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CONTENTS
P.12 SPOTLIGHT
p.12 Professional of the Month: James Swandol, MBA, CBET, CHTM
p.14 Department of the Month: Cincinnati Children’s Hospital Medical Center Clinical Engineering Department
p.16 Next Gen: Nicole Ruffin
p.18 Association of the Month: Healthcare Technology Management Association of Ohio
P.21 INDUSTRY UPDATES
p.21 News & Notes
p.30 Welcome to TechNation
p.31 Ribbon Cutting: TrechIT Solutions
p.32 ECRI Update
p.34 AAMI Update
42
48
P.37 THE BENCH
p.37 Tools of the Trade
p.38 Biomed 101
p.40 Webinar Wednesday
P.42 FEATURE ARTICLES
p.42 Roundtable: Education
p.48 Cover Story: Preventing Scope Creep: Someone Needs to Take Care of It
P.55 EXPERT ADVICE
p.55 Career Center
p.56 SPONSORED: Innovatus Imaging
p.59 Right to Repair
p.60 The Future
p.62 Cybersecurity
p.64 Networking Notes
p.66 Health-ISAC
PUBLISHER John M. Krieg
VICE PRESIDENT Kristin Leavoy
VICE PRESIDENT Jayme McKelvey OF SALES
EDITORIAL John Wallace
CONTRIBUTORS
Roger Bowles
K. Richard Douglas
Jim Fedele
Joie Marhefka
Manny Roman
Steven J. Yelton
ACCOUNT Megan Cabot
EXECUTIVES Emily Hise
ART DEPARTMENT Karlee Gower
Taylor Hayes
Kameryn King
DIGITAL SERVICES Cindy Galindo
Kennedy Krieg
Haley Harris
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
Distribution, Clinical IT, DHTS, Duke Health Technology Solutions
Allison Woollford, Biomedical Equipment Specialist at Duke University Health System
DIGITAL ADVISORY BOARD
Bryant Hawkins Sr., HTM on the Line, Trimedx Site Manager at Children’s of New Orleans
Dr. Brian Bell, HTM Workshop, Faculty Biomedical Engineering at St. Petersburg College in St. Petersburg, Florida
Carlos Villafane, BMET Latino, Certified Biomedical Engineering Technician III, Baycare Health Systems
Chace Torres, Bearded Biomed, Lead Technician SPBS, Dallas-Fort Worth Metroplex
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PROFESSIONAL OF THE MONTH Committed to Excellence
James Swandol, MBA, CBET, CHTM
BY K. RICHARD DOUGLAS
James has demonstrated exceptional leadership, dedication, and a commitment to excellence that has significantly impacted our team and organization,” is one sentence from the nomination for this Professional of the Month; a professional who had been nominated and recognized in the past as well.
James Swandol, MBA, CBET, CHTM, is a manager II in the Healthcare Technology Management Department at Baylor University Medical Center and Baylor Heart and Vascular Hospital in Dallas, Texas.
TechNation previously highlighted Swandol’s achievements in 2017. Since then, he has also contributed to TechNation cover stories.
For all of his success as a biomed and manager, Swandol did not plan that career initially.
“I fell into the biomed field by luck. After the Army, I was working as a personal trainer, things started out great but as the economy began to turn, I started losing clients and decided it was time to pursue a degree. I began going to school for electronics and computer technology and was recruited by a third-party company to work on anesthesia machines upon graduation,” he says.
After graduating with his AAS in electronics and computer technology, he went through Draeger’s Fundamentals of Anesthesia, training on the entire Narkomed series, Apollo and Fabius machines.
“After finishing training at Draeger, I went to GE Healthcare and received training on the Aespire and Advance machines,” Swandol says.
Swandol started out his career as an anesthesia service technician, moving up to lead anesthesia service technician
and then a field service technician, operations manager, BMET II, senior BMET, manager and then manager II. He has also served on the board of directors (member) of the Veterans Center of North Texas and is on the board of directors (Secretary) of the Healthcare Technology Management Association-North Texas.
SUCCESS FOR EVERYONE
After a lengthy career in HTM, with varied experiences and positions, it should come as no surprise that Swandol has been involved in many projects.
“I have been on projects to open a hospital, close a hospital and selling a hospital. I been involved with projects to move central monitoring units, department expansions, department relocates, department refreshes, new installs, and upgrades of equipment just to list a few,” he says.
Swandol says that most of his weekly meetings revolve around projects.
“With all the project work I do as a manager, I wanted to get some more insight into projects and process improvements, so I recently completed a graduate certificate in Six Sigma black belt. The program was very interesting and gave me a much better understanding of how projects work. It helped me understand why we do things the way we do. I found that I enjoy writing project charters and being able to help develop the big picture of a project,” he says.
On the home front, Swandol says he has an amazing, blended family.
“We enjoy hanging out by the pool, playing basketball in the driveway and going to all their games all year long. My wife is a nurse manager; we both work for Baylor Scott and White. We both push one another to succeed and are currently striving to reach director level. I finished up my MBA a couple years ago with her support and she is currently working to finish her MSN degree and plans to pursue her DNP soon after,” Swandol says.
He has a son who is 14, two daughters who are 12 and 6 and a stepson who is almost 14.
“I have been coaching youth sports since 2014. I have enjoyed being able to coach all of my kids at some point and time. I’ve coached baseball, basketball, flag football and soccer. I enjoy coaching for a couple reasons; first, I get to spend time with my kids that they will remember and hopefully cherish. Second, the aha moment when a player finally understands something or being there when a 5-year-old scores their first soccer goal or when one of your players gets his first hit in a baseball game is priceless,” Swandol says.
Another pastime is working out; he says that his workouts are his stress relief.
“I lift weights six days a week. I am lucky to have a home gym and hit the weights as soon as I come home from work. What makes it even better is now that my son is 14 and interested in working out for school athletics; he joins me or I train him after I finish my workout,” Swandol says.
To know Swandol is to understand that his time in the military was important.
“I am a veteran of the United States Army. I served eight years and did two tours in Iraq. The military was the best thing for me and I grew up fast because of it; I was leading a team by the time I was 21 and leading troops in Iraq at 23. I was not a biomed in the Army, I was Transportation, and during my tours in Iraq, we hauled 5,000-gallon tankers of fuel all over the country to deliver fuel to the different bases. My time in Iraq had good days and bad days, but the relationships built with the men and women I deployed with has lasted a lifetime. My unit is still close and just had another reunion in remembrance of 20 years since our deployment to Iraq,” he says.
Swandol says that he wants others around him to succeed and he wants to inspire his technicians to not just meet their goals, but surpass them.
“I enjoy mentoring technicians into great leaders. Since being in management with HTM at BSWH, I have had two technicians get promoted to manager [and] six technicians pass the CBET exam. One of the things I enjoy doing the most is holding leadership mentor sessions with technicians who express interest in going into management. I go over what has worked for me and dive into the daily operations of an HTM manager so that they are prepared for their next step,” he says.
Swandol says to show his gratitude to his team for all their hard work every year, for HTM Week, he spoils the team.
“We start with training sessions on how to succeed, and later in the week we go to a local skeet shooting range, and end the week with a crawfish boil. It has become my tradition; we have been going to the skeet range for six years for HTM week and just had our third crawfish boil. It is always nice to have the team get together to blow off steam and enjoy each other’s company,” he says.
It’s little wonder why Swandol has been nominated for professional recognition twice. He has had a commitment to family, his country, his colleagues, his employer and his own self-development.
BIOMETRICS
FAVORITE BOOK:
“The Progressive Hospital (A Lean Hope)” by Stephen Weller
FAVORITE MOVIE: “Deadpool”
FAVORITE FOOD: Italian
FAVORITE PART OF BEING A BIOMED?
Helping my technicians succeed
DEPARTMENT OF THE MONTH
Cincinnati Children’s Hospital Medical Center Clinical Engineering Department
BY K. RICHARD DOUGLAS
Ci ncinnati Children’s Hospital Medical Center states that it will pursue an “even greater future by elevating and accelerating our focus on Care, Cure, Community and Culture.” That is saying a lot for an institution that has been treating patients since 1883.
Through research and innovation, the medical center is one of the world’s premier children’s hospitals.
The large clinical engineering department, which supports the 762-bed medical center and more than 46 other locations, is made up of two directors, a coordinator and 30 biomeds.
Supporting more than 48,000 active clinical devices and nearly 25,000 active lab/research devices, the team also includes two outpatient techs, four members of its imaging team, two clinical engineers, two CMMS data analysts, five members of the clinical and research lab team, five supervisors and four to five co-op students.
The department’s directors are Salim Kai, MS, CBET, and Jackie Boyer, MBA.
“Data is collected and analyzed in our CMMS. We have custom built dashboards for the leadership team as well as the technicians to provide daily, monthly and quarterly visibility to tasks. Data is shared and reviewed with the various key partners and EOC. CMMS houses integrations to our RTLS, parts ordering, cybersecurity applications. We have adopted the AAMI White Paper FCC in our CMMS,” Boyer says.
The department’s mission statement is: “The Clinical
Engineering department is dedicated to supporting the clinical, research, and educational instrumentation needs of the Cincinnati Children’s Hospital Medical Center by providing effective equipment planning, education, maintenance, and monitoring to ensure quality with cost effectiveness, reliability, safety, and promptness.”
BIG PROJECTS THROUGH CAREFUL PLANNING
The CE team has tackled several large projects in addition to their more routine duties.
One of those projects was the opening of the 600,000-square-foot Critical Care Building, which opened in 2021. The team partnered with Clinical, Design Construction and Leadership to plan and support implementation of new technologies and equipment in addition to the patient move.
“Active participants in simulation and move day planning. Had dry runs of the patient move to time how long it would take for each piece to take place. These meetings took place starting a year prior to the move. Had a dedicated route for each team to ensure constant flow. Helped define what equipment is easy to move and what needs to be in place prior. We had multiple move teams assigned to the departments to coordinate with the clinical teams to know rooms needed to be ready in order of the patient move. We had an all hands-on-deck approach with all members onsite to contribute,” Boyer says.
The department also just kicked off a CMMS RFP, partnering with the Plant Engineering team.
“[We had a] meeting to align goals, priorities, budget, and timeline for the project. Created documentation as a team together and have ongoing open conversations to discuss the project and goals. Evaluation of vendors was
done separate and then met to discuss which ones work best for both teams. Ensured all parties that we are a team and no one group has more weight than the other,” Boyer says.
She says that the team met initially and brainstormed over the current state of our CMMS.
“We needed to understand the strengths and weaknesses of our use cases and daily processes. There were things we liked and planned to keep in our future CMMS (for example: customized data reports already created for leadership, technicians, engineers, clients, etcetera; work order history, and the existing integrations with other systems such as ServiceNow) and things we did not care for that we would address and change,” Boyer says.
As an example, she says that there are some pain points around slowness of the system, service interruptions with downtime to upgrade, and the inability to incorporate best practice to keep up with the changes taking place in the biomed field.
“We have assembled a CMMS evaluation super user team that represents clinical engineering administrative, leadership, clinical engineers, HTM technicians, research, diagnostic imaging, data analytics. The goal is to perform a high level, as well as a granule assessment, of our requirements and what we need to successfully manage the HTM program at Cincinnati Children’s Hospital Medical Center,” Boyer says.
One instance of that was an RTLS initiative to improve capabilities of asset tracking and PAR level management.
“[We] have the multi- mode RFID/RTLS tags on over 5,000 devices. [We are] looking to expand the platform for a more robust RTLS system. Partnering with Operations and EVS,” Boyer says.
The patients who visit the Cincinnati Children’s Hospital Medical Center can be assured that care, cure, community and culture are all reinforced through the efforts of the professional clinical engineering department supporting the efforts of world-class clinicians.
In addition to large projects, the CE team is on standby to help problem solve when called upon.
Another challenge the team tackled was that cleaning procedures were causing premature failure/breaking and they partnered with teams to evaluate options to address these concerns.
The group evaluated what cleaning materials they could standardize on, considering the manufacturer recommendations, but not compromising the cleaning of the device.
Outside of the work environment, the team remains active in the HTM community. They are involved with AAMI, ACCE and the Ohio HTMA and were recognized as Ohio HTMA Shop of the Quarter in May 2024.
The patients who visit the Cincinnati Children’s Hospital Medical Center can be assured that care, cure, community and culture are all reinforced through the efforts of the professional clinical engineering department supporting the efforts of world-class clinicians.
NEXT GEN POWERED BY YP AT MD
Nicole Ruffin
Nicole Ruffin began her HTM education with the Community College of Philadelphia Biomedical Equipment Technology Program. She earned her Biomedical Equipment Technology Proficiency Certificate and an Avante Ultrasound Certificate.
TechNation recently found out more about this BMET II that recently joined the Renovo Solutions team at South Shore Hospital in Weymouth, Massachusetts.
Q: WHERE DID YOU GROW UP?
A: Dover, Delaware
Q: WHERE DID YOU RECEIVE YOUR HTM TRAINING/ EDUCATION?
A: Community College of Philadelphia (CCP)
Q: HOW DID YOU FIRST DISCOVER HTM?
A: An invitation to attend a biomed introduction webinar, presented by Prof. Randy Libros (retired) and Dr. Wooten of CCP.
Q: HOW DID YOU CHOOSE TO GET INTO THIS FIELD?
A: The opportunity to fulfill a dream to work in health care and to honor my late mother who encouraged continued education, at any age.
Q: WHAT DO YOU LIKE MOST ABOUT YOUR POSITION?
A: The multitude of opportunities to learn and grow.
Q: WHAT INTERESTS YOU THE MOST ABOUT HTM?
A: The ever-changing technology and advances in health care.
Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR?
A: Building my incredibly supportive, successful, passionate and steadfast network of HTM professionals. My circle is the BEST!
Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS?
A: I will earn, and maintain, the AAMI BMET certification. I want to grow to be the best biomed I can be and pursue opportunities that will allow me to continue to learn. I want to be a Super Biomed!
FUN FACTS
FAVORITE HOBBY: Singing
FAVORITE SHOW OR MOVIE: “Labyrinth”
FAVORITE MEAL: Anything homemade and made with love
WHAT WOULD YOUR SUPERPOWER BE? Healing and regeneration (think Wolverine)
1 THING ON YOUR BUCKET LIST: To travel to every continent
SOMETHING YOUR CO-WORKERS DON’T KNOW ABOUT YOU:
I have driven coast to coast of the U.S., by myself, over the span of two months. I visited 20 states. I have traveled to Romania, Hungary, Serbia, Mexico and the Bahamas. I love to travel!
All webinars, podcast, and product demos are eligible for 1 CE credit from the ACI.
ON-DEMAND:
Combating Ransomware in Healthcare with Network Detection and Response (NDR)
Tools of the Trade Demo on Kontakt.io’s Asset Tracking Platform
Tools of the Trade Demo on Claroty xDome
Powering the Future of Service Delivery with AI
TUNE IN TO ANY LIVE WEBINAR TO WIN AIRPODS OR $100 AMAZON GIFT CARD
LIVE:
SEPTEMBER 4 | Tenacore Live demo on Tenacore Vending Solution
SEPTEMBER 11 | TKA
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SEPTEMBER 18 | AllParts
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SEPTEMBER 25 | Cynerio
Save the date for this live webinar.
PODCASTS:
sponsored by MMS HTM for the Next Generation
Healthcare
Technology
BY K. RICHARD DOUGLAS
A ASSOCIATION OF THE MONTH
Management Association of Ohio
nyone who has ever traversed the state of Ohio knows that it is composed of flat plains, rolling hills and river valleys, along with beaches along Lake Erie. The state contains the Rock & Roll Hall of Fame and Museum in Cleveland. Dayton is home to the nation’s largest aviation museum.
The state is also home be a large contingent of HTM professionals. The state’s biomed association is the Healthcare Technology Management Association of Ohio (HTMA-OH).
The groups officers are President Ryan Gonzalez, Vice President Roger Hale, Treasurer Ken Mylar and Secretary Jasmine Zirkle.
“HTMA-OH can trace its roots back to 1974. After several instances of going dormant and restarting under different names; HTMA-OH was reborn in 2015 under the current name,” Gonzalez says.
He says that the HTMA-OH organization was started by Ken Burkholder (retired) and Glenn Schneider, among others.
“The Ohio Clinical Engineering Association started in 1974 as a group of hospital medical equipment engineers who were a part of a joint safety committee group of the Greater Cleveland Hospital Association. These engineers had a disagreement with the city of Cleveland over electrical testing laboratory requirements for medical equipment that was in use in the city. After this disagreement was resolved, these engineers continued to meet on a regular basis and the organization Clinical Engineering Technology Association (CETA) was formed,” Gonzalez says.
He says that in 1980, the words “North Coast” were added to the name to designate the geographic area of Northern Ohio near Lake Erie and NCCETA was created. In 2002, after being dormant for a few years, NCCETA was brought back into
existence. In 2003, the decision was made by the 2003 Operations Committee to make the organization state wide and the new name “Ohio Clinical Engineering Association,” or OCEA as the acronym, was selected for the new and larger organization. The association remained active for a number of years until again falling dormant.
“In 2015, thanks to several leaders in the community, it was reborn as the Healthcare Technology Management Association of Ohio. Since its inception, the HTMA-OH has slowly grown its community reach, visibility and association size. Prioritizing bringing together healthcare technology professionals around the state for networking and education,” Gonzalez says.
Annually the association successfully conducts two lunch and learn webinars, two social outings and one multi-day conference.
“Each of these three activities are designed to be free or as low a cost as possible for attendees. We believe it is our job as an association to make these events as inclusive as possible, as well as continually improving them based on feedback from our attendees and vendor sponsors,” Gonzalez says.
He says that the lunch and learn webinars are aimed at providing free, relevant education directly to the HTM front-line staff with the least disruption to their daily work-life.
“Our free social outings are aimed to bring a sense of community and interaction between HTM professionals that work in the same area of the state. The annual conference and expo bring it all together, to include frontline staff, leadership, third-parties, vendors and students. We combine education, social outings, and fun to give the whole state a MD Expo feel, but in their own community,” Gonzalez adds.
He says that the HTMA-OH holds board meetings the first Wednesday of every month. These are not simulcast to non-board members.
“We host at least two lunch and learn webinars each year that are broadcast for anyone to join,” Gonzalez says.
DOING THE ANNUAL CONFERENCE THE RIGHT WAY
The association has a very well-organized and comprehensive annual conference.
“The annual HTMA-OH Conference and Expo is always held on the first Friday in February. The goal of this event is to be as inclusive as possible and appeal to all levels of the HTM profession. From college students to the C-suite, there is something for everyone and it is priced at a level to allow anyone to attend,” Gonzalez says.
He says that the association kicks off the conference with a Top Golf event the night before the conference.
“It is important to our association to make this social event free for all attendees. Thanks to the generosity of our sponsors, we host 125 HTM professionals to three hours of golf, food and adult beverages. Making this event free for attendees allows for maximum participation from all aspects of the HTM community. We have regularly seen HTM shops use this as a chance to have a fully paid shop outing. Vendors see this as a great opportunity to organically interact with the hospital staff and leadership that they conduct business with, but outside of a professional setting,” Gonzalez says.
He says that the conference and expo are a full day event centered around 15 educational classes on a variety of topics to appeal to biomed technicians, imaging technicians, supervisors, managers and above.
“The event is free for students and $20 for all other attendees. As well as education, breakfast, lunch, and dozens of prizes are provided at no additional costs. Lunch is served during the mid-day keynote speaker presentation. We have dedicated expo times to interact with your favorite vendors and potentially meet new future favorites. We wrap up the day with roundtable discussions on important industry influencing topics followed by a social happy hour,” Gonzalez says.
The conference has been a big success for HTMA-OH, and each year it has grown and improved.
“Thanks to the amazing dedication of our board who have continually worked to grow our reach and attendees, as well as feedback and contributions by our vendor sponsors, our conference has doubled and tripled in size over the last few years. This allows us to provide even more value to each and every person who attends,” Gonzalez says.
The group’s 2024 conference was a significant jump forward for the organization.
“Moving locations from previous years, we knew we had the opportunity to bring in more attendees and an improved experience. Our new location allows us to bring everyone together into the same building, add additional education classes, and maximize the visibility of our vendors,” Gonzalez says.
He says that most importantly, they saw the Ohio HTM community come out in larger numbers than ever before.
“Almost double the attendance of the previous year, the true highlight was seeing so many technicians and leaders from hospitals all around the state interacting at Top Golf, at the post conference happy hour and between classes. We truly achieved our goal of bringing together the community,” Gonzalez adds.
He says that the association has begun planning the 2025 event and will be looking to keep expanding the success they have had in the previous few years.
“Better education, better prizes, and more engagement is the goal,” Gonzalez says.
What more can biomeds ask for in a state organization? Education, community and sponsor-supported activities that defray the costs. The HTMA-OH is doing it all right.
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NEWS & NOTES Updates from the HTM Industry
HTM PROS ANNOUNCE PROJECT C.U.R.E. EVENT
Project C.U.R.E. was founded in a Colorado garage in 1987 and has since expanded to seven distribution locations across the U.S., including Nashville, Tennessee in 1999.
Project C.U.R.E. will host an event at its Nashville distribution center on September 19 with drinks from 5:30-6 p.m. and a volunteer project from 6-8:30 p.m.
Probo Medical’s Elizabeth Cook, RSTI’s Kim Rowland and Block Imaging’s Jen Davis are working with Project C.U.R.E. on this volunteer event. The goal is to develop a stronger HTM community in the Nashville area, including HTM pros from Alabama and Georgia.
Since 1987, Project C.U.R.E. has grown to become the world’s
largest distributor of donated medical supplies, equipment, and services to doctors and nurses in more than 135 countries. This is no easy feat. The only way Project C.U.R.E. can continue its efforts is through the help and support of those also willing to get involved — from volunteering to donating, you can help us make a difference.
Royal and Bon Secours Mercy Health (BSMH), one of the nation’s largest Catholic health systems, recently announced a multi-year strategic collaboration for patient monitoring. Putting BSMH clinicians in control, the collaboration will reduce the digital burden on staff and give them more time to spend with patients.
The partnership provides access to the latest Philips monitoring innovations, including a scalable patient monitoring platform that integrates patient data and provides vital insights. It will standardize patient monitoring for BSMH’s 49 hospitals, reducing costs through a predictable payment model and enabling further reinvestment in innovation.
“This collaboration is part of our commitment to drive improved health care quality while reducing costs and addressing health care issues facing entire communities,” said Jodi Pahl, chief nursing officer for workforce experience and nursing outcomes, Bon Secours Mercy Health. “This 10-year journey will bring innovations that will transform care delivery.”
BSMH provides patients care more than 11 million times annually through its network of more than 1,200 care sites, 60,000 associates and 49 hospitals serving communities in Florida, Kentucky, Maryland, New York, Ohio, South Carolina and Virginia, as well as Ireland.
“With implementation occurring over the next three years, followed by seven years of maintenance and updates, we’re
positioned to be at the leading edge of technology,” said Pahl. “This uplifts our mission to improve the health and well-being of our communities and supports our commitments to innovation and stewardship.”
Julia Strandberg, Chief Business Leader, Connected Care at Philips said: “This partnership is a testament to BSMH’s focus on strong clinical engagement and our combined commitment to improving the patient and staff experience. As BSMH’s clinical technology partner, we’re leaning in to understand their needs and apply innovative technologies that can improve patient outcomes. BSMH is committed to bringing quality care to more people by eliminating time-consuming data roadblocks for their staff.”
INDUSTRY UPDATES
HTM PROS ASSIST DURING & AFTER HURRICANE
HTM professionals in Texas and other hurricane impacted areas rose to the occasion to assist clinicians and other health care professionals during the landfall and aftermath of Hurricane Beryl.
Texas experienced severe flooding and wind damage, with reports of at least seven dead in the Houston region. Additionally, the outer bands of the hurricane produced a tornado outbreak, with tornadoes confirmed in Texas, Louisiana, Arkansas, Kentucky, Indiana, New York and Ontario, Canada. As of July 15, a total of 44 fatalities have been confirmed, and preliminary damage estimates are more than $6 billion.
Jennifer Chester, BMET II, with Crothall Healthcare in Houston, Texas shared her experience during the storm.
“Hurricane Beryl has significantly impacted our health care system, primarily through flooding and power outages,” Chester shared. “The heavy rainfall has left creeks and flood-prone areas heavily saturated, making even small storms a serious concern for additional flooding. Wind damage from the hurricane has resulted in downed trees, complicating travel and access. The unpredictable weather conditions continue to pose challenges, particularly with restoring power, as lineman are unable to work during
HTM EXPERT LAUNCHES CONSULTING FIRM
Health-Tek Consulting President and Principal Consultant
George Hampton has more than 40 years of experience in healthcare technology management (HTM). In that time, he has learned successful HTM programs provide significant savings to their stakeholders, while providing clinicians with relief from the daily demands of managing that equipment.
“Our goal is to share these time-tested skills with as many health care providers as possible,” Hampton said.
“Health-Tek Consulting provides our clients with tools and
thunderstorms, leading to prolonged power outages. These conditions have created unsafe situations, necessitating the cancellation or rescheduling of numerous patient appointments. Consequently, we anticipate a significant influx of patients once conditions stabilize and scheduled services resume.”
Chester said her department has been nothing short of amazing!
“Despite the risks associated with traveling under current hazardous conditions, our team has gone above and beyond to ensure the continuity and safety of our devices, teammates and patients,” she said. “Many of our team members have been actively traveling to various locations, performing evaluations, and preemptively checking high-risk equipment to assess potential damages. Fortunately, we have encountered minimal damage so far. However, the team’s readiness and willingness to tackle any challenges that might arise has been a crucial factor in maintaining our operational capabilities during this time. Their proactive efforts have ensured that we remain prepared to handle any situation effectively.”
Chester said she is “proud to be working with such a dedicated group of individuals.”
information essential to create high performance HTM programs. Our goal is to improve patient safety and satisfaction, by building HTM programs that remove the daily obstacles of medical equipment management from busy clinicians, giving them more time to care for patients,” he added.
George Hampton President/Principle Consultant
RIGEL INTRODUCES UPGRADED SAFETEST 60+ ANALYZER
The implementation of rapid and accurate medical device and laboratory equipment testing is provided by Rigel Medical’s newly upgraded SafeTest handheld safety analyzer.
Designed for high performance and accurate electrical testing to reduce the risk of electrical device fault, the improved SafeTest 60+ is a compact, rugged and reliable safety analyzer that is designed to accommodate the demands of high-volume testing regimes.
Offering an easy-to-use color coded user interface, push button operation and fast step selection of test routines, and available in a wide range of power configurations to suit local and international markets, the tester delivers point-to-point insulation resistance testing from 100K to 100MΩ with added patient applied parts testing.
Featuring an accessible and clear user interface (UI), which allows the operator to select the required tests quickly with a single key, the high-performance instrument includes an extensive selection of safety tests for hospital and medical equipment.
The SafeTest 60+ provides basic testing of medical equipment with applied parts, both patient current leakage and insulation measurement to ensure electrical safety of medical beds and chairs, operating tables, hoists, infusion pumps, CPAPs (continuous positive airway pressure), centrifuges and other similar equipment that do not require patient lead testing.
As such, the SafeTest 60+ is suitable for electrical testing to ensure compliance with a range of international safety standards including leakage testing to AAMI ES 60601, NFPA99, IEC 62353 and IEC 61010. Key features for dynamic testing include:
• Active pass/fail thresholds during measurement;
• Patient applied parts testing;
• Manual control of fault conditions and tests;
• Accurate high current, low energy earth bond testing;
• Automatic warning of secondary earth/ground paths; and
• Point to point insulation testing
To meet the needs of some specific types of equipment, the unit also has the capability to carry out accurate ground bond testing to NFPA-99, IEC 62353 and IEC 61010 using Rigel’s high current, low energy test technology. In all cases, full manual control means only those specific tests that are required need to be carried out, with selected single fault conditions ensuring that testing is carried out quickly and efficiently – without any compromise in accuracy or integrity of testing.
As part of the new streamlined approach to carrying out electrical safety tests, an automatic warning of secondary ground paths ensures that users are alerted when invalid results occur, eliminating time consuming re-tests and ensuring correct and valid results are provided first time.
The SafeTest 60+ analyzer is the latest addition to the comprehensive range of high-performance biomedical test equipment from Rigel Medical.
PARTSSOURCE ANNOUNCES NEW TRAINING PARTNERSHIPS, UNVEILS NEW TECHNOLOGIES
PartsSource has announced a new strategic partnerships to address the industry labor shortage and expansions to PartsSource PRO, the company’s flagship solution and the industry’s first and only clinical resource management platform. The Asset Command Center and Visual Analytics for Repair and Service Agreements will be accessible to the 1,600 member hospitals within the PartsSource PRO community. These new capabilities were demonstrated by PartsSource subject matter experts at the AAMI eXchange in Phoenix, Arizona.
In a news release, PartsSource announced a “market-changing initiative, in partnership with the College of Biomedical Equipment Technology (CBET) and Radiological Service Training Institute (RSTI), that will bring the PartsSource PRO Talent solution to the PRO Community to help them address the growing gap between the supply and demand for skilled technical resources.”
The release states that the “comprehensive solution” consists of four digital-first modules which will be integrated into the PartsSource PRO platform:
• Evaluation – Digital competency mapping of clients’ workforce, enabling a data-driven approach to training development and hiring plans to support each client’s service strategy.
• Onboarding – A comprehensive digital-first onboarding approach that prepares new technicians for the role in
weeks, not months.
• Training – Evidence-based, product-specific training, available digitally and in-person, to proactively support clients’ service optimization journey.
• Recruitment – Exclusive recruitment access to CBET’s recent graduates and community through an integrated job board supported by talent-matching expertise.
“Helping our clients address today’s technical labor shortage at scale requires a technology-enabled, evidence-based approach that is integrated into their strategic roadmaps,” said Alex Gedeon, chief operating officer of PartsSource. “Our PRO Talent solution connects our clients’ talent strategies with their service strategies in a single enterprise platform, allowing them to evaluate, activate and manage their talent through a new data-driven approach.”
Dr. Richard Gonzalez, president of CBET, added, “Our partnership with PartsSource is integral to advancing our mission to meet the evolving needs of the health care community with premier education and training in HTM and information technology. We are honored to work with PartsSource and RSTI to bring a new digital-first, integrated approach to talent development for the PartsSource PRO community.”
The news release states that since unveiling the breakthrough evidence-based model to transform service contract management at AAMI eXchange 2023, PartsSou -
rce Repair and Service Agreements (RSA) have generated over $10 million in projected savings for first year clients, and the company is seeing accelerated adoption across the PartsSource PRO client base.
“Building on the successful market introduction of the first-of-its-kind solution that consolidates multiple service contracts into a single managed service agreement, PartsSource is introducing enhanced visual analytics with rich service and labor data, including highlighting frequently repaired, high-cost assets that can indicate the need for capital replacement,” the release added.
“The savings and quality our initial Repair and Service Agreement delivered have motivated Marshfield to continue to add more equipment to this flexible, capitated service agreement solution.” said PartsSource PRO client, Jay Olson, director of biomedical services at Marshfield Clinic Health System.
PartsSource’s latest initiative is a system-wide Asset Command Center, a powerful set of features that gives in-house teams unprecedented insight into the uptime status of mission-critical assets, provides evidence-based recommendations to improve asset availability, and provides end-to-end workflows to bring critical equipment back online faster.
The PartsSource Asset Command Center scope includes:
• Centralized views of device health and performance: Visibility to all asset data in one place with diagnostic signals – including device generated notifications via Glassbeam’s Service Analytics solution – to monitor equipment status and launch alerts in real-time, creating instant visibility to critical and urgent hard-down assets, projected resolution timing and asset performance versus benchmarks.
• Efficient knowledge management: Access to a comprehensive selection of online digital equipment manuals with ease and convenience to support accurate, effective and timely in-house repairs.
“When mission-critical equipment is down, clinical care cannot be delivered and patient care is delayed, negatively affecting the bottom line. The Asset Command Center disrupts the break fix paradigm with upstream diagnostics to proactively identify issues that threaten uptime and reduce risk of future downtime,” said Philip Settimi, MSE, MD, president and CEO of PartsSource. “PartsSource, together with our co-development partners, is shaping the future of asset management to optimize clinical asset availability with an evidence-based, data-driven solution.”
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HID ACQUIRES VIZZIA TECHNOLOGIES
HID, a worldwide leader in trusted identity solutions, has acquired Vizzia Technologies (Vizzia), a leading provider of hardware-agnostic, full-service real-time location systems (RTLS) platforms designed for health care and hospital applications. The addition of Vizzia expands HID’s offering and relevance in the Healthcare RTLS space, including support for asset management and tracking, as well as other
use cases designed to meet the unique needs of healthcare facilities.
Headquartered in Austin, Texas, HID has over 4,500 employees worldwide and operates international offices that support more than 100 countries. HID is an ASSA ABLOY Group brand.
CABMET OFFERS FLASH CARDS
The Colorado Association of Biomedical Equipment Technicians (CABMET) is one of the oldest biomedical societies in the nation. It was founded in 1974.
CABMET is dedicated to providing professional development to not only its members but HTM professionals around the world.
CABMET has developed CBET flashcards (and crossword puzzles!) that are available for free at https://cabmet.org/ cbet-study-check/.
In the future, depending on usage and demand, CABMET may add more flashcards and expand its offering. Right now, it’s a free trial period.
Comments on the flashcards can be sent to info@ cabmet.org.
CABMET’s success is because of its members and the sponsors who continue to support healthcare technology. Visit CABMET.org, come to its annual symposium and be part of a great biomedical organization!
ELITE BIOMEDICAL SOLUTIONS NAMES NEW COO
Alex Heileman was recently named chief operating officer at Elite Biomedical Solutions.
“As COO of Elite Biomedical Solutions, Alex has focused on building and developing our leadership team (next generation). She will continue to have a huge impact in the HTM community for years to come!” said Chief Executive Officer/Co-Owner Jeff Smith.
Heileman is a seasoned health care industry professional with over a decade of experience. Her journey began at the age of 16 when she started as a part-time worker for her father at a health care company. Over the years, she has played a pivotal role in establishing and growing the family’s medical manufacturing and repair business.
In addition to her extensive health care background, Heileman holds a bachelor’s and master’s degree in English education, reflecting her passion for enhancing communication skills in others. Her exceptional ability to connect with individuals from diverse backgrounds has earned her recognition as a skilled communicator.
“Being the COO of Elite is both an honor and a responsibility I hold dearly. I am driven by a profound sense of gratitude
for our dedicated team and a deep love for our mission to advance health care. My vision is to foster innovative disruption and to lead with integrity and compassion. Together, we will make a significant impact on the industry and improve lives around the world,” Heileman shared.
She is actively engaged in various professional organizations, such as Vistage and Women in Manufacturing, where she seeks opportunities to contribute to her community. With her unique blend of health care expertise and communication acumen, Heileman continues to make a significant impact in her field and beyond.
Elite Biomedical Solutions manufactures replacement parts for the health care industry. The company works with hospitals across the country to develop innovative, cost effective, and quality solutions for their needs. It also offers repair depot centers to help with overflow repair work.
Alex Heileman Chief Operating Officer
UPDATES
The latest news and events from TechNation
MD EXPO NEW ENGLAND SHARES PRESHOW PLANNER
An in-depth guide for the upcoming MD Expo New England is available online. The Preshow Planner provides everything healthcare technology management professionals need to prepare for the conference.
The MD Expo Preshow Planner includes a schedule of events, an in-depth look at the educational sessions being offers, registration options, hotel information and details about the Oktoberfest Party sponsored by USOC Bio-Medical Services.
MD Expo is a premier conference dedicated to healthcare technology management professionals. The goal is to offer a distinctive, personalized, and fulfilling conference experience that surpasses all others. This event brings together clinical engineers, biomedical technicians, directors, managers, procurement/asset managers, and other individuals accountable for medical technology. Attendees will have the opportunity to
MD EXPO OFFERS CEUS, NEW H.O.T. WORKSHOP
New for MD Expo New England is the Hands-On Training Workshop or H.O.T. Workshop.
The H.O.T. Workshop is being introduced at MD Expo to provide an all-day, hands-on training option for technicians to learn the ins and outs of servicing different types of equipment. Experts from the HTM community will be on site to provide immersive training.
The H.O.T. Workshop on tap for MD Expo New England is a session on patient monitors.
This session will be offered on Tuesday, October 8 from 9 a.m. to 4 p.m. (with an hour break for lunch). The cost to attend is $100 (discounts not applicable).
The H.O.T. Workshop: Patient Monitors is approved for 6
REGISTER FOR THE HTM MIXER LEXINGTON
connect with industry peers, gain insights into the latest advancements in HTM, and expand their professional network. Discover why MD Expo has been the talk of the town; this is an unmissable event that promises invaluable opportunities.
Find out more at MDExposhow.com and download the Preshow Planner.
CEUs by ACI.
MD Expo also offers a two-day CBET Review. The fee includes access to Part I and Part II. The two-part CBET Review is approved for 8 CEUs by ACI.
The general educational session included with conference registration are at no cost to attendees and are also ACI-approved.
The MD Expo has been pre-approved for up to 8 CEUs (this does not include the CBET Review or HOT Workshop)
Biomeds and HTM professionals can register for the October 2024 conference at MDExpoShow.com.
MD Publishing, the parent company of TechNation and MD Expo, is brining an HTM Mixer to Lexington, Kentucky.
The HTM Mixer Lexington, proudly supported by KAMI, will start on Friday, November 15 and conclude on Saturday, November 16 at the Marriott Resort Griffin Gate (1800 Newtown Pike, Lexington, KY 40511). A kickoff party will be held at 6 p.m. on Nov. 15 with live music, a bourbon tasting, food and entertainment.
An HTM Mixer has everything an MD Expo offers HTM professionals just on a smaller scale. Think of it as a hybrid event that combines the best of a state association annual meeting and an MD Expo. The two-day conference includes an exhibit hall, educational opportunities and networking events.
Register today at HTMMixer.com.
powered by
TECH CHOICE AWARD VOTING STARTS SOON
TechNation magazine will soon announce candidates for the second annual Tech Choice Awards. The Tech Choice Awards (also known as the Wrenchies) shine a spotlight on the heroes of HTM.
“We are excited to carry the Tech Choice Awards into 2025,” MD Publishing Vice President of Sales Jayme McKelvey said in June. “TechNation is constantly looking for ways to celebrate the hard work and innovations of the biomedical and HTM industry. These awards give us another opportunity to recognize individuals, departments and organizations for their contributions and achievements. But, my favorite thing about the Tech Choice Awards is they make people feel valued and inspired, which can lead to increased productivity and engagement. When that happens, we all win!”
Award candidates are being finalized and voting starts on October 1.
The Tech Choice Award categories are:
• Professional of the Year, sponsored by 626 Holdings
• Department of the Year, sponsored by USOC Medical
• Young Professional of the Year, sponsored by Prescott’s
• ISO Employee of the Year
• Director/Manager of the Year, sponsored by MW Imaging
• Military BMET of the Year, sponsored by College of Biomedical Equipment Technology
• Lifetime Achievement Award, sponsored by Renovo Solutions
• Humanitarian Award, sponsored by Pronk Technologies
• Women in Leadership Award, sponsored by Avante Health Solutions
• Industry Influencer of the Year, sponsored by Soma Tech Intl
• Outstanding Vendor of the Year
• Association of the Year, sponsored by MultiMedical Systems
• Educator of the Year Visit 1technation.com/techchoiceawards for information.
• Short-term & Long-term staff available
• Heavy PM months
• Sick, PTO, Military leave
• Inventory Verifications
• Infusion Pump Month Support
• Off-site PM support
WELCOME TO THE TECHNATION COMMUNITY!
HEALTH TEK CONSULTING
Q: WHAT PRODUCT, SERVICE OR SOLUTIONS DOES YOUR COMPANY PROVIDE TO THE INDUSTRY?
Health Tek Consulting empowers clients to establish cutting-edge HTM programs, emphasizing operational efficiency, financial excellence, and continuous process enhancement.
Q: TELL US WHAT DIFFERENTIATES YOUR COMPANY FROM THE COMPETITION?
What sets Health Tek Consulting apart is our relentless commitment to delivering industry-leading HTM programs tailored to each client’s unique needs. We combine deep expertise in operational efficiency, financial performance, and process improvement with a client-centric approach that ensures measurable outcomes and sustainable success. Our team’s dedication to innovation and continuous improvement allows us to consistently exceed expectations and drive meaningful results in the healthcare technology management sector.
Q: WHY DID YOU CHOOSE TECHNATION FOR ADVERTISING?
George Hampton, President/Principle Consultant
I chose TechNation because I have a long successful relationship with the publication. I know that individuals that have a passion for our industry faithfully read this trade magazine. I want to connect with those people and make a difference in our industry.
For more information, visit health-tekconsulting.com.
RIBBON CUTTING
TrechIT Solutions
TrechIT Solutions is a premier IT managed services provider specializing in the medical imaging sector. TrechIT Solutions supports medical imaging companies of all sizes, from enterprise hospitals to small single modality offices.
TrechIT Solutions is excited to introduce its flagship service, PACS Admin as a Service, offering expert management of Picture Archiving and Communication Systems (PACS). Additionally, TrechIT Solutions provides workflow automation, system troubleshooting and system architecture solutions.
“At TrechIT Solutions, we are dedicated to enhancing efficiency and delivering exceptional value to our clients,” CEO Daniel Nudelman said.
TechNation recently found out more about TrechIT Solutions via a question-and-answer session with Nudelman.
Q: HOW DOES YOUR COMPANY STAND OUT IN THE MEDICAL
EQUIPMENT SPACE?
NUDELMAN: We distinguish ourselves by specializing in the IT side of medical imaging, bridging the gap between the modality and IT infrastructure. We excel where the network cable meets the wall, taking over to ensure seamless integration and functionality. Our unique expertise allows us to communicate effectively with both imaging engineers and IT professionals, understanding and managing both modality settings and IT requirements. This dual fluency ensures our clients receive comprehensive support and optimal performance.
Q: WHAT IS ON THE HORIZON FOR YOUR COMPANY?
NUDELMAN: Our current goal is to expand and partner with service providers to ensure seamless end-to-end installations, maintenance and repairs. We aim to become the key liaison between imaging engineers and IT departments, facilitating smooth communication and efficient operations. By forging these partnerships, we strive to enhance the quality and reliability of medical imaging services for our clients.
When acting as the customer’s PACS Admin, your team of imaging engineers work closely with familiar faces, fostering strong relationships and collaboration. This approach ensures that all aspects of the system are managed effectively, providing a cohesive and reliable service experience.
Q: IS THERE ANYTHING ELSE YOU WOULD LIKE READERS TO KNOW?
NUDELMAN: Our commitment to bridging the gap between imaging modalities and IT infrastructure sets us apart. We look forward to collaborating with industry leaders to drive advancements and improve patient care through superior IT solutions. Additionally, we can serve as the IT Managed Service Provider (MSP) for imaging service companies themselves, offering expertise that understands the unique demands and intricacies of the medical imaging industry. This dual capability ensures that both the imaging facilities and the service companies supporting them operate at peak efficiency.
For more information, visit trechit.com, email info@trechit.com or call 888-788-5022.
ECRI UPDATE
4 Key Steps for Reducing Alarm Fatigue and Improving How Telemetry Alarms are Managed
In June 2024, ECRI convened a panel discussion to share best practices for optimizing telemetry monitoring implementations to reduce alarm fatigue and improve patient safety. Interested readers can view the full webcast at the URL listed below.
Telemetry monitors are patient-worn devices that allow the patient’s heart rate, heart rhythm and other physiologic conditions to be assessed without restricting the patient to a bed. These devices allow cardiac patients to move around the facility – if they are well enough to do so – while still being monitored. However, inappropriate deployment protocols, alarm settings, or notification processes can prevent staff from learning about potentially life-threatening changes in the patient’s condition or can lead to alarm fatigue. The result can be missed alarms and potentially severe consequences for the patient.
Panelists who participated in ECRI’s June 5, 2024, webcast emphasized that a safe, effective telemetry monitoring program requires a good alarm management strategy. Following are some of their key recommendations.
1. AVOID TELEMETRY OVERUSE
Early in the program, Priyanka Shah – a principal project engineer in ECRI’s Device Safety group – presented one of ECRI’s key recommendations for reducing nuisance alarms and alarm fatigue: Do not use telemetry monitoring on patients who do not require that level of monitoring. Ms. Shah used the example of ECG “leads off” alarms to explain the recommendation. Leads-off alarms are a common occurrence with telemetry monitoring. They warn care providers that the telemetry monitor has lost contact with the patient, often because an ECG lead has become detached from, or is in poor contact with, the patient’s skin. In some cases, the alarm could be a precursor notification for a lethal arrhythmia. For patients with cardiac conditions, leads-off alarms must be addressed immediately, since
they indicate that the patient is not being monitored (or could be experiencing a potentially lethal arrhythmia).
Now consider a scenario in which all patients in a care area are placed on a telemetry pack, even patients who are not at risk of a cardiac event. For that latter group of patients, a leads-off alarm would be less urgent because the patient’s condition may be non-cardiac or of a lower acuity, such that ECG monitoring is not required. Thus, an interruption in ECG monitoring is unlikely to be as clinically significant as it would be for cardiac patients.
Nevertheless, leads-off conditions will occasionally occur among all monitored patients, and alarms will activate. That means staff will be faced with determining which leads-off alarms are critical, and which are low-priority. That’s a recipe for alarm fatigue and missed alarms.
A more effective strategy is to use telemetry monitoring only on patients who are determined to be at risk. That will reduce the overall number of alarms that activate, as well as minimize confusion about the priority level of leads-off alarms. Similarly, telemetry monitoring should continue only as long as the patient’s condition requires it. Organizations should follow AHA guidelines and define clear criteria for initiating – and discontinuing – telemetry monitoring.
2.
CONSIDER THE ‘HUMAN ELEMENT’ – WHAT DO STAFF MEMBERS NEED?
Rosemary Wurster, DNP, RN, NEA-BC – a senior vice president and chief nurse executive at Bayhealth – provided the clinician’s and administrator’s perspective. One of her key recommendations is that facilities should always consider the “human element” when implementing and evaluating technology. “As an organizational leader, it’s very important for me to think about how my greatest resource – my people –will be interacting with the technology. How can we create a work environment that helps them do their jobs effectively?”
Panelists discussed the example of telemetry imple -
Priyanka Shah Principal Project Engineer, Device Safety, ECRI
Rosemary Wurster
DNP, RN,
NEA-BC, Senior Vice President and Chief Nurse Executive, Bayhealth
mentations that use a monitor watcher room, sometimes referred to as a “war room.” In such setups, it’s important to review every detail – things like: how the room is configured, who is performing the monitoring watching function, what their working conditions are like, how they receive information about the patient, and how they communicate alarm information to care providers at the bedside. Other questions to think about include: Is the working environment both functional and comfortable? Are restrooms easily accessible? Are staff given sufficient breaks, so that they can rest physically and mentally? And is sufficient coverage provided during those times?
Additionally, Wurster stressed the value of recognizing that monitor watchers are part of the care team. When savvy staff in the monitoring room observe an issue with a patient and communicate it to the care providers, they get invested in that patient’s care. Teams should close the loop with those monitor watchers, describing how the situation was resolved so they can recognize the full value of their contribution.
3. ASSESS PRACTICES ON ALL SHIFTS –DAYS, NIGHTS, AND WEEKENDS
Best practices for assessing an organization’s alarm management strategies were described by Marc Schlessinger, a senior consultant and investigator for ECRI’s Healthcare Incident Investigation & Technology Consulting program.
ECRI recommends activities like those that it performs during its proactive assessments of monitoring utilization and alarm management for interested health care organizations. These assessments include three main components: (1) An evaluation of the facility’s policies and procedures. (2) A review of recent incidents and near misses related to monitoring that have occurred at the facility. And (3) site visits to the care areas where telemetry is used, so that evaluators can assess the physical layout, observe practices and interview staff.
To get the full picture, Schlessinger emphasized the need to assess practices during all shifts – days, nights and weekends. “Anybody who has ever worked at a hospital knows that what happens at 9 p.m. may not be the same thing that happens at 4 p.m. It’s important to get a 24-hour perspective of what’s happening.”
All panelists agreed that alarm management needs to be an ongoing effort. “Leadership has the responsibility to be continuously evaluating the effectiveness of the organization’s processes,” stressed Wurster. “Health care changes quickly. Technology changes quickly. We’re in an environment with significant staff turnover. All those factors contribute to the need to continuously evaluate how things are being done, and whether current processes are meeting the organization’s patient care goals.”
Managing that ongoing effort would be the role of an organization’s multidisciplinary alarm management committee. Unfortunately, many facilities lack such a committee: Almost half of the 200 respondents to a poll conducted during ECRI’s webcast indicated that their facilities do not currently have an active alarm management committee.
TO LEARN MORE .
. .
To view the full webcast, visit: https://ly.ecri.org/ LabWebcast2024_TelemetryAlarmManagement.
For more information about ECRI’s Monitoring Utilization & Alarm Management proactive assessment services, email TechConsulting@ecri.org or contact ECRI by telephone at (610) 825-6000, ext. 5891.
AAMI UPDATE
Life Cycle Cybersecurity and Working with Vendors
With more and more medical devices connected to the Internet, clinical engineers and biomedical equipment technicians are increasingly tasked with managing cybersecurity throughout the entire life cycle of a device.
According to AAMI Fellow and Medcrypt Chief Cybersecurity Strategist Axel Wirth and Vidya Murthy, chief operating officer at Medcrypt, managing a device’s life cycle includes working with vendors as they fulfill their postmarket obligations and you defend your network. During the 2024 AAMI eXchange in Phoenix, Arizona, Wirth and Murthy presented on how device purchasers and operators can foster cooperation with vendors.
This topic is extremely relevant given the recent increase in cyberattacks on the health care sector. Per Murthy, the “fundamental change” consists of a massive spike in attacks that are motivated by theft. Not only did the health care and public health industry suffer nearly a quarter of all ransomware attacks in 2022, but incidents like the Change Healthcare attack have seriously harmed patients. According to Murthy, “data has shown … that patients have been lost.” Researchers found that between 42 and 67 Medicare patients died due to the fallout of ransomware attacks between 2016 and 2020.
PREPARING FOR THE POSTMARKET PHASE
The postmarket phase is heavily regulated by FDA and begins as soon as a device is live in the field. For instance, if a device has software or the capacity to connect to the
internet, it needs to meet cybersecurity considerations. Once a device is released, a manufacturer must be sure it cannot be exploited or deprecated. According to Murthy, how security is assessed by HDOs needs to be “part of the core procurement process.”
The ideal premarket security plan will include information on patching, patch management and security posture. To comply with regulator’s expectations, this planning process will need to occur early in the premarket phase. Proper documentation also allows FDA and the device purchaser alike to understand a vendor’s precautions. Ideally, devices will be designed with the postmarket phase in mind – additions like a software bill of materials (SBOM) and ongoing monitoring will be useful. Postmarket maintenance, however, requires a risk-based triage process, and this will require a given device manufacturer to share information as needed.
ROLE OF HDOS
HHS’s Healthcare and Public Health (HPH) goals are also relevant. According to Wirth, “I would assume that the urgency of documents like this will accelerate because of the Change breach.” While the HHS document is voluntary for now, it is Wirth’s expectation that there will be “enforcement” of these priorities in the future.
Given HHS’ priorities and the post-Change Healthcare landscape, Wirth pointed to some important priorities for vendors and healthcare delivery organizations (HDOs) alike. HDOs need to “have a strategic plan that comes top down and is established by business leadership.” Leadership also “need[s] to understand that your cyber risk is their business risk.” IT, clinical engineering and necessary non-clinical departments should be involved, and they should be able to execute basic security fundamentals and have housekeeping measures in place.
Wirth also touted the usefulness of SBOM, which in his
words, is meant to mitigate the next WannaCry and ensure that you don’t remain in the “fire drill model” for incident response. Ideally, SBOM should be available through an HDO’s CMMS.
Nevertheless, challenges remain for both manufacturers and HDOs. Manufacturers continue to face supply chain issues related to the source of their software and firmware, as well as interoperability concerns. Hospitals must deal with asset inventory issues including managing legacy devices. “Medical device asset inventories, at least from the cybersecurity perspective, tend to be pretty poor,” Wirth said.
PATH TO CYBERSECURITY SUCCESS
HDO security practices will ideally feature an evaluation of security features, responsibility agreements, information on patching, provision for security risk management and more.
The Healthcare & Public Health Sector Coordinating Council’s Model Contract Language for Medtech Cybersecurity is an excellent resource. The manufacturer’s disclosure statement for medical device security provides answers to most basic security questions. This resource is used internationally by health care providers, ISOs and security services.
IEC 80001’s Responsibility Agreement is another well-established resource that assigns overall responsibility for medical device cybersecurity, which typically lies with the HDO but can be contracted to a third-party and includes shared aspects.
Cybersecurity risk assessments will vary by organization but should include a risk analysis, risk evaluation, risk controls and an assessment of residual risk. And if the worst happens, and there is an incident at your facility? The HDO and device manufacturer are the primary stakeholders responsible for the outcome. Ultimately, the four most important tenets of medical device cybersecurity are protecting the device itself, protection of the overall ecosystem, management of medical devices and proper incident response.
For more information, visit aami.org.
on WebinarWednesday.live. Eligible for 1 CE credit from the ACI.
TOOLS OF THE TRADE
Introducing the Tenacore Vending Services – a convenient and innovative product for health care facilities. This state-of-the-art inventory solution is specifically designed to store and dispense patient cables and other high-use products. With its userfriendly interface, clinicians and administrators can quickly access a wide variety of products, ensuring they always have the right equipment on-hand.
The machine designs allow it to fit seamlessly into any environment, while its secure storage system ensures products are kept in stock and organized. Experience the next generation of supply chain management with Tenacore Vending Services.
For more information, visit tenacore.com.
BIOMED 101
Preparing for Joint Commission, CMMS or DNV Inspection
BY RODGERICK WILLIAMS
The best way to get through an inspection is by “Staying Survey Ready.” But for those of you who have recently taken over a HTM department or who are reading this article to understand how to manage the leadership of a HTM department, I will take you through the things to do to prepare an inspection as best as you can without being 100% confident.
Here’s the order of attack:
• Review the MEMP (Medical Equipment Management Plan).
• Round all areas that may be surveyed – walk through all departments and look for expired PM stickers or no PM stickers.
• Check the database for open PMs.
• Check the database for high risk/life support PMs – make sure these PMs have been completed at 100 percent.
• Check the database for vendor performed PMs – make sure these PMs have attachments with readings.
• Round looking for broken medical devices. Remove nursing tape and adhesive off everything and fix everything that is broken. Remove items with cracks or holes from service.
• Send emails to all clinical leaders asking them to round their areas looking for expired PM stickers and broken medical equipment.
• Check the database for open work orders and close what you cannot locate.
• Clean up the HTM shop. Make sure there are no boxes on the floor. Make sure nothing is within 18 inches of a sprinkler head.
• Check the lab.
• Verify output is recorded on PMs on electrosurgical units, defibs, anesthesia machines, ventilators, centrifuges, blanket warmers and blood warmers. Verify some output stickers on the devices and the PMs.
REVIEW THE MEMP
Verify there are approved policies in the MEMP. For a JC hospital, go to the Environment of Care section online and get all of the latest medical equipment policies and cater them to your facility. If you do not have any policies at all,
look online at teaching hospitals for templates. HTM policies don’t change much that often. Verify with the regulatory body’s websites for minor current changes.
ROUNDING FOR PMS
The best way to round for PMs is to put general test equipment on a cart and go to each area that will be inspected. Perform a PM on each device with an expired PM sticker or no PM sticker. I like to have a PM sticker or a “No PM sticker” on all devices in the medical equipment management plan in an effort to reduce confusion between technicians and clinicians.
CHECKING THE DATABASE FOR OPEN GENERAL PMS
There may be some PMs that were performed, but not closed. For example, Alaris infusion pump PMs are performed with the Alaris service laptop using the Alaris System Maintenance Software. The Alaris System Maintenance software records what PMs were performed. Verify if the PMs were actually performed by checking the PM stickers on the devices and the database to be sure someone just didn’t close the PMs in the system. Now look for devices that did not have a PM for two consecutive years, or two PM cycles, or whatever your policy criteria is for removing a medical device from the inventory. You will find some devices are on the PM program that should not be in the active inventory. These devices can be removed from the inventory according to the policy and these PMs can be closed. HTM cannot perform a PM on devices that are lost or no longer in the facility. Send documentation to the CFO, CNO, Clinical Owner and Accounting regarding the devices being removed from the active inventory. Be sure to advise the owner of the device that the device will be placed back on the Medical Equipment Management Plan once it is found and a PM is performed. Export all remaining open PMs into Excel. Sort the open PMs by department and send a copy of the open PMs to the department leaders – copy the CNO, Director, Manager or Charge Nurse. Announce you need assistance finding devices that have open PMs during the safety huddle. Inform the facility of the PM sticker program. Reinforce the facility sticker program with emails with pictures of the stickers and explanations of what the stickers mean. I personally like to use a color for each year, so we can tell if a device is expired by looking at the sticker
across the room. JC now says 100% of all PMs need to be performed, but I don’t think that’s possible. A continuous 100% PM completion makes me question a technician. No one will find every asset monthly. Clinicians will hide things, patients will take things. Housekeeping will throw things out with the linen. The ambulance will take IV pumps to other facilities. I still strive for 95% actually performed. I allow 5% to be unable to locate, but closed in 60 days or in accordance with the policy.
CHECK THE DATABASE FOR IMAGING OR HIGH RISK/LIFE SUPPORT PMS
High Risk/Life Support PMs need to be completed at 100%. Verify vendor records for vendor performed PMs in an effort to cross reference if PMs were performed by outside vendors and not just left open in the database. These PMs should not be listed as unable to locate. We cannot lose an MRI, CT, or X-ray room and it’s very difficult to lose an anesthesia machine, or a ventilator. One thing we can misplace here is a defibrillator. We need to go by department and verify all defibrillators. Check every crash cart.
This is one of the top things inspectors find. Also, while checking the defib PM sticker, verify the daily checks were performed by the nurses on the check sheet on the crash cart.
CHECK THE LAB
The lab is different than all other areas minus radiology. The lab manages most of their service events. They have a book that keeps up with their PMs and service. Check their books because when they have an issue, they will still try and make it HTMs fault. In a perfect world, all devices on the Medical Equipment Management Plan will be managed by HTM, but since the world is not perfect, we have the lab. Most policies have a statement that says “All service events generated by HTM are the responsibility of HTM. Service events not generated by HTM are the responsibility of the person that generated the service event. Discuss responsibilities with lab leadership. Here are the things that are 100% the responsibility of HTM – centrifuges, blood bank refrigerators, ultralow freezer, blood warmers.
• Centrifuges – Make sure a tachometer test has been performed. Perform a stop watch verification of the timer. I like to use an output sticker on centrifuges where applicable.
• Blood Bank Refrigerators – Perform a fire and ice test of the alarm where you violated the high and low alarms with ice and warm fluid and verify the temperature with an external thermometer.
• Ultralow freezer – Get a thermometer that goes low enough to verify the operating temperature of the freezer. Verify facilities or an outside vendor has cleaned the coils/performed a mechanical PM on the devices. BMETs are not usually trained in refrigeration. Blood Bank Refrigerators – Look in ICU, anesthesia and surgery for these devices and make sure they are clean and have current PMs.
Rodgerick Williams, MSHA, is the national director of corporate accounts with Tenacore.
CHECKLIST
The document “Preparing for Joint Commission, CMMS, or DNV Inspection” provides a check list for Health Technology Management (HTM) departments to prepare for inspections. Here are the key points:
GENERAL PREPARATION STRATEGY
• Staying Survey Ready: Maintain ongoing readiness rather than preparing only before inspections.
• Leadership Transition: New HTM department leaders should familiarize themselves with the inspection preparation process.
STEPS FOR INSPECTION READINESS
1. Review the Medical Equipment Management Plan (MEMP):
• Ensure MEMP has approved and up-to-date policies.
• Customize policies from reputable sources if necessary.
2. Round All Areas for Survey:
• Walk through departments to check for expired or missing PM stickers.
• Remove broken devices and repair as needed.
3. Database Checks:
• Verify completion of all PMs, especially high-risk/life support equipment.
• Ensure vendor-performed PMs have attached readings.
• Look for devices without PMs for two consecutive cycles and remove them from active inventory if appropriate.
4. Communication and Documentation:
• Email clinical leaders to check for expired PM stickers and broken equipment.
• Export open PMs into Excel, sort by department, and send to department leaders.
• Announce needs during safety huddles and reinforce sticker programs with visual aids.
5. Specific Checks:
• Imaging and High-Risk Equipment: Ensure 100% completion of PMs.
• Crash Carts: Verify defibrillators and daily checks.
• Lab Equipment: Check PM books, centrifuges, blood bank refrigerators, and ultralow thermometers for compliance and maintenance.
Detailed Actions for Specific Equipment
• Centrifuges: Perform tachometer tests and stopwatch verifications.
• Blood Bank Refrigerators: Conduct fire and ice tests, and ensure external temperature verification.
• Ultralow Thermometers: Verify operating temperatures with appropriate thermometers.
• Blood Bank Refrigerators in ICU, Anesthesia, and Surgery: Ensure cleanliness and current PMs. This methodical approach ensures that HTM departments are well-prepared for inspections by addressing potential issues systematically and maintaining clear communication with clinical leaders.
CITREX H5 GAS FLOW ANALYZER AND MULTIGASANALYSER OR-703
The CITREX H5 Gas Flow Analyzer and MultiGasAnalyser OR-703 was the subject of the latest Tools of the Trade Live Demo from Webinar Wednesday. The session was sponsored by IMT Analytics and eligible for 1 CE credit from the ACI.
IMT Analytics is a world leader in the manufacture, distribution and service of gas flow analyzers. These high-precision medical gas flow and pressure measurement instruments are capable of testing a wide range of medical devices such as ventilators and anesthesia machines, oxygen flow meters, pressure gauges and suction devices. Since 1999, the brand has been well known globally for dependable, high-quality products and services.
IMT Managing Director Daniel Benz and Business Development Director Kerwin Sanger presented the Tools of the Trade Live Demo of the CITREX H5 Gas Flow Analyzer and MultiGasAnalyser OR-703. The session featured a great combination to meet ventilator and anesthesia machine testing requirements. The H5 and OR-703 combination offers a host of features ideal for biomedical engineers, independent service providers and equipment manufacturers.
Following their insightful presentation, the presenters fielded questions from attendees. The complete sessions, including the Q&A portion, is available for on-demand viewing at WebinarWednesday.live.
It was an informative and popular live demo. It recorded the highest registration and attendee numbers so far this year! Alan Nicewarner, CBET, with BSW Health in Texas was one of the attendees and won a pair of Apple Airpods as part of the Webinar Wednesday 10th anniversary celebration.
After the webinar, attendees were asked “What was your single biggest takeaway from today’s product demo?”
“Integration of many testing parameters in one smart device.”
- Yousri M.F.Okasha, Senior Clinical Engineer, King Faisal Hospital.
“Revision of my knowledge.”
- Manas Sengupta, Consultant, Global Biomedics.
“Test equipment has come a long way.”
- Todd Forsch, Tech, Avera.
“Being able to store the equipment PM sequence and step through the PM.”
- Joel Coffman, CBET, Chambersburg Hospital.
All webinars, podcast, and product demos are eligible for 1 CE credit from the ACI.
Watch these webinars on-demand
cynerio.com
COMBATING RANSOMWARE IN HEALTHCARE
Healthcare technology management professionals know all too well how cybersecurity attacks impact health care facilities.
In the most recent Webinar Wednesday presentation from TechNation, healthcare technology management pros learned valuable insights. The session was sponsored by Cynerio.
The webinar “Combating Ransomware in Healthcare with Network Detection and Response (NDR)” delivered expert information to healthcare technology management professionals and is eligible for 1 credit from the ACI.
Cyberattack tactics continue to outpace health care protections, resulting in disrupted care and financial impact measured by the million. To combat evolving attacks, healthcare technology management pros know new technologies must be explored and tested.
Cynerio Security Evangelist Chad Holmes explored new solutions like NDR, EDR, and XDR for the healthcare technology management professionals attending the live webinar. Holmes also shared the benefits these solutions are providing early adopters. Throughout the session, healthcare technology management professionals witnessed how Holmes examined the impact of cyberattacks and the limitations of current defenses. Then, Holmes introduced healthcare technology management professionals to NDR, a powerful technology that can quickly identify and stop attacks, minimizing damage and downtime. By attending, healthcare technology management leaders were able to gain insights into the evolving threat landscape and how NDR, EDR, and XDR can protect their patients, systems and finances.
Holmes also fielded questions from technology management professionals and provided thoughtful and insightful answers.
Healthcare technology management professional Robin Faut a Clinical Engineer II with Advent Health in Kansas was a lucky attendee. Faut won a pair of Apple Air Pods as part of the Webinar Wednesday 10th anniversary celebration. More prizes will be given away at future webinars!
Healthcare technology management professionals were asked “What does Webinar Wednesday provide the industry?”
“Excellent technical resource. Educational opportunities. Tools of the trade exhibitions.”
- Jon Troutner, BMET III, Saint Luke’s South Hospital.
“A source for continuous learning and provides an idea of what’s new on the horizon.” -
Joel Coffman, BMET, Chambersburg Hospital.
“Webinar Wednesday helps to connect the industry through education and exposure.”
- Justin Cozadd, Biomed, Corewell Health.
AIV Transmitter Case Kits
Replace all outer plastic and exterior membrane switches in-house
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Send to AIV for inclusive at rate repair
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Send to AIV for at rate repair on TRAM/MMS moduls
A ROUNDTABLE Education
shortage of qualified biomeds is a major obstacle for the nation’s health care industry as more and more HTM professionals earn retirement status. A tidal wave of support for the HTM career field can be seen in trade publications like TechNation as well as on various social media accounts maintained by HTM experts throughout the nation and world. However, the need for an educated hiring pool remains.
TechNation looks at HTM education in this month’s Roundtable article. Several experts took time to share their insights and offer tips. Participants in the article are:
• Brian Bell, Ph.D., faculty of biomedical engineering technology, St Petersburg College;
• Roger A. Bowles, professor-biomedical equipment technology program, Texas State Technical College Waco;
• James Linton, MiM, PmP, Cmbb, AAMIF, professor/coordina-
tor, biomedical engineering technology at St. Clair College and Sessional instructor at the University of Windsor;
• Joie N. Marhefka, Ph.D., biomedical engineering technology program coordinator, Penn State New Kensington;
• Danielle McGeary, vice president of HTM, AAMI;
• Dr. Jeffrey Smoot, professor of biomedical technology at MiraCosta College and CEO of Interactive Healthcare Designs LLC; and
• Steven J. Yelton, P.E., AAMIF, professor emeritus, Cincinnati State Technical and Community College.
Q: WHAT DEGREES/PROGRAMS ARE AVAILABLE FOR SOMEONE INTERESTED IN AN HTM CAREER?
BELL: Some degrees/program available are:
• Certificate in Medical Equipment Repair
• Certificate in Medical Device Design and Manufacturing
• Certificate in Medical Device Networking and Cybersecurity
• A.S. Degree in Biomedical Engineering Technology
BOWLES: At Texas State Technical College, we offer an Associate of Applied Science Degree in Biomedical Equipment Technology and an Associate of Applied Science Degree in Medical Imaging Systems Technology.
CORDERO: There are several educational paths to suit a variety of HTM career goals. Key undergraduate and graduate degrees include biomedical engineering, healthcare technology management, clinical engineering, and healthcare information technology. Advanced studies,
such as master’s degrees in these fields, and certifications like Certified Clinical Engineer (CCE), Certified Healthcare Technology Manager (CHTM), and Certified Biomedical Equipment Technician (CBET) are also important.
GONZALES: Degrees and programs available for someone interested in an HTM career include Biomedical Equipment Technology (BMET) and Healthcare Information Systems Management (HISM) certificate and degree programs like those offered at the College of Biomedical Equipment Technology. Experienced professionals from other industries and the military with transferable skillsets also have tremendous opportunities in this field. While there are other educational pathways in HTM, it is crucial that any academic program closely aligns with the industry to ensure that technicians are equipped with the skills demanded by the industry. As I like to say, “There can be no light between the education delivered and the industry skills demanded of new technicians.”
HASLUEM : Here at TechNation, we offer free education through our Webinar Wednesday series covering a wide range of subjects from electrical safety workflow to cybersecurity. All of our webinars are eligible for 1 continuing education credit from the ACI.
LINTON: At St Clair College, we offer a 3-year associate degree also known in Canada as an advanced diploma. After completion of this associate degree or any 3-year BMET educational program, a student with a “B” or better average may then enroll at the University of Windsor in the Bachelor of Engineering Technology-Biomedical Stream. Outside of this, there are a pair of two-year BME technician programs in Canada, in the USA there are apprenticeships, 1-year, 2-year and 3-year training options.
LEDESMA: The degrees I have seen available now for someone interested in the HTM career field are associate degrees and certificates. The colleges offering these types of degrees have programs all across the nation and a quick search will place anyone at the front door of a new, exciting career.
MCGEARY: There are currently 60 HTM specific degree programs in the United States. Many are two-year biomedical technology degrees for those interested in pursuing a career as a biomedical equipment technician and there is also a master’s degree program in clinical engineering at the University of Connecticut for those who want to pursue the clinical engineering side of the HTM field. Additionally, AAMI offers a BMET apprenticeship, which is a two-year hybrid program that combines on-the-job learning with formal learning. It is a great alternative and pathway into the field for those who college is not an option for.
SMOOT: If someone is interested in pursuing a career in HTM there are different avenues available for them. On-thejob training (which I do not recommend because of lack of
foundational knowledge), certificate program, associate degree, bachelor’s, master’s, Ph.D. Associate degrees are the more popular because when the HTM community was developed junior colleges developed the curriculum.
Q: WHAT ARE IMPORTANT FACTORS TO CONSIDER WHEN LOOKING FOR HTM EDUCATION?
BELL: When I suggest or recommend programs in HTM – here is what I look for:
• Partners with industry (i.e. local health care organizations, manufacturers and third-party service providers) so that you can have a great entry point into a work experience or internship
• Provides opportunities for hands-on learning. In other words, “Do they let you use medical devices and test equipment that real biomeds use?”
• Includes courses in networking and computer repair as part of the degree. These are great skills that often set you apart as a top candidate.
BOWLES: A candidate should look for an established program that provides hands-on training provided by instructors who have served time as technicians in the career field. Also, the degree should be accredited by one of the regional accrediting organizations so that it is easier to transfer credit in the future to a four-year university. Some technicians will want to pursue a four-year degree to advance their careers into management positions. Many universities allow block transfers of technical credits, as well as some academics from accredited two-year schools.
CORDERO: Ensure that both the institute and the program are accredited. Look for comprehensive programs covering medical device technology, healthcare IT, regulatory compliance and clinical engineering. Select programs with robust hands-on training, internships and simulation labs. When I obtained my degree, I did not get much support or assistance from my university in landing my first job in the field. I recommend looking into the institution’s job placement services and its track record in finding jobs for its graduates.
GONZALES: When looking for HTM education, important factors to consider include return on investment and career potential, by examining the career services and placement rates of the institution to determine ROI. Additionally, students should consider the anticipated skills and competency level that will be acquired upon completing the program. It is crucial for students to select a program that is closely aligned with the job they are seeking, as not all programs are equal in preparing students for their desired career path. Students should also ensure that the program offers strong career services to support job placement requirements and carefully examine the organization’s reputation to determine if it is the right fit for them.
Brian Bell St Petersburg College
HASLUEM: 1. Reputation – This year Webinar Wednesday is celebrating 10 years of providing up-to-date information on products and services to the HTM industry, and over the years has built up a reputation that the industry can rely on.
2. Cost – Our webinars are free!
3. CE credit
4. Convenience – you can view our live and on-demand webinars without going anywhere.
LINTON: The most important thing to consider is how many courses are being taught by people who have actual biomedical experience. Outside of this, it is good to consider the rate of graduate employment, professor/school connections to industry, school reputation, do you get along with the professors (seriously go to an open house and have a chat!), the variety of equipment they have to work on, the variety of career paths they will expose you to (dialysis, general, imaging, management, cybersecurity, etc.) are just some of the things to look for. Some things to avoid would be programs with low job placement rates, instructors who can “do” but not teach, places that are too easy (diploma mills), anywhere that professors are condescending, places where professors left the industry long ago and are not active in the biomedical community and can’t tell you of any upgrading they’ve done. In the age of “Google” there’s no reason to not do the research and even reach out to look for a fit/match. Picking a place to get HTM/BMET education from should be treated like when you’re looking for a job.
LEDESMA: Some important factors to consider when looking for HTM education are delivery methods such as in-person, online, synchronous, and asynchronous as well as location and cost. There are many colleges across the nation that may be in a city near someone interested in the HTM industry. There are programs and resources for individuals who may not have the means to travel, but still want to change career fields to HTM.
MARHEFKA: I still feel that a hands-on component is important in HTM education. I recommend a program that has good connections for internships. I also recommend that, if you are looking at a certificate or associate degree program,
you look for one where the credits will count toward a bachelor’s degree, should you decide to pursue one later.
MCGEARY: It’s important to find a school that offers a forum of education that works for you. With the advent of so much virtual education, it’s important for the student to determine if they learn better in a traditional brick and mortar setting or in a virtual one.
SMOOT: Some of the main factors to consider (no particular order):
• Who are the instructors for the BMET subjects and have they worked in a hospital?
• Site visits
• Understanding test equipment: electrical safety analyzers, patient simulators, defibrillator analyzers, etc.
• Troubleshooting of systems and equipment.
• NFPA 99
• The attitude and temperament of the HTM pro.
• Foundation for entry level BMET jobs.
YELTON: The successful student will have a passion for electronics, mathematics and science and will enjoy working in the health care environment.
Q: WHAT ARE THE LATEST TRENDS IN HTM EDUCATION?
BELL: Three trends in HTM education are:
• Blended/hybrid education models that allow students more flexibility for classroom delivery. For example, a class may have both in-person labs and online activities. Reducing driving and costs for students while maintaining hands-on medical device lab activities.
• Innovative Digital Experiences – for example, NVRT labs virtual reality modules for BMETs, increasing number of industry driven content from YouTube to podcast.
• Colleges collaborating with high schools to offer certificate and degree options for students in high school.
BOWLES: Virtual technology in training. I like the idea. First, especially in areas like ultrasound, it allows students to perform complex tasks without disassembling an actual machine. Second, it opens up recruiting opportunities.
Roger A. Bowles Texas State Technical College Waco
Ismael Cordero ECRI
Richard L. “Monty” Gonzales College of Biomedical Equipment Technology
CORDERO: The dynamic nature of the HTM field requires professionals who are not only technically proficient but also adaptable to new technologies and regulatory environments. Educational programs are starting to cover technological integration with courses on Artificial Intelligence (AI), Internet of Medical Things (IoMT) and cybersecurity. Educational programs are also combining biomedical engineering with health informatics and business management, emphasizing eco-friendly practices and understanding global health issues and standards.
GONZALES: The latest trends in HTM education include the integration of information technology, cybersecurity, and medical device integration as essential skills for biomedical equipment technician competency. We also see a broad recognition of the importance of critical skills such as effective communication and customer service skills in the field. Additionally, there is an emphasis on a competency-based approach to education and training, with employers prioritizing skills mastery over the time spent obtaining education. Lastly, we support ethics training as a valuable component of education, especially given the rapid advancements in technology, including Artificial Intelligence (AI), and other revolutionary changes shaping the HTM career field.
HASLUEM: New Tools of the Trade product demos, where attendees can see a product being demonstrated live, are very popular, as are our podcasts series – again free to register and CE eligible. Our Tools of the Trade product demos launched in May of 2023.
LINTON: The increasing demand for people skills! Yes, the hot thing to say right now is teaching about AI and cybersecurity (which we do), but truthfully teaching those are fair easier than people skills such as learning how to “put out a fire” with a customer. On the job, one can always learn and improve cybersecurity/AI knowledge but if a new grad screws up with a lack of empathy, emotional intelligence, communication skills or confidence then they are done for. Due to this, the latest trend I believe, is that schools need to recognize the need
for non-technical skill training as well to complement it. One way we do this is by replacing exams with in-person scenario training that puts students “in the OR with a frantic surgical staff” or similar.
LEDESMA: The latest trend in HTM education is bringing the cybersecurity process into our industry. With a vast amount of medical equipment being put on hospital networks, HTM professionals need to know how to help install, secure and defend against bad actors. We are considered to be on the front line and continue to further bolster support and help in securing patient information.
MARHEFKA: Content-wise, I think networking and communication are current topics being emphasized. VR/ AR and AI are technologies that are being incorporated into education.
MCGEARY: VR is a major new trend in HTM education. The advent of VR education in HTM now allows students to learn technical concepts anywhere really enabling schools to expand their reach.
SMOOT: Home health, artificial intelligence in health care, remote diagnostics (patient and equipment), sensor technology, VR/AR training and troubleshooting.
YELTON: HTM education generally includes a mix of live and remote education and some of the latest trends include the use of virtual reality or virtual augmentation.
Q:
HOW CAN HTM PROFESSIONALS OBTAIN CONTINUING EDUCATION?
BELL: Three ways to stay educated in HTM are:
• Local biomed associations (i.e. Florida Biomedical Symposium, North Carolina Biomedical Association’s Symposium, CABMET 2024 Symposium)
• National conferences (i.e. AAMI eXchance and MD Expo)
• Biomed content creators (HTM On The Line, BeardedBiomed, HTM Workshop, TechNation TV)
In addition, if you can find someone within your organization you trust who has more experience that you, ask them to mentor you and teach you what they have learned.
James Linton St. Clair College & University of Windsor
Joie N. Marhefka Penn State New Kensington
Linda Hasluem MD Publishing
Isaiah Ledesma St. Philip’s College
Dr. Jeffrey Smoot
MiraCosta College & Interactive Healthcare Designs LLC
BOWLES: Attend as many in-person events like MD Expo and the AAMI eXchange as possible. Take advantage of webinars and online certification programs.
CORDERO: Continuing education is essential for HTM professionals to stay current with the latest technologies, regulations and industry best practices. Several ways HTM professionals can obtain continuing education include professional certifications, online courses and webinars, vendor-specific training, conferences and workshops, and local and regional professional society events. Attend events like the Association for the Advancement of Medical Instrumentation (AAMI) eXchange and HIMSS Global Health Conference for learning and networking.
GONZALES: In today’s educational landscape, it is a mistake to categorize education levels based on traditional 2-year and 4-year concepts as they no longer accurately reflect the reality of modern academic paths. Instead, students and employers should consider the anticipated competency and skills-based metrics associated with educational programs. For example, one can attain an associate degree in about a year and a bachelor’s degree in approximately three years in many cases, rather than the traditional 2 and 4-year timelines. The critical factor is ensuring that the academic pathway chosen aligns with the individual’s professional ambitions and trajectory. It is beneficial for students to pace their education and career growth by earning certificates or associate degrees, gaining industry experience, and then determining their next steps towards further education. Aligning academic and professional growth is essential in today’s dynamic job market and evolving educational landscape.
HASLUEM: Visit our website webinarwednesday.live, where we have a calendar of all our upcoming webinars, including Tools of the Trade demos and podcasts, plus we have an archive of all our podcasts and past webinars, where you can still obtain a CE credit for webinars broadcast within the past calendar year. Click. Watch. Earn – easy as that!
LINTON: Continuing education is what keeps us all from becoming dinosaurs in the industry and as a HTM educator I am always at risk of this. I combat it by taking BME webinars,
J. Yelton Cincinnati State Technical and Community College
being an active member of BME communities such as AAMI and always looking for new training opportunities specifically in newer areas such as AI integration into medical devices and digital health. Since HTM is multidisciplinary it’s important to always look just outside the “normal” HTM realm as well to keep on the cutting edge. For example, following and taking education from CHIME for digital health items that may be more IT related but have a place in HTM as well.
LEDESMA: HTM professionals can attend TechNation’s expos and online webinars to help in their pursuit of continuing education. In addition, AAMI offers additional online webinars/ resources and does host a conference to bring HTM professionals together. A majority of the colleges offer additional degrees, certificates, enhanced skills awards, and occupational skills awards to provide HTM professionals the opportunity to specialize in particular health care modalities.
MARHEFKA: There are so many ways to obtain continuing education. Some options include taking a college class, pursuing a bachelor’s degree (or advanced degree), obtaining a certification (such as CBET, CRES, CHTM, or a networking certification), attending conferences such as AAMI eXchange or MD Expo, participating in webinars on relevant topics, and reading technical publications.
MCGEARY: A two-year degree is a great entry point into the field. However, if folks want to move up into HTM managerial positions or hospital administration roles, they will eventually need to go back and get at least a four-year degree.
SMOOT: There are several ways to obtain continuing education but the HTM professional has to decide what path they desire. One of the ways is through local chapter meetings that have continuing education unit (CEU) certified presentations. Another way is through regional and national conferences where CEU classes are presented. MD Expo is a fantastic way of obtaining CEUs.
YELTON: HTM professionals are encouraged to continue their education in several ways. They may pursue live or remote education with local colleges and universities as well as through continuing education with organizations such as AAMI.
Danielle McGeary AAMI
Steven
PREVENTING ‘SCOPE CREEP’
How to Address Service Requests for Non-medical Devices
By K. Richard Douglas
S
ome brands have become so famous for their products or services that they invite additional scrutiny. Apple is expected to offer something newer and better every year at their Worldwide Developers Conference (WWDC) event. Bentley and Porsche are always expected to wow auto enthusiasts with their latest models. Anything less would invite criticism.
Being very good at what you do can be a double-edged sword. HTM is known as a service-focused department. Customers can be certain that the biomed department will make things right. The other impact of that service-focus is that the biomed department can become a dumping ground for equipment that is not always its responsibility.
Many gray area devices or pieces of equipment may end up getting routed to the biomed department that aren’t necessarily within the department’s purview. Often, the determining factor is staffing. Who has the resources to handle the equipment in question may be enough to funnel it to HTM.
“Throughout the country there is equipment that is [in] gray areas on whether they are managed by the HTM department or not. Some examples are nurse-call, beds/ stretchers, sterilizers, software, lab equipment and imaging. These items are [in] gray areas since some organizations have this equipment managed by the HTM department or other departments (Engineering, Facilities, Sterile Processing, IT, Imaging, Lab). As with the non-medical devices, when an HTM department proves efficacy, they may be asked to take over the management of these gray area items from another department,” says Renato Castro, CHTM,
CBET, assistant manager of biomedical engineering at Stanford Health Care Tri-Valley in Pleasanton, California.
He says that this is great news in that the HTM department is being looked at to provide great service. This should, however, be taken cautiously. Occasionally these extra responsibilities are added slowly without extra resources being provided to the department, which increases the load on each member of the HTM department.
“During my time with third-party organizations, this is referred to as ‘scope creep,’” Castro says.
Leo Velasquez, manager of clinical engineering and central equipment at Cook Children’s in Fort Worth, Texas says that when he first started at Cook Children’s Medical Center, he was a little surprised to see some of the non-traditional equipment that had fallen under the purview of the biomed equipment techs there.
“Not only were they taking care of the gray area items of nurse calls, hospital cribs, stretchers and beds, but also non-traditional items of microwaves, video games, VR and 3D printing. These items did seem to gravitate towards the HTM department because we had a group that had an electro-mechanical aptitude that could be adapted to these jobs,” Velasquez says.
He says that the department’s director, Sal Cruz, came from a military background where a great deal of emphasis was placed on self-sufficiency, so doing whatever was necessary, came naturally.
“Our director, was also never one to miss an opportunity to advocate for the team so he would not only tackle these untraditional jobs but would fully embrace them to bring them to a high level of service,” Velasquez says.
He adds that, generally, with this accomplished, the necessary resources needed to absorb these activities would become available. The functioning benefits of smooth
operation are apparent to our C-suite and clinical staff.
“Over the long term, this has resulted in a culture here that recognized the department as a key ingredient to smother operation and has helped the department go from eight techs to 18 now, and climbing,” Velasquez adds.
The emphasis on pleasing customers appears to be universal among HTM as the feedback on why biomed receives more than its share is consistent.
“Departments will call on the biomed department because they know that we are big on customer service and will try to assist wherever possible even if it is out of our scope,” Allison Woolford, CBET, biomedical equipment specialist in clinical engineering and periop team lead at Duke University Health System says.
She explains that biomed wants to minimize the impact on patient care. Sometimes, biomed departments are called to manage or repair these out-of-scope devices because the previous owning department encountered problems managing it (i.e. budget cuts, employees leaving the department).
regulator or the tank is empty, that company would replace the regulator and/or tank,” Woolford says.
She says that sometimes departments will call the biomed department even though they know that biomed doesn’t manage that device, but they know that they can get in contact with someone. She points to several examples of this: computers that the nurses use to access EPIC, digital clocks not working, room is either too hot or too cold, telephone is not working, door handle came off the door or someone is unable to open a file cabinet or a Pyxis machine because it is jammed.
He says that he has been in a couple shops where the biomed shop has been requested to work on more consumer-level electronics
(i.e. TVs, microwaves, phones, radios, laptops)
- Renato Castro
She cites the nurse call system, replacing TVs in patient rooms (because the TV is controlled by the pillow speaker for the nurse call system), repairing the pneumatic tube system, replacing motors in the transfer units or blowers or repairing OR table patient positioners/stirrups/armboards, as just a few examples.
“Regulators for medical gas tanks – some devices need to use the big medical gas tanks when there is no pipeline gas hookups in the room. Normally these tanks are managed by Airgas or some similar company that delivers the medical gas tanks and when there is an issue with the
“With biomed, we are tasked with the repair and maintenance of equipment used for diagnosis, treatment and care of patients. If we follow this, then technically everything in a hospital would fall under us, but we narrow it down even more than that because that’s a broad definition. Clearly defined roles are what is needed and all departments need to sit down and actually discuss what should go to each department,” says Bryan Bailey, CBET, CLRT.
Matthew Kenney, field service representative with Southeastern Biomedical Associates says that it’s always about showing your worth to the C-suite.
“Have open conversations with your senior leaders about the consequences of taking on more ‘additional items.’ Sometimes this could lead to more FTEs being allocated. Having these important conversations upfront will help lead to fewer headaches later,” he says.
PUSHING
BACK
While it may be a compliment of sorts to have more devices
The HTM department can be counted on to repair anything that is broken.
entrusted to the biomed department, it can also create an unintentional burden or take time away from devices that are unarguably within biomed’s domain. How can the HTM department avoid being the dumping ground for these additional devices?
That answer can fall into two groups; medical and non-medical devices. For medical devices, there are some questions to ask.
“Before an HTM department accepts adding into their scope of work, a thorough evaluation of the resource drain and requirements of that ask should be completed. Is their team currently trained/qualified to work on that equipment? Do we need to purchase any licenses to work on the equipment? How many labor hours will be needed to be spent on this extra ask? Are there extra regulatory bodies that will need to be considered? How will funding work for support? Would this extra work stretch the current staff too thin?” Castro explains.
He says that all this information needs to be metricized to determine the required funding and FTEs to be successful.
“It is hard to say who should be owning some of these items because they could be considered grey area due to how they are viewed. The newer stretchers have scales on them and some will consider that device needs to be managed by biomed because that information may be added to the patient’s medical chart,” Woolford points out.
She says that sometimes biomed tries to clear the grey areas by saying that if the information for replacing an item can be found in the user/operator’s manual, then that part should be managed by the user.
“If it requires a tool, service password, or the information is found in the service manual, then those items are managed by the biomed department. An example of this would be the EKG leads for the EKG machine. EKG leads are plug and play cables that do not require a tool to replace. Staff maintaining this inventory and being able to replace these cables as they break will reduce down time,” Woolford says.
Kenney says that HTM leaders need to do their homework.
“Show the cost of maintaining the equipment. Include [the] costs of contracts, parts, labor and training. Sometimes it’s OK to tell the C-suite no. Don’t set your department up for failure. You need to make sure you get the buy-in from the techs too. Get their perspective. Make them part of the solution. Ultimately no one will fight for your department more than you. Come prepared. Another key is to ask fellow HTM colleagues for their advice with a particular piece of equipment maintenance. They may have experiences that you haven’t thought of yet,” he says.
ADEQUATE STAFF & FUNDING
How does HTM obtain additional funding and resources to take on the repairs/maintenance of extra equipment?
BIOMED PROFESSIONALS:
Renato
CHTM, CBET, Assistant Manager of Biomedical Engineering
“As far as funding and resources go, the people that determine if we need additional funding and resources need to understand the roles of those areas to make an informed decision. There needs to be a standard of equipment per tech and we need to make sure we are also hiring technicians with integrity. We need to make quality repairs and not quick repairs just to get the device back into service,” Bailey says.
For medical devices, Castro says that adding one extra modality to your department may only add a third of an fulltime employee (FTE) worth of labor, but if this happens multiple times, your department may inadvertently add on multiple FTEs worth of labor without obtaining extra resources.
“This is how scope creep will affect a department’s workload. To avoid this, an HTM department needs to establish a baseline budget for their current scope of work. This includes, operational funds, FTE labor requirements and a capital budget to run. From here, whenever scope of work changes (either increased or decreased), the necessary budget needs to be documented and reported to upper leadership. This will help explain why extra staffing or budget may be required to finance,” he says.
Bailey adds that it’s hard for biomed to avoid being a dumping ground for additional maintenance items.
rapport with their clinical counterparts, the departments start to see biomed as a one-stop shop solution center. This is great in that you have built confidence with the clinical teams, but it does occasionally come with out-ofscope requests,” Castro says.
He says that he has been in a couple shops where the biomed shop has been requested to work on more consumer-level electronics (i.e. TVs, microwaves, phones, radios, laptops).
“Sometimes it’s OK to tell the C-suite no. Don’t set your department up for failure. You need to make sure you get the buy-in from the techs too. Get their perspective. Make them part of the solution. Ultimately no one will fight for your department more than you. Come prepared.”
- Bryan Bailey
“What I feel is the best tactic is to work with Plant/Engineering and IT to define roles more clearly within a hospital or health system. This tends to be a problem because each department suffers the same problems of manpower and the proper equipment to do the job needed,” he says.
DRAWING A CLEAR LINE
Biomed must also draw a clear line when more non-medical devices are added to their inventory of equipment.
“When an HTM/biomed department develops a good
“I find that most biomed techs love to help when possible. This leads to them assisting with these requests. Unfortunately, this will sometimes become a case of a favor becoming an obligation. Once certain staff are aware that biomed has helped with these, it will become their expectation that biomed continues to help,” Castro says.
He says that while it may go against the helpful nature of biomed teams, they must draw a clear line as to what we support and what we don’t.
“This usually starts with written language in the MEMP (Medical Equipment Management Plan) or general policy stating what equipment the HTM department supports. This will empower all members of the team to deny requests for out-of-scope equipment and allow management to backup this choice,” Castro adds.
The HTM department can be counted on to repair anything that is broken. That good reputation has to be tempered with some parameters when necessary to prevent HTM from reaching burn-out because it is stretched too thin with equipment it should not be responsible for. With some respectful push-back, funding and staffing requests and a clear delineation of responsibilities; everything can get fixed in a timely manner.
Bryan Bailey CBET, CLRT
Castro
Matthew Kenney Field Service Representative
Leo Velasquez Manager of Clinical Engineering and Central Equipment
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CAREER CENTER
Can managers identify a problematic employee?
BY KATHLEEN FURORE
What are some things managers should look for that indicate an employee could become a problem? And how can/should they handle the situation before it gets out of hand?
“Spotting a problematic employee early on is crucial to preventing deeper issues,” stresses Riccardo Ocleppo, founder and CEO of OPIT Role. “As a manager, signs such as consistent late deliveries, unwillingness to collaborate, excessive absenteeism, and negative behavior toward peers should serve as red flags.”
Licensed clinical social worker Dr. Elizabeth Barlow, founder and CEO of the virtual mental health service provider Kinder Mind, says she looks for employees who lack empathy, don’t take feedback well or make excuses instead of taking responsibility.
When problems begin to arise, Barlow says her approach is to “address issues quickly by setting clear expectations and monitoring progress, while Ocleppo addresses it promptly yet delicately “by opening a transparent conversation about the observed behavior, laying out expectations, and providing support for improvement to prevent the situation from getting out of hand.”
There are even ways to try to prevent problems before they occur – having clearly defined roles and criteria for success among them, according to Darrin Murriner
co-founder CEO of the coaching and team development platform Cloverleaf.
“From there they need to be resourced adequately to do the job and get continued development to make sure their skills are consistent with what is required in the role,” Murriner explains. “They also need good leadership that communicates clearly how the goals of the organization impact the specific needs for the employee that is filling the position, and then they must be held accountable to achieving those goals.”
And when an employee’s performance becomes problematic and doesn’t meet expectations, Murriner says “equipping them with resources they need, better clarifying expectations, and moving them into a new role or adjusting the role” is imperative.
And if none of those things stem the problem?
Murriner says “exiting the person from the organization” is the best option “in the most extreme cases.”
Barlow agrees.
“If problems continue, it may be best to part ways,” she concludes.
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.
20/20 IMAGING INSIGHTS
Let’s Focus on the Lens
BY TED LUCIDI, CBET
We’re going to begin a series focusing on some of the key components within an ultrasound probe. Some of these components are high-failure items, while others, you may think, are not. All have several aspects in common. If, or when these components fail, they can have a significant impact on the safety, performance and effectiveness of the probe.
Ultrasound transducers (or probes) are highly complex, Class II medical devices with their own unique 510k clearances we see all the time on television, in health care facilities, and even throughout this and other periodicals. Have you ever given thought to how they are designed, manufactured, tested and repaired?
Innovatus Imaging maintains two facilities dedicated to ultrasound probes: Our FDA-registered Center for Design and Manufacturing in Denver, Colorado and our Center of Excellence for Ultrasound Repair in Tulsa, Oklahoma. Together, these facilities address the entire life cycle of transducers including design, engineering, manufacturing and finally restoration to OEM form, fit and function. A transducer begins life as a series of user needs,
intended use(s) and requirements or design inputs. It, ultimately, ends as a finished product, but there is a tremendous amount of work and testing that occurs in between. This includes electrical, mechanical, acoustic, and chemical verifications and validations. Manufacturers need to ensure they are producing a safe and effective product. Simply put, the output should equal the sum of the design inputs. Or even better, manufacturers answer the question, “Did I make the transducer correctly?” Furthermore, it is critical that the product meets user needs and intended use(s). Manufacturers answer the question, “Did I make the correct product?” Our Denver facility manufactures ultrasound probes from concept to production and must follow FDA regulations every step of the way.
Many of these same manufacturing processes and philosophies are implemented when we engineer solutions for ultrasound probe restoration. The objective is to return a probe to OEM form, fit, and function and not significantly change design, safety, performance or intended use.
Because we are a manufacturer, we have all the necessary instruments, knowledge, training, scientists, and processes to ensure this outcome. Our engineers also design and manufacture proprietary test and repair fixtures based on the specific needs of various OEM makes and models. Let’s begin this series by looking at the acoustic lens. Sometimes, it’s just referred to as the lens. End-users sometimes call it the footprint, the membrane, the matching layer, and yes, the rubber thingy on top. The lens may seem quite simple, but it is actually much more complex than it appears, and it serves multiple purposes.
FUNCTIONS
Focus: As the name implies, the acoustic lens functions similarly to the lenses in our eyes, or the corrective lenses in our glasses or contacts. Although the scanner console performs electronic steering and focusing of the ultrasound energy, the probe’s acoustic lens provides a mechanical focus. It is constructed using very specific materials, molded using very precise dimensions, and it may even have a slight curvature.
Chemical Barrier: If you’ve ever had a sonogram, you know that scan gel is applied to your body, between the probe and your skin, to help improve image quality. Also, probes are cleaned, and may be high-level disinfected, after every use. As such, the lens is designed to serve as a chemical barrier to prevent contaminants from entering the probe housing, damaging the acoustic array and sensitive electronics.
Electrical Isolation: Referring to sensitive electronics, the acoustic array or “crystals” are pulsed with high voltage (typically up to several hundred volts). So as not to expose the patient or sonographer to such a potential, the rubber-like lens serves as an electrical insulator.
Other Notable Requirements: The lens, as well as other components that may contact the patient and sonographer, need to be biocompatible so as to not induce any adverse reactions. OEMs are required to use materials certified to the ISO 10993 standard for biocompatibility. The materials also need to be compatible with the dozens of OEM recommended cleaners and disinfectants.
COMMON FAILURES
Throughout the life cycle of an ultrasound probe, the lens may undergo some of the most significant wear of any component. With repeated exposure to harsh chemicals, the lens, and the seal surrounding it, will degrade over time. The lens is also the victim of accidental trauma and physical damage. The smallest cut or opening will permit gel, disinfectants and other contaminants to enter and degrade the internal components.
Typically, lens damage is not addressed until gels and chemical disinfectants have had the opportunity to induce more severe damage, leading to performance problems. It’s why we stress the importance of sonographers performing routine visual inspections on every probe in their department and informing the HTM team of any concerns as early detection may mitigate extensive damage.
COMMON SYMPTOMS
When a lens failure has occurred (or is progressing), sonographers may complain of poor or reduced penetration, regional shadowing in the image, and even no image whatsoever. From a QC perspective, you would see changes in uniformity over-time as well as changes in penetration and resolution over-time. What once was, would no longer be achievable.
Innovatus Imaging is not just a repair provider, we are your service partner. We are here to assist you and your customers with obtaining the maximum lifespan for your ultrasound probes and MRI coils. We’re able to train HTM teams as well as clinical staff on best-practices for extending the life of your ultrasound probes. For questions, assistance, or more information, please reach out to training@innovatusimaging.com. If you have a failed probe, we can help! We have the most-comprehensive repair capabilities on standard, 3D/4D, and TEE probe models, and welcome the opportunity to assist you.
Ted Lucidi, CBET, is the director of commercial operations and business analytics at Innovatus Imaging.
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RIGHT TO REPAIR
FTC Takes Action, State Enforcement Ramps Up
BY NATHAN PROCTOR
Right to Repair is based on a simple premise. People should be able to fix equipment they own, and the manufacturer shouldn’t be allowed to restrict who repairs that equipment. When the manufacturer has that control, and undermines competition on costs, convenience and quality, things go poorly
In addition to ensuring robust competition for repair of medical equipment, you can find examples where Right to Repair is needed across our economy.
The last few months have seen some important gains as Right to Repair laws have taken effect, while the FTC has taken new actions to support repair choice.
CELEBRATING REPAIR INDEPENDENCE DAY
On July 1, Right to Repair laws took effect in California and Minnesota. California’s new law covers most consumer electronics made in 2021 and after, while Minnesota’s covers these products as well as business electronics such as enterprise computing. Together, Right to Repair supporters marked this milestone by celebrating Repair Independence Day.
Both the Minnesota and California coalitions held events, and Repair.org released a new guide to help people take advantage of their new rights, and know how to file complaints when those rights are denied.
These new laws give state attorneys general the
ability to fine companies who do not adequately support repair for covered products.
FTC WARNS COMPANIES
On July 3, the Federal Trade Commission (FTC) warned 8 companies that their warranty statements need to be corrected to protect consumers’ Right to Repair.
The letters, sent to aeris Health, Blueair, Medify Air, Oransi, InMovement, ASRock, Zotac, and Gigabyte called on the companies to remove “statements that consumers must use specified parts or service providers to keep their warranties intact” or stop placing “warranty void if removed stickers” on products.
Blueair and Oransi were identified in U.S. PIRG Education Fund’s Warranties in the Void reports for the issues the FTC raised in July. Our researchers found language in the warranties for these companies’ products that purported to void warranties for unauthorized repairs, something which is generally a violation of federal warranty law. In fact 45 of the 50 companies we surveyed either had terms in their warranties with these claims, or their customer service teams made these claims when asked.
Over the past six years, PIRG and its allies have pushed on the FTC to do more to address issues around warranties.
Nathan Proctor is senior director of the U.S. PIRG Campaign for the Right to Repair.
THE FUTURE
VR Works for Biomed Education
BY JOIE N. MARHEFKA
One of my biomedical engineering technology (BET) students at Penn State New Kensington responded to an anonymous survey about 360-degree video and virtual reality (VR) with the following quote: “I believe that the use of new technology like VR to supplement lessons is both praiseworthy and a necessity. If a program wants to better prepare their students for the future, then VR-based course work is the next best thing after real practical experience. I also believe that if an educational institution with a program like BET wants to remain competitive, then they must adopt VR into its curriculum.” I had added some 360-degree video content to my courses and was glad to see that this student found it to be worthwhile. And, I couldn’t agree more.
Augmented reality (AR), VR, and 360-degree video are valuable tools to help students learn that can also help HTM professionals to do their jobs.
I have been working to incorporate this type of content into my classes. I recorded 360-degree videos of
various work locations, including biomed shops, operating rooms, and imaging rooms, to introduce my students to potential careers and job sites. I also recorded videos of preventative maintenance procedures and repairs on equipment that we don’t have in our lab on campus. The students watch these videos using VR headsets and are able to interact with pop-ups that are embedded to provide more information – such as pictures of the inside of the device or links to service manuals. In this case, 360-degree video is a way that we are introducing students to a wider range of equipment prior to their internships while also dealing with budget realities that prevent us from having every type of device on campus. Several students commented that the 360-degree video felt like an in-person demonstration more than a traditional video. In addition, I worked with a recent graduate to create a series of 360-degree videos to give students practice with troubleshooting and customer service through a “choose your own adventure” situation. After watching each video, where a nurse describes a problem, the students are given a choice of how to respond. They are then directed to a video showing the outcome of their decision and given an additional set of choices. Through a series of videos and questions, the students reach a resolution – for example successfully identifying the problem and solution, or perhaps, angering the clinical
staff. I am planning to introduce the students to AR, and its applications in device maintenance and troubleshooting, during the next school year.
My goal of adding AR, VR and 360-degree video to my classes is twofold. First, I want to introduce the students to equipment and experiences that can’t be replicated in the classroom. Second, I want to introduce the students to technologies that they will likely use in their future careers.
I recently attended the AAMI eXchange. The conference included several educational sessions and exhibits related to AR and VR. Device companies demonstrated ways that they are incorporating AR and VR into their products, including using AR and VR to help with servicing equipment. This really got me thinking about uses of AR, VR and 360-degree video in HTM beyond the traditional classroom setting.
I imagine in the future VR will have many applications in training. VR can be, and in some cases already is being, used to complement and maybe even replace in-person training sessions. VR can be used to help technicians become familiar with equipment before a hands-on training or to review content following an in-person session.
AR can be used to help walk technicians through maintenance or troubleshooting procedures. It can
provide detailed information about and models of components of a device.
A 360-degree video could be used in new employee orientation or to introduce a technician to a new work area such as an operating room, an offsite clinic or a different hospital. This would allow them to become acclimated to the workspace at their own pace and to review room set-up as needed. A 360-degree video could also be used as a means to practice handling stressful situations, troubleshooting and customer service. This type of training would benefit HTM professionals as well as students.
I anticipate that AR, VR and 360-degree video will help many organizations to increase efficiency and save money. I am taking strides to familiarize my students with these technologies so that they will be ready to use them on the job. It will certainly be interesting to see how these technologies affect the HTM industry over the next few years.
Contrast Injector Training
Joie N. Marhefka, Ph.D., is the biomedical engineering technology program coordinator at Penn State New Kensington.
CYBERSECURITY
Can Your Firewalls Withstand the Heat of Modern Attacks?
BY DEVIN SHEEHAN
Cy ber threats, and specifically ransomware, have increasingly breached defenses for the past years.1 With these looming threats, how is your organization ensuring they do not fall victim to the next cyber-attack? One important factor to review is the strength and competency of your network security firewalls. Does your approach use the latest protection in the continuously evolving security technologies?
Firewalls are a critical component of any strategy and one of the oldest lines of defenses. The term “firewall” can be coined back in the cyber field since 19882, and remains relevant today. But how much do you know about firewalls? Are you confident your organization’s firewalls are top notch? What if I told you that according to a survey of 1,200 qualified IT security professionals, only 44.3% of organizations are currently using a next-generation firewall?3 Let’s break down this 36-year-old cyber-term and discuss what actions you and your organization can take to protect from fatal attacks.
Cybersecurity is an always evolving field and firewalls are no exception. Cybersecurity experts categorize firewalls into two main types: traditional firewalls and next-generation firewalls (NGFWs). Traditional firewalls primarily focus on keeping out malicious traffic that makes the attempt to enter through a network firewall. The first generation of firewalls was introduced in the fourth quarter of 1989, starting as merely a packet-filter firewall or a stateless firewall. It had the ability to perform functions up to Layer 4 of the Open System Interconnection (OSI) model. This improved the ability to inspect traffic entering and leaving the network. A packet-filter firewall could take packets that were sent between devices on a network and see if the packet matched the pre-defined rules set by the network team. The rules were based on network protocols and their headers, allowable ports and/or approved destinations. However, this provided a low level of security
as hackers could disguise their communications within regular approved network traffic such as Domain Name System (DNS) or Hypertext Transfer Protocol (HTTP).4
In 1991, there was another advancement in the firewall, opening the firewalls’ ability to operate on the seventh layer of the OSI model (application layer). Unlike traditional firewalls that primarily focused on inspecting packets at the network and transport layer, these advanced firewalls could analyze traffic based on specific applications, protocols and user behaviors. This capability allowed for more granular control and a deeper understanding of the data passing through the network, enabling the identification, and blocking of sophisticated threats that exploit application vulnerabilities. This evolution significantly improved the firewall’s ability to safeguard sensitive information and maintain the integrity of network communication.
Building on the advancement of firewalls, NGFWs have further revolutionized network security by integrating these application-layer inspection capabilities with additional features. It incorporates intrusion prevention systems (IPS), malware detection, and real-time threat intelligence, providing comprehensive visibility and control over network traffic. They are designed to understand and monitor applications, such as Facebook and Google, and services based on URLs and common ports (e.g., port 53). This evolution is a large leap in cybersecurity, adapting to the increasingly complex threat landscape and offering robust protection for modern network environments. Despite the ever-evolving firewalls, today’s networking environment has become so complex that these traditional firewalls alone are often insufficient. Over the years, additional security technologies have been integrated with firewalls, such as anti-malware, intrusion prevention system (IPS), deep packet inspection (DPI), VPN, URL filtering, etc. With the help of these technologies’ firewalls can combat various types of attacks. However, with the rise of hybrid workforces, wireless networks, and cloud environments, network security is becoming increasingly challenging. Your network is rapidly being pulled away from your local permitter spreading across a dynamic, ever-changing, multiparameter environment. This naturally increases the attack surface of your organization’s network. So, what can be done to reduce how much of the
attack surface is vulnerable? While every organization has different goals and resources, here are three firewall approaches to consider:
1. Firewall as a Service (FWaaS): This method provides a scalable solution without the need for expensive on-premises hardware. It is ideal for organizations that may be “behind” the curve in terms of network security and need to catch up quickly, for an organization that has many of their employees spread across the country or working remotely or have limited IT resources to manage firewalls. However, if your organization has ample IT resources, desires more control over your firewalls and doesn’t plan to expand rapidly, then this approach may not suitable. 5, 6
2. Hybrid Mesh Network Firewall. This method offers a unique and modern approach by deploying a combination of firewalls in multiple form factors, including on-premises, cloud, virtualized, or a mixture.7 It simplifies cybersecurity operations by unifying security rules and policies under a centralized management console.8 Additional benefits include lowering total cost of ownership through system consolidation, quick responses to security concerns, and leveraging multiple firewall technologies within a single framework. However, if your organization lacks IT resources to manage a multi-firewall setup, this method may not be appropriate. Even a small configuration mistake could result in a costly cyber-attack for your organization.
3. Using Network Firewalls to create Micro-segmentation. This method creates zones across your environment to isolate/segment your network, allowing firewall policies to explicitly deny traffic that is not required for a system/application.9 This approach forms the foundation for creating a zero-trust network, significantly reducing your network attack surface, improving security, minimizing the impact of cyber-attacks, and enabling a quicker remediation of
incidents. While this solution may be overkill for some organizations, it is a very secure approach. However, this approach can be very manual and complex to manage, especially with a high number of firewall rules and segmentations. If your organization does not have the IT resources to support this method, then this may not be best for your organization. While these approaches are not the only ways you can utilize for protecting your company’s network, it is important to evaluate the resources/tools your company can leverage. Take time to consider your organization’s cybersecurity goals and collaborate with your IT team to implement next-generation firewalls if you haven’t already. Explore different strategies to enhance those firewalls and create a more secure network.
SOURCES
1. Cisco Cyber Threat Trends Report: From Trojan Takeovers to Ransomware Roulette
2. Who Invented the Firewall? History, Types, and Generations of Firewall. - PCInsider (thepcinsider.com)
The great thing about the TCP/IP suite is that it comes with its own set of tools, such as ping and IPCONFIG (IFCONFIG in Linux). Being in the TCP/IP suite, these commands work on nearly any computer system using the Internet protocol. Additionally, some commands are just as useful but have specific functions for troubleshooting communications. These commands are ARP, TRACERT, NETSTAT, and NSLOOKUP.
ARP -A:
Ever need to figure out which machines are on the same network as the one being repaired? Perhaps there was a need to figure out a MAC address to a machine, and only the IP is known. ARP can help in both cases. The Address Resolution Protocol, ARP, is a cache of the LAN IPs and MACs seen over the network. (Note: MACS and LAN IPs are masked in this article’s pictures.) This information is usually only accessible on the switch or router. However, by using ARP -A in the command line, a technician can look up IPs and MAC addresses of all the other network machines on a LAN. By entering ARP -A (the IP of a machine), a MAC address can be looked up for any specific IP. There are limitations to ARP. It is a list that is relative to the machine being used. That machine may not have seen all IPs in its specific VLAN. Also, ARP is a possible vulnerability for hacking. Therefore, if a duplicate MAC exists, this is a potential network security issue. All these reasons make ARP a powerful tool for figuring out who is on the LAN.
TRACERT can give critical information in cases where communication is either slow or not functional. When the cabling, IP, and ACL settings are correct, yet the communication is failing, try using this command. TRACERT counts the number of routers between a machine and the target IP. It also works with DNS names, so a website name or a LAN server can be used as a target. TRACERT sends three pings to each LAN router (masked in the pictures) and presents the data showing the speed of communication. This trace will go through LAN routers and then through each of the Internet routers used to get to the target. Each router, called a “hop”, is a step in the network path between the machine and the target. If there are over 30 hops, the destination is slow and may be unreachable. The router where the responses stop is either a problem or is blocking the ping results. If there are routers that do not reply, their step will be represented with asterisks. Any significant delay in ping time or a request timeout that causes no responses afterward shows a problem in that router. In this way, TRACERT can show issues with the LAN or the Internet itself. It can be quite useful to see how a network responds between a source and a destination IP.
TRACERT:
NETSTAT -B
Netstat is a command to see the individual programs on a computer and who they are communicating to. It shows the type of communication, Machine IP (masked in the picture), and port used after the colon. The destination IP and port are listed even if it is over the Internet. The state of the communication and the Process Identifier called a PID are also listed. This is mostly used in Windows with the NETSTAT -A (Show active) -N (Show IPs and Ports) -O (Show PID) and the -B (Match IP to processes) option. Regardless of the options used, this list shows exactly who a computer is communicating with and what software is using it. That is a powerful tool to verify that a process is communicating. If the PID number is not clear, use the task manager in a details list to pair up the communication and the software. Using this tool, technicians can view all communications in and out of a machine. With NETSTAT, nothing can hide in the background. This is handy if you either suspect something is unnecessarily using system resources or potentially even suspect malicious software.
NSLOOKUP
Finally, there is a tool allowing us to directly talk to our DNS server and ask it for an IP given a website name, or a name given to an IP. This command is NSLOOKUP. It is a potential troubleshooter for the DNS itself, but mostly, it is used to look up an IP that is not always easy to remember or that changes dynamically. NSLOOKUP is easy to use. Use the command and the IP or name to find, as pictured (my LAN IPs and MACS are masked in these pictures) As these commands are widely used. Any machine using an IP has these commands: Windows, Linux, or even an Apple Terminal use these commands. They will allow for flexibility in troubleshooting communication issues regardless of the hardware that is using the network. Try these out and see what they can do
Garrett Seeley, MS, CBET, IS A Biomedical Equipment Support Specialist-Imaging WITH VISN 17: VA North Texas Health Care System/ Dallas Veterans Affairs Medical Center.
HEALTH-ISAC Enhancing Cybersecurity in Rural Hospitals
BY PHIL ENGLERT
Ru ral hospitals face unique challenges, including financial constraints and staffing shortages. Between 2010 and 2021, 136 rural hospitals closed, with a Crisis in Rural Healthcare report stating 600 more of the remaining 1,796 are at risk of closing. Many rural residents are older, lower-income and in worse health than urban populations. A significant portion of those served are under or uninsured. They experience higher rates of substance use and chronic health issues such as high blood pressure and obesity. Staffing remains a significant challenge, with 21% of the population living in rural areas being served by only 10% of physicians.
HealthIT Security.com reports that “Cyberattacks are pivoting to target smaller health care companies and specialty clinics without the resources to protect themselves, instead of larger health systems that – despite being treasure troves of personal and medical data – generally have more sophisticated security.” Most smaller hospitals are connected to larger systems becoming the “path of least resistance” into those larger health care networks increasing risk on a national level.
Cyberattacks on the health care system pose significant risks to patient care and safety. From 2018 to 2022, significant data breaches reported to the Department of Health and Human Services (HHS) increased by 95%, including numerous ransomware attacks. In alignment with the National Cybersecurity Strategy, the budget invests in protecting the nation’s health care
system from cyber threats. It includes $800 million to help high-need, low-resourced hospitals cover the upfront costs of implementing essential cybersecurity practices and $500 million for an incentive program encouraging all hospitals to invest in advanced cybersecurity measures.
Congressional funding and coordinated government efforts are essential for enhancing rural health care cybersecurity. Subsidies and enhanced payments from the Centers for Medicare & Medicaid Services (CMS) are crucial. Government-funded cyber response teams, staffed by larger health care organizations, could provide vital support to rural hospitals. These teams, possibly coordinated under agencies like the Administration for Strategic Preparedness and Response (ASPR), the Health Sector Coordinating Council (HSCC), and the Health Information Sharing and Analysis Center (HealthISAC), would be instrumental in responding to and recovering from cyberattacks.
The publication of Health Industry Cybersecurity Practices (HICP) is a crucial resource for rural health care entities. This multi-volume publication offers consensus-based cybersecurity guidelines. It includes a technical volume specifically designed for small health care organizations, providing implementation guidance for essential security tools such as vulnerability management and email protection systems. These guidelines outline basic steps all small organizations should adopt to enhance their cybersecurity posture.
Recent legislative efforts underscore the critical need for improved cybersecurity in rural health care settings. Senators Josh Hawley (R-MO) and Gary Peters (D-MI) have introduced the Rural Hospital Cybersecurity Enhancement Act. This legislation mandates that the Cybersecurity and Infrastructure Security Agency (CISA) director devise a comprehensive workforce develop -
ment strategy for rural hospital cybersecurity. Moreover, the act requires the creation of instructional materials for rural hospitals to train staff on essential cybersecurity measures. The legislation includes support for new curricula, public-private partnerships and policy recommendations. Though still in the introduction phase, this act has brought significant attention to rural health care cybersecurity issues.
Senator Mark Warner (D-VA) has introduced the Health Care Cybersecurity Improvement Act of 2024, which proposes advance and accelerated payments to providers in the event of a cybersecurity incident, provided they meet minimum cybersecurity standards. This legislation recognizes that smaller health care organizations and specialty clinics, often targeted by cybercriminals, need substantial support to protect themselves and the more extensive health care networks they connect to.
In addition to these two proposed legislations, the White House has issued the National Cybersecurity Strategy and Implementation Plan and the National Cyber Workforce and Education Strategy. Both initiatives highlight the administration’s focus on cybersecurity across various sectors, including health care. These strategies advocate a whole-of-nation approach to addressing ongoing cyber threats, emphasizing collaboration between government and private entities.
On March 11, President Biden submitted his fiscal year 2025 budget request to Congress. The president’s budget proposes substantial financial incentives to assist hospitals in defending against cyberattacks, with $1.3 billion allocated for this purpose. Initially, funds would target approximately 2,000 hospitals having the greatest need. In subsequent years, smaller amounts would be available to all hospitals that adopt enhanced cybersecurity practices. The budget also introduces penalties for hospitals failing to meet essential cybersecurity standards, with enforcement starting in FY 2029. Penalties could reach up to 100% of the annual market basket increase, with additional reductions of up to 1% from the base payment for non-compliant hospitals.
The budget allocates $13 billion across civilian departments and agencies to bolster federal cybersecurity, including an additional $103 million for CISA, totaling $3 billion to enhance cyberspace resilience and defense. Critical investments include $470 million for deploying federal network tools, $394 million for CISA’s internal cybersecurity capabilities, $41 million for critical infrastructure security coordination, and
$116 million for critical infrastructure cyber event reporting.
The Advanced Research Projects Agency for Health (ARPA-H) recently launched the Universal PatchinG and Remediation for Autonomous DEfense (UPGRADE) program to bolster health care cybersecurity. This initiative, funded with over $50 million, focuses on developing advanced tools to enhance and automate cybersecurity measures in health care facilities.
Grant proposals will involve implementing real-time monitoring and automated responses to detect and address threats in hospital IT systems. This includes simulating real-world conditions using high-fidelity digital hospital equipment models and effectively testing patches before deployment. Successful proposals will utilize advanced algorithms and machine learning to identify potential threats and vulnerabilities in hospital IT systems. Once vulnerabilities are detected, the program, UPGRADE, will automatically generate, test, and deploy patches with minimal disruption to hospital operations. The program’s success relies on the collaboration between IT staff, medical device manufacturers, health care providers, human factors engineers, and cybersecurity experts. The developed solutions will be adaptable to various health care environments, from small clinics to large hospital networks.
The UPGRADE program will enhance health care facilities’ cybersecurity posture by streamlining the process of identifying and addressing vulnerabilities. It aims to reduce the time from detecting a vulnerability to deploying a safe, automated patch in days. This initiative is part of a broader effort by the Department of Health and Human Services (HHS) to improve cyber resilience across the health care system, addressing the sector’s ongoing and evolving cyber threats. These combined efforts highlight a significant federal commitment to improving cybersecurity in rural health care settings. By addressing workforce development, providing financial incentives, enhancing federal coordination, and leveraging existing resources, these initiatives aim to fortify the nation’s rural health care infrastructure against growing cyber threats.
Phil Englert is the director of medical device security for Health-ISAC.
BULLETIN BOARD
Ben Calibrating, or Ben C. for short, is the face of MedWrench! While he may just be a small lego figure, you can find him all over the world.
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STEP 1: Like the MedWrench Facebook & LinkedIn pages
on the way to Pueblo, Colorado.
STEP 3: Post a funny caption with your picture telling us what Ben C. is up to
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EVENTS: SEPTEMBER
11-12
STEP 2: Post your picture of
#BenC went to work today, unfortunately he just sat there holding a wrench watching
STEP 4: Make sure you tag @MedWrench in your post so our team can see it
and Hollywood
#BenC truckin through Central California. It’s not all beaches, palm
SEPTEMBER 22-25
BLOGS:
AI From a BME Perspective:
Bridging Innovation and Responsibility in Healthcare
BY DANIEL MILEWSKI PERDOMO
The medical world is rapidly changing with daily advances in materials science, genomic engineering, and above all artificial intelligence (AI). The rapid adoption and improvements of large language models such as OpenAI’s ChatGPT, highlight that AI is becoming an ever-increasing presence in the lives of innumerable people.
Biomedical engineering technologists are in a unique position where they utilize interdisciplinary approaches in order to decrease the risk of an adverse event occurring to a patient or medical device user. By integrating various fields such as mechanical, electrical, medical, and social, positive patient outcomes are increased.
CONTINUING EDUCATION:
#BenC is making his way through the rain
trees,
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