masses as to the concepts and the first grassroots meeting in October 2006 was held with over 35 attendees. These three local HTM founders were Al Moretti, Joe Bandra and Robert Shue,” Czajka says. The pandemic proved that the group can rally meeting participation in a non-traditional format. “We hold quarterly meetings and strive to have them in person. During the pandemic, we alternated between virtual and in-person depending on

the state of things. We were surprised to see incredible participation during our first virtual meeting,” Czajka says. FOCUS ON FUTURE BIOMEDS CEAI is serving one of the most important roles in HTM today. That role is to bring new HTM professionals into the field as well as prepare current techs for roles in management. “The CEAI feels the diminishing HTM pipeline is one of the biggest priorities for our organization to assist with right now. We have really been focusing on the pipeline issue and trying to invigorate our local HTM professionals to become a part of the solution,” Czajka says. He says that the group brings awareness of the profession using AAMI tools such as HTM in Box and the AAMI BMET apprenticeship program. “We also ensure our conferences have education sessions on prepping techs to become leaders as well sessions designed specifically for the new

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SPOTLIGHT generation of techs. This will be our second year with a conference theme focused on the HTM pipeline issue. We are just trying to do our part to keep the HTM field fueled with good talent and ready to go,” Czajka says. Part of bringing new biomeds into the field is helping them finance their education and training. “We have had a scholarship program since 2012. Students working toward a career in the HTM field can submit an application via our website to be considered for a scholarship. Historically, our awards have been between $1,000-$3,000 and we strongly encourage anyone in school that wishes to move into our field to apply today,” Czajka says. Over $25,000 has been awarded in CEAI scholarships to aid future HTM professionals in their undergraduate studies quest. 2022 CONFERENCE With the disruption of the past couple of years largely in the rearview mirror, organizations that hold annual events can get back to a more normal atmosphere. CEAI has a popular conference with the next event right around the corner. “Our conference occurs every fall at Drury Lane in Oak Brook, Illinois. It’s a two-day event featuring education, networking, a keynote, lunch and a vendor expo. Participation and feedback from our past conferences have been stellar and we are well on

our way into planning our 2022 show which will take place September 28-29,” Czajka says. He says that, historically, the first day focuses on education and networking. The sessions’ targeted audience ranges from biomed and imaging techs to leaders to something that applies to everyone in the field. The second day has additional education in the morning until the keynote speaker at lunch. Following that is the vendor expo where attendees can explore the many booths, network with colleagues, grab a drink and learn about additional business opportunities. “We’re proud to share that our conference is ACI accredited for credits towards the AAMI certifications,” Czajka says. The 2021 conference was the first one put on by the current leadership team. “It was significant to us because COVID forced us to cancel the 2020 conference and all of us were new to our roles leading to a few lessons learned. Because COVID was going through ebbs and flows last year, it was challenging to predict what the event would be like months in advance or if it would be allowed to take place at all,” Czajka says. He says that in the end, the group was able to pull off a successful show with only about three months of planning. “By comparison, we usually plan about eight months in advance in order to schedule speakers and

coordinate sponsors,” Czajka says. “This year we are hitting the ground running and getting things locked in much earlier. At this juncture, we’re feeling very comfortable with vendor participation, and we’ve started to schedule some exciting new speakers. I attended the MD Expo shows in Las Vegas and Atlanta which gave me great ideas for what people want to see,” Czajka adds. He says that the association also has leadership elections this year and would really like to see some new faces join the team. “After 15 years, this is such a strong, well-run organization and it is due to the diversity of ideas we have from the leadership team,” Czajka says. He says that the CEAI has had 12 highly successful annual conferences, attended by not only local membership, but attendees from numerous states across the country. “There have been six elected CEAI officer administrations continuing the lead forward and projecting the HTM vision to its membership and the industry across the country,” Czajka says. The association offers a solid networking base among CEAI member’s – past and present – who yearn to share comradery, knowledge, resources and experiences. CEAI is among the list of admired HTM associations in the country.

The Leadership team from the 2021 conference

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TECHNATION

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COMPANY SHOWCASE

The Nuvolo Connected Workplace for Healthcare Solution

oday, your healthcare technology management (HTM) team does so much more than just maintenance – and they need a modern computerized maintenance management system (CMMS) that does, too.

According to analysis of work order data, HTM and healthcare facilities departments spend over 40% of their time on non-maintenance-related work, and yet most CMMS systems only support maintenance functions. The Nuvolo Connected Workplace for Healthcare solution is unique in the market because it’s a combination of software products — built on the ServiceNow platform—that are developed specifically to meet the needs of healthcare, as well as enable collaboration between hospital support departments versus having them work in separate tools and silos. No matter where you are, Nuvolo is too. All Nuvolo products are cloud-based with mobile capabilities so you can work from anywhere right on your mobile devices. CONNECT YOUR HTM TEAM Nuvolo’s HTM Asset Management is one such product included in the Connected Workplace for Healthcare solution. Nuvolo’s HTM Asset

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Management is a modern CMMS that meets the needs of today’s HTM departments with capabilities to efficiently manage your medical devices, technicians, vendors, costs, and compliance. Whether you’re a medical device service provider, or you work at a small hospital, a large multi-state health system, or something in between, the Nuvolo HTM Asset Management CMMS is scalable to meet the needs of your organization. One of the many benefits of HTM Asset Management is its built-in automated workflows, which enable your HTM team and customers to work smarter, not harder. For example, the Nuvolo Service Portal provides end users with the tools to place a service request from their computers or mobile devices. The system automatically creates a work order, assigns it to the proper technician or team, alerts them of the work order, and automatically escalates it if a technician doesn’t accept the work order in the required time frame – no more delayed or missed service requests, or the need for someone to sit in the shop to take calls. The new planned maintenance (PM) capabilities completely reimagine and simplify scheduling and managing PMs, giving you the tools

to easily schedule PMs with checklists based on location, model, equipment type, and technician skills. You can also monitor completion and compliance with real-time dashboards and reports. Want to know if a device is covered by a service contract before you start working on it? HTM Asset Management does that, too. Nuvolo’s contract management capabilities allow you to connect your contracts with each covered device, giving you full visibility into the coverage levels, contract costs, whether that contract is adding value, and when it expires. Nuvolo’s products not only connect with each other, they can integrate with other external business applications – such as your enterprise resource planning (ERP), real time location system (RTLS), time and attendance applications, etc. – to connect all pertinent data, giving you full visibility into your business in one place. HTM teams need an accurate asset inventory to meet regulatory requirements and identify devices impacted by alerts, recalls and cyber risks. Nuvolo’s partnership with ECRI enables HTM departments to automate the process of keeping your CMMS inventory data “clean”. With a subscription to ECRI, you can

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SPOTLIGHT

about

NUVOLO • Nuvolo’s Connected Workplace for Healthcare solution provides integrated cloud-based applications for full life-cycle management of HTM and facilities assets • Investor and employeeowned company started in 2013 by CEO Tom Stanford automatically send your asset data to ECRI to ensure it’s using industry-approved model name and number, manufacturer, and more. Nuvolo has built-in integrations with GE Healthcare, PartsSource, and Siemens Healthineers, so you can buy parts directly from them through your Nuvolo CMMS and automatically update work orders and purchase requests with the status of the purchase and cost. CONNECT YOUR CYBERSECURITY PROGRAMS You cannot protect what you do not know about. Nuvolo’s OT Security product improves and simplifies your medical device cybersecurity program (aka operational technology “OT”) by combining your OT monitoring application with your equipment inventory and service management tools, providing visibility between HTM, IT and facilities departments to enable orchestrated prevention and remediation of OT cyber threats. Nuvolo’s OT Security takes a proactive and automated approach to cybersecurity by giving HTM and facilities departments the tools to automatically update their asset inventory when new devices are identified on the network; assess the security risk of your devices, match any threats with impacted devices and

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create work orders if HTM or IT action is needed; enable coordination with IT; and provide cybersecurity dashboards, reports, and compliance documentation. CONNECT YOUR CAPITAL PLANNING TEAM Ditch the spreadsheets and identify your clinical equipment replacement needs in seconds, not weeks. Nuvolo’s Capital Planning product is used in conjunction with HTM Asset Management to identify and prioritize your clinical equipment replacement needs. Using data from your CMMS, Capital Planning will instantly score and prioritize your clinical equipment replacement needs so you can see in real-time which devices should be replaced and when, and how much needs to be budgeted each year. Additionally, capital planners now have an analytics suite and reporting tools to configure, produce, filter, and distribute reports based on live data. CONNECT YOUR FACILITIES MAINTENANCE TEAMS Performance and outcomes improve when departments that work together have a clear view of all the components they manage and work they must collaborate on. Nuvolo’s Facilities Maintenance product has the same capabilities found in HTM

• 350+ employees and growing rapidly • Worldwide offices: U.S., UK, India, Bulgaria, Canada and Netherlands • Strong commitment to supporting the healthcare community: • Dedicated healthcare teams – we hire and partner with industry subject matter experts • Nuvolo software used in over 2,200 hospitals (and growing) • Active involvement in HTM associations to keep pulse on client needs and changing regulations, identify best practices, and provide thought leadership • Provide philanthropic support to the HTM community through the Nuvolo Connected Learning and Nuvolo BMET Apprenticeship Certification programs.

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Asset Management but is designed to meet the unique needs of healthcare facilities departments: • Coordinate between departments using one application to assign and track work on equipment and facility maintenance, routine inspections, and projects • Ensure regulatory compliance with both out-of-thebox and easy-to-create dashboards and reports • Integrate with your billing and financial applications, sensors, building automation systems, and other applications to get actionable data in one place • Perform rounds through your mobile device • Perform condition assessments CONNECT YOUR CONSTRUCTION AND PROJECT TEAMS Nuvolo’s Projects product manages the delivery of high quality, cost-effective renovations, and new building development. It helps you coordinate on projects with all

applicable departments and manage construction projects across facilities, office spaces, and more. • Ensure your projects stay on time and budget by tracking key milestones and baselines throughout the project lifecycle • Manage the construction permit process and lifecycle • Track costs and have real time reporting on capital and expense financials including cash flow analysis • When doing an RFx, perform your bidding and sourcing in the same system as your projects Other products included in the Connected Workplace for Healthcare solution are Real Estate, Space, Dispatch, Sustainability, Reservations, Calibration, Warehouse, and Physical Inventory. Interested in learning more? Explore the Nuvolo Connected Workplace for Healthcare solution at nuvolo.com.

The Value of the Nuvolo Connected Workplace for Healthcare Solution Efficiently and effectively manage your medical equipment's maintenance needs

Improve the accuracy of your equipment inventory Get access to real-time data to make informed decisions and ensure high performance and regulatory compliance Connect to the teams you work with for better coordination with IT, Facilities and others

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NEWS & NOTES Updates from the HTM Industry SoCal • October 11-13, 2022 REGISTER TODAY FOR MD EXPO MD Expo, MD Publishing’s signature healthcare technology management (HTM) event, is heading back to Cali, as in sunny Southern California! Registration is currently open, and a discounted room rate is available at the Pechanga Casino & Resort in Temecula. Registration is free for hospital employees, active members of the military and students. The event also includes free food and drink at its unique networking events. One of the highlights of the biannual MD Expo is the excellent educational offerings. HTM professionals can earn

credits toward certification while also obtaining top-flight education from some of the field’s leading presenters. The MD Expo will conclude with an event you won’t want to miss! Cap off the event with a concert on the lawn featuring the Main Squeeze, an American funk band from Bloomington, Indiana, that has been featured on Monday Night Football and the Bonnaroo Music Festival. Register for MD Expo and/or sign up for the newsletter at MDExpoShow.com.

BUSINESS DEVELOPMENT MANAGER SUPPORTS SEAWARD’S U.S. GROWTH Electrical safety test and measurement equipment specialist Seaward Electronic has appointed a new member to the sales team to support expansion of its U.S. operations. James Durrence joins as business development manager and will be working alongside the company’s senior leadership team to develop further existing markets and secure new sales. In joining Seaward Group USA, Durrence will be part of a team based at the company’s Tampa Bay, Florida head office at a time when the market for electrical safety test products in North America is seeing significant growth and investment. Seaward is part of Metrawatt’s GMC Instrumentation Group, a collaboration of separate specialist test equipment manufacturing businesses based in Germany, Switzerland and the USA. Sean Daley, vice president and chief operating officer at Seaward USA, said, “I look forward to working with James as we continue to invest and strengthen our U.S.

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operations. His appointment comes as we are seeing success and an expanding customer base, which requires growing access to the latest technical and business support skills.” Employing around 170 people, the Seaward Group is a leading manufacturer of electronic test and measurement instruJames Durrence ments used in a wide variety of electrical, medical, industrial and energy sector applications.

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US MED-EQUIP LAUNCHES GOUSME APP Ordering a ventilator on demand for critical patients unable to breathe on their own just got easier for hospitals thanks to new technology from US Med-Equip (USME), a provider of rented medical equipment. USME partners with hospitals and health care facilities for the rental, sales, service and asset management of movable medical equipment – diagnostic and clinical devices ranging from infusion pumps and ultrasound machines to defibrillators, incubators and more. GoUSME, an online portal and iOS/Android app, is designed to help front-line clinicians order and manage equipment rented from US Med-Equip with the click of a button. The technology is the company’s latest development as it bolsters its services and support to help meet demand from hospitals streamlining processes and turning to smarter options so they can reduce costs and focus time and energy away from equipment logistics onto helping patients heal. US Med-Equip makes tracking hospitals’ equipment easy, too. USME uses passive RFID technology to tag and

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locate movable medical equipment rented to and owned by health care partners. The company’s proprietary software collects data from RFID reader scans through doors and walls, helping hospitals quickly locate RFIDtagged equipment to conduct preventative maintenance and improve usage efficiencies without disrupting patients in their rooms. In other news, USME is expanding to Greensboro, N.C., to meet the growing equipment and service needs of hospitals and other health care partners throughout the Eastern U.S. US Med-Equip is opening new branches to meet demand from hospitals turning to USME, which continues to invest heavily in its equipment fleet and the technology and services to support it. From major medical centers to rural hospitals, US Med-Equip serves thousands of hospitals from nearly 50 locations across the country.

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PARTSSOURCE UPDATES PARTSSOURCE PRO PartsSource, an online marketplace for medical equipment maintenance parts and services, has announced updates to PartsSource Pro, the company’s flagship solution and clinical resource management platform. PartsSource Pro 2022 features expanded benefits to improve supply chain resiliency and healthcare technology management (HTM) team performance by providing members with visibility to supply chain risks, a resource optimization roadmap service, and exclusive educational resources on the online PartsSource Community. Approximately 1,500 hospitals subscribe to and rely on PartsSource Pro, as its combination of best processes, cloud-software and logistical support delivers top-quartile performance for hospital clinical engineering and supply chain teams across the U.S. In 2021, 3.3 hospitals joined PartsSource Pro every week. The solution also helped prevent over 6,000 potential stock out days for PartsSource Pro member health systems by ensuring availability of mission-critical products. PartsSource Pro 2022 makes more resources available to secure mission-critical supplies and expand capacity to ensure clinical availability and patient safety. Powered by PRECISION Procurement data, benchmarks and ordering trends from peer hospitals across the country, the PartsSource Supply Chain Risk Monitor provides macro and micro visibility into risk, relative supplier performance trends and the

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evidence-based data necessary to mitigate impact and identify strategic opportunities to improve clinical resource uptime. Beginning this summer, the monitor will be used in planning conversations with dedicated account management to help clients pinpoint risks and explore opportunities to mitigate such as, the selection of high-quality alternatives, identification of expanded guaranteed stock options, purchase of anticipated stock ahead of leading disruption indicators and strategic preventative maintenance adjustments. HTM Advisory Services helps PartsSource Pro members evaluate and strategize opportunities to shift resources to maximize high-value priorities and expand the effective capacity of their teams. Introduced in 2021, the service model focuses on understanding each client’s place on the HTM maturity journey and increasing focus on value-driving initiatives and health system priorities. The new Resource Optimization Roadmap, a consultative service plan (valued at $50K-$100K), will guide clients to benchmark performance, equip them with a customized plan to optimize resources and a roadmap to implement improvements to service strategies and team structures. For more information, visit tinyurl.com/2p8a3mfu.

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INFUSYSTEM ANNOUNCES MASTER SERVICE AGREEMENT InfuSystem Holdings Inc. has entered into a three-year master service agreement with a leading global healthcare technology and diagnostic company, effective April 25, 2022. As part of the master service agreement, InfuSystem will be providing its biomedical services, which include annual preventative maintenance and repair solutions, to a majority of the fleet of infusion pumps at hospitals and other medical facilities under contract with this tier one global health care company. Service will be conducted on-site at the acute care facility or off-site at one of InfuSystem’s seven service centers.

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This global healthcare technology and diagnostic company’s preferred customers’ infusion pump fleet consists of more than 300,000 pumps located in 1,200 medical facilities, including 800 hospital systems in the U.S. and Canada. This preferred national service agreement is estimated to generate approximately $10 to $12 million, after an initial ramp-up period, in annual revenue under InfuSystem’s DME service platform. For more information, visit infusystem.com.

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CROTHALL HEALTHCARE SEEKS APPRENTICES A U.S. national BMET Apprenticeship Program recently launched by AAMI has gained a valuable new employer partner. Crothall Healthcare (Crothall), a U.S. healthcare support services provider, will be hiring 10 biomedical equipment technicians (BMETs) in its Healthcare Technology Solutions (HTS) division within the year. “AAMI’s apprenticeship program will allow us to diversify our talent pipeline further and ensure our company culture, protocols, and processes are instilled in our team from the very first day,” said Codi Nelson, CBET, Crothall Healthcare Technology Solutions program director. AAMI’s BMET Apprenticeship Program, recognized by the U.S. Department of Labor, combines traditional education with up to 6,000 hours of on-the-job learning. Prospective BMETs are hired by program partners in their area, who then provide them with training and paid work experience, as well as cover expenses for the requisite educational courses.

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Crothall HTS provides a valuable perspective for apprentices working with evolving and increasingly networked medical device technologies, and the company offers clinical engineering service solutions for clients nationwide, including diagnostic imaging repair services, transparent medical equipment management and medical device cybersecurity. Crothall HTS’s broad reach across the country is just one reason why Danielle McGeary, vice president of HTM at AAMI, is thrilled to call them an employer partner for the growing BMET Apprenticeship Program, she said, “With Crothall HTS participating in this national program, prospective BMETs will have more opportunities to get the hands-on experiences that are so necessary for this crucial field.” Applicants interested in apprenticing at Crothall can find postings on the company’s career page at crothall.com/careers.

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Q: WHAT PRODUCT, SERVICE, OR SOLUTION DOES YOUR COMPANY PROVIDE TO THE INDUSTRY? “PM BioMedical partners with industry leaders across the nation to provide the highest quality medical equipment for hospitals, clinics, and companies alike. Located in Orange County, California, PM BioMedical strives to provide a common ground for end user biomedical equipment. We buy, sell, and service patient monitoring equipment, as well as rent. We are also a sole source to purchase your hospital surplus.” – Ali Marwan Youssef COO Q: TELL US WHAT DIFFERENTIATES YOUR COMPANY FROM THE COMPETITION. “We can say quality, turn times, and pricing, but those are the most common. All these companies strive for the obvious and we assure you, you will get those key factors from PM BioMedical, but what really differentiates us is the combined years our employees have in the industry. With that comes knowledge, constant improvements, and the highest quality repairs. Being a new company but having 35+ years of experience allows us to build in a way other companies don’t. Our experience has given us the recourse to create a tool to fully integrate with your biomed shop. It is our goal to be fully automated and integrate into your workflow to make working with a vendor seeming less.” – Pranil Singh CEO

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ECRI UPDATE

McLaren Northern Michigan’s Award-Winning Technology Integration Initiative

cLaren Northern Michigan (Petoskey, Michigan) has been selected as the winner of ECRI’s 16th Health Technology Excellence Award for its successful integration of patient care technologies to be deployed in a newly constructed addition to the hospital. ECRI’s annual Award recognizes outstanding initiatives undertaken by ECRI member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology.

“You could hear a pin drop.” Odds are you know that feeling: sitting in a meeting where the tension is high and the outcome is not at all certain. That’s how Rich Reamer described the atmosphere when McLaren brought together – in one room, at one time – the sales and technical teams from the vendors who would help equip a newly constructed addition to the facility. As the regional manager of clinical engineering at McLaren, Reamer was intimately involved in the organization’s efforts to build an integrated patient care technology environment within the planned addition to McLaren Northern Michigan hospital. When designing the addition, the organization knew it wanted more than just new physical spaces; it wanted to build the safest and most advanced integrated patient experience. That meant putting considerable

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thought into which technologies would be used in those spaces, how those technologies would interact with one another, and what implementation measures would be required to ensure that the technologies functioned well together. THE CHALLENGE: ACHIEVING INTEGRATION McLaren’s approach to achieving its goals involved bringing together the suppliers of the technologies that would be used in the space, and then challenging them to work together to build an integrated solution that streamlined the delivery of information to the care team. One of the most consequential parts of the project was the aforementioned meeting. The participants represented companies that provide high-quality solutions within specific areas of expertise, namely nurse call, patient monitoring, staff communications, electronic medical record (EMR), real-time locating system (RTLS), patient safety, virtual nursing, patient education, Internet Protocol television (IPTV), and patient interaction and entertainment. During that meeting, McLaren nursing leadership and clinical engineering management presented the following challenge: What would it look like if all of you worked together to build the best integrated solution? What additional benefits might be realized if we, collectively, work to integrate each of your products so that information is delivered to our care

teams through a single interface? Reamer recounts that, at first, the participants were protective of their products, and didn’t necessarily want to mix their products in with the others. “But once everybody opened up their mind to what we were doing, the walls started coming down.” It didn’t take long for the initial discomfort to give way to excitement and energy. Ultimately, vendors saw potential in being able to tout their successful integration with other technologies. For McLaren, success required selecting product solutions that use an open architecture and identifying vendor partners who were willing to collaborate. THE RESULT: TOOLS FOR IMPROVING PATIENT CARE AND THE PATIENT EXPERIENCE One of McLaren’s key requirements for its technology-integration initiative was to optimize the flow of information to and from clinicians – providing them with data they need to care for patients, but doing so in a way that is not overwhelming. The organization’s extensive planning yielded a system that integrates the following technologies and data sources: • Staff communication device (Vocera). McLaren selected a hands-free communication device to be the primary connection between clinicians and the other integrated technologies. The system supports team communications

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McLaren Northern Michigan’s efforts to integrate the technologies to be deployed in the new wing of the hospital (shown in the foreground) earned the organization ECRI’s 2022 Health Technology Excellence Award. (Image courtesy of McLaren Northern Michigan.)

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with simple voice commands, and it delivers data from the other systems without interrupting patient-caregiver interactions. Nurse call system (Rauland R5). The nurse call system informs clinicians of patient requests and emergent needs. Physiologic monitoring and telemetry (Spacelabs). These devices send critical data about the patient’s physiologic condition. Bed (Stryker iBed Awareness). This system provides information about the patient’s bed settings, and it issues alerts regarding potential falls. EMR (Cerner). Data from many of the other systems regarding the proper management of the patient is recorded in, and accessible through, the EMR. Electronic whiteboard (Medi+Sign). This system, which incorporates a digital whiteboard in the patient’s room, displays automated and real-time updates related to the patient’s care, including care team assignments and the schedule for the day. Virtual nurse (Banyan). A TV-mounted camera and audio system in the patient room allow a “virtual nurse” (i.e., a nurse

connecting from a remote location) to assist with questions and concerns, and even assist during alert events by providing an extra set of eyes and ears, as well as audible support. • RTLS (Midmark). The system helps users quickly locate staff and devices, which can be critical during safety events. A second key requirement was to provide patients with easy access to the resources they need to understand their care and to be comfortable during their stay. The following components are instrumental in that regard: • Bedside patient tablet (Curbell Rego). This tablet replaces the traditional nurse call pendant/ remote control. Patients can use the device to call for nurse assistance or to control the television and room lights. They also can use it to access their medical record through their private portal within the McLaren Health Care system, to communicate with the virtual nurse, or to access the Internet, stream videos, or use social media. • IPTV (Telehealth IPTV). In addition to providing cable TV and other patient entertainment, this system can be used to connect with the virtual nurse; to view test

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results, radiology images, or documentation of treatment and other requested information; or to display patient-specific education regarding the patient’s stay and their condition. McLaren notes that the integrated system offers nine total systems working together – either in total integration or in a supporting capacity – to improve safety and quality outcomes for the hospital’s patients. ECRI congratulates the McLaren team for its successful effort to get technology vendors to work together to implement a solution that optimizes the flow of information to and from clinicians, and that provides patients with easy access to the resources they need to understand their care and to be comfortable during their stay. TO LEARN MORE . . . To read more about this, and other award-winning projects, visit www.ecri.org/health-devicesaward-winners. If you have a project that you’d like considered for the 2023 Award, visit https://www. ecri.org/health-technology-excellence-award, and tell ECRI about it. The Award competition is a great way to gain recognition for the work you do to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. (Applicants must subscribe to one of ECRI’s programs or services.) You can also contact ECRI by telephone at 610-825-6000, ext. 5891, or by email at clientservices@ecri.org.

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AAMI UPDATE

New AAMI Consensus Report: Guidance on Risk Management for AI, ML

AMI recently published a consensus report (CR) for identifying, evaluating and managing risk for healthcare technology that incorporates artificial intelligence (AI) or machine learning (ML).

AAMI CR34971:2022, Guidance on the Application of ISO 14971 to Artificial Intelligence and Machine Learning, responds to an urgent, immediate need. Existing standards for regulated medical devices do not yet adequately address the potential risks of emerging AI and ML applications, which “could jeopardize patient health and safety, increase inequalities and inefficiencies, undermine trust in health care, and adversely impact the management of health care,” the CR states. Now, for those familiar with the widely used international standard, ISO 14971:2019, Medical devices – Application of risk management to medical devices, AAMI’s CR is a must-have companion for risk management of AI- or ML-enabled medical systems and devices. “We intentionally structured the

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CR to be easy for people that know 14971 to use,” said Pat Baird, co-chair of the AAMI Artificial Intelligence Committee and senior regulatory specialist at Philips. “Readers are probably aware of the existing companion document, 24971, which provides guidance on how to use 14971. We modeled the structure of 34971 to be similar to a section in 24971 about risk management for in vitro diagnostics. The idea is that the risk management process is the same, and here are a few new ways that this particular technology can fail that you might not have thought about.” Baird is part of a small task force of the AAMI Artificial Intelligence Committee that developed CR34971, which was reviewed by the full committee and by risk analysis experts at the British Standards Institute (BSI). The committee then approved the consensus-driven report. AAMI and BSI plan to use this CR as the basis for an AAMI technical report and a British Standard. “We hope to complete the AAMI technical report and the BSI standard sometime this year,” said Joe Lewelling, senior advisor on content and

strategy at AAMI. “The AAMI committee,” which includes clinical, manufacturing, regulatory, information technology and risk management expertise, “is working hand in hand with a similarly focused BSI committee on these documents.” Longer term, AAMI and BSI expect to propose these resources to the International Standards Organization as guidance, informative, or annex documents to ISO 14971 or ISO 24971. LEARNING FROM OTHER INDUSTRIES To develop the CR, “we conducted a literature review for ML failures in multiple industries, in an attempt to learn from others that have gone

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before us,” Baird said. Additionally, the task force reviewed prepublication documents from ISO/IEC JTC 1/SC 42, a subcommittee of a joint technical committee on artificial intelligence that is developing a series of horizontal (cross-sector) standards that address such issues as bias management. The CR offers insights into how risk management systems and processes can be adapted for AI and ML medical devices. It also details safety-related characteristics and considerations in five areas: • Data management • Bias • Data storage, security, privacy • The dangers of overtrust in AI • Adaptive systems The CR includes informative

annexes covering the risk management process, risk management examples, considerations for autonomous systems and personnel qualifications. For example, personnel qualifications apply to people developing AI- or ML-enabled products. “One of the things we noticed in the literature about ML systems is that many times failures occurred because, although the development team had data, they didn’t have knowledge,” Baird said. “Developers had logical assumptions regarding the use of their product, but the reality was different, leading to failure. To be successful, we really need to understand the context of use and leverage the wisdom around us. We felt it was important to stress this point when discussing risk management.”

NEXT STEPS The AAMI Artificial Intelligence Committee is now turning its attention to other issues that warrant exploration and consensus, such as change control for systems that continue to learn over time. “The use of ML in health care has the potential make significant improvements in the delivery of health care, but only if those products are safe and effective,” Baird said. “So, the logical first step is to address safety-related concerns. New technologies always introduce new risks, and good risk management is obviously a key driver for the medical device sector. We always put safety first, and improvements to performance can come a little later.”

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RIBBON CUTTING Siella Medical

iella Medical is a biomedical equipment services company that provides a wide range of medical equipment to hospitals, health care facilities, clinics and medical companies. With a focus on infusion pumps, it can repair, deliver pump rentals, or provide units for purchase directly to a pharmacy or homecare facility. Siella Medical also repairs and refurbishes damaged patient monitoring devices for most OEMs. The company also offers full biomedical services for pumps and other equipment in need of annual preventative maintenance checks.

George Davis CEO of Siella Medical

set Siella Medical apart from even the biggest competitors, as infusion pumps have always been a unique niche to the general population of common patient monitors when it comes to employing qualified and certified technicians, obtaining parts, and providing quick turnaround times. Even though our prices are competitive, pricing alone is not our major selling point. Collectively, our entire team, from sales, customer service, technicians, all the way to shipping and receiving, takes pride in the incomparable service and personal attention we provide our customers.

exchange program that allows biomeds to simply send in their broken cables, either singly or in bunches, and our tech team identifies the damaged cables, and sends replacements back to the hospital at an exchange cost – saving the hospitals time and money.

Q: WHAT IS ON THE HORIZON FOR YOUR COMPANY? DO YOU HAVE ANY GOALS YOU WOULD LIKE TO ACHIEVE IN THE NEAR FUTURE? A: To not only be an approved vendor for all our customers, but to be the preferred vendor and first choice for all their biomed needs.

TechNation recently learned more about the company via a question-and-answer session with CEO George Davis. Q: WHAT ARE SOME OF THE SERVICES AND PRODUCTS YOU OFFER? IS THERE A SPECIFIC OR NEW ONE YOU ARE EXCITED ABOUT RIGHT NOW? A: With over 30 years of experience specializing in infusion pump repair, we have been able to seamlessly take on many other medical equipment devices such as modules, telemetry units, fetal transducers, monitors, blenders as well as some surgical equipment. We are especially proud to offer in-house technical support from our skilled technical team who are certified in most major OEMs such as Philips, GE Healthcare, BBraun, Moog Medical, BD, Baxter, and Welch Allyn. Recently we launched a cable

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Q: HOW DOES YOUR COMPANY STAND OUT IN THE MEDICAL EQUIPMENT FIELD? A: We provide exceptional technical support on patient monitoring devices, infusion pumps and surgical equipment. Our entire team of experienced technicians are certified in almost all major OEM repair. Again, having 30 years of experience in the repairing, PM’ing and replacing infusion pumps has

Q: IS THERE ANYTHING ELSE YOU WOULD LIKE OUR READERS TO KNOW? A: Although we are growing, our goal will always be to put our customer’s needs first and to maintain long-term partnerships that make us the hospital’s number one source for their biomed needs. For more information, visit siellamedical.com.

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SHOP TALK POWERED BY

SMITHS MEDICAL MEDFUSION 3500

CYNOSURE PALOMAR STARLUX 300

Can anybody help me with how to replace the super capacitor on a Medfusion 3500 properly. I have blown out one mainboard already. It seems there is a proper way to do it. Is it like replacing a backup battery? Must I leave the unit on somehow or use jumpers to feed 5 volts while removing the capacitor? I need helpful advice please.

You do not want any power attached to the device. Also, be sure to discharge the capacitor before you remove it. Capacitors hold a charge by nature and you do not want it to discharge by accident and take out other components. By the way, my post is merely around replacing capacitors in general. I am not sure about this specific repair whether it’s soldered in to the mainboard, another board, etc. Use a good soldering iron with a solder sucker. Make sure polarity is right when you place new one on. Not sure how you have blown out the motherboard in attempting to replace the supercap. It is fairly straight forward. Just cut the 4 dabs of hot glue that should be around the edges of the cap being careful to not gouge the board tracings. Then just unsolder the cap from the opposite side. If you do not have good soldering skills do not attempt it. You should apply some fresh solder to the connections to make it easier to desolder then use a solder sucker to remove. I have performed over 25 of these with no issues and it always corrects the supercap alerts at great savings over factory repair or board replacement costs.

Were those supercaps you changed from a Medfusion 3500 mainborad? I am hesitant to try again. I thought it was straight forward desolder/remove and replace with new supercap but the mainboard lost all functions. I talked to an experienced tech from another facility and he said you have to continuously maintain voltage while removing and installing a supercap otherwise you will lose everything and/ or damage the mainboard. But he declined to tell me how. I figure to attached aux power (5 volts) to the capacitor terminals during removal/ installing. I will give it try.

Yes, we only have the Medfusion 3500 model and I have done many as mentioned with no problems. I did not need to discharge the cap or keep a voltage on the board. You may have damaged surrounding components or caused an electrostatic shock to the board. Make sure you are grounded before handling the board.

I have error 054. I checked according to the manual, but the error is still there. I made a bypass directly in front of the hose connector and then it works. So, the problem is in the handle itself, but after undressing there is nothing wrong with it. I also connected an external pump and flushed the entire handle system and the error is still there. What else should I check?

So, you already know the error code is directing you to the flow for the flashlamp. You also already verified that it is the hand piece and not the flow switch in the base unit. High pressure indicates that there is some sort of occlusion in the flow. Water is passing through, but something is restricting the flow like clogged arteries. That actually sounds like what is seen on the chill tip side, so check to make sure that the lines weren’t accidentally crossed on the previous repair. If they are, then dismantle the chill tip and clean it out. There are little apertures that get easily clogged and need a paper clip to ensure they are properly cleaned. If the tubes are not crossed, then do the same thing for the lamp housing checking the tight places.

I checked the wires and they are not crossed, but to be sure I connected the crossed ones, the error is the same. I undressed the handle, but there are no bends in the handle. The channels by the lamp are clean. I connected an external pump to the handle to flush the system, the fluid flows freely. There does not seem to be a blockage anywhere. Is it possible that the pressure sensor is not working to its full extent? The circuit seems very simple but there is this simple flaw somewhere.

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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JULY 2022

TECHNATION

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BIOMED 101

Challenge of Implementing Biomedical Equipment into an IT Environment BY GREGORY GOLL, CHTM, CBET

here has been a rapid evolution between the world of healthcare technology management (HTM) and information technologies (IT). In the beginning, these two fields had a definite line of separation of exactly which group maintained which equipment. The HTM department was primarily focused on devices that were directly involved in patient care. IT was focused on workstations and networks. An example of this were patient monitoring systems. These systems resided on their own segregated vendor supplied network. The technology of transmitting patient data into an electronic medical record (EMR) was still evolving.

Very rapidly, HTM staff needed to evolve because devices were being networked between separate physical locations. This created an entirely new set of challenges – especially involving patient safety. A greater need was identified to understand network topology and the different components that make up an IT network. Early intervention by HTM staff became increasingly important in the identification of which devices needed to be networked and why. Another important concern involved the associated costs involved with building the supporting IT network. When most older buildings were designed there was, in many cases, little or no concern about creating a space where IT network equipment could be located. A building made in the 1950s would have been more concerned with the location of standard facility systems such as electrical, plumbing and heat. Early HTM/IT networks were forced to find space within the existing building’s structure to exist. The environment where the equipment was installed also became a concern. The locations might require additional climate control. Additional power requirements needed to be considered. New devices are much more sensitive to heat exposure and power interruption. Now, cooperation between HTM and IT is more important than ever. It is now part of the HTM professional’s role to understand the IT world and the roles of project management in their respective work environment.

TECHNATION + JULY 2022

In order to save money, hospitals began to explore options such as combining different types of equipment on the same internal networks. This opened an entirely new area of concern. If a network was not designed to carry real time patient information, there can be issues with time delays in data transmission. A new technical skill set is required for understanding data transmission across a network. Once HTM equipment became dependent on similar software to IT systems, another group of challenges emerged. Operating system software became a concern, the ability to integrate different software programs opened a new required skill set. When purchasing new equipment there is a new importance in understanding the life cycle of the software. Devices may incorporate a vendor software, which requires a separate software to operate properly. Now companies such as Microsoft directly are part of the proper operation of a medical device. The documentation challenges became more complicated. The tracking of all the software revisions used becomes very important. An end-of-life letter for a software such as Windows now may completely change the useable life of a critical device. Information security is the new horizon that all technical professionals face. The securing of patient information is a major concern. Patient information has become a large target for hackers. Confidential patient information can easily be sold. Cybersecurity takes on several forms from physically securing devices, securing access to sensitive areas and creation of protective data firewalls to prevent unauthorized access to a network. All these challenges also open a world of opportunities for an HTM professional. This will continue to evolve in the future. The ability for HTM professionals to evolve amid these new challenges will help ensure job security and allow for future opportunities. For more information, check out the presentation recorded at MD Expo Atlanta earlier this year at tinyurl.com/2ecryv3s. – Gregory Goll, CHTM, CBET, is a manager of projects and medical imaging services department for the WellStar Health System.

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WEBINAR WEDNESDAY

Presenters Deliver Top-Notch Knowledge STAFF REPORT

he Webinar Wednesday series continues to provide excellent educational material for industry experts on a variety of healthcare technology management (HTM) topics. More than 1,000 HTM professionals have logged in for live presentations through May 15 of this year with many more viewing the webinars via the on-demand option at WebinarWednesday. live. Recent webinars have included presentations on cybersecurity issues, patient safety, and real time locating service.

IOMT VULNERABILITY MANAGEMENT Jeremy Linden, senior director, product management at Asimily and Robert Harbick, information security engineer at Southcoast Health, recently co-presented the Webinar Wednesday session “Two Approaches to IoMT Vulnerability Management.” The webinar was eligible for 1 credit from the ACI. It was sponsored by Asimily. The objective of the webinar was to share information about the similarities and differences in these solutions, how to effectively use each one, and how Southcoast has integrated the two solutions to achieve superior results compared to either alone. Attendees will now be able to: • Understand the difference between the approach of traditional vulnerability management solutions and IoMT passive network monitoring • Know where the traditional VM approach works and falls short for connected medical devices

TECHNATION + JULY 2022

• Integrate traditional VM and IoMT passive monitoring together in a vulnerability management program The presenters also took questions from attendees during the webinar. One question was, “Is segmentation a good solution for empty vulnerability management?” The answer was yes – to a degree. “In the end, segmentation, at best, will reduce the blast radius of an attack, right? It’s going to mean that, in a successful attack, it is a lot less successful than it would be, and that’s very important,” Linden explained. “But it’s not a substitute for actually remediating the specific issues, right? And actually reducing the inherent risk and the likelihood of exploitation of these vulnerabilities. So, I would say, you know, some segmentation is good.” The duo expanded on the answer and replied to other queries during the webinar. The entire session along with the Q&A can be viewed on demand at WebinarWednesday.live. The webinar was a big hit with attendees providing feedback via a survey that included the question, “How does the HTM industry benefit from Webinar Wednesdays?” “Learning passive and active vulnerabilities on IOMT,” said Arondo Bia, supervisory biomedical equipment specialist. “It is a resource for learning and advancing the knowledge base of the community,” said Marion Quijano, BMET III. “Discussions from all over allow people to bounce ideas and knowledge off each other,” MedDevice Cybersecurity Analyst Scott Keith said.

PATIENT SAFETY The Webinar Wednesday session “HTM Professionals’ Role on a Patient Safe Endoscope” was presented by Healthmark Industries Special Projects Manager Jahan Azizi. The session was sponsored by Healthmark Industries and eligible for 1 credit from the ACI. In this 60-minute webinar, Azizi provided an overview of the HTM professional’s role as it pertains to patient safety with a specific focus on safety-related endoscopes. He discussed the importance of reporting requirements to the FDA with examples of reported problems and how preventative maintenance (PM) can help with preventing potential harm to patients from the compromised endoscope. The webinar also discussed what HTM professionals do as well as medical devices and the different types. Azizi discussed the role of HTM professionals in the hospital as related to patient safety. He addressed reporting and why is it important. He also shared insights regarding endoscope clinical use and history, scope design (angles, internal lumens, etc.) and a look inside the endoscope. Azizi explored technologies that require PM and expertise of the HTM professionals, the endoscope leak test, enhanced inspection technologies and sample extraction devices for chemical testing. As part of his presentation, Azizi opened the floor to questions. One attendee asked, “What are examples of HTM and SPD success stories?” “This is one of those questions that if you don’t have problems, you do a great job and nobody knows about it,” he said. “So,

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THE BENCH sometimes I think that if you haven’t been in the headline of your local newspaper, you’re in good shape.” He added that it is important to work with others. “We collaborated with FDA, with medical device manufacturers – those that were willing to do that. So, I think clearly that collaboration is the key,” he said. He added that when he attends the AAMI conference, he makes a point to interact with the committees and check on standards and guidelines. Attendees provided feedback regarding the webinar via a survey. One question attendees answered was, “How has Webinar Wednesday helped you in your career?” “Keeps me up to date with what is going on in other areas and helps in making sure we are doing all the right things to ensure the safety of our patients,” Endoscopy Tech Janet Woodland said. “Provides a broad-based general education involving many topics,” Certified Biomedical Technician Glenn Fraser said. “This particular webinar was outstanding in tying together technical details with the clinical engineering role in patient safety. I am really impressed with the quality of the Webinar Wednesday for continuing education,” Biomedical Engineer Emily Salmon said. CYBER-CONNECTED WORLD The presentation “The Biomedical Challenge – When Efficiency Is Not Enough” by Hunter Cobbs was sponsored by CyberMDX, a Forescout Company, and eligible for 1 credit from the ACI. In this 60-minute webinar, Cobbs explored the cross sections of the valued biomedical role in a cyber-connected world. Managing thousands of connected medical devices without smart, automated tools is a highly laborious and tedious task. In addition to detailed classification, location tracking, utilization, downtime scheduling, and FDA recall tracking, HTM professionals also need to consider securing those assets. In the new normal, security must be part of medical device lifecycle management. The session explored the cross sections of an HTM professional’s valued role in a cyber-connected world.

Cobbs also answered questions from attendees as part of his presentation. One HTM professional asked, “I work for a mid-size hospital and I think we do feel constrained by resources. Are there any shortcuts you can recommend? So, we can do more with less.” His answer, in short, was yes. “Absolutely, one of the main things, once again, back to the better together story, is to get connected with your IT department,” Cobbs said. “Second, if you have something like a device and our solution, it will actually recommend how you should approach the problem.” He answered other questions and the complete Q&A session is available via on-demand viewing at WebinarWednesday.live. Approximately 100 individuals registered for the webinar. Attendees provided feedback via a post-webinar survey that included the question, “What is the biggest takeaway you got from today’s Webinar Wednesday?” “As we are learning in our facility, security must be part of medical device lifecycle management. We have had several incidents of ransomware in the last two months,” Biomedical Engineering Technician Edward Dalisay said. “The need for Biomed and IT to work together to protect health care facilities from cyberattacks,” Tech Manager and BMET II Christina Bottomley said.

submitted questions during a Q&A session with the presenter. One question was, “What are the metrics that can predict how much a typical hospital can save by reducing the number of assets?” Jennings provided a thoughtful answer. “There’s a couple of ways to go on to that. One is that there is certain industry data that can show that on a general level,” he explained. “So, there’s certainly industry data and reports that show what typical utilization rate is across hospitals. And there’s plenty of, you know, places that have used these systems that can talk about what kind of utilization improvements you can make. And those two numbers can give you an idea of what the ballpark figure is for saving based on any given hospital size.” He said there was another way to answer that question and provided more information in the Q&A session which is available for free on-demand viewing as part of the webinar at WebinarWednesday. live. Attendees provided feedback regarding the webinar via a survey that included the question, “How will today’s webinar help you improve in your role?” “It helps bring down the time to locate devices due for maintenance,” Biomed Victor Pablico said. “I am trying to gather information to setup an RTLS system at our site. This was very helpful,” Chief Biomedical Engineering Kevin Hutcherson said.

RTLS The webinar “A Powerful Duo: Why RTLS Needs Both Accuracy and Confidence to Power Automation was sponsored by Cognosos and eligible for 1 credit from the ACI. In this 60-minute webinar, Cognosos’ Chief Product Officer Adrian Jennings examined the importance of RTLS “confidence” as it relates to workflow automation in health care. This informative session covered the wide-ranging impact that both low and high confidence levels can have on mobile asset management practices. He also provided guidance for teams on how high-confidence location data can empower better purchasing decisions and automate tedious manual processes. The webinar drew HTM professionals seeking knowledge and CE credit. Many

For more information about the Webinar Wednesday series, including recorded sessions and a list of upcoming presentations, visit WebinarWednesday.live.

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Thank you sponsors:

JULY 2022

TECHNATION

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TOOLS OF THE TRADE Rigel Medical

UniPulse 400 defibrillator analyzer

he compact UniPulse 400 incorporates all the common features needed to perform full preventative maintenance on all types of defibrillators to deliver accurate and time-efficient testing. The lightweight, battery-powered and portable unit, which is equipped with a pacer function for comprehensive testing of defibrillator functionality, can easily be carried around facilities by busy technicians for rapid analyzing all monophasic, biphasic, standard and pulsating waveforms. Incorporating advanced measurement technology, including dedicated fast keys and to enable biomed test engineers to select the relevant test function in seconds, the tester’s large internal memory and on-board results storage also helps to reduce test time and supports hospital and health care teams working towards automated database record keeping systems. The UniPulse 400 can be linked to Rigel’s Med-eBase software to enable test results to be downloaded quickly to a USB or direct to a computer-based records storage system. For more information, visit rigelmedical.com/gb/.

TECHNATION + JULY 2022

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JULY 2022

TECHNATION

ROUNDTABLE

ROUNDTABLE CMMS

echNation contacted several experts to find out the latest about computerized maintenance management systems (CMMS) in the health care sector. Participating in this roundtable article are EQ2 LLC President and CTO Navneet Agarwal, Medigate by Claroty Director of Product Marketing Samuel Hill, Nuvolo Vice President of Healthcare Marketing Strategy Heidi Horn, Fluke Global Software Product Marketing Manager Mitch Kruse, Phoenix Data Systems, Inc. CEO/ President Ben Mannisto and TruAsset LLC Director of Business Development Amanda Moser.

HOW CAN A CMMS HELP HTM PROFESSIONALS ADDRESS CYBERSECURITY CONCERNS? AGARWAL: Cybersecurity awareness and preparedness are critical for HTM professionals. They need to know what actions a CMMS vendor has taken to prevent an attack and what actions will be taken for recovery should an attack affect the CMMS directly. In addition, integrations of the CMMS with third-party cybersecurity applications such as Ordr, Medigate, Armis, etc. help to keep medical devices and other networked applications properly monitored for existing and new cybersecurity concerns. HILL: HTM professionals are starting to become highly involved in cybersecurity, as the devices they maintain pose serious risk to the hospital. The first way HTM can address cybersecurity is to maintain the CMMS as an accurate and complete inventory of every medical device. With the CMMS inventory accurate, the HTM team can fully support the cybersecurity work of patching vulnerabilities. Finally, when compliance audits occur, the CMMS will contain the record for every device inspected, without any surprises. The CMMS is useful for cybersecurity, if the device inventory and details are accurate. HORN: It obviously depends on the CMMS. 46

TECHNATION + JULY 2022

Navneet Agarwal EQ2 Most legacy CMMS products can only identify what devices your hospital(s) have inventoried in their CMMS but will not be able to correlate which devices are actually affected. It’s then up to the HTM department to manually look at each device to figure out next steps. When integrated with a network passive monitoring application, Nuvolo’s OT Security product simplifies the process and takes a proactive and automated approach by giving HTM departments the tools to automatically update the asset inventory when a device is identified on the network; assess the security risk of your devices; match the threat with impacted devices and create work orders if HTM or IT action is needed; enable coordination with IT; and provide cybersecurity dashboards, reports and compliance documentation. KRUSE: It starts with a cloud-based CMMS system built on a world-class cloud infrastructure such as AWS or Azure. Second, there needs to be user- and role-based authentication built into the system login and specific data type access for the system. And, most importantly, there should be policies around personal information being entered into the system to minimize exposure.

MANNISTO: A good CMMS must have opportunities to manage and evaluate extensive cyber security risk points for each piece of equipment that is in the CMMS software. These points need to be readily visible and reportable such that any cyber security issues can be recognized and remediated quickly. Phoenix has built into AIMS 3 extensive opportunities to identify data security issue points on each piece of equipment in the AIMS system. There are approximately 185 data points that can be used to identify risks or conditions that require monitoring. MOSER: A CMMS solution should be able to provide links to security applications and track version numbers of medical equipment to provide a one stop location to access the information pertinent to maintaining that equipment. It should allow easy searching and alerts as to potential security issues. WHAT FEATURES SHOULD HTM PROFESSIONALS LOOK FOR WHEN PURCHASING A CMMS? AGARWAL: Along with core CMMS software solutions – such as work orders and basic maintenance management functions – reports and dashboards to aid in maintaining compliance, and cybersecurity preparedness are important. The ability to integrate or interface with third-party solutions is increasingly becoming necessary. These include procurement systems or service documents and the ability to interface with IoMT and cybersecurity devices. Automation ensures a standard workflow process and ensures that the work is performed consistently. Finally, electrical safety tester interfaces and real-time locations service (RTLS) systems improve the work order processes for the medical system. HILL: The first thing I would look for is the way the CMMS transitions from asset inventory to workflow. To gauge this, I would ask questions like these:

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ROUNDTABLE for most HTM applications. And, of course, having the ability to closely track and manage maintenance inventories is valuable.

Samuel Hill Medigate by Claroty

• How easy is it to find the most up-to-date information? • Is the user experience simple to use? • Does it automate manual work? HORN: The acronym CMMS – computerized maintenance management system – is an outdated concept heralding from the days when biomed shops were only in charge of maintaining clinical equipment. Today’s HTM departments do so much more than just maintenance, and so their CMMS should, too. In addition to what most CMMS applications can do – inventory equipment, schedule PMs, issue and track work orders, report on compliance – CMMS systems that meet the needs of today’s HTM departments also should automate many common workflows (i.e. enable equipment users to request service through a service portal and automatically assign work orders to the proper technicians), have the ability to manage technician productivity and service contracts, prioritize equipment capital planning and replacement needs, manage your AEM program, identify and coordinate response to cyber threats, monitor device utilization, manage your parts and stockrooms, track maintenance costs at the device level, monitor vendor performance, and the list goes on. If you are supplementing your CMMS with spreadsheets, it’s time for a new CMMS. KRUSE: The CMMS software should be flexible enough to be configured to the specific workflows needed for HTM maintenance. It should comply with any relevant industry regulations. Robust reporting and PM scheduling are important

MANNISTO: HTM professionals should be concerned about a number of points when considering a new CMMS. All historical data should be brought forth to the new CMMS. That data should be cleaned and normalized such that the historical HTM department experience can be recognized and potentially evaluated and remediated where appropriate. A good CMMS must also have a comprehensive API to be able to interface with any other third party software. Most importantly, the CMMS should facilitate efficient technician workflow processes since the technician is typically between 65-80% of the HTM department budget. Technician efficiency is critical to long term success and cost containment or reduction. MOSER: The primary focus of any CMMS should be the ability to maximize technician efficiency by streamlining the PM process and allowing required data to be accessed in an expedient manner. The HTM community is facing the same staffing issues other industries are and time management is more vital than ever. The same holds true from an administrative standpoint, as management also needs the ability to quickly review technician productivity, PM and repair completion, and reporting metrics to maintain the efficiency in the organization they oversee. CAN YOU TELL READERS A LITTLE ABOUT WHAT YOUR CMMS OFFERS? AGARWAL: EQ2 is one of the few CMMS vendors where both the company and the product are committed solely to the health care market and as such our core competencies of health care expertise, product quality and customer service are strong. HEMS is built on its own platform so we can modify and meet the needs for health care clients as the needs arise, and our system is not dependent on the hospital’s use of any enterprise platform. Yet, we integrate or interface with numerous third-party applications, improving workflows and making information accessible in multiple systems. We just released “HEMS Web,” providing an enhanced user experience that significantly

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reduces the IT resource time needed at implementation time. HILL: Medigate does not sell a CMMS, rather we integrate with the leading vendors in this space to provide up-to-date device info to the CMMS. HORN: Nuvolo Connected Workplace for Healthcare solution is unique in the market, because it’s a combination of software products – all built on the ServiceNow platform – that enable hospital departments to collaborate versus work in silos. Nuvolo’s HTM Asset Management is one such product. Nuvolo’s HTM Asset Management is a modern CMMS that meets the needs of today’s HTM departments with tools to efficiently manage your equipment, technicians, vendors, costs and compliance. Other products included in the Connected Workplace for Healthcare solution support OT Security, Capital Equipment Planning, Facilities Maintenance, Projects, Real Estate, Space Management, Warehouse Management, Calibration, Field Service Dispatch, and Sustainability.

Heidi Horn Nuvolo

KRUSE: eMaint is a leading CMMS software that has been serving health care customers for years. It is a highly configurable system that allows customers to modify screens to work the way they want to work. eMaint excels at maintaining compliance for customers and provides robust tools for reporting and dashboards. eMaint also comes with an API for the enterprise edition that enables integration with other JULY 2022

TECHNATION

ROUNDTABLE management and equipment downtime reporting to a 24/7 call center with automatic assignment and escalation. Often, they are looking to unify different lines of service so that HTM or Facilities data is connected throughout the enterprise, leading to better planning for workflows, procurement, risk mitigation and compliance.

Mitch Kruse Fluke Global HTM-related software, making the maintenance function even more efficient. MANNISTO: AIMS 3 is the fifth AIMS rebuild and assemblage of over 35 years of CMMS user needs blended with today’s software and hardware technology. The primary focus of AIMS 3 is user ease and efficiency, especially for technicians who represent 65-80% of labor costs. The software is constantly evolving and optimizes HTM department user’s workflows and changing needs. Phoenix serves approximately 3,000 hospitals in 22 countries with between 50,000-60,000 who use AIMS every day. MOSER: TruAsset was built for the HTM community. We offer a fully customizable service request system, contract management, parts inventory management, AEM functionality and many of the “little things” that save time when it matters most. We excel at providing all the features of an Enterprise CMMS and the user-friendly interface of a simpler program. We offer this with continual support to our clients and accessibility to our team for a rapid response to any questions and an opportunity to learn about new features. HOW DO YOU WORK WITH CUSTOMERS AND POTENTIAL CUSTOMERS TO UPGRADE A CMMS TO MEET THE EVER-EVOLVING NEEDS OF HEALTHCARE? AGARWAL: We assess new needs that have evolved since their last upgrade. Clients have new goals they are trying to achieve, along with plans for how to achieve them. This can be everything from improved contract

TECHNATION + JULY 2022

HORN: One of the reasons why Nuvolo has been so successful is it is built on a highly configurable platform that allows us to continuously make enhancements and add capabilities and integrations to meet the ever-evolving needs of health care and HTM departments. We are now providing customers with two major releases per year with enhancements, ensuring our product doesn’t become obsolete and need to be sunsetted. When there are new releases, Nuvolo works with our customers to help them understand what new capabilities are in the release and determine when they will want to upgrade it. These new software upgrades are included as part of a customer’s software subscription, and therefore there is no extra cost to benefit from the new capabilities. The process for upgrading is relatively simple and can be performed over a weekend with almost no downtime.

Phoenix to add hundreds of enhancements to the AIMS software every year. MOSER: We frequently communicate with our customers to understand what their needs are. Our program is continually being improved upon and we implement new features continuously with no charge to our customers. We monitor the data metrics that regulatory agencies like The Joint Commission, DNV and numerous others are requesting and ensure that we can simplify that data reporting to ensure smooth surveys. WHAT ARE PERIODIC AUTOMATIC REPLENISHMENT (PAR) LEVELS AND HOW DO THEY HELP HTM PROFESSIONALS? AGARWAL: PAR levels are established so that parts and devices do not fall below minimum levels and do not exceed maximum levels. CMMS reporting helps alert the HTM professional when they are getting close to either level so that they can respond accordingly. Having enough parts and devices on hand lowers the risk of running too low when there is a surge of need on either. At the same time, carrying too much inventory can be costly.

KRUSE: eMaint has a world-class customer support and services organization ready to help customers or prospects modify eMaint to meet their specific needs. eMaint can handle the modifications for customers, or customers can opt for training to modify their own systems. The health care industry is constantly changing, making the flexibility and configurability of eMaint valuable. It can meet customers’ needs today and into the future.

HILL: PAR levels are a bit like the difference between intention and impact. We might intend to have a certain number of devices, or a PAR level, in a specific unit, but the impact (or felt experience by our front-line care teams) may be that they do not have enough. PAR levels need to be dynamically updated, based on current needs, to truly be effective. When done right, PAR levelling serves to instill confidence in front-line staff that they will have the devices and tools they need to get the job done.

MANNISTO: Phoenix views the AIMS 3 user and the Phoenix Implementation Team as partners to achieve optimum HTM department efficiency from both the software and the workflows of existing technicians. Phoenix hosts a yearly AIMS User Group where users suggest to the AIMS product manager what is needed to keep them current with industry compliance as well as what can make their jobs easier and more efficient. Phoenix commonly adds user requests to software in two upgrades per year. It is common for

HORN: Some CMMS vendors – including Nuvolo – enables HTM departments to manage the quantities of items moving into their stock rooms when received and out of the stock room when used. In addition, you can determine what you want the minimum quantity of certain parts, supplies and equipment to have on-hand in your stock room – known as PAR levels – and then set auto replenishment alerts to reorder when quantities fall below PAR levels. Having stock room management with PAR-level capabilities in your CMMS can help ensure you have critical parts,

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ROUNDTABLE supplies and equipment available when you need it and reduce down-time. KRUSE: Par Levels are the optimal level for inventory on hand values based on day to day operations. Par levels can change depending on the inventory usage and work being performed throughout the year. eMaint can track inventory usage and trend on parts usage. Par levels can be updated based on review of inventory usage.

Ben Mannisto Phoenix Data Systems, Inc.

MANNISTO: Through the Phoenix Data subsidiary, Superior Analytics, Phoenix uses extensive KPIs to provide a view of how well a department is doing per KPI from Superior’s database. This often informs HTM professionals where they can save labor time and thus control if not reduce labor costs. MOSER: PAR levels set the minimum alert trigger and can be applied in several ways. It could be by alerting when certain commonly used parts need to be ordered due to low stock, or when integrated to an RTLS system to alert your team when too many pumps are stacking up and need attention. Setting these levels correctly and managing the information provided allows the HTM professionals to be proactive and not reactive. WHAT ELSE SHOULD TECHNATION READERS KNOW ABOUT CMMS? AGARWAL: CMMS systems such as EQ2’s HEMS are evolving quickly to meet a rapidly changing landscape. Hospitals are

requesting more and more integrations for cybersecurity, for financial and procurement systems, and for single sign-on. The CMMS is becoming “smarter,” meaning intuitive interfaces with the overall product becoming easier to use and dashboards and reports quickly providing actionable data at the fingertips, and with mobile apps that can work both online and offline so that work can be completed anywhere – even without a connection. The increased sophistication of some of these needs could make it seem like CMMS systems are costly. But that is not always the case as EQ2 recently put together a package called “HEMS Essentials” which provides the most basic modules at an affordable price based on bed size. HILL: As the future comes at us quickly, an accurate and detailed inventory in the CMMS can support improved decision making around device life cycle management. While the CMMS is difficult to keep up to date today, there are some positive strides around integrating with health care IoT security tools that consistently provide the CMMS with accurate and detailed data. HORN: The CMMS is the primary tool for HTM departments to manage and prioritize all the work they are responsible for – whether that work is maintaining equipment, managing vendors, mitigating cyber threats, ensuring regulatory compliance, prioritizing equipment replacement, performing rounds, ordering parts and the list goes on. If you are finding that you need to supplement the capabilities of your CMMS with spreadsheets, it’s time to look for a new CMMS. Similarly, HTM departments work with the facilities, IT, EVS, construction, real estate and other support departments almost daily, so you want your CMMS to help you better coordinate with the teams you work with in order to work smarter, not harder. KRUSE: CMMS is a highly competitive sector with many products to choose from. That competitiveness benefits customers. With a CMMS, maintenance and repair operations can become a profit center in companies through extending the life of assets, eliminating catastrophic production failures, and gaining efficiency through technology. The adoption of IIoT and emerging technologies such as AI increases the value

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

Amanda Moser TruAsset LLC of a CMMS as a critical component within a connected reliability program. A CMMS can give companies greater insights than ever before into the health of their organizations. MANNISTO: Often, decision makers will listen to a polished and effective sales pitch without asking the pertinent questions about delivery and implementation. This can cause meaningful disappointment by purchasers of some CMMS systems. More specifically, as said above, technician’s labor is between 65-80% of the HTM department budget. You will want to partner with a vendor who is committed to a quality product and implementation that facilitates labor efficiency and potential cost reduction. AIMS was specifically created by healthcare engineers for healthcare clients and has been a CMMS system explicitly dedicated to the healthcare industry for over 35 years. MOSER: The CMMS at its base function can maintain asset and PM history, but beyond that there is a tremendous amount of value that can be added to this through service request systems, time management, and reporting. We strive to help customers build processes that can make management of clinical engineering easier. Additionally, contract management, parts inventory tracking and automated functions within a system can save time on each PM that adds up through the course of a year.

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COVER STORY

SECURE NETWORK HTM, IT COLL ABOR ATION V ITAL FOR HOSPITAL S

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COVER SPOTLIGHT STORY

BY K. RICHARD DOUGLAS

hile there has been an evolution in the HTM/IT/IS ecosystem that has produced hybrid and specialist positions, the challenges that overlap the professions remain abundant.

The focus of these departments intertwines frequently and the goals of each group – to protect the integrity of the network, patient safety and hardening the ever-increasing surface of modern-day health care systems – unites all parties under a common umbrella. The roles of HTM and IT/IS require something of a balancing act. Both are critical to the facilities they serve, but often they have methods or protocols that conflict. As the universe of IoMT and IoT continues to expand, and devices containing patient protected health information (PHI) evolves, the need for collaboration across the groups is critical to workflows and cybersecurity. Today, it’s not enough to maintain the hardware and software of devices on the network. The perils posed by threat actors exploiting any possible vulnerability is continuously growing. That threat can target any medical device that has an operating system as well as any device that may connect to the Internet through the facility’s access points. For this reason, mitigation of threats is paramount and awareness of the entire surface that is vulnerable must be known to HTM and IT/IS and written protocols must be followed precisely. The methods used by cyber threat actors continue to grow as well. Collaboration between departments is key and any tips or insights to enhance and bolster that effort should be pursued. But what happens when circumstances outside of HTM’s control prevent the biomed department from being able to complete a project, or install a device on the network, because IT/IS will not approve it?

THE HTM PERSPECTIVE While many goals and objectives of IT and biomed are closely aligned and many procedures are more standardized across both groups, the safety protocols that IT requires can often be frustrating when it encroaches on areas outside of biomed’s control. Other times, availability might hold up projects. Obsolete legacy platforms, that no longer receive security updates, have caused many problems. There have been several operating systems that have faced this inevitability in recent years. There was a time, not long ago, when most ATMs still ran Windows 7. Before that, many ATMs ran on Windows XP. These systems were in place even after they were considered obsolete. So, it comes as no surprise that this scenario may also impact biomeds who have the best intentions. Hosameldin “Sam” Elsemany, CCE, CBET, a clinical engineer in the department of clinical engineering with UConn Health has dealt with a related issue in the NICU area. “We are scheduled to go live with integrating our NICU bedside monitors with Epic and our network security team is refusing to connect the Philips server to the hospital since it has Windows 2008 OS,” Elsemany says. He says that there were a couple of options to connect the bedside monitors to Epic. “One option was to connect each bedside monitor to the network via HL7 middleware, but we couldn’t use that option because our bedside monitors are end-of-life and the serial port, needed to connect to the middleware, was not available to order,” Elsemany says. He says that the second option was to connect to the network via the Philips gateway server, and as mentioned, the server has W2008 and was never patched in the past. “Now we are exploring the possibility of patching the server, putting it behind a

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

firewall, and segmenting it on the network until the whole bedside monitor system is replaced/upgraded,” Elsemany says. He says that although it is very expensive to upgrade the NICU monitors and it was not on the hospital’s radar to purchase this year, due to supply chain issues, Philips has a lead time of 10 months to deliver the new monitors/server if they were purchased in May of this year. “That limits our options to connecting the outdated server to the network with all associated cybersecurity risks,” Elsemany says. “One tool we found very useful in mitigating and monitoring medical device cybersecurity risks is to use a healthcare security platform software application. The application monitors all devices connected to the hospital network, provides detailed reports of the risk level associated with each device and recommends how to mitigate those risks,” Elsemany adds. He says that it is then up to the CE team to work with the hospital network security team and vendors to patch the device or make network changes to alleviate the risks. “We invested in that software last year and it was a great step in the right direction towards creating a CE device cybersecurity program,” Elsemany adds. Elsemany says that regardless of the efforts taken by in-house CE/IT to minimize cybersecurity risks with medical devices, there will always be medical devices that received 510K clearance with now outdated operating systems such as Windows 7 and XP. “The vendor won’t have patches for those systems and CE must work with the IT team to find ways to reduce risks with those systems. CE must also have a plan to replace those systems in the near future to eliminate the risks,” he says. Aged operating systems provide a perfect illustration of when all parties want to do what is right, but collaboration is needed to explore all options.

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TECHNATION

COVER STORY “Concerning some of the frustrations, it is important for HTM professionals to have a basic understanding of the job requirements of the IT/IS cybersecurity department. In my experience, they are not intentionally making things difficult in the installation, implementation or security management of medical equipment. It is extremely important for HTM departments to understand the ‘why’ behind IT/IS requirements for connected medical devices,” says Mike Busdicker, MBA, CHTM, FACHE, system director of clinical engineering at Intermountain Healthcare. He says that once biomed understands the requirements, it becomes imperative to be imbedded in the process and work collaboratively toward solutions. “There cannot be an ‘us and them’ mentality or we will hinder the ability to implement a program that benefits the patients we serve and the overall health care environment. There are a lot of bad players out there and we need to be on the same page in order to protect our organizations, caregivers and patients,” Busdicker says. He says that recently, their HTM department was struggling with the disabling of ports on their laptops because of cybersecurity risks. “This hindered the ability to download service software and connect to medical devices for calibration and troubleshooting. Our HTM medical equipment security team worked with the IT/IS cybersecurity team to establish an exemption process that would meet the requirements of both departments. This is an example of both departments working together to develop a solution to meet the needs of the health care system,” Busdicker adds.

“

THE IT/IS PERSPECTIVE Some IT/IS security professionals clearly recognize the challenges placed before HTM because of the extraordinary advances in technology during the past decade. “The HTM field is changing as more and more medical devices are relying on microchips, an underlying off-the-shelf operating system and network/EMR integration. There is so much more to the HTM field than there used to be 10 years ago. Preventative maintenance is still critical, but there are so many more elements that can impact the clinical efficacy and the safety of devices on the network,” says Ali K. Youssef, director of medical device and IOT security, information privacy and security office at Henry Ford Health in Detroit. He says that IT team members have had years to hone their skills and mature frameworks and processes for dealing with cybersecurity. “Institutions like ISO, NIST and others have helped pave the way. IT teams are generally not mature in dealing with IOT and medical device security issues, or even understanding the medical device life cycle,” Youssef says. He says that some of the most common gaps in IT systems are: • Poor IOT/medical device identification and classification. The traditional tools do well with identifying servers and workstations, but do not address IOT/medical devices very well. • There is not an automated mechanism to sift through the thousands of ever-growing known vulnerabilities and correlate them to the IOT

and medical device inventory connected to the network. • There is not a clear automated way to gauge the risk associated with each vulnerability and boil down the most important devices to focus on. He says that in order to deal with these challenges, people and processes alone are not sufficient. “We need to rely on technology, and more specifically medical device and IOT security management tools,” Youssef says.“Without these tools, the task of understanding and remediating risks associated with medical devices is extremely difficult and time consuming. Understanding and sifting through the volume of vulnerabilities coming out on a daily basis manually is a poor use of time and resources,” Youssef says. Youssef adds that from an healthcare delivery organization (HDO) standpoint, medical device and IOT security can be aligned around existing cybersecurity programs. “There are some key things to be aware of when we’re dealing with medical devices on the network. Passive security scanning is as far as one can go in order to avoid impacting the functionality of a given medical device. The devices often do not integrate with active directory and do not support AV or EDR. Minor changes can be made to existing HTM policies to include a security focus. For example, requesting security documents like the MDS2 and SBOM from the medical device manufacturers, prior to procurement, ensuring that there is a focus on cybersecurity as a part of the

The HTM field is changing as more and more medical devices are relying on microchips, an underlying off-the-shelf operating system and network/EMR integration. There is so much more to the HTM field than there used to be 10 years ago. - Ali K. Youssef

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COVER COVER STORY STORY preventative maintenance and ultimately ensuring the devices are wiped appropriately during the decommissioning process,” he says. Youssef points out that scenarios will arise where a medical device may require a firmware patch due to a known vulnerability. Assuming a patch is available from the manufacturer, in many cases HTM departments have to quickly find the devices and install the patch on a device per device basis. “Some of the newer medical devices allow for centralized management, but unfortunately the majority of medical devices in use throughout health systems are anywhere between 10 to 20 years old. Having the ability to bring in staff augmentation to help quickly for these types of scenarios is important and can help to prevent staff burnout,” he says. Youssef says that as HDOs focus on medical device security, it is becoming increasingly important to have dedicated teams focused on this area that can speak the language of IT and HTM. “The trend toward cross training HTM on IT principals and vice versa continues to be critical. The Configuration Management Database (CMDB) and CMMS need to have some level of integration in order for each to enrich the data of the other. The goal of both departments is to improve patient safety and promote the confidentiality, integrity and availability of medical devices which requires cooperation from both teams,” he says. CHALLENGES AND REALITIES There are some challenges that are likely to frustrate HTM when either timing or technology limitations are obstacles to repairs or maintenance. “It is hard for the standard IT desktop/application team to understand that medical devices using common operating systems cannot just be ‘patched.’ A patch could have an ill-effect on the medical device application side of the device. If there is a vulnerability with the OS, the device should be segmented or placed behind a dedicated firewall. Both sound easy when you read and think

about it, but configuration, testing and deployment all need to then occur. Time, money and other resources are required. However, segmenting and firewalling could be a faster solution than a patch that needs to go through FDA validation,” says David Soffer, manager of the medical device IS specialist team at WellSpan Health. Occasionally, HTM will also face challenges because of storage trends when adding new equipment to the network or making replacements. “The cloud is here, and devices are sending data up ‘there.’ We have devices that send to the vendor’s cloud space. Data is collected and then available for review and analytics. Our IT security team reviewed the cloud server connections from the vendor documentation and allowed the IP and port for communication. As we acquire equipment, it goes through a very large technology assessment. That way all technical teams involved, along with the customer and vendor, can discuss options, challenges and solutions that are available,” Soffer says. He says that in the IT world, a great defense comes with a great offense. “If we set up the device accordingly, to make it as secure as possible, there should be minimal issues with connectivity. Unfortunately, it always seems the dark side of hacking and finding OS holes is faster than our defense,” Soffer says. Is there any way to streamline the permissions required by IT when new equipment is placed on the network? “As mentioned above, we perform a technology assessment with the vendor pre-purchase for new medical equipment being requested. The vendor is provided the form in advance so their appropriate teams can answer the questions,” Soffer says. He says that the questions focus on network connectivity, server requirements, application deployment for workstations and so on. “There are also questions about special power, ventilation, fluids such as steam or water, consumables, user training, etc. There is even more to the form which provides information needed

EMPOWERING THE BIOMEDICAL/HTM PROFESSIONAL

in advance to provide a successful purchase, installation and user deployment. The days of devices just showing up because someone was able to sneak a PO through the purchasing system are long over. Working together provides a successful outcome,” Soffer adds. What if the system is down and the part being replaced needs to be re-registered on the network and it is off-hours? “This is your worst-case scenario question. Like a CT reconstruction computer goes down and the vendor is working with the local hospital on-call imaging technician. But then the on-call tech realizes the new computer will not plug right into the network because it is DHCP reserved IP. Now the network team needs to be called so someone can update the switch port with the new MAC address of the reconstruction computer. Am I far off from a real-world situation?” Soffer asks. He says that luckily, he does have on-call procedures, escalation trees and IT managers that rotate on-call. “Everyone likes to think they have the worst of the worst figured out for afterhours coverage, but it doesn’t always go the way it has been planned. If we have a system outage, we have an escalation process that brings teams and leaders together on a live call. This is like a verbal incident command where staff are reporting in, leaders are making decisions and work is being tasked. Having the live communication with real-time decision making and feedback is a seamless way to work through and eventually solve issues,” Soffer says. Busdicker says that within his health care system, they have an IT/IS team dedicated to the cybersecurity of the organization and there are caregivers within the HTM department focusing on medical equipment. “These two teams meet routinely, communicate constantly and work collaboratively to ensure we are fulfilling the requirements associated with medical equipment security and data protection. To bridge the requirements, and ensure a safe environment, these teams need to be on the same page with the same end goal in mind,” he says.

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EXPERT ADVICE

CAREER CENTER Advice for Negotiating Salary, Benefits

Kathleen Furore

BY KATHLEEN FUORE

egotiating a salary and benefits is challenging even for the most experienced job seeker. But it can be especially tricky for new grads just entering the workforce, whether they’re graduating from high school, trade school or college. How can they enter negotiations in a way that will help them get the best salary and benefits without offending a prospective employer?

If the answer could be summed up in two words, those words would be, “have confidence!” “Often the biggest challenge young people face in negotiating salary is confidence. They worry that negotiating might lead to either losing the opportunity or to being poorly thought of within the firm,” says Aliza Knox, author of “Don’t Quit Your Day Job: The 6 Mindshifts You Need to Rise and Thrive at Work.” The truth is that, at least in most cases, neither of those things is likely to happen, especially in today’s tight job market, Knox says. “By the time a company gets to making you an offer, they’ve decided they want you and have also expended a fair amount of time and energy in the hiring process, which they are loath to redo,” she explains. “They are unlikely to retract an offer just because you’ve countered with a reasonable request for a higher salary, although they may say no. For example, some companies set all new grad starting salaries at the same level to ensure pay equity and they will not budge on that.” Attorney and career coach Kelli

TECHNATION + JULY 2022

Lanski, author of “First Job Essentials: The Young Professional’s Guide to Getting a Job and Getting Your Career Off to a Great Start,” suggests taking three steps to negotiate professionally: 1. Do your research. “Know the expected salaries for this type of role in your market,” Lanski says. 2. Think critically about what you would need to accept this role. When deciding what requests to put on the negotiating table, Lanski says to remember you can negotiate your salary, and frequently other personalized benefits like vacation time, but not benefits like insurance premiums because they apply to all employees. 3. Send a brief email request. Start by expressing your enthusiasm and indicate you want to accept the offer if you can come to a resolution on salary and benefits, Lanski suggests. “Explain your counter-offer succinctly and thank them for their consideration, and support your request based on your research and market expectations, not on what you feel you need because you rented a pricey apartment or have a dog with expensive taste,” Lanski says. “And be reasonable! If you get an offer for a salary of $40,000 and were hoping for double or triple that, it may be time to walk away. A huge mismatch in salary expectations is often an indicator that this is not the right role for you, and you should respectfully decline.” Knox also stresses the importance of entering any negotiation being clear about what you want but understanding that most negotiations end in a compromise. “You may not get what you want, but usually, once the company has decided

they want you, your request won’t affect getting the job,” she says. “And once you’ve started and are performing, no one even thinks about the initial negotiation again.” Asking for a better starting package sometimes even impresses the prospective employer, as Knox notes in this example: “A young woman I know graduated from college in May 2019 and took an unpaid, remote internship at a startup in San Francisco. After three months, the company offered her a full-time position,” Knox recalls. “She was excited and wanted the role, but she also secured an offer of the same salary from a similar company in North Carolina, where the cost of living is significantly lower. Although she was afraid to ask for more money, she decided to negotiate for what she wanted.” The result? “Instead of being offended, the head of HR praised her for asking, saying she was delighted that the young woman had advocated for herself because so few young women do. And long story short, she ended up getting a higher salary than the original offer,” Knox continues. “The lesson is that if a company wants to hire you, they’ve determined that you have value. In exchange for that value, you should be able to ask for what you want, within reason. This may include additional vacation time, flexible hours, remote work or a higher salary.” – 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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TechNation Magazine July 2022

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