TechNation November 2023 by MD Publishing

1technation.com

Vol. 14

NOVEMBER 2023

ADVANCING THE BIOMEDICAL / HTM PROFESSIONAL

TIPS FOR GREAT CONTRACT MANAGEMENT FLEXIBILITY AND MONITORING PAGE 54

Professional of the Month

Charles Woolfolk

Corporate Profile 22 Cox Prosight Center 58 Career What to Do When Bullied at Work

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CONTENTS P.12 SPOTLIGHT p.12 Department of the Month: The ProHealth Care Biomedical Engineering Department p.14 Professional of the Month: Charles Woolfolk p.18 Shifting Gears: Answering the Call p.20 Next Gen: Emily Mengel p.22 Corporate Profile: Cox Prosight P.26 INDUSTRY UPDATES p.26 News & Notes p.32 AAMI Update p.34 ECRI Update p.37 Welcome to TechNation p.39 Ribbon Cutting: Bright Biomedical, LLC P.41 THE BENCH p.41 Tools of the Trade p.42 Biomed 101 p.45 Webinar Wednesday

54 FEATURE ARTICLES p.46 Roundtable: Asset Tracking p.54 Cover Story: Tips for Great Contract Management P.58 EXPERT ADVICE p.58 Career Center p.60 [Sponsored Content] Innovatus Imaging p.62 The Future p.64 [Sponsored Content] Capital i P.66 CONNECTED p.66 Cybersecurity p.68 HIMSS p.70 Health-ISAC p.72 Get Connected Company Directory p.74 Networking Notes

TechNation (Vol. 14, Issue #11) November 2023 is published monthly by MD Publishing, 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. ©2023

November 2023 | TechNation 9

PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

VICE PRESIDENT OF SALES

Jayme McKelvey

EDITORIAL

John Wallace

CONTRIBUTORS

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

ACCOUNT EXECUTIVES

Megan Cabot Emily Hise

ART DEPARTMENT

Karlee Gower Taylor Hayes Kameryn Johnson

DIGITAL SERVICES

Cindy Galindo Kennedy Krieg Haley Wells

EVENTS

Kristin Leavoy

WEBINARS

Linda Hasluem

HTMJOBS.COM

Kristen Register Sydney Krieg

ACCOUNTING

Diane Costea

CIRCULATION

Joanna Manjarrez

EDITORIAL BOARD Rob Bundick, Director HTM & Biomedical Engineering, ProHealth Care Carol Davis-Smith, CCE, FACCE, AAMIF, Owner/ President of Carol Davis-Smith & Associates, LLC Jim Fedele, CBET, Senior Director of Clinical Engineering, UPMC Bryant Hawkins Sr., Site Manager, Children’s Hospital of New Orleans

86 P.77 BREAKROOM p.77 Bulletin Board p.78 [Contest] What’s on Your Bench? p.79 Biomed Brainbuster p.80 TechNation Poll p.81 CEAI Scrapbook p.86 #IamTechNation p.82 Service Index p.85 Alphabetical Index Like us on Facebook, facebook.com/TechNationMag Follow us on LinkedIn, linkedin.com/company/iamtechnation Subscribe to TechNation TV, youtube.com/@TechNation_TV

Benjamin Scoggin, MBA, MMCi, Director, Clinical Engineering | Biomedical Operations, Equipment Distribution, Clinical IT, DHTS, Duke Health Technology Solutions Allison Woollford, Biomedical Equipment Specialist at Duke University Health System

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

10 TechNation | November 2023

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SPOTLIGHT

DEPARTMENT OF THE MONTH

The ProHealth Care Biomedical Engineering Department

BY K. RICHARD DOUGLAS

roHealth Care is one of the largest health care providers in Wisconsin, serving patients in Waukesha County and portions of Dodge, Jefferson, Racine and Walworth counties. The health system has been operating since 1914.

The team also has a big leg-up in the integration and cybersecurity areas with dedicated specialists on board. “We have two biomed integrations analyst positions and a biomed security DBA imbedded in the department. They assist with all of the device integrations for our medical devices from EMR integrations to PACS, network connectivity and any other digital connections for devices,” Inderdahl says.

Many innovations and expansions have occurred since its founding. The system’s growth has tested its biomedical engineering department. The 29-member department includes Director Rob Bundick; Manager Nick Inderdahl; Supervisor Dan Blaisdell and HTM Program Manager Lani Bartkowiak. Other members of the department include Medical Equipment Project Coordinator Rachel Schneider; Equipment Planner Haylee Miles; Biomed Equipment Lifecycle Planner Chuck Overeem and Biomed Engineering Database Administrator (DBA) Robin Shilkey. The team also includes imaging techs, a procurement specialist, integration analysts, biomed engineers and an operations specialist. Department members manage equipment at four hospitals, which includes 274-bed ProHealth Waukesha Memorial Hospital; 18-bed ProHealth Waukesha Memorial Hospital-Mukwonago; 63-bed ProHealth Oconomowoc Memorial Hospital and 40-bed ProHealth Rehabilitation Hospital of Wisconsin. The group also provides equipment management at a freestanding outpatient cancer center, 15 clinics, 11 urgent care sites within clinics and to ProHealth Angels Grace Hospice. All service contracts for medical equipment are managed by the department and most are budgeted under the department. “Service contracts are scrutinized and we try to do as much as we can in-house. We invest in the training of our team so we can minimize contract costs. Of course, there are always those ‘one-off’ devices/systems that just make sense,” Inderdahl says.

STRATEGIC GROWTH The biomed department is active in a number of projects to continuously modernize its processes in order to manage the equipment inventory throughout the equipment life cycle. “We are included in all aspects of the medical device/ system life cycle from purchase to sale of old/unneeded equipment. We handle the capital planning for fleet replacements as well as high-end devices,” Inderdahl says. “We implemented the ORDR application as we saw a lack of visibility of the network posture our medical devices had in our environment,” he adds. There was a lack of details on what these systems were doing on the network. “ORDR provided this for our medical devices as well as all other things connected to the network. We could now see what our devices were talking to internally and, more importantly, externally,” Inderdahl says. He says that the department then implemented GE’s SKEYE program to assist in two things – gather missing details of the networked devices to complete the informatics page in the CMMS and get a handle on the vulnerabilities that were appearing in the passive network detection platform, ORDR. “SKEYE monitors our ORDR system 24-hours a day and notifies ProHealth of medical devices that have a vulnerability or alarm that needs to be addressed,” Inderdahl says. He says that these notifications then turn into a work order for the team to complete. “This process is helping ProHealth Care maintain a strong security posture for our medical devices, to the extent that is possible. Our next venture is going to be segmenta-

12 TechNation | November 2023

tion at the firewall, with the help of ORDR and our IT teams,” Inderdahl says. Coming up with solutions to challenges has stimulated the department’s expansion. “Department growth over the last six years is a result of problem solving. The need for dedicated integration analysts, security DBA, HTM program manager, project coordinator, equipment planner, and life cycle planner resulted from various issues or concerns that were encountered,” Inderdahl says. He says that many of the problems that the team has faced are common among HTM departments. “The need to implement cybersecurity and the need to capture detailed informatics information to support cybersecurity and device integration was a problem we could not overlook. We added a cybersecurity DBA and another integration analyst to the department and that highlighted our strengths and weaknesses,” Inderdahl says. “We learned early on that while we did a good job of capturing informatics information for device integration, we needed to capture more detailed information for a successful cybersecurity program,” Inderdahl adds. He says that work orders were created for staff to review all networked equipment for informatics accuracy. “We created detailed fields in our CMMS for technicians to enter data as these work orders were completed or as new equipment is onboarded. All data was reviewed by our security DBA or integration analysts for accuracy. Currently we are implementing a plan to ensure all window updates/ patches are installed and information captured and documented in the CMMS,” Inderdahl says. Other growth opportunities arose from challenges related to additions to inventory. “Our capital asset management program for all imaging modalities and many biomed modalities provided leadership with a cost forecast and plan to replace aging fleet. Responsibilities related to the planning, onboarding and installation of the equipment grew. This provided many challenges and opportunities to improve and help the organization,” Inderdahl says. He says that these challenges allowed for growth by adding a program manager, a project manager medical equipment and an equipment planner. “These new roles efficiently complete tasks previously provided by department leadership and staff,” Inderdahl adds. Away from work, the team members are involved with AAMI and the local biomed association. “Wisconsin Biomedical Association – Lani is a ‘Southern Delegate’ and assists with meeting and annual conference planning,” Inderdahl says. The biomed team at ProHealth Care met challenges with problem-solvers and specialists, and as a result, have created a well-rounded HTM department for the future of equipment management.

November 2023 | TechNation 13

SPOTLIGHT

PROFESSIONAL OF THE MONTH Charles Woolfolk Prioritizing Family and Team

BY K. RICHARD DOUGLAS or many who have entered the HTM profession, there was initially an interest in health care, but a reluctance to pursue the clinician path. Not everyone is cut out to deal with some of the aspects of patient care.

That was the case with Charles Woolfolk, HTM manager in the Baylor Scott and White (BSW) Healthcare Technology Management Department in Temple, Texas. “I think I always gravitated to the health care field but knew right away that I wasn’t interested in direct patient care. My wife had a client that told her about the HTM field and I was immediately interested in the opportunity to get started right away,” Woolfolk recalls. Woolfolk enrolled in the HTM biomed/imaging program at Texas State Technical College (TSTC) in Waco, Texas. He says that he was a little late to register and Debbie Tharp at TSTC got him into the program about a week before the semester started. “I didn’t know what to expect, but was happy to realize the curriculum and approach fit my learning style. I would say after my first semester, I became even more excited about the opportunity to make this my career. Once I started the position, it was eye-opening to see the great amount of focus required by HTM to maintain safe medical equipment,” he says. The biomed program at TSTC suited Woolfolk perfectly and it allowed him to move on to a major health care employer. “The small classes and hands-on learning approach was great for me. I feel like I was able to

14 TechNation | November 2023

graduate from the program with a good understanding of what to expect going into the field. I did my internship at Baylor Scott and White Memorial Hospital in Temple, and eventually finished my internship in dialysis where I was offered a position. Today we facilitate multiple internships per semester, and many interns have joined our team after graduation. Once I started in my position, I went to Fresenius Level I and Level II training,” he says. Since entering the profession, Woolfolk has worked as a BMET I, BMET II and HTM Manager I. He has been in his current position for the past three years. His area of specialty is dialysis. “I started in dialysis and currently manage the team covering our central Texas clinics and in-patient units. Every day presents a new challenge in dialysis and it keeps me learning daily,” he says. Woolfolk also manages the biomed teams at BSW McLane Children’s Hospital and BSW Waco Hillcrest hospitals, including the Waco area clinics and Temple region clinics. FAMILY AND TEAM FOCUS Challenges and special projects are a part of HTM. As both a manager and along with his team, the challenges have been addressed and projects completed. “COVID-19 provided a unique challenge in the form of surge equipment. We worked a call rotation with other managers to stage surge ventilators for transport to needing hospitals within our system,” Woolfolk says. He says that another responsibility was providing design input and regulatory guidance for a new in-patient dialysis water system. He says that his team successfully moved it to a brand-new suite with brand new equipment in August of 2022. More recent projects have included configuring and inventorying approximately 700 infusion pumps

and syringe pumps for various projects within the system and multiple patient monitoring projects implemented in the past two years at Children’s Hospital and Waco Hillcrest “Nurse Call transition at Waco Hillcrest was house wide. It provided challenges to our biomed team during the transition which they met head on while supporting the transition,” Woolfolk says. Off the job, Woolfolk enjoys spending time with his family and being outdoors. “Fishing is a favorite hobby, and I like taking trips to the Boundary Waters in Minnesota for a week of fishing and camping, and cooler weather. I love all sports and enjoy cheering for the Duke Blue Devils with my family. I like to play golf when I get a chance, and my sons are taking an interest lately which gives me a great excuse with my wife,” he jokes. Woolfolk puts his focus on his family and his team on the job. “I am lucky enough to be married 15 years to the best wife and mother to our three kids; son (14), son (10) and daughter (3),” he says. He says that his family is the most important part of his life. He also recognizes the important aspects of his work. “I am a person that tries to enjoy everything I am doing, including tackling challenging issues/problems and working to improve processes for my team and myself. I enjoy my job because of the sense of fulfillment I get knowing my team always puts patient safety first. If patient safety is the true focus of the team, everything falls into place after that. I try to be as helpful as possible because people remember that and are willing to reciprocate,” Woolfolk says. Temple, Texas is better for having this dedicated HTM professional on the job and as a member of the community.

BIOMETRICS FAVORITE BOOK:

“Blood Meridian” by Cormac McCarthy

FAVORITE MOVIE: “Road to Perdition”

HIDDEN TALENT: I play guitar.

FAVORITE FOOD: Crawfish Etouffee

WHAT’S ON MY BENCH?

I always have multi-driver, channel locks, Teflon tape, Sharpie and tape measure. That usually gets me through the day in the dialysis world.

FAVORITE PART OF BEING A BIOMED?

My favorite part of being a biomed is the opportunities to have a direct impact on safe and effective patient care, as well as the responsibility of calmly resolving urgent issues for the facility and clinical staff.

November 2023 | TechNation 15

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SPOTLIGHT

SHIFTING GEARS Answering the Call

BY K. RICHARD DOUGLAS

nswering the call of duty and serving the U.S. in any branch of the Armed Forces is a commitment that deserves respect. The same can be said of people who commit to being a bone marrow donor. Although the latter does not hold the certainty of participation that enlisting in the military does, it is a selfless act meant to benefit others. Some people make a commitment to military service and others make a commitment to registration with a bone marrow registry. Yet a story about an Air Force biomed, which appeared in the Public Affairs news publication for Yokota Air Base in the western Tokyo area of Japan, described the experience of one Airman’s experience donating bone marrow. The base serves as both a Japan Air Self-Defense Force and United States Air Force Base and is home to the 374th Airlift Wing and the 374th Medical Group. Senior Airman Nikko Foster, an Air Force biomed with the 374th Medical Support Squadron, stationed at the Yokota Air base, attended the Medical Education and Training Campus (METC) at Fort Sam Houston in Texas for his biomed training. One day, while leaving a class, he encountered a registration table for an organization called “Be The Match,” which registers people as potential bone marrow donors. Biomeds know that their work is helping people, maybe even saving lives, so it wasn’t a stretch to

18 TechNation | November 2023

understand why Foster signed up. At the time, one of the personnel with Be The Match took a swab from the inside of his cheek. This cheek cell sample allows clinicians to determine a tissue type. Bone marrow donations have the potential to save lives. The donated stem cells can offer hope to persons afflicted with forms of blood or lymph system cancers or other life-threatening diseases. Because Foster’s job in the military could have him stationed almost anywhere, he listed his sister’s phone number on the application. Foster completed the paperwork and then went on his way. In January, Foster received a call from his sister. He had nearly forgotten about the bone marrow registration that he had completed two years earlier. His sister informed him that he had been selected as a transplant candidate. In real terms, what this means is that there was a match for human leukocyte antigen (HLA), the protein that is used to match patients and donors for blood stem cell transplants. The majority of patients do not have a fully matched donor in their own family. The match is not made based on blood type. Healthy blood stem cells have the power to cure diseases like leukemia, sickle cell disease, multiple myeloma, severe aplastic anemia, lymphoma and other diseases. TRAVELING TO TEXAS After receiving the notification, Foster had about a month to prepare, which required flying back to the U.S. He first had to visit a doctor to ascertain that he was healthy enough to make the donation and then he booked a flight to San Antonio, Texas. Although complications associated with the procedure are rare, the Be The Match organization suggested that Foster have someone accompany

Senior Airman Anthony Tabor, left, and Senior Airman Nikko Foster, 374th Medical Support Squadron biomedical equipment technicians, are seen at Yokota Air Base, Japan.

Senior Airman Nikko Foster, 374th Medical Support Squadron biomedical equipment technician, is seen at Yokota Air Base, Japan.

him on the trip. Foster took one of his fellow biomeds, which would also give the co-worker the opportunity to visit with family. The process was going to take five days. In preparation, Foster had to go to a clinic to receive shots of a drug called filgrastim. This is a drug that stimulates the growth of blood-forming cells. The drug can have side-effects in some cases, that include bleeding/bruising, blood in the urine, elevated heart rate, fever, back pain and some others. The blood-forming cells, peripheral blood stem cells (PBSC), are then removed from the blood via an IV in one arm, which is passed through a machine that separates out the cells, and then the blood is returned into the other arm. After Foster received the injections, he and his co-worker were able to explore San Antonio and enjoy some American food. When all injections were completed, Foster and his co-worker went to the location for the procedure. In his words, it was a “large, circular room with sunlight gently filtering through the window shades, creating a surprisingly cozy atmosphere.”

Foster, his co-worker and a nurse were the only ones in the room and the nurse brought them some breakfast tacos. The procedure took four hours, but can take up to eight. The PBSC donation procedure can cause headaches or bone and muscle aches, as a result of the filgrastim, and these will fade within several days. Foster says he would do it all again without hesitation. He is grateful for the chance to help someone, although he may never know who that person was. It is like enlisting in the military; you don’t always know all the people you are helping. Be The Match can provide a kit to interested parties to swab the inside of their own cheek. The swab kit can be ordered online. The swab can then be dropped in the mail. Your HLA type will then be added to the donor registry. You will then be contacted if there is a match to a patient in need. As in Foster’s case, you may be contacted two or three years later. For more information, visit BeTheMatch.org.

November 2023 | TechNation 19

SPOTLIGHT

NEXT GEN POWERED BY YP AT MD

Emily Mengel

irst Health Advisory Security Project Manager Emily Mengel holds a Bachelor’s of Science in biological engineering from Mississippi State University and a masters in biomedical engineering jointly from North Carolina State University and the University of North Carolina at Chapel Hill. She has also earned A+ and Network+ certifications. TechNation recently found out more about Mengel.

Q: WHERE DID YOU GROW UP? A: Trussville, Alabama (just outside of Birmingham) Q: WHERE DID YOU RECEIVE YOUR HTM TRAINING/ EDUCATION? A: After receiving my master’s degree in biomedical engineering, my first HTM job was at Carl Vinson VA Medical Center in Dublin, Georgia, as a biomedical engineer. There my supervisor and co-workers taught me the basics of the HTM industry, networking, medical device security and much more. It was a very hands-on job, and the experience laid the foundation for me. Q: HOW DID YOU FIRST DISCOVER HTM? A: I learned about HTM from graduates of my graduate program who had gone to work at the VA. They both really enjoyed the HTM field, and after speaking to them I decided to apply to VA jobs across the country. Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: I’ve wanted to work in health care for as long as I can remember. My grandfather is a retired family practitioner. My parents are both engineers and instilled a love of problem solving at a young age. When it came time to choosing a major, I couldn’t choose between health care and engineering. That’s how I ended up in biomedical engineering and choosing a career in HTM.

surrounding asset management and how to leverage their software to meet their process improvement goals. Q: WHAT INTERESTS YOU THE MOST ABOUT HTM? A: I enjoy studying data and analytics and understanding communication pathways. Medical device integration, cybersecurity and data analysis guiding process improvement are my favorite areas of HTM. I think data can truly help you improve and shows the true picture of what’s going on. As one former supervisor used to say, “Data doesn’t lie.” Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: Being recognized as a 2022 Health Care Leadership Award recipient was truly an honor. It is my goal to show young girls that they can be engineers and make an impact in their communities even behind the scenes of a hospital. Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS? A: I want to complete my PMP coursework and exam to become a certified project manager and continue growing my knowledge of medical device security through certifications.

FUN FACTS FAVORITE HOBBY:

Crafting with my Cricut and Cricut press

FAVORITE SHOW OR MOVIE: “Parks and Recreation”

FAVORITE MEAL: Chicken parmigiana

WHAT WOULD YOUR SUPERPOWER BE? Teleportation

1 THING ON YOUR BUCKET LIST:

Travel to all 50 states by the time I am 50 (I’m currently at 30 states)

Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION? A: I enjoy getting to work with clients across the country and seeing how HTM practices are being implemented at different facilities. I also love advising clients on current best practices

20 TechNation | November 2023

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SPOTLIGHT

CORPORATE PROFILE

Cox Prosight

ox Prosight is an IoT enabled platform solution from Cox Communications, which is the largest private telecom company in America. At Cox, we are dedicated to empowering others to build a better future and celebrate diverse products, people, suppliers, communities, and the characteristics that make each one unique. Cox Communications is the largest division of Cox Enterprises, a family-owned business founded in 1898 by Governor James M. Cox. The Cox Prosight team’s mission is to help hospitals unleash the true potential of becoming a connected hospital by tracking, monitoring, and protecting assets, people and conditions utilizing real-time locating systems (RTLS). This powerful solution furthers Cox’s commitment to reinventing the health care journey to a more personalized, frictionless and overall better patient experience. Q: CAN YOU EXPLAIN YOUR COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS? Cox Prosight: Every hospital faces challenges around equipment location and utilization and the process to manage equipment in hospitals is typically manual which can be time consuming. We built Cox Prosight to face this challenge head on. Cox Prosight is an IoT-enabled solution that provides a hospital with the ability to track and monitor assets, environments, and people across a hospital facility. We take the manual processes of tracking and monitoring equipment, along with other use cases, and automate them with real-time location data to streamline operations for hospitals. Hospitals can gain real-time visibility into

22 TechNation | November 2023

the location, status and utilization of all your medical equipment. Prosight leverages location-based intelligence, enabling caregivers and operational leaders in a hospital to find equipment in real-time, along with increasing visibility on equipment status and utilization to help right-size equipment inventory and eliminate stockouts. Our amazing customer success team leads all of our customers through deployment, training and scaling to meet their goals. We work with our customers every step of the way to ensure success through our proven, repeatable processes. Q: WHAT ARE SOME ADVANTAGES THAT YOUR COMPANY HAS OVER THE COMPETITION? Cox Prosight: RTLS has been around for quite some time but there have historically been challenges around adoption and scaling. These obstacles to adoption are due to three main factors: 1) outdated, legacy technologies 2) proprietary, single-use architecture and 3) cost. Cox Prosight was designed to circumvent these historical adoption challenges. Our solution is scalable, flexible and cost-effective enabling hospitals to realize a return on investment quickly and efficiently. Additionally, our platform is hardware agnostic which allows us to create the best RTLS program with the right hardware based on our customers’ needs. This enables our customers to get the most value out of the platform. Q: WHAT PRODUCT OR SERVICE THAT YOUR COMPANY OFFERS ARE YOU MOST EXCITED ABOUT RIGHT NOW? Cox Prosight: Asset tracking is our bread and butter and what the solution was first built to achieve, but the extensibility of the platform is what makes us very excited for the future. By investing in Cox Prosight, hospitals have a platform that can be scaled

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INDUSTRY UPDATES

RIBBON CUTTING

Bright Biomedical LLC

right Biomedical LLC Owner and Operations Manager Bobby de Sosa, CBET, describes the company as a partner that works with customers. TechNation recently found out more about the company.

Q: WHAT ARE SOME OF THE SERVICES AND PRODUCTS YOU OFFER? A: We assist facilities with their Alaris infusion system fleet maintenance. When a hospital or equipment supplier needs to get their equipment up to date for annual maintenance, repairs, etc. we send our team in. We help them reach compliance from A-Z with the goal of reaching 100% completion within the timeframe. On top of maintenance, we also provide asset management solutions. This involves taking inventory, maintenance scheduling and strategizing, assisting with implementing new fleets and recall remediation. Infusion pumps and all associated devices can really take a lot of time out of your technician’s already tight schedule so having our focused pump services can free up time for your technicians to perform at their peak. This is what we do. No training is necessary, just give us directions and we will reach the target. I’m excited to work on infusion pumps because even though they are seen as introductory biomed equipment, the importance of patient safety can’t be overlooked. ECRI labeled infusion pump safety as their #3 concern for patient safety in 2023 and #1 in 2017!

Q: HOW DOES YOUR COMPANY STAND OUT IN THE MEDICAL EQUIPMENT FIELD? A: Bright stands out in the medical equipment field because of “The Bright Method.” It’s a workflow system designed to handle large quantities of devices. Most facilities have thousands of pumps, and this requires a system to handle them efficiently. Time and time again, The Bright Method has proven itself. We often receive positive feedback on the way we approach infusion pump maintenance and receive compliments on the quality we bring to the table. Q: WHAT IS ON THE HORIZON FOR YOUR COMPANY? A: Great new clients. With The Bright Method, we’re looking to prove the concept as much as possible. We’re looking to fill our schedule with great people who want the best for their patients. My goals for the future are to apply myself as a CBET and add on to the list of equipment we service. We’re going in the direction of patient monitor and defibrillator maintenance. With more work I will be able to provide more jobs to excellent technicians and even help teach the next generation as interns! After all, that’s how I started. Q: IS THERE ANYTHING ELSE YOU WOULD LIKE OUR READERS TO KNOW? A: We don’t call ourselves Bright because we think we are smart. We call ourselves Bright because our mission is to B Right to our clients, the equipment and to the patients. For more information, visit BrightBiomedical.com or email info@brightbiomedical.com.

November 2023 | TechNation 39

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THE BENCH

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With an easy-to -use inter face, the Smar tTank has preloaded test sequences that walk the operator through each test step quickly and seamlessly. All the hardware needed to test gas modules is built into the Smar tTank – replacing the need for separate gas regulators, flow meters, syringes, tubes, pressure gauges, barometers and even the ser vice manuals. Join the Live Demo to see how the Smar tTank can improve your gas monitor testing and save time and money.

For more information, visit smarttanktester.com. November 2023 | TechNation 41

THE BENCH

BIOMED 101

Exploring Alternative Maintenance Programs for Medical Devices

BY CHATGPT EDITOR’S NOTE: This Biomed 101 article was created by asking ChatGPT to “write a 1,000 word article about alternative maintenance program for medical devices.” n the fast-paced world of health care, the proper maintenance of medical devices is critical to ensuring patient safety and the delivery of quality care. Traditionally, health care facilities have relied on manufacturer-recommended maintenance programs to keep their medical equipment in optimal condition. However, in recent years, alternative maintenance programs have gained recognition as viable alternatives. In this article, we’ll delve into the concept of alternative maintenance programs for medical devices, exploring their benefits, challenges and the growing trend towards their adoption. THE CONVENTIONAL APPROACH TO MEDICAL DEVICE MAINTENANCE Historically, health care facilities have followed manufacturer-recommended maintenance programs, often referred to as original equipment manufacturer (OEM) service contracts. These programs typically involve: • Scheduled Maintenance: OEMs provide a predetermined maintenance schedule for each medical device, outlining when inspections, calibrations and parts replacements should occur. 42 TechNation | November 2023

• Exclusive Parts and Service: Facilities under OEM contracts are usually required to purchase replacement parts and services exclusively from the manufacturer, which can be costly. • High Costs: OEM service contracts can be expensive, especially for larger health care facilities with extensive equipment inventories. • Regulatory Compliance: Adherence to regulatory standards and guidelines is a primary concern, and OEMs are expected to help facilities meet these requirements. THE RISE OF ALTERNATIVE MAINTENANCE PROGRAMS In recent years, health care providers have started exploring alternative maintenance programs as a way to address some of the challenges associated with OEM contracts. These alternative programs offer several advantages: • Cost Savings: One of the most significant benefits of alternative maintenance programs is the potential for cost savings. By working with third-party service providers or in-house biomedical teams, health care facilities can reduce service contract costs and access competitively priced replacement parts. • Flexibility: Alternative maintenance programs offer greater flexibility in scheduling and customizing maintenance

routines to match the specific needs of each facility. This adaptability can lead to improved equipment uptime and patient care. • Reduced Downtime: Quick response times and on-site repairs by in-house biomedical teams or third-party service providers can significantly reduce equipment downtime, ensuring that health care providers have access to the tools they need when they need them. • Extended Equipment Lifespan: Properly executed alternative maintenance programs can extend the lifespan of medical devices, delaying the need for costly replacements. • Compliance and Accreditation: Many alternative maintenance providers are well-versed in regulatory compliance and can help health care facilities meet accreditation requirements, ensuring patient safety. CHALLENGES AND CONSIDERATIONS While alternative maintenance programs offer numerous benefits, they also come with their own set of challenges and considerations: • Regulatory Compliance: Ensuring compliance with regulatory standards is a crucial aspect of medical device maintenance. Health care facilities adopting alternative programs must be diligent in meeting these requirements. • Qualified Personnel: Effective alternative maintenance programs require skilled biomedical technicians or third-party service providers with the expertise to handle a wide range of medical devices. • Risk Management: There is an inherent risk in deviating from OEM service contracts. Facilities must carefully evaluate the potential risks and benefits and have contingency plans in place. • Parts Availability: Some medical device manufacturers may limit access to replacement parts for devices under alternative maintenance programs. Facilities must ensure a reliable supply chain for parts. • Documentation and Record-Keeping: Proper documentation of maintenance activities is essential for regulatory compliance and accountability. Facilities must establish robust record-keeping procedures. CASE STUDIES: SUCCESS STORIES IN ALTERNATIVE MAINTENANCE To illustrate the effectiveness of alternative maintenance programs, let’s examine a few real-world case studies: • Large Hospital System: A large hospital system with multiple facilities decided to transition from OEM service contracts to an alternative maintenance program. By partnering with a third-party service provider, they

reduced their maintenance costs by 30% across their entire equipment inventory. The flexibility of the new program also allowed them to schedule maintenance during off-peak hours, minimizing disruptions to patient care. • Rural Health Care Clinic: A rural health care clinic with limited resources opted for an in-house biomedical team to handle maintenance. While initially requiring an investment in training and equipment, this approach saved them over 40% on maintenance costs in the first year alone. The clinic also reported improved equipment reliability and uptime. • Specialized Medical Facility: A specialized medical facility required maintenance for highly specialized equipment not covered by OEM service contracts. They collaborated with a niche third-party provider with expertise in their specific equipment. This partnership ensured the availability of replacement parts and reduced the risk of downtime due to equipment failure. THE FUTURE OF ALTERNATIVE MAINTENANCE PROGRAMS As health care continues to evolve, the adoption of alternative maintenance programs for medical devices is expected to grow. Factors contributing to this trend include: • Cost Pressures: Health care providers are under increasing pressure to reduce costs without compromising patient care. Alternative maintenance programs offer a viable solution to achieve cost savings. • Technological Advancements: Advances in medical device technology are making it easier for biomedical technicians and third-party providers to diagnose and repair equipment, reducing the reliance on OEMs. • Regulatory Support: Regulatory bodies are recognizing the value of alternative maintenance programs and are working to provide clearer guidelines and standards for their implementation. CONCLUSION Alternative maintenance programs for medical devices are gaining momentum as health care facilities seek cost-effective solutions without compromising patient safety or quality of care. While these programs offer various benefits, they also come with challenges that require careful consideration and planning. By striking a balance between cost savings and regulatory compliance, health care providers can ensure the longevity and reliability of their medical equipment while reducing the financial burden associated with OEM service contracts. As the health care landscape continues to evolve, alternative maintenance programs are poised to play an increasingly vital role in the delivery of quality patient care.

November 2023 | TechNation 43

THE MEDICAL PRODUCT SUPPORT NETWORK

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“Significant Time Savings When Performing X-ray Testing in the Hospital Environment. A Real-Life Case Study”

Tools of the Trade Demo: Cynch Asset Management System

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“What used to take us 3-4 hours now takes 25 minutes!” is the feedback from a case study that presenter Dr. Michael Olding, head of product management at RTI Group, shared during the presentation. A case study looking at how to achieve significant time savings when performing X-ray testing was the subject of his talk. In a hospital environment, maintaining X-ray equipment means covering many modalities and departments, with the demands for efficiency higher than ever. Olding looked at how performing X-ray testing can be simplified and made more efficient, while maintaining full traceability from X-ray test exposure through reporting. Attendees can avoid arduous calculations and manual analysis and discover how everything can be automated to save time and get systems back up and running more efficiently. Attendees provided feedback via a survey that included the question, “What was your single biggest takeaway from today’s webinar?” •

•

“I have not had time to attend a show in the past year – this gave me an excellent opportunity to see a good product,” said Mary Coker, project manager, Cone Health.

“Generative AI: The Future of Healthcare Cybersecurity”

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Kontakt.io Global Head of Healthcare Practice Kapil Asher and Matt Cannell, senior director, professional service at Kontakt.io, shared their real-life experiences in deploying RTLS solutions across multiple hospitals. During this engaging discussion, they provided valuable lessons learned. The experts also shed light on how Kontakt.io’s cuttingedge technology facilitates the quickest deployments in the industry. The webinar also offered exclusive tricks and tips that hospital leaders must know before planning for an RTLS deployment project. The presenters shared additional expert insights via a question-and-answers session. Attendees provided feedback regarding the webinar via a survey that included the question, “Why did you attend today’s webinar?” •

The new TechNation Tools of the Trade live demo series is proving to be very popular with HTM professionals. The August Tools of the Trade live demo featured the Cynch ERP platform. Cynch is a best-of-breed SaaS CMMS plus asset management system that includes real-time asset history, maintenance, repair, purchasing, inventory management, subcontracting and warranty claims. Customers login to the Cynch portal through their own websites to manage their entire operation in one place. Technicians can see their work queue, follow a guided inspection and maintenance process, add notes, upload photos, add MRO inventory parts to the work order, see asset-specific user/repair manuals and much more. Cynch also offers lightning-fast filtering and searching of enormous asset catalogs. Attendees provided feedback via a survey that included the question, “What was your single biggest takeaway from today’s product demo?”

“Wireless technology helps speed up X-ray testing,” said Timothy Hoof, CBET, Indian Health Service.

“The Kontakt.io Playbook: Expert Insights on Successful RTLS Deployments in Hospitals”

“To know how to implement RTLS in hospital facilities and save revenue/time and scale its resources,” said Elijah Mwanyange, Biomed/CBET, Adventist Healthcare-Whiteoak.

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Chad Holmes and the Cynerio team discussed the explosive growth of Generative AI and how it is leading to numerous innovations. Among the most promising opportunities are those in the health care industry, where limited resources and historic underinvestment are leading to dramatically increased rates of successful cyber-attacks. Holmes discussed the immediate benefits of Generative AI in health care. The Cynerio team demonstrated the values Generative AI provides to forward-thinking health care organizations. Attendees also provided feedback via a survey following the webinar. One question attendees answered was, “Was today’s presentation worth your time?” •

“Yes. Very interesting to hear how AI is now influencing the medical technology sector,” said Jeremy Ekalo, BMET II, City of Hope.

IN CASE YOU MISSED IT Watch these webinars on-demand

November 2023 | TechNation 45

ROUNDTABLE

Asset Tracking

his month, TechNation asked several industry insiders to share the latest regarding asset tracking technologies. Participating in the roundtable article are Kontakt.io Senior Director of Healthcare Enterprise IoT Solutions Kapil Asher, Cox Prosight Product Director Jaiganesh Balasubramanian, Vizzia Technologies Clinical Support Manager Miranda Baras, Capital i CEO Tony Danko and Midmark RTLS Director of Hardware Research and Innovation H.T. Snowday.

Q: WHAT ARE THE DIFFERENT ASSET TRACKING TECHNOLOGIES? ASHER: There is a wide variety of asset tracking technologies in the market and the selection of the right technology depends on the use case and the business requirements that need to be solved. We

46 TechNation | November 2023

focus on tracking technologies that are most used in a health care environment below: • Bluetooth Low Energy (BLE): Using BLE location sensors attached to medical devices, this technology can be used with any open source BLE “scanners” the health system may have already invested in to provide location services. • Wi-Fi: Battery operated location sensors that utilize specific Wi-Fi access points capable of providing location services. • Proprietary Active RTLS: Battery operated location sensors that utilize a proprietary RF protocol like 900MHz, providing location services in conjunction with add-on technologies like InfraRed. • Passive RFID: Passive location sensors powered by external scanners providing location services only when tags pass a particular chokepoint. BARAS: Real-time location systems (RTLS) utilizes a combination of wireless technologies such as: radio-frequency identification (RFID); Wi-Fi; Bluetooth Low Energy (BLE); ultrasound; and infrared. More equipment manufacturers are

introducing a variety of inexpensive BLE devices. The Vizzia IoT Lab at the University of New Mexico is testing several new sensors to ensure they can achieve clinical grade requirements that hospitals demand for room level accuracy versus zone level. DANKO: Some of the different asset tracking technologies commonly used in HTM are RadioFrequency Identification (Passive RFID and Active RFID), Barcoding, Real-Time Location Systems (RTLS), Global Positioning System (GPS), NFC (Near-Field Communication), Ultrasound and Acoustic Technologies, Bluetooth Low Energy (BLE), Infrared (IR), Cloud-Based Software and IoT Platforms. SNOWDAY: Technology, such as a real-time locating system (RTLS), can bring new efficiencies to teams tasked with having the right equipment at the right time. Asset tracking and management specifically is a foundational use case for RTLS, which provides location information and utilization insights. It’s important to consider that different technologies have varying levels of locating precision. Ask yourself … Do you need to know the exact location of the asset in question or will general location suffice? An infrared (IR) sensory network provides highly accurate room, bed and chair-level location data. IR locating technology is definitive location data – it’s a 1:1 relationship between the tag and sensor. Assets rarely need to be located to the definitive room level, so choosing IR is more about what you want to do with RTLS in the future when considering automating nurse call or optimizing patient flow. As an alternative, BLE uses an algorithm to estimate an asset’s location. With an appropriate density of sensors, a near-room location – within three meters – can be achieved. Equipment tags emit BLE signals to multiple plug-in BLE sensors. The network of sensors detects and transmits location coordinates to determine and display a location in the cloudbased software, making it low maintenance yet secure. There’s also leveraging a typical hospital Wi-Fi Internet network; however, it typically provides only zone-level location information. Wi-Fi networks with more access points are better able to estimate locations, yet because these signals pass through walls and ceilings, the location data is estimated, not definitive.

Q: WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF THE DIFFERENT ASSET TRACKING TECHNOLOGIES? ASHER: The biggest advantage of BLE is its open-

source protocol. This is the only technology that allows interoperability between tags and the location service infrastructure. BLE lets users choose tags from multiple vendors and does not lock them within a monopolistic ecosystem. This creates a price and technological competition that benefits the customers. Moreover, modern network infrastructure, such as lighting, tablets, TVs, etc., all have BLE capabilities, allowing the creation of a dense location service infrastructure that is unmatched by any previous generation asset tracking technologies. BLE is also inherently a low power-consuming protocol that enjoys a longer battery life compared to all other active technologies, making maintenance of the system easier. Combined with cloud software, BLE truly can meet most HTM requirements from a data-sharing point of view. While Wi-Fi can provide many advantages of BLE, like utilizing existing network infrastructure, it requires licenses to utilize those capabilities. The biggest disadvantage of Wi-Fi is battery life. Wi-Fi demands high power consumption, requiring constant battery replacements by HTM departments. It is not unusual for health systems to abandon a Wi-Fi based tracking system because of time-consuming battery management. Proprietary Active RFID, as the name suggests, this technology locks the health system into a closed ecosystem that does not work with other tag suppliers. In addition, there is the need for an overlay network and location sensors in the ceilings, requiring power and network cable drops in various areas of the building and making the deployment expensive. This technology outperforms Wi-Fi in terms of battery life longevity but is not as good as BLE. Passive RFID technology is as good as the last time the tag passed a chokepoint. The data from this technology is not real-time and, in many HTM use cases, not very useful. Like proprietary active RFID, this also requires expensive installation and cable drops. The only advantage of passive RFID is that the tags are battery-free and never require any replacement, making them maintenance-free. Ultimately, the use case requirements should dictate the choice of technology. HTM leaders should select an asset tracking solution that is easy to maintain and provides a high return on investment (ROI). BALASUBRAMANIAN: RTLS technology is a vital part of any hospital’s infrastructure. Effective RTLS will help your hospital in its journey to become a leader in the health care industry. As such, it is important for providers to consider which RTLS option is correct for their needs. Wi-Fi-based RTLS technology utilizes pre-existing wireless access points to track assets. The primary benefit of a Wi-Fi-based system is that it

November 2023 | TechNation 47

ROUNDTABLE

Kapil Asher Kontakt.io

Jaiganesh Balasubramanian Cox Prosight

Miranda Baras Vizzia Technologies

Tony Danko Capital i

HT Snowday Midmark RTLS

uses a hospital’s pre-established infrastructure, Disadvantages are line-of-sight required, manual eliminating the need for additional infrastructure scanning, limited data capacity. RTLS advantages are costs. Infrared, or IR, RTLS technology is powered by real-rime tracking, high precision, versatility. technology that is like a television remote. A major Disadvantages are cost, complexity, interference. benefit of IR is that it can be significantly more GPS advantages are global coverage, real-time accurate than other RTLS technologies. Ultratracking, versatility. Disadvantages are limited indoor wideband is a radio-based form of RTLS technology accuracy, dependence on satellite signal, power that aims to provide short and stable tracking consumption. BLE advantages are low power technology. The leading benefit of UWB RTLS consumption, cost-effective, ease of deployment. technology, by far, is location precision. Ultrasound Disadvantages are limited range, accuracy. Cloudidentification is a RTLS technology that utilizes simple, Based Software and IoT Platforms advantages are inexpensive badges and tags to transmit and centralized management, data analysis, scalability. communicate locations using microphones. On Disadvantages are dependent on other technologies, average, ultrasound can track assets within 3-5 cost of implementation. meters. Bluetooth technology is common across all sorts of devices. On top of ease of use, SNOWDAY: IR is appealing to health it’s far and away the most diverse form systems because of its high of RTLS technology. BLE provides asset granularity. Not only does it “BLE is gaining tracking advantages like geofencing, empower comprehensive workflow popularity because it’s solutions, but biomedical teams zonal coverage, choke point coverage and maintenance management – among can leverage the precise more cost effective and specifically a variety of others. location data to reduce time spent searching for equipment. One easy to install – think BARAS: When selecting specific consideration for tag placement is days not months. ” technologies for these use cases, it is that IR tags do need to be exposed crucial to align the technology choice for sensors to pick up their signal. IR - HT S N OW DAY with the specific requirements and can also have an expensive upfront desired level of location certainty. installation cost for a typical wired Technologies such as RFID, Wi-Fi and BLE typically solution or ongoing labor and maintenance costs if provide estimated location information, which is choosing wireless. BLE is gaining popularity because suitable for less demanding applications where it’s more cost effective and easy to install – think proximity or general location is sufficient. On the days not months – without disrupting patient care or other hand, technologies like infrared (IR) and going down the path of a construction project. Its ultrasound (US) offer more precise and certain near-room accuracy is satisfactory for meeting goals location data, making them well-suited for use cases like tracking equipment where you need a general that demand high accuracy and reliability. location. It allows for tag size and placement flexibility, which is useful when considering how the DANKO: RFID advantages are high accuracy, equipment can be placed in conditions where the tag efficiency, long read range (Active RFID), Durability. may be hidden from view such as in cabinets, Disadvantages are cost, interference, limited range misplaced in the laundry or even accidently disposed (Passive RFID). Barcoding advantages are costof in the trash. Wi-Fi locating is beneficial when effective, simplicity, widespread adoption. health systems want to piggyback on existing

48 TechNation | November 2023

infrastructure. However, it’s the least accurate of the locating technology. The difference can be as much as the software showing an IV pump is located in room 204 on the second floor, but because Wi-Fi penetrates structure, it’s actually located in the room above, 304 on the third floor. Regardless of the technology used for asset tracking, biomedical teams reap the benefits productively and financially. They can find equipment needed for preventive maintenance faster, create more organized and informed approaches to their daily workflow and how they communicate with clinical teams, reduce costly unnecessary equipment expenditures and optimize inventory fleet with more insight into utilization and movement history. Q: WHAT ARE SOME OF THE NEWEST FEATURES AVAILABLE? ASHER: Modern RTLS systems offered by Kontakt.io are packed with features that not only address traditional biomed asset tracking but also offer a comprehensive IoT platform that integrates various environmental sensing capabilities such as temperature, humidity, air quality, light, motion, air pressure and carbon monoxide. The data is freely available with open-source integration protocols that can be used by facilities management and security systems. Combined with built-in RF and InfraRed sensors, Kontakt.io provides the industry’s most accurate room-level location certainty in asset tracking. Another trend is the use of AI to redefine RTLS’ capabilities. We can use AI to analyze patterns and predict trends, scan for hidden waste and inefficiencies, protect devices and networks from malicious attacks, and integrate with user applications to get insights within seconds.

BALASUBRAMANIAN: RTLS 2.0, as it’s been termed, offers significant advantages and improvements over legacy RTLS solutions. RTLS 2.0 allows hospitals to deploy a platform solution and unlock several uses cases including asset tracking, staff duress and workflow, environmental monitoring, patient wandering/elopement/workflow without the need to constantly add more infrastructure. The newest features include the ability to integrate with other health IT systems like asset management or EMR/ EHR without significant cost hurdles eliminating the silos which exist in these systems today. BARAS: The Vizzia InVIEW data analytics platform continues to integrate with other key hospital workflow solutions such as CMMS and EMRs. To ensure that mission-critical data is secure, Vizzia

recently achieved the System and Organization Controls (SOC) 2 Type II compliance certification. Vizzia has also conducted a successful machine learning (ML) pilot that yielded substantial operational improvements across several inventory KPIs to include up to a 52% improvement in key out-of-stock metrics and reducing overstock rates by up to 20%. DANKO: Artificial intelligence (AI) and machine learning are being used to analyze the data collected from asset tracking systems. This enables predictive analytics, anomaly detection and optimization of asset management processes. Some asset tracking systems are also incorporating environmental sensors (e.g., temperature, humidity, accelerometers) to monitor the conditions of assets and measure utilization based on device movement parameters. SNOWDAY: At Midmark RTLS, we believe innovation fuels success. Though we have been successful in the on-premises nature of our business for the last 30 years, we were the first RTLS partner to lead to the cloud, where we believe the future of RTLS technology is headed. This allows a true enterprise solution for health care systems with multiple facilities, while avoiding the burden on IT. With BLE locating technology, we were able to remove the network complexity through a simple yet sophisticated RTLS architecture. Through this innovation, we’ve been able to track equipment as it moves across facilities so biomedical teams can better manage their inventory and reduce costs. Location specific notifications and inventory distribution are other improvements in advanced asset tracking technology. For location notifications, staff can be notified in-the-moment when a piece of equipment leaves or enters an unauthorized area. These real-time notifications help reduce loss and better manage capital expenses. To achieve improved inventory distribution, each unit in a facility can choose the level of inventory they need to operate efficiently, and their RTLS can monitor it. When the number of assets for a designated area falls out of the selected range, an automatic alert can be sent to biomedical teams, creating a more proactive inventory management approach.

Q: HOW CAN ASSET TRACKING SYSTEMS HELP A HEALTH CARE FACILITY SAVE MONEY? ASHER: Asset tracking systems help a health care facility save money in major ways: • ROI on asset utilization – Asset tracking solutions

November 2023 | TechNation 49

ROUNDTABLE provided by Kontakt.io help health facilities significantly increase asset utilization, eliminating the need to purchase buffer quantities of IV pumps or beds and wheelchairs. We are also saving hospitals hundreds of thousands of dollars by reducing rental equipment and preventing the loss of small devices. • Improvement in productivity – Although a soft, intangible return on investment, helping biomed engineers search for medical devices for PMs in seconds improves their efficiency significantly. The time saved is utilized to stay on top of PMs, satisfy Joint Commission mandates on 100% PM compliance, and repurpose extra time to learn new skills. BALASUBRAMANIAN: Asset tracking systems can help reduce search time for equipment for nursing, clinical engineering and biomedical teams. Improvements translate into the various teams focus more on care, equipment maintenance and replenishment. Asset tracking can help improve utilization of equipment, hence reducing yearly repurchasing of equipment not needed and reduction in rental costs. In addition, it can help reduce loss of equipment by alerting when equipment leaves a building or has been left unattended. Asset tracking can help improve and automate various asset workflows including preventive maintenance, rental returns and replenishment. BARAS: As the number of devices per hospital bed has nearly doubled to 15, utilization rates of medical equipment only average 42%. After an RTLS solution is deployed in a hospital, utilization rates of equipment typically increase to 75% or greater. This results in a reduction of the rental fleet size and lower equipment purchases. The additional benefits include reduced search time by nurses who spend up to an hour per shift looking for equipment and biomeds trying to locate devices for PMs and product recalls. A 350bed hospital can save on average $487,000 annually and 255,000 hours. DANKO: One of the most difficult data points to capture is asset utilization. A good asset tracking system will enable health care facility staff to easily locate available assets and reduce the need for over-purchasing or renting equipment, leading to significant cost savings. SNOWDAY: With increased asset visibility and real-time location data, biomedical teams can right-size their inventory more effectively. One Midmark RTLS customer in Michigan reduced capital expenses by $1 million because they were able to determine that they didn’t need additional

50 TechNation | November 2023

equipment; they just needed to use what they had more effectively. They downsized their fleet from 900 IV pumps to 600, and their utilization rate jumped by 133%. Another large cancer center improved OR cardiac case start times by 25% with the real-time asset location data. They were able to more efficiently prepare operating rooms with the high-demand surgical equipment, allowing them to reduce surgery delays.

Q: WHAT SHOULD AN HTM/BIOMED DEPARTMENT LOOK FOR WHEN PURCHASING AN ASSET TRACKING SYSTEM? ASHER: There are four factors that a biomed department should consider while choosing an Asset Tracking system: total cost of ownership, ease of installation and maintenance, use case scalability and location accuracy. Kontakt.io is best suited to meet all these criteria. Since we are based on open standards such as Bluetooth Low Energy and Wi-Fi, we can leverage the economies of scale achieved by these technologies into our products, making them less than a third of the cost of other RTLS providers. Being cloud-managed, Kontakt.io eliminates the need for physical or virtual servers and databases, reducing the burden on the IT teams. Our room-level accuracy sensors are completely wireless, eliminating the need for additional power or data cable pulls. Finally, open standards systems also offer biomed the flexibility to choose IoT sensors from multiple vendors, breaking the shackles of monopolistic RTLS systems. This is very helpful in scaling the RTLS platform to incorporate niche use cases that are beyond the scope of HW product development by the vendor. For example – leak detectors, vibration sensors, or specific mechanical or environmental condition monitors. BARAS: It’s important to have a clear understanding of the challenges facing your health care facility and all the various clinical uses cases that need to be included (i.e., devices, patients and staff ). Typically, RTLS solutions fall into two broad categories of hardware and software. Look for a full-service partner that can provide onsite support for installation, training and ongoing maintenance. Talking with several biomed leaders at other ‘go live’ facilities will provide keen insights on lessons learned. DANKO: When an HTM department is considering purchasing an asset tracking system, it is important to consider the return on investment. By conducting and demonstrating a positive ROI, the department

will be better positioned to gain approval for capital investment. It is also important to evaluate the support and training the asset tracking provider offers. A system that has limited support and training will frustrate the organization and render the system ineffective over time.

champion open and APIs, and we believe that should be the standard for RTLS today.

BALASUBRAMANIAN: There has been considerable technological evolution over the last few years with BLE leading the way. BLE provides significant cost savings while providing improved battery life of tags SNOWDAY: Midmark RTLS approaches real-time and ease of deployment and maintenance. Investing locating with three components: in an extensible IoT platform should be considered • Software. RTLS is a journey, not a destination. Your compared to a purpose-built asset tracking solution. RTLS solutions should be scalable so that they grow A platform will provide extensibility to other with your RTLS goals over time. RTLS doesn’t focus problems the facility wants to solve in the future solely on solving singular problems, but instead including wayfinding, staff duress, environmental takes location-based information and applies it to monitoring and patient flow solutions without a similar challenges and goals such as significant reinvestment. With increasing asset visibility and mancaregivers and clinicians on the agement, patient and staff safety and go, a solution that provides the “Artificial intelligence workflow capacity. staff the mobility and visibility in (AI) and machine • Hardware. RTLS technology success the palm of their hands would be is grounded in accuracy. Different lolearning are being used important to realize broader cating technologies offer different benefits. to analyze the data levels of granularity, and it’s important to determine how accurate your BARAS: Health care workers face collected from asset location information needs to be. Lopersonal safety risks, staffing tracking systems. This cating people and locating equipshortages and burnout. Staff ment may not necessarily need to be safety is top of mind for hospital enables predictive the same level of granularity. leaders, as workplace violence is • Service. The key to RTLS success is four times more common in health analytics, anomaly just as much about the right partner care than in other professions. detection and and process as much as it is the techVizzia offers a silent staff duress nology. From success coaching to alarm which provides room-level optimization of asset best practice implementation to anaaccuracy to immediately report management processes.” the exact room location to lytics education, a dedicated and clinically versed RTLS partner is what designated security personnel, - TO N Y DA N KO makes all the difference in a sustainenabling them to provide able RTLS program that drives reimmediate help. sults. A partner can help you channel RTLS data into continuous process improvement DANKO: Asset tracking systems are a great and workflow efficiencies. management tool provided your department invests the time maintaining and monitoring the asset Q: IS THERE ANYTHING ELSE YOU WOULD LIKE TO tracking devices. I have seen too many times SHARE WITH TECHNATION READERS? throughout my career an asset tracking systems that ASHER: As RTLS becomes more affordable, fast-todies on the vine and having to recapture the devices deploy and agile, we see significant market growth. within the first three to five years. Hospitals of various sizes are now rolling out RTLS solutions, many of which are working with Kontakt.io. SNOWDAY: When choosing an RTLS, it’s important to Many companies are working towards integrating consider not just short-term but long-term goals as multiple use cases and analytical dashboards into well. How are best practices established? Does your our robust location services platform, which is facility want to leverage your RTLS investment and developed on the principles of open-source use the sensory network for patient flow or staff protocols. We are democratizing data sharing so safety? Selecting which needs and initiatives you end-users can benefit from real-time location in want RTLS to support in the future will help you make multiple facets of patient care, including staff the right decision today. location, patient throughput, environmental condition monitoring and wayfinding. At Kontakt.io, we

November 2023 | TechNation 51

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COVER STORY

TIPS FOR GREAT

CONTRACT MANAGEMENT FLEXIBILITY AND MONITORING

54 TechNation | November 2023

COVER STORY

BY K. RICHARD DOUGLAS n an age of tight budgets, funding cuts and costly regulations, health care organizations have to pinch pennies and make well-considered decisions about anything that impacts the bottom line.

That means that the C-suite is going to notice budgets and expenditures more than ever before. The biomed department plays an important role in this endeavor, with input and expert insights into medical equipment management, the balancing of internal and external servicing and negotiations and agreements with vendors and OEMs. One of the areas of equipment management oversight is contract management; both the level of contract services required versus in-house management and the negotiation of costs or contracts that must be implemented and maintained. Like many undertakings, there is the surface appearance of approaching this endeavor and the more nuanced version of managing contracts that requires insights that are often overlooked. Some of the considerations include coordination with clinical departments and physicians, methods for tracking contract life cycle and associated vendor forms, interactions with vendors and setting expectations and parameters, as well as considering areas of leverage. COST-SAVING CONSIDERATIONS Upsetting the apple cart can be a good thing. Changing the status quo can yield improvements, and in some cases, cut costs. “An efficient contract management plan is the foundation to furthering efficiencies in other pillars of HTM; from operating and capital budgeting, cost-saving initiatives, capital refresh, staff training to cybersecurity assessment,” says Darwin Fontanares, MBA, CHTM, CBET, BSBMET, senior manager of IT/Biomedical Engineering at Stanford Health Care Tri-Valley in Pleasanton, California. With the biomedical engineering department taking the lead on equipment management decisions, Fontanares says that his department was able to cut costs. “Prior to 2018, medical equipment contract funding was spread across clinical areas on a distributed budget, where each department owned their contracts individually. Biomed suggested to our chief of finance that in order for our organization to make informed decisions on contractual medical device agreements, we recommended that the budget be consolidated into a single source biomed cost center,” he says.

Fontanares says that as subject matter experts, the biomedical engineering department would be the sole decision maker on optimizing medical equipment management plans by reducing costs, while increasing productivity. “Within a year, we were able to save the organization hundreds of thousands of dollars by categorizing maintenance agreements as full-service versus PM-only contracts and by delegating service plans as OEM, third-party or in-house,” he explains. REVIEWING VENDOR PERFORMANCE A framework for managing service contracts considers vendor assessment and evaluation, negotiations and workflows. This topic was the focus of the fall 2022 MD Expo session, “Contract Management Techniques” presented by Brian Miller and Dean Skillicorn, CBET, CHTM. The presentation covered the topics of negotiating agreements, building contract structures, analyzing the available data and understanding contracts and related information. The presenters say that it is crucial to have data from the performance of your equipment to review what is in the contract compared to performance. Everything that is included in the contract should be clearly understood. They suggest that HTM take steps to ask vendors to bring more flexibility in contracting. In addition to an intimate knowledge of the language of your service contracts, the presenters suggest knowing how your vendor is staffed, what geographical considerations impact availability and readiness and discussions at point of sale (POS). They also say that the vendor is evaluating your organization as a whole. Some vendors provide products and services used in many departments. Vendor review meetings should be a given with service contracts. Skillicorn suggests that vendor review meetings occur at least annually depending on the volume of business that is being done with the vendor. “High volume gets done quarterly, medium volume gets done semi-annually, and minimal volume annually. This really needs to be coordinated with the supply chain management division of the facility, not by HTM, IT or facility services. Supply chain management typically should be the center of vendor relations. Using this practice keeps the vendor at a distance to management situations with contracts and severe service issues,” he says. Miller says that fleet management, balancing in-house and outsourced services and gathering and leveraging the correct data in equipment manage-

November 2023 | TechNation 55

COVER STORY ment is one of the pillars of a well-run health care service (SaaS) approach that allows for collaboration organization. and capturing several relevant data points. With regard to vendor meetings, he says that they “Creating a master-list spreadsheet through should be held regularly with a defined cadence apSmartsheet helped create quick accessibility to full propriate to the equipment’s redundancy (or quantity) oversight of all biomed contracts. Data point columns within the facility, frequency of usage, it’s criticality to include the manufacturer, model, serial numbers, start patient care, revenue generating potential, it’s acquisiand end dates, length of term, aggregate cost, annual tion cost and/or service agreement cost, monthly cost, full-service cost, its historical reliability and the versus PM only, network integration, power of the clinical users. MediTract # (live link to contract “An efficient contract “Also, the in-house personnel need database), ITS # (PO requisition to collect and bring their own data, tracking), invoice frequency management plan is end-user feedback, etcetera to these and overall contract approval stage the foundation to meetings to align with the vendor’s status,” Fontanares says. data,” Miller adds. He says that furthermore, for furthering efficiencies What happens if it appears that the veneach line item, they embed a “comdor is underperforming in its obligations? in other pillars of HTM; ments quick-link” to document “Does the vendor’s performance important granular details, such as from operating and meet their agreement’s terms and convendor contacts, internal contract ditions? If yes, renegotiate to include administrator personnel, purchasing capital budgeting, your terms. If no, escalate the issue to specialists assigned to the contract, the vendor’s executives and micromancost-saving initiatives, special amendment requests and age the vendor until performance imunique terms and conditions. capital refresh, staff proves, while also looking for an alter“At any given moment, we can native vendor, transition to in-house provide a substantial status update training to service delivery and note for future to clinical staff administration, and equipment replacement discussions,” vendors alike,” Fontanares says. cybersecurity Miller says. He says that the data can be assessment.” He says to also document and restreamlined through filters and pivot port everything and share a summary tables that would assist in making with the clinical care team; ensuring informed decisions on budget foreeveryone on your team is aware of the casting, determining what can be issue(s) and resolution. converted to third-party or in-house HTM should have information inservice from OEM and opportunities hand during these vendor perforfor biomed staff training to contribute mance meetings to be prepared and to overall cost-savings. make the meetings as constructive as “Also, by having full oversight of possible. the portfolio of contracts per vendor, “Use work order records generatit provides leverage on negotiating Darwin Fontanares ed by the health care organization’s additional discounts. The Smartsheet Stanford Health Care computerized maintenance managecan also assist with managing devices Tri-Valley ment system (CMMS) and those from that integrate with both the hospital the vendor. Hopefully both sets innetwork and vendor networks to clude pertinent date and time logs, parts details, test ensure appropriate security assessments are compliequipment details and personnel involved. I recomant. It also serves as a digital dashboard to keep track mend the vendor provide their data in advance of the of receiving vendor invoices in a timely manner to meeting so it can be reviewed, and questions prepared ensure Biomed is on track with accurate operating to make the meeting more productive,” Miller says. costs each month. Keeping track of the length of terms also assists with forecasting and creating TRACKING AND MONITORING GUIDANCE spend-plan roadmaps for capital refresh as technolIt’s one thing to embrace contract management ideas ogies evolve,” Fontanares says. and another to effectively implement a means to track He says that aside from all the aforementioned every component that impacts decisions. The Stanford benefits of strategic contract planning, this body of Health biomed team developed an efficient approach work helps translate to the executive administration to tracking all important aspects using a software as a that HTM is more than just a cost-spending depart-

56 TechNation | November 2023

COVER STORY ment; the biomed department can show its added value to the organization and enterprise as a whole that it is also a cost-saving center. STRATEGIC LEVERAGING The vendor, by no means, holds all the cards in negotiations. There are incentives that HTM can propose to incentivize the vendor to adopt to more of HTM’s terms. “Leverage examples include (A) an upcoming equipment purchase at the health care organization that the vendor would like to participate in, (B) the current vendor’s service agreement expires in less than one year, (C) the vendor has multiple equipment items and/or multiple different service agreements throughout the health care organization that you can combine into one,” Miller suggests. He says that even before leveraging any of these, ask for your terms to be included as the vendor might be agreeable. “Most large organizations will respond that their terms and conditions are boilerplate, standard, etcetera, however, everything is negotiable. Meet with the clinical care team (end-users), purchasing/supply chain, etc. and determine what terms are needed, then prioritize them and assign a value to each; making it a business discussion with your vendor,” Miller says. It is at the point of sale that the buyer holds the most leverage. The OEM is most willing to listen to requests at this moment in order to close a sale. What should HTM, or those who HTM is advising, be focused on at this important meeting? “It’s about price and response; especially, if the equipment or its technology is new to the marketplace. The equipment sale closing is always paramount to the point of sale (POS) service agreement; so, you must communicate and strategize with the clinical champion, who wants the equipment, to make sure you are both on the same page,” Miller suggests. He says that the goals are to get the equipment, at the lowest price, with the best service coverage and come in under the capital and operational budget (i.e., make the CFO happy). “If the equipment is ubiquitous in the marketplace, obtain competitive service agreement quotes from [an] ISO or multi-vendor service organizations,” Miller adds. Leverage can also be exercised at the point when a vendor’s system or equipment is not performing up to expectations, unresolved service issues or when it compromises patient care. This is when a “make-right” structure is considered. Skillicorn says that the make-right should be routed through supply chain management (SCM) as it

controls the vendor relationship. “SCM should bring everyone to the table and openly discuss the issues internally in the organization with all stakeholders. Once that happens, then the vendor is brought in to discuss. The key to this is management of users/clinicians/physicians from running directly to the vendor and making demands that may or may not be supported by the organization at a higher level. Centralizing this through SCM contains the emotional side on interactions with the vendor. When this process is followed, it removes emotions, politics and potential threats to business operations,” he says. Because these negotiations involve equipment used by clinicians, the input of those clinicians is important to the process. The problem may arise that the clinicians are not “business people.” Many physicians have experience in the ownership of practices and have learned many business principles, but others are simply focused on medicine. How does HTM communicate with clinicians regarding contract negotiations and expectations? “It depends on the clinician. Some wish to learn and be educated on the business of equipment and managed or direct service, while others just want it fixed and are not interested in the details,” Miller says. He added that he believes the best way to communicate with the clinical team is to understand their workflow, issues, etcetera before there is a problem. “Find their pain points, log jams, historical issues with specific equipment, process of reporting service issues, etcetera, and you will likely learn you speak different languages, but the goals are the same: resolving the problem quickly with clear communication. Then, lay out a plan to ensure they get what they want: functioning, reliable equipment and systems,” Miller suggests. With these considerations, contract management and negotiations can prove to be an area of cost savings, increased vendor performance and concise tracking, increasing the HTM department’s value even more.

Brian Miller Cortechs.ai

Dean Skillicorn St. Luke’s Health System

November 2023 | TechNation 57

EXPERT ADVICE

CAREER CENTER What to Do When Bullied at Work

BY KATHLEEN FURORE

was quite surprised to read statistics from the 2021 WBI U.S. Workplace Bullying Survey from the Workplace Bullying Institute showing that an estimated 48.6 million Americans are bullied at work in some way. Since this is apparently a quite-common occurrence, I wondered: What can workers do if they feel they are being bullied by anyone they work with – whether that’s a supervisor or co-worker? It’s a topic that Bonnie Low-Kramen, author of “Staff Matters, People-Focused Solutions for the Ultimate New Workplace,” says she is passionate about – and it’s something clients she’s worked with have experienced. “One of my students had her exec take her head in his hands as he shook it from side to side saying, ‘Did you bring your brain to work today?’ ” says Low-Kramen, who is quick to stress that the first thing to understand is that “bullying has no place in any workplace!” When it does happen, here are some steps victims can take, according to Low-Kramen and Clarke Duncan, founder of OutsourcingStaff.ph. DOCUMENT, DOCUMENT, DOCUMENT. “Keeping a record of all bullying incidents, including dates, times, locations, what happened, and any witnesses, can be helpful if the situation escalates or if HR needs evidence,” Duncan says. Low-Kamemn agrees, and stresses that specificity matters. “Saying, ‘He is always mean to me’ won’t help. Saying, ‘On March 9, he called me a moron and threw a pen at me at the staff meeting’ will help,” she says. “Keep notes of who else was in the room to be witnesses. Bullying is evaluated by frequency and severity.” CONSIDER CONFRONTING THE OFFENDER. “If they feel safe doing so, the victim should calmly express their feelings to the bully and ask them to stop their behavior,” Duncan says. “Often, individuals may not be aware that their actions are causing distress.” “Be ready to act immediately following the bullying. Stay calm, direct and clear,” Low-Kamen advises. Say or write, ‘We

58 TechNation | November 2023

need to talk about what just happened in the meeting. No one speaks to me like that. It is not productive.’ Another way she suggests broaching the incident is to say, ‘You may not know it, but what you just said was offensive and rude. I like working here but that can’t happen again.’ ” If all else fails, file a report. “If the bullying continues, it’s time to involve Human Resources or higher management,” Duncan says. “Formal complaints should be lodged, and backed by the documented evidence.” “Say, ‘XYZ happened and I have documentation. This feels like a hostile work environment,’ ” Low-Kramen echoes. “If a company truly has a zero-tolerance policy for bullying, then something might be done in the form of coaching for the bully.” While there’s no sure way to know how a company might respond to a bullying incident, exploring company policies might offer some clues, Low-Kramen says. “Company leaders can choose to build a company culture that is rooted in respect and dignity. That would translate to having strong policies and expectations around bullying/ harassing behaviors that are communicated pre-hiring of staff and executives,” she explains. “This culture of accountability can be communicated on the website, in hiring materials including job descriptions, and in board materials.” The bottom line, Low-Kamen says, is that no job is worth tolerating bullying, extreme or not. “Holding bullies accountable is the only way the behaviors stop. Also, even when a company seems to have strong policies around bullying, the big difference is if top executives empower HR to put teeth into those policies or if the policies are simply words on a paper,” she concludes. “The staff knows if leaders are willing to stand up for them by holding people accountable for their actions.” 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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November 2023 | TechNation 59

EXPERT ADVICE

20/20 IMAGING INSIGHTS

5 UPDATED Steps to Sustainable MRI Repairs

BY TED LUCIDI, CBET always appreciate revisiting topics from earlier 20/20 articles. It allows me the ability to assess the content with a new perspective and learn if there’s an opportunity to provide additional, or more up-to-date, information. It also re-presents content to those who may not have been supporting imaging modalities, or those who may not have been TechNation subscribers, at the time. We released our first TechNation article back in January 2019, and provided readers with 5 steps for obtaining sustainable MRI coil repairs. Following are 5 UPDATED Key Questions to ask about MRI coil repair processes to help you make wise, informed decisions that you, your team and your patients can live with. CABLE HARNESSES Question: Are system cables replaced or are they spliced? A common practice in the coil repair space is to splice or bridge failed wires in a coil’s system cable. Splicing, or bridging, a failed cable is a very cost-effective means of addressing a damaged or intermittent wire. It also offers a very rapid turn-around time. That being said, spliced or bridged wires within system cables can result in latent failures. There are, sometimes, dozens of wires within a system cable. If a single wire has failed, you can bet that others have failed, or are on their way to failing. The end results are more-frequent repairs, more down time, and potentially, more performance issues. Sustainable repair processes replace all of the wires in a system cable, resulting in higher first-time fix rates. Replacing costs slightly more, however; the longevity of the repair and life extension of the coil more than compensate for the additional cost and helps to lower the overall cost of ownership. Some of the latest coil models from Philips utilize fiber optic cables. Innovatus Imaging has the ability to fabricate traditional replacement

60 TechNation | November 2023

system cables, but also fiber optic cables. This approach to repair is just one of the reasons that we can provide a 6-month warranty period.

Replacement Cable Fabrication TESTING METHODS Question: What testing methods are used to troubleshoot and assess overall performance? And, is the provider able to find potential hidden electrical performance issues? Simplistic testing, or single point of failure testing, often fails to identify additional issues affecting a coil’s overall performance. Single point of failure repairs are, as above, quick and cost effective. A more sustainable approach is one that is holistic in nature. As a former manufacturer of MRI coils, we utilized and currently employ, modular testing, which breaks-down the coil into individual segments and assesses the performance of each section. A holistic approach to repair is one that can help to identify borderline QC problems, result in higher first-time fix rates, fewer latent failures and greater long-term value.