Tech nation jan 2016 by Md Abdul Haleem Bahadur

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Vol. 7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

JANUARY 2016

N U R&S E S

BIOMEDS A Winning Team for Positive Outcomes

18 Biomed Adventures

Flying High

34 The Roundtable

Patient Monitors

64 MedWrench Bulletin Board

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34 42 TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

HE ROUNDTABLE – T Patient Monitors Patient monitoring devices have advanced over the years as new technology continues to extend the capability of these life-saving tools. TechNation contacted experts in the industry to gain their insights to patient monitors, including the latest advances, software updates and the benefits of purchasing new or refurbished equipment. Next month’s Roundtable article: Digital Radiography

NURSES & BIOMEDS: A WINNING TEAM FOR POSITIVE OUTCOMES HTM professionals and nurses benefit from teamwork. Each profession is vital to positive patient outcomes. Nurses and other clinicians can benefit from regular interaction with biomeds by learning tips to overcome common errors. Biomeds can learn from nurses by observing how they interact with patients and the high-tech devices they rely upon on a daily basis. We examine how working together can benefit both professions. Next month’s Feature article: Alternative Equipment Management: What works best

TechNation (Vol. 7, Issue #1) January 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

JANUARY 2016

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INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Andrew Parker

ART DEPARTMENT

Jonathan Riley Jessica Laurain Kara Kronen

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas Patrick K. Lynch John Noblitt Todd Rogers Manny Roman David Scott Cindy Stephens Karen Waninger Steven Yelton

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Kim Callahan

CIRCULATION

Lisa Cover

EDITORIAL BOARD

Eddie Acosta, Clinical Systems Engineer at Kaiser Permanente Manny Roman, CRES, Founding Member of I.C.E. Karen Waninger, MBA, CBET Robert Preston, CBET, A+, 2014 TechNation Professional of the Year Salim Kai, MSPSL, CBET, Clinical Safety Engineer University of Michigan Health System

P.12 SPOTLIGHT p.12 p.16 p. 18

Department of the Month: John Peter Smith Health Network Clinical Engineering Department Professional of the Month: Joel Camargo Biomed Adventures: Flying High

P.22 THE BENCH p.22 p.24 p.27 p.28 p.30 p.32

ECRI Institute Update AAMI Update Tools of the Trade Webinar Wednesday Biomed 101 Shop Talk

P.50 EXPERT ADVICE p.50 p.52 p.54 p.56 p.58

Career Center Ultrasound Tech Expert Sponsored by Conquest Imaging The Future Patrick Lynch Roman Review

P.60 BREAKROOM p.60 p.62 p.64 p.70

Did You Know? The Vault MedWrench Bulletin Board Parting Shot

p.66 Index Like us on Facebook, www.facebook.com/TechNationMag

James R. Fedele, Director, Biomedical Engineering Izabella Gieras, MS, MBA, CCE, Director of Clinical Technology, Huntington Memorial Hospital Inhel Rekik, Biomedical Engineer, MS, Clinical Engineer

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DEPARTMENT PROFILE John Peter Smith Health Network Clinical Engineering Department By K. Richard Douglas

ospitals often bear the names of benefactors; those who donated funds for construction or a founding physician. A hospital can also be named after the person who deeded the land that it was built on.

That was the case when the future mayor of Fort Worth, Texas, John Peter Smith deeded five acres of land in the downtown area in 1877. The hospital got its official name in 1954. Today, John Peter Smith (JPS) Health Network includes a 537-bed hospital on Main Street, a fire-story Patient Care Pavilion, a facility providing psychiatric services and an outpatient care center. There is also a Center for Cancer Care, the Center for Pain Management, the Cypress Health Center, the Orthopedic and Sports Medicine Center and a number of clinics. Responsibility for the maintenance and repair of over 21,000 assets falls to the network’s team of HTM professionals. JPS Health Network’s 25-person Clinical Engineering Department includes three imaging specialists, an imaging team lead, three biomedical team leads, three biomedical specialists, 11 biomedical equipment technicians and two database coordinators. Additionally, there is one manager and one director. Six of the biomeds have CBET certification and three other team

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JANUARY 2016

members have recently taken the exam. The clinical engineering team repairs and maintains the equipment at the hospital, which is the only Level 1 trauma facility in Tarrant County. The hospital had more than one million patient encounters during 2014 and the facility’s emergency department peaks at over 400 visits daily. The urgent care exceeds 60,000 visits annually. With this kind of equipment usage, the team is kept very busy. But, this is only part of what the network handles. The JPS Health Network also delivers 5,000 babies annually and provides health care to correctional facilities in the county. Also, it is the only facility in the county to provide a psychiatric emergency center. In addition, the network runs an outpatient surgery center and has 61 clinics throughout the community. Moving some service contracts to the department’s in-house capabilities was an early goal for the team manager. “In the almost two years that I’ve been on board, I have pushed to adopt in-house service. When I arrived, we had six BMETs and two imaging specialists to maintain a 535-plus bed hospital, school-based clinics, outpatient surgery centers, and other community clinics. We relied heavily on service contracts,” says Joshua Virnoche, MBA, CBET, manager of the clinical engineering team. “Over the last 12 months, we’ve reduced the amount of service contracts we hold by $1.3 million. We brought on additional technicians, lobbied for training, and have increased our customer satisfaction vastly,” Virnoche says. “I understand there are certain items that we will maintain service contracts on, but the goal is to minimize

all contracted services and have our in-house techs be, at least, first call on everything that has a service contract.” In addition to cutting down on service contract expenses, the CE team is represented on nearly every committee in the network. “We provide report outs to the facility safety committee on recalls, corrective maintenance completion, preventive maintenance completion, nurse call work orders [and] project updates,” Virnoche says. “These items are reported up through the Environment of Care committee which also has representation from our department.” Beyond providing information to these committees, the department has team members participating in the Laser Safety, Radiation Safety, RTLS, Critical Alarms and various other groups throughout the JPS Health Network.

AREAS OF SPECIALTY Virnoche says that the department is broken down into four separate teams of specialization. The Critical Care team maintains the NICU, ICU, progressive care and CVICU, along with additional duties throughout the hospital. The experience level of his team is mixed. “[The] Perioperative Care team maintains the ER, OR, Outpatient OR, Sterile Processing, Endoscopy, as well as other areas. This team is mostly experienced technicians, with a few new-to-the-field technicians on board,” Virnoche says. The department also utilizes a Support Services team, which maintains the laboratory, school-based clinics, the county jail’s needs, outpatient clinics and many other areas. The experience level of

The Clinical Engineering Department at JPS Health Network is responsible for more than 21,000 assets.

“Our team is always flexible and we work to make accommodations for everyone that needs us.” this team is also mixed. There is also an imaging team, which is responsible for all types of imaging equipment. “This team is a split of experienced biomed techs that have advanced to imaging, and experienced imaging technicians,” Virnoche adds.

PROBLEM SOLVERS Besides the more routine PM and repair projects, the department has had some shorter-term challenges. “In the summer, we were part of a team that was used to ensure hospital and patient safety, during a planned power outage for new construction,” Virnoche says. “This was 10 days of work, from 11 p.m. until 5 a.m. We ensured our equipment was shut down properly and came back online during this process.”

Since then, the team helped with the completion of construction, and participated in the opening of, a new cardiovascular wing, EP, and Cath Labs. “Additionally, we are very involved in the RTLS implementation in the hospital. We are currently in phase one of three, and will begin with piloting the system in the next few weeks,” Virnoche adds. The service commitment and mindset of the biomeds played a crucial role in one recent project. “Something unique to BMETs, in my opinion, is that we are problem solvers, and for that reason people are drawn to us for help,” Virnoche reasons. He offers an example. “Our team is always flexible and we work to make accommodations for everyone that needs us. For example, we

had an orthopedic clinic that was moving to a new location in the same part of the city. The old clinic needed to use their X-ray unit until the day the clinic shut down (Friday), but also needed to use the X-ray unit the day the new clinic opened (Monday),” Virnoche says. He explains that the imaging team orchestrated a move of a C-arm, CR reader, and portable X-ray unit to the new clinic, to ensure the clinic could see patients until the X-ray room could be de-installed and reinstalled in the new clinic. Virnoche sums up the motivation for the department as; “We do whatever is asked of us. Our entire goal is to ensure our patients receive the best care possible.”

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PROFESSIONAL OF THE MONTH Joel Camargo By K. Richard Douglas

ccording to the website of the Florida Biomedical Society: “The FBS BMET of Year was established as a way to recognize those biomedical professionals that distinguish themselves during the course of each calendar year.”

The society’s chapters each submit a nominee for the annual award. The site’s description continues; “The FBS BMET of the Year is someone who embraces and works to achieve the goals and values of the FBS and works for the betterment of the Biomedical Profession.” The 2015 Biomedical Technician of the Year award was presented to Joel Camargo, a Biomedical Electronics Specialist who works for Broward Health in Fort Lauderdale, Florida, at the recent FBS Symposium. The fact that Camargo’s efforts came to the attention of his peers is testament to his work ethic. That may seem a little ironic since he did not set out with a goal of becoming a biomed at first. “I actually stumbled across the biomedical profession at an Army recruiting office,” Camargo remembers. “Initially I was interested in becoming an X-ray technician, but after watching a short laser disc video (I’m dating myself), of a technician disassembling all this strange equipment with these fancy tools, I was sold.”

TRAINING Camargo received his HTM training through the military. “A week after signing up with the Army, I was enrolled into the Biomedical Equipment Technician

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JANUARY 2016

“ I actually stumbled across the biomedical profession at an Army recruiting office. Initially I was interested in becoming an X-ray technician, but after watching a short laser disc video (I’m dating myself), of a technician disassembling all this strange equipment with these fancy tools, I was sold.” Program at the Fitzsimons Army Medical Center in Aurora, Colorado. The school was almost a year long and was broken down into two-week modules. The first couple of weeks covered Ohm’s Law, theory, and quickly covered basic soldering techniques,” Camargo says. “By the time I was studying for the last module, I was troubleshooting high-voltage X-ray machines. The

Army gave me a great foundation of training to start my career and has served me well ever since.” After exiting the service, he landed close to his boyhood home in New England. “After leaving the Army as a young biomed with a couple of years of experience under my belt, I was fortunate enough to be hired on at the Massachusetts General Hospital in Boston. I had some really great mentors there that helped me to develop the skills and confidence needed in tackling just about any problem that arose in a hospital setting,” Camargo says. “They have a really great biomed team, and I will never forget my time there.” After a few years in Boston, he decided to move to Florida and took a position as a senior biomedical technician at Palmetto General Hospital in Hialeah, Florida. “I also enjoyed my time there and made some great friends there as well. Soon after I took a position here at Broward Health and have worked with a great team ever since,” he says. Camargo spends the large majority of his time in surgery, servicing anesthesia machines for all the hospitals within the Broward Health organization. Beyond that, the rest of his time is spent assisting colleagues servicing all types of equipment that comes into the lab. Camargo has helped many a biomed intern get off on the right foot as well. Like many biomeds, there are those times when changing technology can present a challenge. “I think the greatest challenge I’ve encountered is how quickly the

MEET THE BIOMED FAVORITE MOVIE “Predator” with Arnold Swarzenegger

FAVORITE BOOK

The first novel I read for fun as a kid, “Hardwired” by Walter Jon Williams

FAVORITE FOOD Pad Thai

HIDDEN TALENT

I enjoy sketch drawing when I can find the time.

FAVORITE PART OF BEING A BIOMED

Joel Camargo repairs an anesthesia machine.

integration of Wi-Fi and networking has changed the way biomed equipment is being used in the hospital setting, and how it affects the way we train and prepare for any technical issues that may arise and how it affects scheduled maintenance as well,” Camargo says. Asked if he has won any awards during his career, the one from FBS is still fresh in his thoughts. “As far as awards go, I was lucky enough to receive the 2015 Biomedical Technician of the Year award from the Florida Biomedical Society,” Camargo says. “It’s an honor to be recognized for doing something you love to do every day, but most of us do this because we have a passion for it, accolades or not.”

LEISURE TIME When not working, Camargo enjoys being a DIY’er and has installed a new floor in a bedroom, as well as tackling auto repairs. “I enjoy doing my own work at home and try to tackle anything that I think can be done safely myself,” he says. Camargo echos the words of Professor Arthur Szathmary when he reflects on his chosen career and the message he would like to send TechNation readers. “I think what I’d like to say, is if you love your job, you’ll never work a day in your life. Find your passion and everything will fall into place,” he says.

I think it has to be the sense of accomplishment I feel after helping a nurse figure out a problem, or finally turning on a monitor after rebuilding it. It’s a different issue every day, but the feeling at the end of the day is always the same.

WHAT’S ON MY BENCH

A pen and small pad of paper to help me remember important little details that occur throughout the day. A pocket-sized screwdriver that I use all day long as my all-purpose MacGyver tool. Believe it or not, my cellphone has become a great tool for calling vendors for tech support, calling my fellow biomeds for assistance or just taking pictures as you disassemble a piece of equipment for repair. Not sure how we got along without them. I don’t think that I could do my job without mentioning my laptop. It replaces hundreds of paper service manuals with digital versions, gives me access to the Internet and allows me access to our digital database. Without it my job would be far more tedious.

SPOTLIGHT

BIOMED ADVENTURES Biomed Flying High K. Richard Douglas

t was the dream of Biomed Ryan Zamudio to get behind the wheel of a fixed wing aircraft. Based on his prior occupation, he might have ended up sailing through the sky at 1,500 mph, but he settled for the more leisurely pace of a Piper.

“Prior to becoming a biomed, I was on active duty in the Air Force as a Crew Chief on F-16 fighters for 11 years (1998-2009). A couple of years into my career, I won a few awards in my unit and had the privilege of getting a ride in the backseat of an F-16 during a training mission,” Zamudio remembers. “Ever since that ride, I have been kicking myself for not pursuing a career as an aviator from the start. Now that I am established in the biomed career field, on both the military and civilian sides, I figured it was time to chase the dream of being able to fly, even if it was only for recreation.” To pursue the dream of recreational flying, Zamudio enrolled in a private pilot course offered through the Travis AFB Aero Club. He flew about four times a week while completing the book work and successfully passed his FAA knowledge exams and check-ride just two and a half months from the day he started. “I had this breakneck pace going at the same time as my full-time job and

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JANUARY 2016

attending college for my bachelor’s degree in business management,” he says. After years of driving cars and motorcycles around a racetrack as a hobby, Zamudio found that his first experience behind the wheel of an aircraft came naturally. The rocky ride, that can be a part of flying a small plane, was another story. “The part I had to get over was the susceptibility a small plane has to even light turbulence. I have never been a fan of heights, nor am I excited about riding in planes that I do not personally maintain. I have taken steps to mitigate this fear by skydiving once and taking a ride in a hot-air balloon,” Zamudio explains. “Despite this, I only came to trust the airplane and the winds around the second or third flight. The instructor showed me what it feels like when the aircraft stalls — wings no longer produce lift — and had me induce and recover from a couple stalls on my own,” he adds. “We also simulated an engine failure. Although it was initially scary, it was a good way to gain confidence in the air.”

THE CHALLENGE IS IN THE BOOKS Zamudio says that he found the rules of flying the most challenging aspect of learning to fly a plane. The sheer abundance of rules was the problem. “I spent about 50 to 60 hours on the book-work portion, in addition to the 50 flying hours I accrued,” he says. “The certification consists of a written exam and a verbal on the day of the check-ride, and anything printed in the Federal Aviation Regulations is a fair question.” Not only are the rules a challenge to memorize, but those things peripheral and integral to flying are often invisible

Ryan Zamundio prepares for his flight to MD Expo.

to the outside observer. Zamudio is well aware of each now. “Now that I have my license, the real challenge is remembering everything else involved. Flight planning, plan filing, radio communications, watching your gauge indications, visual and instrument navigation, being aware of other aircraft in your vicinity, staying on top of weather conditions for the entire route, etcetera,” he says. He says that the ability to multitask helps a lot. “A momentary loss of situational awareness can result in a revocation of my license on the first offense or even more dire consequences,” Zamudio explains. With his newfound ability to travel above the ground, it seemed like the natural choice to travel from his home airport in California to the recent MD

Ryan Zamundio and fellow biomed Dwayne Jackson flew from California to Las Vegas for the 2015 Fall MD Expo.

“ Now that I am established in the biomed career field, on both the military and civilian sides, I figured it was time to chase the dream of being able to fly, even if it was only for recreation.” Expo in Las Vegas. Zamudio says that the trip went according to plan. “This being my first cross-country flight since getting my license in September, I started planning two weeks in advance. I became obsessed with it to the point of mental exhaustion! I picked up my coworker, Dwayne Jackson, at his home airport in Modesto,” Zamudio says. “Like any real buddy on a bro-trip, Dwayne brought the Gatorade, chips and music for our flight. We stopped to fuel up at Shafter-Minter airfield, in the middle of nowhere, because they had nice pilot rest facilities and cheap gas,” he continues. “I had to consider that we were flying over mountains, which presents a whole different challenge, so we opted to take a longer route toward the south to ensure a safer crossing. The most we experienced was some moderate

turbulence as we passed over Tehachapi.” One glitch did occur on the trip. On the final leg going into Las Vegas, they lost radio communication with air traffic control, but once they cleared the hills, they regained contact. “I had never had to fly near class-B airspace before — think: B means ‘busy’ — but the air traffic controllers made sure we stayed clear of the big planes on the way to Henderson Executive Airport. Once we landed, Dwayne and I took some pictures with the plane before we got our rental vehicle and drove to the hotel. We then headed to the Las Vegas Strip for a celebration dinner,” Zamudio says. Luckily, the trip back to California was smooth sailing. Since they were traveling on a Saturday, it was possible to cross through some of the military

training airspaces that they had to navigate around on the trip to Las Vegas. This shaved an hour off of the return trip, according to Zamudio.

ON THE JOB When not taking to the sky, Zamudio is a BMET with UCSF Benioff Children’s Hospital Oakland. “We do not have equipment ‘specialists’ on our crew, so in addition to performing general biomedical work, we are all required to have substantial working knowledge about imaging, anesthesia, ventilators and other specialized equipment from all departments of our facility,” Zamudio says. “As a level-1 pediatric trauma center, and one of the busiest children’s hospitals in Northern California, there is never a dull day.”

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ECRI UPDATE

Dirty Endoscopes Top ECRI Institute’s 2016 Technology Hazards List – Part 1

very year hospitals are blindsided and patients are harmed by unexpected health technology hazards. Medical technology is intended to improve patient care, but even the best of technology – if configured, used, or maintained improperly – can lead to problems.

Flexible endoscopes in general, and duodenoscopes in particular, are of specific concern because their complex design and long, narrow channels can make effective cleaning difficult. A series of fatal carbapenem-resistant Enterobacteriaceae (CRE) infections that attracted a lot of attention in 2014 and 2015 illustrates this concern. The deaths were associated with the use of duodenoscopes that had not been successfully disinfected between uses. Facilities need to emphasize to their reprocessing staff that inattention to the cleaning steps within the reprocessing protocol can lead to deadly infections.

To help hospitals prioritize technology safety efforts that warrant their attention and to reduce risks to patients, ECRI Institute publishes an annual list of top 10 health technology hazards. The “2016 Top 10 Health Technology Hazards” list includes both high-profile and unexpected issues, as well as ones that are emerging, such as hazards related to electronic health records. In this issue, we focus on hazards one through five. All the topics selected for the list must, to some degree, be preventable. But any one of the other criteria can, on its own, warrant including a topic on the list. ECRI Institute encourages TechNation readers to examine these same factors when judging the criticality of these and other hazards at their own facilities. Spread the word about ECRI Institute’s “2016 Top 10 Health Technology Hazards” – and let it help your facility focus its patient safety efforts. A free version of the report can be downloaded at www.ecri.org/2016hazards.

Missed Alarms Can Have Fatal Consequences Failure to recognize and respond to an actionable clinical alarm condition in a timely manner can result in serious patient injury or death. Patients are put at risk: • When an alarm condition is not detected by a medical device • When the condition is detected, but not successfully communicated to a staff member who can respond • Or when the condition is communicated to clinical staff, but not appropriately addressed – whether because staff fail to notice the alarm, choose to ignore an alarm that warrants a response, or otherwise respond incorrectly.

Inadequate Cleaning of Flexible Endoscopes Before Disinfection Can Spread Deadly Pathogens The failure to adequately reprocess contaminated instruments – that is, to clean and disinfect or sterilize them – before using them on subsequent patients can lead to the spread of deadly pathogens. A key aspect of effective reprocessing is cleaning biologic debris and other foreign material from instruments before the disinfection or sterilization step. If this precleaning is not carried out properly, the disinfection or sterilization step may not be effective. 22

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Addressing clinical alarm hazards in all their forms requires a comprehensive alarm management program that includes stakeholders from throughout the organization. Failure to Effectively Monitor Postoperative Patients for Opioid-Induced Respiratory Depression Can Lead to Brain Injury or Death Hospitalized patients receiving postoperative opioids – such as morphine, hydromorphone, or fentanyl – are at risk for drug-induced respiratory depression, which can lead to anoxic brain injury or death. Even if they are otherwise healthy, such patients can be at risk if, for example: • They are receiving another drug that also has a sedating effect. • They have diagnosed or undiagnosed comorbidities that predispose them to respiratory compromise, such as morbid obesity or sleep apnea.

• A medication error results in delivery of more medication than intended – for example, an error is made when programming the dose or concentration on the infusion pump, or a bag or syringe of the wrong concentration or wrong medication is used. Intermittent spot checks of oxygenation and ventilation every few hours are inadequate for reliably detecting opioid-induced respiratory depression. To address this problem, a health care facility’s medical leadership should implement the relevant recommendations from the Anesthesia Patient Safety Foundation (APSF) and The Joint Commission. Inadequate Surveillance of Monitored Patients in a Telemetry Setting May Put Patients at Risk Inadequate surveillance of monitored patients in telemetry settings can lead to unrecognized critical events and subsequent patient harm. Factors that can contribute to this problem include: • The incorrect assumption that monitoring systems can reliably detect all potentially lethal arrhythmias • The trend toward using telemetry monitoring with sicker patients than in the past and in care areas where patients are not as closely supervised • The display of patient monitoring information solely at the central station, where events may be missed if staff are not present to observe the patient waveforms and data or if they are distracted with other tasks.

ECRI Institute estimates that approximately 70 percent of accidents involving a medical device can be attributed to user error or the technique of use. Errors can result if training: • Is not provided or is insufficient or ineffective (e.g., if it does not provide an assurance of competency) • Does not include all relevant team members, including physicians, per diem staff, and new hires, as well as regular staff • Is not completed by all relevant team members before they use a device in clinical practice

Consequences include serious patient injury or death. Alleviating this problem entails educating appropriate personnel about the limitations of monitoring technology and the factors that could lead to missed events, as well as implementing measures to improve patient surveillance.

ECRI Institute estimates that approximately 70 percent of accidents involving a medical device can be attributed to user error or the technique of use. Many of these incidents could have been avoided if users had a better understanding of the instructions for use and device operation. Facilities should make training a key part of the acquisition process for new OR technologies, as well as an ongoing consideration for existing technologies. Stay tuned for the next issue of TechNation where hazards six through 10 from the list are covered.

Insufficient Training of Clinicians on Operating Room Technologies Puts Patients at Increased Risk of Harm Insufficient training of clinicians on operating room (OR) technologies can result in use errors that lead to prolonged surgery, complications that require additional treatment, and even serious patient injury or death.

THIS ARTICLE IS EXCERPTED FROM ECRI Institute’s Top 10 Health Technology Hazards for 2016 Executive Brief that was posted on ECRI Institute’s website. For questions about the technology hazards or to purchase the comprehensive 2016 Top 10 Health Technology Hazards Solutions Kit, visit www.ecri.org/hazardsolutions, or contact ECRI Institute by telephone at 610-825-6000, ext. 5891, or by email at clientservices@ecri.org.

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AAMI UPDATE

AAMI CEO Announces Retirement Plans

AMI President and CEO Mary Logan announced her plan to retire at the end of this year during the fall AAMI Board of Directors meeting. Her departure will come almost eight years after she took the helm of the association.

Logan, only the second president and CEO in AAMI’s 48-year history, said her decision was based on personal and professional reasons. Personally, Logan, who will be just shy of 63 when she retires, said she wanted to spend more time with her husband and family, and enjoy a new chapter in her life. Professionally, Logan said she believes the end of next year would be good timing for a leadership change because the association would be in the middle of a three-year strategic plan, providing a new president with a clear path forward. “This was a difficult decision because I love AAMI and all that it represents. But it’s the right decision,” Logan said. “I think I’ve been the right president for AAMI during a pivotal period in its history. Looking ahead, AAMI will need a fresh perspective so that it can continue to grow and fulfill its mission in setting the standards – literally and figuratively – for healthcare technology and advancing the cause of patient safety.” Under Logan’s leadership, AAMI has positioned itself as a champion of healthcare technology and patient safety, enjoyed robust financial health, and vastly expanded its portfolio of resources for members and others in healthcare technology. “It didn’t take very long for everyone to recognize that a new energy arrived at AAMI when Mary became president and CEO,” said AAMI Board Chair Michael H. Scholla, global director of regulatory and standards at DuPont. “Mary quickly

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JANUARY 2016

learned the subtleties of various membership constituents and put plans in place to add more value from being an AAMI member. If I were to pick three major accomplishments they would be: being a great voice for our association in all situations, reinventing the role of the AAMI Foundation by focusing on key problems not addressed by other organizations, and leading by example.“ When making her announcement, Logan emphasized that her work was far from finished. “Anyone who knows me understands that I am not one to sit on the sidelines,” she said. “It’s been my honor to serve our members and work with AAMI staff, and I’m going to give it my all over the next 14 months.” The process to find a new president for AAMI will begin in the next few months with the formation of a search committee and the selection of a search firm.

HTM PROFESSIONALS, INDUSTRY FIND COMMON GROUND DURING SUPPORTABILITY FORUM Healthcare technology management (HTM) professionals have voiced concerns for years about the supportability of medical devices – from the availability of service manuals, documentation, and training from manufacturers to the cost of replacement parts. That discussion reached a new level when HTM professionals sat down with manufacturers to address one another’s interest and concerns head on.

MARY LOGAN AAMI President and CEO

During the Forum on Supportability of Healthcare Technology, more than 30 stakeholders representing HTM, original equipment manufacturers (OEMs), regulatory bodies, academic institutions, and service providers met at AAMI’s offices. Holding a meeting like this where all stakeholders could finally talk face-to-face was a major goal of the AAMI Supportability Task Force. Although the participants took time to identify the major supportability issues from both an HTM and manufacturer perspective, the workshop focused on developing solutions, not airing grievances. The major output was a “roadmap” that will guide future projects and initiatives. “The HTM and manufacturer communities came together to identify prospective solutions,” Michael W. Lane, associate director of the University of Vermont’s Technical Services Partnership, explained. “Some of these solutions will be easier than others to

effect. However, as author Seth Godin writes, ‘I learned that a long walk and calm conversation are an incredible combination if you want to build a bridge.’ The solutions from the Supportability Forum are part of that long walk.” The “low-hanging fruit” along this path – the actions the group agreed would help improve the situation with the least difficulty – included: • Creating minimum competencies for servicing and supporting healthcare technology • Remotely delivering training at lower cost • Having HTMs and other device users provide manufacturers with feedback to improve drive design • Developing service manuals with parts lists and schematic diagrams and offering these resources online • Creating and deploying templates for service licensing agreements and service strategies The group also identified solutions that would have a major impact on supportability but would be much more difficult to implement. Such items include mutually agreed upon accreditation standards for individuals who support and maintain devices and a web portal to exchange data and other important information between HTMs and manufacturers. Despite the difficulty of the road ahead, both HTMs and manufacturers said they are hopeful. “Change is possible and will happen because HTMs and manufacturers are both committed to doing what is best for patients and the clinicians who care for them,” said Michael L Mestek, program manager, medical affairs at Medtronic. Mike Capuano, manager of biomedical technology at Hamilton Health Sciences, agreed. “I consider the AAMI Forum on

Supportability a success. Not because it resolved the issue then and there but because it showed that it can be resolved and that continued focus on the issue will give it momentum towards resolution,” Capuano said. “Representatives of the OEM and HTM sectors interacted like colleagues. This is a very good sign, and I look forward to continued work with them on this important issue.”

FOR MORE INFORMATION, please visit www.aami.org/benchmarking.

NEW VIDEO PROMOTES HTM AS A CAREER OPTION A video highlighting healthcare technology management as an exciting and cutting-edge career choice is now available. It was created for AAMI with help from Indiana University-Purdue University Indianapolis (IUPUI). The video features students in the Healthcare Engineering Technology Management department (formerly called Biomedical Engineering Technology department) of IUPUI. The video opens with the words, “Looking for a Rewarding Career? Consider a Career in Healthcare Technology Management.” It closes with the URL www.IamHTM.com – a website created by AAMI to promote the HTM field. Other than those words, the video shows captivating footage of work with healthcare technology, with musical accompaniment. “I’d like to thank Barb Christe of IUPUI, and her IUPUI students on this terrific video,” says Patrick Bernat, AAMI’s director of healthcare technology management. “The video is brief, sleek, and of very high quality. It really hits the mark.” Christe is the associate professor and program director in the department at IUPUI. The video is available on YouTube at www.youtube.com/ watch?v=u1iTyvkwj3o. It was produced by Aaron Turner (www.aaroturn.com).

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C Biomedical, a unit of BC Group Inernational Inc., has released its newest model of safety analyzer, the SA-2500. The SA-2500 was created to fill the need for a more capable and user-friendly safety analyzer with AC + DC measurement. The new analyzer is a portable, durable instrument and has advanced testing abilities.

The SA-2500 includes all the usual features of a standard safety analyzer, including line voltage measurement, earth/ground lead resistance/leakage current, point-to-point testing, enclosure/chassis leakage current, external resistance and external leakage current. The SA-2500 has a universal power supply compatible with line voltages from 90-240 VAC with load currents up to 16 amps. All measurements are true RMS readings. The SA-2500 includes a variety of other features. With microprocessor-based technology, the SA2500 is able to separate and measure the AC and DC signals. The SA-2500 also has the ability to measure the quality of insulation of a productâ&#x20AC;&#x2122;s power wiring. This feature ensures that the insulation of internal

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wiring is intact and ensures a safe resistance between the power wiring and any exposed metal parts. The SA-2500 can be controlled remotely from a PC or laptop, which allows users to control measurements and test sequences. Through the Remote Operation, users are also able to produce reports and print results from a computer. The Remote Control Software allows the user to generate automated test sequences, providing for repeatable and consistent test procedures that can be shared or sent to technicians as needed. FOR INFORMATION about the SA-2500 or for purchasing information visit the online store at www.BCGroupStore.com or contact a sales representative at 314-638-3800.

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1TECHNATION.COM

Webinar

Wednesday

WEBINAR WEDNESDAY Supply Chain Management & Ultrasound Tips Staff Reports

echNation’s Webinar Wednesday series continues to provide top-notch educational opportunities to HTM professionals around the world. These free sessions have become popular educational tools for biomeds at every level. The most recent webinar, titled “Troubleshooting Techniques and Tips for the New Philips EPIQ 5/7 Systems” and sponsored by Conquest Imaging, addressed basic troubleshooting techniques and tips for the new Philips EPIQ 5/7 systems. The discussion began with an external overview followed by system architecture including image formation, processing, display and power subsystems. Signal flows and basic techniques were also be covered. The webinar was presented by Conquest Imaging Training Director Jim Rickner. He has over 20 years of experience working on a variety of electronic equipment. His experience includes repairing and operating flight simulators, specialty aircraft avionics, destructive material testing instruments and a variety of ultrasound systems. He has worked for Conquest Imaging over nine years and was the senior field service engineer prior to becoming the training director.

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JANUARY 2016

The webinar was informative and provided for questions at the end of the presentation with a Q&A session. Rickner answered several questions, and an overflow of questions meant some were later answered via email. The webinar received a 4.4 rating on a 5-point scale from the 282 attendees. Attendees also praised the webinar in a post-webinar survey. “Outstanding presentation by Jim Rickner. His 20 years’ experience with industry electronics was quite evident! Very clear and detailed explanations of the basic operations and troubleshooting of the EPIQ machines,” Paul R. wrote. “This was a great primer into the EPIQ platform and was well worth the time spent to watch it, very organized and informative,” Alan C. wrote. Another recent TechNation Webinar Wednesday presentation “Digital Tools to Enhance Supply Chain Management” by Kevin Gill, director national sales at AllParts Medical, examined the needs, shortcomings and ultimate goal of HTM professionals. There were 198 preregistered attendees for the AllParts Medical-sponsored webinar. Gill used the webinar to educate attendees on how to leverage online tools to better manage logistics flow within a biomed department. He looked at the small steps that have been taken in an attempt to formulate an all-encompassing interoperability solution for HTM professionals. He provided a brief overview of the “HTM Software Ecosystem” and said that while the tools are helpful none of them provide a

“This was a great primer into the EPIQ platform and was well worth the time spent to watch it, very organized and informative.” - Alan C.

complete solution that makes asset lifecycle management a promise unfilled. Tools are not standardized, harmonized or even well understood, according to the presentation. Gill said some of the obstacles preventing the development of a complete solution include too much customization; the software doesn’t match the workflow and costs. AllParts is working on a solution and has a new website that features some solutions. Gill encourages HTM professionals to push for standardization, single sign-in with one-time data entry and a people strategy (not just a productivity strategy). He said a solution must be found. The goal, Gill said, is HTM congruence that realizes real asset lifecycle management. TO VIEW A RECORDING of these webinars and others, or for more information about the webinar series, visit 1TechNation.com/Webinars.

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BIOMED 101

10 Best Practices for Electrosurgical Unit Testing Provided By Fluke Biomedical

ips to quickly and effectively test electrosurgical devices to ensure performance and safety

Let’s start with the basics Electrosurgical units (ESU) use a high-frequency electrical current to cut tissue and control bleeding by causing coagulation. Tissue resistance to the high-density current causes a heating effect which results in tissue destruction. Electrical current is delivered and received through cables and electrodes. The electrodes may be activated by either a hand piece switch or a footswitch. The ESU may use a monopolar or a bipolar mode.

MONOPOLAR VS. BIPOLAR

and the surgeon has little or no control over bleeding. This is the effect obtained by high frequency and low voltage. In blended cut mode, the surgeon achieves a much wider incision by heating up the tissue and letting it cool. This is achieved by lower frequency and higher voltage than pure cut. COAG Coagulation is performed by using high voltage and low frequency. In COAG mode, heat is incapable of explosive vaporization, therefore, resulting in a thermal coagulum, also known as a clot. In COAG mode, the surgeon has more control over bleeding because the tissue is allowed time to cauterize in between contact.

In monopolar mode, electrical current is delivered to the patient via an active cable and electrode. Current returns to the unit through a return electrode pad or plate to disperse the return current, thus preventing focused heat which can cause burns. In bipolar mode, two electrodes, typically the tips of a pair of forceps or scissors, serve as the equivalent of the active and dispersive leads in the monopolar mode.

10 BEST PRACTICES FOR ESU PERFORMANCE TESTING

MODES OF ELECTROSURGERY: CUT VS COAG

2. Adopt a consistent inspection frequency If the service manual and inspection procedure from the manufacturer is not available, the frequency of inspection must still be determined. One method for determining how often a medical device should be tested is a risk-based method used by the University of VT

CUT There are two types of cut modes: blended cut and pure cut. Pure cut is typically used for dissection only. In pure cut mode, the surgeon achieves a cut that is very similar to an incision produced by a medical scalpel. The cut is narrow, deep

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1. Always refer to the manufacturer’s service manual Manufacturer recommended test procedures should always be followed. Refer to the service manual for performance inspection tasks specific to the device. These service manuals typically recommend an inspection frequency. Complete the performance inspection per the manufacturer’s procedure.

Biomedical Engineering Department. This method is described in “Medical Equipment Quality Assurance: Inspection Program Development and Procedures” by J. Tobey Clark et al. available from Fluke Biomedical. For electrosurgery generators this risk-based method yields a twice per year (every 6 months) inspection frequency. Additionally, most major electrosurgical device manufacturers recommend semi-annual preventive maintenance testing to ensure the performance of the unit. 3. Adopt a formal standardized test procedure If the service manual and inspection procedure from the manufacturer is not available, it is still the responsibility of the medical facility to choose and standardize a test procedure. It is important that the electrosurgery generator functionality be quantitatively evaluated by comparing it to the manufacturer’s specifications, or the requirements in the applicable medical device standard. When the medical device manufacturer’s specifications are not known, the IEC standard requirements are a reasonable substitute. Once the inspection criteria have been agreed upon, no changes should be made without a rationale statement describing why a change was required, what the change is, and how this change was validated. 4. Pair additional test equipment with your electrosurgical analyzer for comprehensive testing Most manufacturer performance inspection procedures require electrical safety tests including ground wire

resistance and chassis leakage. Keep an electrical safety analyzer close by to complete the electrical safety portion of the performance inspection easily. Additionally, a medical oscilloscope can be used to show the actual wave shape of the device under test (DUT). This waveform output can be compared to the DUT’s service manual. 5. Be mindful of test leads while testing Keep all test leads and interconnecting leads as short as possible and do not cross or coil measurement leads. Radio frequency energy behaves differently than low frequency energy. It radiates and induces electrical current flow in addition to any conductive current flow through test leads that cross and coiled leads. When leads are too long they act more like antenna than test leads. 6. Always exercise caution when dealing with active electrodes Active electrodes present many dangers. Do not touch the active electrode or return pad/plate of the ESU while it is activated in either cut or coagulation mode. Turn off the ESU before adjusting or removing connections. Additionally, be aware of other flammable hazards: • Alcohol • Oxygen • Moisture 7. Perform all tests necessary to ensure performance Power distribution/output tests: Power distribution/output tests measure the power output properties of the ESU and supply output current (A), power (W), peak-to-peak voltage (V), and crest factor values. The power distribution test evaluates the output across multiple loads to determine how well the impedance-sensing-circuits of new generation electrosurgery generators automatically adjust the output of the ESU so that it is not reduced by the presented load.

High Frequency (RF) leakage current tests: The RF leakage current in electrosurgical units is a critical parameter to measure because it may cause accidental burns in patients. The particular standard for electrosurgical units, IEC 60601-2-2, indicates the maximum RF leakage levels and defines the elements and their layout to do these measurements. RECM tests: The RECM (return electrode current monitor) is the “watch-dog” that alarms (both audibly and visually) and prevents the electrosurgery generator from energizing when the high limit threshold for current flowing through the return electrode plate or pad has been exceeded. Inert gas flow and pressure parameters: In some electrosurgery generators a special option allows an inert gas envelope to be produced encasing the surgery site so that oxygen is eliminated at that specific spot. Oxygen causes charring of the tissue at the site of the surgery. Eliminating oxygen prevents this charring and produces cleaner, more precise incisions. These more precise wounds heal faster, with less opportunity for infection of the tissue. Test the gas flow and pressure for such inert gas outputs. 8. Use test automation to quickly perform tests, document measurements, and archive data One of the best ways to shorten learning curves for infrequently used test instruments and new or infrequently scheduled testing is to standardize the procedure. Additionally, make sure that pictures accompany the work instructions to show how it looks when test leads are properly placed, where mechanical adjustment and lubrication points are located, and wave form shapes are exemplified. To ensure that the flow and sequence of the tests are complied with, prevention of doing test out of order ensures that data is consistent and statistically relevant. There should be just one test report in which all test

results are documented. Test automation software provides these benefits when coupled with electrosurgical analyzers. 9. Always archive test results The purpose of testing and producing test results is to have a continuing stream of data showing all changes in the performance and safety of the electro surgery generator year over year. Long-term trending of this statistically relevant information provides the basis for predictive maintenance (i.e., when the next repair is most likely to happen) so that parts (especially long-lead time and costly parts) can be ordered and received just-in-time for the repair event. This saves money and increases up-time (the amount of time the medical device is available for use). The best place to archive test result information is in a database/CMMS (computerized maintenance management system). Archiving paper into filing cabinets rarely results in anyone capturing or understanding the longterm implications of failures. 10. Choose to test with an analyzer that you can depend on for complete preventive maintenance and safety testing. The QA-ES Electrosurgery Analyzer is an ESU tester you can depend on for preventive maintenance and ESU safety testing to test all critical functions. The Ansur-Automated QA-ES analyzer streamlines ESU preventive maintenance and allows users to increase productivity with the following functions: • Step-by-step test templates includes pictures, diagrams and hyperlinks • User-friendly Ansur test automation functionalities • Checklists and user messages • Output power, current, peak-to-peak voltage, and crest factor measurements • Low frequency leakage currents included when using an automation compatible with Fluke Biomedical electrical safety analyzers.

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SHOP TALK

Conversations from the TechNation ListServ & MedWrench Q:

Our facility is having difficulty retaining staff in our transport and other support areas. I have been asked by my COO if we could create a higher level position; (better pay) for persons that have shown an ability to multitask, or excel in their current job where they do menial tasks such as electrical safety or environmental survey rounds in hosptial rooms for outdated stickers and unsafe conditions. I was wondering if anybody out there was currently doing this or if you have looked at this type of system within your hosptials. I do know that there are some staff in these areas that would be well suited to do this task with proper training and an annual or semi-annual compentency check. This would help in two ways that I can see. It could be a springboard to help younger job seekers (employees) maybe decide to go on to college to become a skilled biomed or nurse, as well as take some of the lesser value work off of the higher paid engineers and allow them to do what they do best. I have heard of hospitals that have a PM only staff; but never to this degree of helping out to keep and retain talented staff in other departments. I conceive this being something like a transporter would be doing electrical/environmental only inspections during their lull period and then go back to transporting when the transport need arises. Any comments will be greatly appreciated about this idea and/or how a PM only person(s) structure works well or not. If you have tried or are currently doing something like this, I would love to hear about pitfalls or milestones you have encountered.

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Great idea and forward thinking. In a JACHO inspection not too long ago we were asked by the inspector, who happened to be a retired engineer, what makes us qualified to work on certain equipment, he was asking all of us but was looking at one of our Biomed I technicians. This question could have been drilled down to a gnats fanny if he wanted to but he was OK with our response which was: We have competencies for our staff on test equipment. We hold weekly cross-training sessions which are documented and our staff has a PM competency for that specific piece of equipment signed off on by a senior tech. The inspector already knew this individual had an associate of science degree in biomed technology. I just wonder, in your case, how far your competency check-off list would go if somehow a patient was injured or worse. A good lawyer would have some serious concerns about your staffing methods if this situation happened to occur. I would certainly run the idea through your risk/quality folks as well as your EOC committee just to protect yourself. I would also look at my risk assessment policy in my equipment management plan and determine the cut-off point which you would feel comfortable having this type equipment have maintenance performed by these job positions. Our risk assessment is in levels from patient death/injury to no significant risk. Whatever you decide, I would also run this decision through the committee. Unfortunately, in my career, I have been in front of multiple lawyers giving a deposition multiple times. It’s quite

impressive how the lawyers drill down on qualifications for those who work on medical equipment. The moneymaker is finding fault in the facility and this is often by having someone in the facility do something wrong, out of policy or having non-qualified folks performing tasks they should not be doing. The latter is often the case. I remember one particular incident many years ago at another facility I worked at. There was a STAT call for me to go to nuc med. When I arrived there was a middle-aged male getting off the floor, the carbon fiber table top had broke and he fell. The very first thing out of his mouth was “I want to see all maintenance records for this equipment.” I kid you not. Fortunately. in this case, the manufacturer of the table was at fault and there was a nationwide recall. Not trying to yell “the sky is falling” I would just spread the risk, make sure the equipment they work on is not critical and to show competencies and continued education.

I’m trying to do that here, we have been a one biomed shop but over time the hospital has grown, and since I’m also the preparedness coordinator, safety equipment management coordinator for biomed/ facilities, and other responsibilities, I am begging for at least a part-time employee who I can train and who can do the mundane stuff and work their way up.

We have two staff members that rotate through the hospital and clinics cleaning medical equipment on

the floors. Part of their duties are to report safety issues and physical plant issues. Their title is “Equipment Technician.”

I have a Philips HDI 5000. It gives the FEC error 19C40404. My manual gives no more detail than FEC. It also states the source could be elsewhere. The symptom is a boot error of 002 only when a probe is selected. Diagnostics do not give an error. Selecting the fake probe results in the same symptoms. Any assistance would be greatly appreciated.

Reseat all the boards in FEC. Also make sure you do not have L12 in slot one because it will bog down the FEC. Check power supply, Follow Up: Appears to be fixed. I found the PSM voltages to be in spec and clean except the 5V and 5Vref. The 5Vref has noise, approximately 100mV. The 5V supply was 5.22V and no noise. The max allowed is 5.1V. I checked a

second machine and it had 5.18V. The first machine would produce the error every time a probe was selected. The second machine would only do this occasionally. After much searching and head scratching I found the Vicor supply to be the problem. The PSM has 3 Vicor 5V modules. There is a master and two slaves to boost available current. The master is controlled on the Trim or SC input. I found all feedback and trim components to be within spec. It would appear the Vicor modules change with age. By reducing the size of the gain resistor R832 on U39 voltage set amplifier the voltage is reduced on the master 5V Vicor supply module. A 10 percent reduction of resistance results in approximately 5 percent voltage reduction. Now that the 5V supply is running at 5.08 the unit has not failed. The second machine has not failed either. I never did find the source for the noise on the 5V ref line. It does not seem to cause image noise or any other problems. Hope this helps. I have a hand

drawn schematic of the Trim set amplifiers if anyone is interested.

I found your post at a forum where you wrote that you had error 002 in your ultrasound. Can you send me schematic of the Trim set. Maybe you have advice how to win this error? Follow Up: I found that my first solution of the trim resistors did not take care of the whole problem. It showed up after my return. I can send the partial schematic if you would like.

Remove the front-end controller and look for a burnt spot on the motherboard. We had the same problem that drove us crazy until we discovered the motherboard had a partial burn transistor. THESE POSTS are from TechNation’s ListServ and MedWrench.com. Go to www.1TechNation.com/Listserv or www.MedWrench. com/?community.threads to find out how you can join and be part of the discussion.

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ROUNDTABLE Patient Monitors

1TECHNATION.COM

NOVEMBER JANUARY 2016 2014

atient monitoring devices have advanced over the years as new technology continues to extend the capabilities of these life-saving tools. TechNation contacted experts in the industry to gain their insights to patient monitors, including the latest advances, software updates and the benefits of purchasing new or refurbished equipment.

The panel of experts includes Pacific Medical Director of Technical Solutions Brian Barton, Gopher Medical Product Specialist Matt Bion, Sage Services Senior Integration Director Ed Decker, BioMedical Equipment Service Company (BMES) President and CEO Ed Evans, Southwestern Biomedical Electronics President Larry Neilson and Integrity Biomedical Services Service Manager Brad Sailsbury.

WHAT ARE THE LATEST ADVANCES IN PATIENT MONITORS?

Barton: Remote patient monitors and alarm trends into a remote alarm that is reusable by nurses. Wireless alarms. Integration live patient monitoring equipment. It all gets out on the same main screen so you can have it all on one screen. For instance, you can be on Floor 3 and see Floor 4. Bion: One product worth mentioning is wireless telemetry with Frequency Hoping Spread Spectrum (FHSS) technology. It works within a subchannel of Wireless Medical Telemetry Service (WMTS) bandwidth – it carries a strong signal and is known to be very reliable. This technology can be found in GE’s Apex Pro FH Telemetery System. Furthermore, the Apex Pro FH can transmit and receive information from 640 different channels. Using this advanced technology, the transmitter is capable of monitoring ECG, SP02, NIBP and Temperature and provides increased monitoring flexibility, more secure with less signal dropout problems.

Decker: We’re seeing more patient monitoring devices with color touch screens for ease of use and wireless capabilities allowing continuous connectivity to central monitoring and electronic medical records (EMR). Many of the devices are also being designed to be more portable/wearable offering patients the freedom to move around the hospital. Evans: Patient monitors have come a long way in the last several years. Although not new, most patient monitors now have several ways of communicating information from the patient to the appropriate system within the hospital. Many monitors are already on a network backbone throughout the hospital using telemetry/transceivers. They use data management software that links them with the network that allows for off-site and on-site analyzation of patient data as needed. Neilson: Many features that were additional options on patient monitoring systems a few years ago are now included at no additional cost. ETC02 is widely used and required in many sedation procedures and is typically an “add-on option,” but is available from nearly all manufacturers. New and/or improved audio/visual alarm variations are now engineered into monitors as alarm management is increasingly important. EMR interface is now a must. All new monitoring must interface to record gathering software. Diagnostic software is improving, such as arrhythmia or other cardiac activity. Sailsbury: Patient monitoring at its core has not changed. The body is the same and we are measuring the same parameters. What has changed is the new way of looking at data, mainly with mobile devices. Due to advances in mobile technology we have access to complete data from wherever we are, which leads to better patient care.

WHAT ARE SOME IMPORTANT PATIENT MONITOR TOOLS/ FEATURES HTM PROFESSIONALS SHOULD CONSIDER TO ASSIST WITH ALARM MANAGEMENT?

Barton: Logarithm now with alarms. How many times patients go from Level 1 to Level 3. Alarm trends for patient care. P02 Level 96 to Level 98 they will set it so they can maintain the patient much better. Makes for a happy patient. You can essentially have a reduced staff and save money with accurate alarm management. Bion: I believe it comes down to staff training. For example, making sure all the clinical staff is adequately trained and fully understands all the alarm configurations and significance of each alarm. In addition, reviewing the monitor’s recorder history is helpful for establishing alarm patterns and identifying possible issues. Furthermore, it would be useful to collaborate with the manufacturer and other local hospitals for their input and solutions. Evans: Alarm management is of course an important factor in the health care industry. There are tools available now that allow for better management and programming of patient monitors. For example, Philips uses the Mark2 tool which allows a variety of setups of profiles on monitors. Tools like this allow each monitor to be programmed according to the needs of each specific department in the hospital. Discussing these types of tools when purchasing equipment is always a good idea. Neilson: Visual, audible, and staff notification techniques are all equally important. Most monitoring currently manufactured has color LEDs in various forms, bars, lights, etc. and these typically can be user changed to allow notification of a specific color/frequency/audible pitch for staff to immediately recognize. Sailsbury: The features to combat this exist today, but staff needs to be educated on and empowered to use them. Alarm fatigue is a problem most facilities are facing. Educating staff to use the device settings specifically for their patient is one way to combat this. Patients are not all created the same, so expecting staff to use the same settings for each patient will create unnecessary alarms.

THE ROUNDTABLE

HOW DO YOU RECOMMEND THE MANAGEMENT OF SOFTWARE UPDATES FOR PATIENT MONITORS?

scenarios. Also if some devices get updates and one or two missed, then they are different. One should ask “Will this improve patient care?” or “Will this confuse staff and harm patient care?” And, “Is this update important?” In my opinion, it must be controlled by the HTM department.

Barton: When you purchase monitors, always negotiate software updates at the time of purchase. Bion: The biomedical department needs to work closely with other departments within their institution and the manufacturer to learn more about the update. For example, is this a mandatory or optional suggested update by the OEM? How will this update affect other equipment? Once these questions are answered, the biomed department has some form of asset management program to track products and repairs within their system so information could be stored in a central location for status updates and scheduling purposes. Decker: We interact with HTM professionals regularly because of our service expertise across a wide range of OEMs and devices. We frequently receive tech support calls as a result of software incompatibility. Many facilities appear to stagger software updates by departments causing one department to have one revision of software on their equipment and another area of the hospital to have a later revision of software on their equipment. This can cause incompatibility issues if the equipment moves from department to department. So, a hospitalwide software update is a recommendation to eliminate any potential conflicts. 36

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BRIAN BARTON Pacific Medical Director of Technical Solutions

Evans: In today’s world of ever changing software and updates happening rapidly, management of updates can get confusing and very disorganized at times. As a result, I recommend that hospitals utilize some type of system to keep track of what revision is on each monitor at the time of each update. My suggestion would be to utilize a two-step process. First, make sure there is a physical label on each monitor of its current revision. Second, record that in some type of asset management system. This will allow for quick recall on revisions when needed. Neilson: Some manufacturers today include software updates on their sales quotes. If they don’t, they should. It should be negotiated into the contract at the time of purchase. Updates can improve performance but they can also confuse the user. Staff may be so familiar with their equipment and soft key operation, a non-required update gets installed and “hey where is the remote view button” or any number of

NOVEMBER JANUARY 2016 2014

Sailsbury: I suggest a very proactive process of reaching out to the device manufacturer on a regular basis. Schedule a time every three to six months to check for mandatory and voluntary updates. This approach will give the facility control in making sure everything is up to date.

HOW CAN HTM PROFESSIONALS ENSURE SERVICE KEYS ARE PROVIDED WITHOUT INCURRING ADDITIONAL COSTS?

Barton: Negotiate all service keys and service manuals when you purchase the units. The sales reps here will give it to you, whereas you have to purchase new to get it from the OEM. Bion: Becoming more involved with the decision-making process when purchasing capital medical equipment. During the initial stages of the equipment negotiations, use the hospital’s buying power and negotiate that the software licenses will be provided for the lifespan of the equipment. When issuing the purchase order, be clear what keys are included and for how long is spelled out as a line item in the purchase contract. The ultimate goal is to keep costs

BRAD SAILSBURY Integrity Biomedical Services Service Manager

down from the initial purchase for years to come. Decker: HTM professionals need to be included in the decision-making process as hospital administrators and clinicians evaluate suppliers for any upcoming equipment purchases. HTM professionals understand the ongoing resources needed and costs associated with maintaining patient monitoring equipment during its lifecycle and can insist that training and that service keys are included in the purchase price. Neilson: It’s got to be done at the negotiating table at the time of purchase, or at service contract signing time. Sailsbury: The first step to this is to only buy from someone who is willing to train your staff. If necessary, be sure to work this into your contract at the time of purchase.

IS IT POSSIBLE TO KEEP UP WITH THE LATEST ADVANCES AND IMPROVEMENTS WITHOUT

BUYING BRAND NEW?

WHAT ARE THE PROS AND CONS OF USING OEM PARTS FOR REPAIRS?

Barton: Work with your third-party vendors, as they can get you into a year old monitor instead of having to buy new. If you just need a bed system instead of a whole floor, you are able to buy at a cost savings. Bion: Yes it is, by working with an established reputable vendor. Specializing in patient monitoring, we can offer current products with technical support services; along with buying options, new, demo and refurbished equipment. With a seasoned sales and support staff we offer customers more options and provide solutions. From building servers to selling monitors with the latest software, we understand the technical requirements needed. Selling current technology with the same warranty as the manufacturer, plus saving customers money, it makes financial sense to explore other options, such as refurbished equipment. Decker: Yes, in many cases hospitals can. A large piece of our business is the sale of used/ refurbished patient monitoring equipment. We have access to some of the newest equipment on the market providing our customers a price competitive and trusted alternative when purchasing new from an OEM is cost prohibitive. Evans: It certainly is. The third-party market provides some fantastic opportunities in this area. In fact, I would suggest that the best value would actually be found in purchasing refurbished

ED DECKER Sage Services Senior Integration Director

equipment. We have found that we can save hospitals a considerable amount of money by going this route. Many of the advancements that have been made these days are progressive in the sense that a series of small changes lead to big changes in technology. As a result, while refurbished may not be new, it provides a way to keep up with those progressive changes without killing the budget. Neilson: In most cases it is. Many good and valuable improvements cannot be installed in older equipment. Health care facilities should consider their use of monitoring. Some older equipment still has a valuable place in many facilities. Sailsbury: Yes, it is absolutely possible to have the latest and greatest without buying new. Many times third-party companies will have the latest model of preowned equipment. I suggest that facilities in search of equipment research all avenues before purchasing.

Bion: There are several advantages to using OEM parts for repair processes. First, the quality of parts and the reliability of the parts used are to be considered. Also you can be confident that the parts went through a quality-testing process and reliability testing. The only problem with using OEM parts in the repair process is the cost of parts is generally higher increasing the cost of repair. Decker: In many cases the OEMs don’t offer a complete parts inventory for their patient monitors making it difficult for HTM professionals trying to service their equipment onsite. Also, many of the OEM parts sold are priced excessively high making onsite repairs cost prohibitive. Evans: There has been a general belief that OEM parts are best for many years now. However there are challenges that come with OEM parts and the customer experience when getting parts. Premium price points, slow delivery time, shorter warranty periods, backorders, and lengthy processes to get parts returned when there is a problem are just a few of those challenges. With that said, we utilize OEM parts in many of the patient monitors we repair and refurbish. The pros of using OEM parts are pretty straight forward as well. You know the part will be designed correctly. You can also know that you will not have to hunt a part

ED EVANS Bio-Medical Equipment Service Company (BMES) President and CEO

down with multiple vendors to find it. With that said, this is why we stock a variety of parts to be able to meet our customers’ needs promptly and with a high-quality part. Neilson: Pros are that you should receive the part that works and is recommended by the manufacturer, however I know that some, not all, parts change at the manufacturer. An example is a NEC display that may no longer be available so the manufacturer has to change to whatever is available. So just because you purchase OEM parts, it may not be the same as what you are replacing. Cons are typically price. We purchase our parts from the same manufacturer of the component that failed. The electronics industry changes very quickly these days and manufacturers often have to send out a “kit” to fit a part/ assembly that they no longer can purchase. Sailsbury: Sometimes the OEM may provide a new part or a part that is a new rev level or software version. However, the

THE ROUNDTABLE

Evans: When replacing or adding patient monitors to existing networks in the hospital, remember to include all software and hardware options that are needed. This will speed up the process for you and get the equipment on site much faster. If you are unsure of what options you need that’s a great discussion to have on the front end of getting a quote. That’s why one of the first questions we ask customers when they inquire about patient monitors is, “What options do you need your monitor to have?”

exceed OEM offerings and are sold at a fraction of the cost. HTM professionals can expect savings of 25 to 50 percent or more depending on the part.

LARRY NEILSON Southwestern Biomedical Electronics President

newest model may be an insignificant change and with a refurbished part you may get a longer warranty and the equipment will continue working exactly as it should. Cost is certainly another aspect to explore, many times OEM parts have a significantly higher price point.

WHAT ARE THE PROS AND CONS OF USING REMANUFACTURED PARTS FOR REPAIRS?

Bion: The only advantage to using OEM remanufactured parts is the cost is generally lower than OEM parts. Parts might not be of the same quality, and testing might not be as detailed as the OEM processes. But the cost is reduced and may be more affordable to the consumer. Decker: HTM professionals should feel confident in buying refurbished parts as long as it’s a trusted source with industry expertise and knowledge. These parts typically come with warranties that match or

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Evans: There are many variables with this question, however there are two main drivers from my perspective. First, its important to make sure that any part used that is not OEM is tested out well before being put into use. In today’s world of so many third-party compatible part options it is critical to make sure the part was manufactured well and is fully compatible regarding form, fit and function. It’s not enough to just check function anymore from my perspective. We put a lot of focus in this area to ensure that all parts used meet our standards of form, fit and function. Second, well-made parts are well-made parts. Ask yourself this question, “Where is the best value going to be long-term for the health care facility using this part?” Often non-OEM parts can provide a better value than OEM parts when it comes to the budget constraints being faced today. While at the same time providing a high-quality part. Neilson: Pros are hopefully price and warranty may also be better than the OEM. Also, in our services, we provide a better part and I believe that is the case in many ISOs. Again, an organization that provides a remanufactured part must be better in many areas for repeat business. Cons are receiving a lesser quality and/ or used part and that depends on the provider.

NOVEMBER JANUARY 2016 2014

MATT BION Gopher Medical Product Specialist

Sailsbury: Our customers typically enjoy reduced costs and a longer warranty on high-quality products. Additionally, we continue to provide parts for aging equipment that the manufacturer will no longer support. The part may not be new but we provide a longer warranty than the manufacturer to combat this.

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR HTM PROFESSIONALS TO KNOW ABOUT PATIENT MONITORS?

Bion: When purchasing equipment or sending your products in for repair, do not base your decision solely on the lowest bid – look at the whole picture. For example, look at the quality of the product, turnaround times, product knowledge, integrity and values. You will benefit in the long run by doing so. There is a lot of truth in the saying, “You get what you pay for.”

Neilson: Cost containment has always been a high priority and in our experience this is more important than ever since the enactment of the Affordable Care Act. HTM professionals should at least investigate the independent companies that can help them with prolonging the life of their patient monitoring devices. There are many good ISOs out there and finding one with experience and staying power (longevity) can be a tremendous asset to their department. Sailsbury: Patient monitoring is a first-line defense for staff and having monitors that work accurately is non-negotiable. It is invaluable for HTM professionals to have a trusted source for both education and support. In selecting an equipment manufacturer or service provider, look for a well-educated team that provides quality products and reacts quickly to your support questions and parts needs.

THE ROUNDTABLE

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N U R&S E S

BIOMEDS

A Winning Team for Positive Outcomes BY K. RICHARD DOUGLAS

When patients and family members see strong relationships between nursing, clinicians and biomeds, the patient and family members feel more at ease and have better satisfaction. - Jason Misner, CBET

NURSES & BIOMEDS

Biomed Team on staff

JASON MISNER, CBET

Biomedical Supervisor for ARAMARK Healthcare Technologies

STEVEN KELLEY

Manager of Biomedical Engineering at Piedmont Atlanta Hospital

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egistered nurse, public speaker and author Donna Wilk Cardillo once said: “Nursing is not for everyone. It takes a very strong, intelligent, and compassionate person to take on the ills of the world with passion and purpose and work to maintain the health and well being of the planet. No wonder we’re exhausted at the end of the day.” There are 2.9 million registered nurses nationwide and nursing makes up the largest health care profession in the U.S. Nursing is a profession that also requires critical thinking skills and the role of the nurse has evolved with the changing face of health care. From Joyce Slinsky to Mary Todd Lincoln to Florence Nightingale, nurses have been a part of American and world history, offering caring and compassionate treatment to patients in diverse settings. As one of the primary users of medical equipment, nurses inherit a unique dynamic with HTM professionals. The two occupations are vastly different but share the same common goal of providing good outcomes for patients. The primary touch point though is the equipment that biomeds fix and maintain and that nurses rely on to do their jobs. Because of the mandatory interaction and the close proximity

JANUARY 2016

that the two professions work in, it is critical that they respect and cooperate with each other, with continuous dialogue as a goal and necessity. Cultivating a close working relation with all clinical staff demonstrates to those colleagues the value of the biomeds as more than repair people. Just as HTM professionals have faced an environment that has moved toward more complex technology, nursing has evolved within an increasingly complex health care environment to require more education. As reported in the Wall Street Journal, nurses are finding that more education is a requirement of employment. The WSJ reports that part of this is because the number of “nursing programs of all kinds jumped 41 percent” between 2002 and 2012 in response to an anticipated shortfall of nurses. Still, many hospitals have patient-to-nurse ratios that reflect understaffing in an era of belttightening. This impacts quality of care and makes each nurse’s job more difficult. The profession seems to be cyclical in the numbers of graduating nurses and a shortage of instructors is a recurring problem. In this environment, where nurses are entering the profession with more education and skills, it becomes incumbent upon HTM professionals to continue that education as it relates to the proper handling and use of medical devices. One problem that vexes nurses and the HTM profession is quickly advancing technology. This includes more complex medical instrumentation and the reality that full interoperability is a ways off yet. When devices can’t talk to the EHR, nurses are faced with more work.

Nurses report that they already spend at least an hour of each shift dealing with medical devices, according to a Harris Poll. Alarm fatigue and troubleshooting make the nurse’s job more difficult and frequently requires the intervention of a biomed. TWO-WAY STREET Rounding is an important way for biomeds and nurses to share information. Communication and the ability to listen to the nurses’ needs was revealed in an AAMI News article as the quality that nurses look for most in an HTM professional. According to the article, there are several ways that the HTM department can build stronger relationships with nurses. Some of the suggestions included publicizing your team, listening first, speaking the same language, attending clinical meetings and involving the nursing staff in purchasing decisions. Another suggestion was to do rounds. “One of the most important tasks biomeds have is daily rounding. Rounding provides biomeds the ability to interact with nurses and other clinicians without entirely focusing on broken equipment,” says Jason Misner, CBET, biomedical supervisor for ARAMARK Healthcare Technologies in Albany, Georgia. “Daily rounding allows the building [of] personal relationships with nurses and other clinicians, which helps everyone when dealing with medical equipment related problems,” Misner says. “When patients and family members see strong relationships between nursing, clinicians and biomeds, the patient and family members

feel more at ease and have better satisfaction.” Nurses agree that this is a beneficial activity, although they may see it from a more “welcome to my world” vantage point. “Biomeds rounding with nurses allows them to see the equipment they work with in real world, patient situations. It’s easier for the biomed to then understand the abundance of technology nurses deal with daily; the distraction that occurs from nuisance alarms; the frustration staff deal with when equipment doesn’t function as expected, etcetera,” says

day. Biomed is a part of this and discusses issues each day. I listen to issues in the patient care areas and jump in to assist when appropriate,” says Steven Kelley, manager of biomedical engineering at Piedmont Atlanta Hospital. “One big issue is that the nurses do not always know what Biomed does and what we can assist with. Rounding on each unit on a regular basis allows us to communicate this to the nurses and gives them a way to share what is not working back with us. This is a very important process,” Kelley says.

One of the most important tasks biomeds have is daily rounding [....] Daily rounding allows the building [of] personal relationships with nurses and other clinicians, which helps everyone when dealing with medical equipment related problems.” - Jason Misner, CBET

Maria Cvach DNP, RN, FAAN, Assistant Director of Nursing, Clinical Standards, at The Johns Hopkins Hospital. “Biomeds make rounds and check in daily with the charge nurse to see if there are issues that need to be addressed,” she adds. BIOMEDS EMPOWER NURSES HTM professionals know that they can aid their nurse colleagues, but it requires a regular dialogue. “We hold safety huddles every

Misner says that rounding allows for the expression of concerns by nurses that the nurse may not think rises to the importance of a service call. “These concerns are perfect opportunities to teach and bond. It is the greatest compliment when a department requests you by name for their equipment issues,” he says. “I have been on rounds and found that there was an intermittent signal coverage in telemetry,” Misner says. “I found that one of the floors communication closet UPS was

NURSES & BIOMEDS

Working in the demo lab, we were able to play with default settings until we got the monitor screens to function most effectively ... Our biomed used this opportunity to teach us about the different options for the display screen and explained some of the default settings.” - Maria Cvach, DNP, RN, FAAN

powered off. I also was told that this issue had been going on for about 12 hours. I used this opportunity to train the telemetry staff. They understand now [that] even if they are having an intermittent issue, it is better to call biomed than not.” The working relationship that biomeds and nurses can express through rounding may play out to a bigger audience as well. From the nurses’ perspective, knowing what their world looks like is a recurring and important theme. “By rounding together, a unified front is presented to the staff and patients. This promotes a culture of collaboration,” says Nancy Laster, BSN, RN, CENP, senior director of Inpatient CV Nursing at Piedmont Atlanta Hospital. “The rounding also helps to understand that perspective of the staff that are actually using the processes that are put into place. A couple of weeks ago, I rounded with the head of our Biomed Department to assess the equipment needs and process of the units,” Laster says. “Both of our perceptions were different from what the staff actually did in the clinical areas. This rounding revealed areas for

1TECHNATION.COM

JANUARY 2016

education and improvement of processes. If the clinicians are able to spend more time with patients, and less time looking for equipment that is needed everyone is happier and safer,” she adds. There are times when interactions between HTM and nurses benefit the biomed and others where the nurses glean some important information. “We have a demo lab which includes the basic equipment that is used on units such as monitors, ventilators, and the nurse call system,” Cvach says. She explains that nurses benefit from testing patient scenarios in the demo lab. Recently, some changes were made to the monitors which caused an unintended change in the display screen. “Working in the demo lab, we were able to play with default settings until we got the monitor screens to function most effectively,” she says. “Our biomed used this opportunity to teach us about the different options for the display screen and explained some of the default settings. This is much more effective than trying to read the operators manual which is not user friendly for nurses.”

OPEN LINES OF COMMUNICATION Using the right approach with nurses and other clinicians may include the way things are said. Also, making time for shared inservice training can be helpful. “Anytime I repair or determine why equipment is not working the way it should be working, I make sure I communicate with as many users as possible,” Misner says. “What I found and what may have been done different is anything to prevent the issue again. I have found that the majority of people appreciate any information to prevent downtime of equipment. It is very important not to blame or embarrass the end user, if it is found out it is a user error.” “We have identified common issues with beds and sent out a troubleshooting guide for them to check before they send the bed down for repair,” Kelley says. “We do continuous training in OR to make them aware of common issues like putting items on the base of the OR tables and then they get crushed when the table is lowered. We worked with the OR staff to identify a better process of where to put the equipment and to do a stop and check before lowering the table.” Structured training time benefits both groups on many levels, according to Misner. “Another way I have found we can empower nurses with troubleshooting information to reduce down-time is sitting in on as many in-service training side-byside with nurses,” he says. “This provides relationship building and mutual respect for all. I have found during in-service training you can learn so much from one another. You can learn what concerns nursing

has with new technology and what they need help with to do their jobs. You also have the ability to ask questions that nurses may not ask and will help them use and treat the equipment better.” Kelley points out that biomeds need to be more than just the fix-it guys for the equipment. “We need to show that we can assist in a lot of other areas around patient care support by taking on concerns and issues they are having that we can assist with,” he says. “It might be an issue with power cables from the equipment causing a trip hazard. Or mounting a vital signs monitor on a workstation on wheels so they only have to push one device into a room instead of two,” Kelley says. Kelley also says that biomeds might conduct training on equipment tracking systems so they can better manage and find their equipment and save time. Nurses appreciate having the troubleshooting knowledge. “Knowledge is power. If a nurse or clinician, at the point of care can troubleshoot equipment, it gives them the power to move on with the task at hand,” Laster says. “Clinicians at the bedside do not want to take on the duties of a biomed tech, but troubleshooting allows them to see if there is a simple fix. If it is a simple fix, it allows the flow of work to continue.” The gist of every insight on this topic leads back to communication and mutual respect. As is the case in every profession, there is a need for cooperation and coexistence between people with widely varying backgrounds and skill sets. Listening and learning benefit both groups.

Misner says HTM professionals can benefit from good relationships with their nursing colleagues. “Every interaction with nursing is an opportunity to learn. Even if we learn terminology, protocols or just their expectations. Knowing nurses’ terminology helps communication between biomed and nursing. Understanding nursing protocols and expectations allows the biomed department to be more efficient in supporting the nursing and clinical staff,” Misner says. Kelley agrees that both professions and patients benefit from a quality working relationship. “As biomed better understands the needs and issues of the nurse’s daily routine, we can make adjustments to our process to make everyone’s day better,” Kelley adds. And therein lies the two-way street that benefits each professions. Walking a mile in the shoes of a colleague in a very different occupation can prove to be mutually beneficial. While nurses are the customers of biomeds; biomeds and nurses have the same mutual customers. “I believe we are at the beginning of working together to define processes and structure in our hospital. It is very important to learn from other disciplines. It is very surprising to see what someone has observed from a different perspective,” Laster says. “Hospitals across the country are moving from a culture of silos to an integrated machine that works for the common goal of patient outcomes,” Laster adds. “We have always worked toward patient outcomes, but not always in unison.”

MARIA

Assistant CVACH, DNP, RN , FA Dir Standard ector of Nursin AN , The Jo hns Hopk g, Clinical ins Hosp ital

NANCY LASTER, BSN, RN, CENP

Senior Director of Inpatient CV Nursing at Piedmont Atlanta Hospital

Teamwork makes the dream work!

NURSES & BIOMEDS

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JANUARY 2016

1TECHNATION.COM

CAREER CENTER By Todd Rogers

retend for a moment that you are desperately unemployed. It might look like this: you’ve got bills piling up, you’ve got kids to feed, it’s been greater than 6 months since your last check and your parents and siblings are not willing to lend you any more money. Now, imagine that you’re sitting in an interview for a job that seems to be an ideal fit. Things are going smashingly well and you’re getting your hopes up that the slump is nearly over. And then suddenly, the hiring manager asks you a question that takes your breath away; he asks one of those questions that you were hoping, no, that you were praying he would not ask. You get that surge in your gut. You feel your tongue dry up. Your palms become clammy. You fidget as you try to come up with the most plausible answer. You start to form words and the only thing that stumbles past your lips is a clumsy set of utterances that resembles the words of a drunk college student on Spring Break.

TODD ROGERS Talent Acquisition Specialist for TriMedx, Axess Ultrasound, eProtex and TriMedx Foundation

1TECHNATION.COM

JANUARY 2016

A week goes by and in your mailbox you discover a thin envelope. You don’t even need to open it. Thin envelopes are the epitaph of a deceased job opportunity. What could you have done differently? I prepare dozens of people for job interviews each month and I’m going to share with you the one preparation exercise that seems to work better and more often than any other. But, it comes with a warning: this is not an easy exercise. This is not a quick-fix, either. However, if you take me up on this challenge, you probably won’t have to prepare for another job interview for the rest of your career. The reason that people stumble on interview questions is that they don’t prepare for the unexpected. The conundrum is, how does someone prepare for something when he or she has no idea what that something might be? I’ve thought about this one for a long time. As far as interviews go, I have an answer: you can’t prepare for the actual question that’s going to punch you in the gut. There’s absolutely no way to anticipate what a complete stranger is

going to ask you. It’s doubly difficult when that stranger holds all, or nearly all, of the power. After all, you’re desperately unemployed. As such, I can assure you, you have very little power in that situation. You have to prepare and anticipate that you will be asked something that you really don’t want to be asked. There are contextually appropriate questions and inappropriate questions. I highly doubt that you will be asked about off-limit topics. But some of the appropriate ones include: Why are you unemployed? Why have you been unemployed for this long? Have you ever been fired from a job? What is some of the most difficult advice a boss has ever given you? I could probably make this list go on for several pages. But, deep inside of you lurk a few questions that you really don’t want to confront in private, let along during a job interview. And if you really want to bomb the interview, then make sure you remain in denial of those difficult items. If, however, you want to ace the interview, please take out a single sheet of paper and do the following exercise for one week. As you do this exercise,

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bear in mind that you will share this information with absolutely no one at all. This exercise is entirely personal and at the end of the week, you will destroy the evidence. On the top of the piece of paper, write the following sentence: “I really hope that no potential employer ever asks me the following questions.” After that, start writing what those questions are. After each question, write out a response and say it out loud. Repeat for 5 minutes each day. When 5 minutes is up, put the paper away but make sure that you come back to the exercise the following day. Repeat it again: write out more questions and write out more answers. Say them out loud. I don’t want to sound like a deep-South preacher but pay close attention: you are going to have to confront the demons at some point in your life. Those demons are in the business of making your life difficult. If left unchecked, the demons will always get the best of you, every … single … time. But, if there’s one thing I know about demons, it is that their power exists only if you allow them to have it. When you unmask their little demon faces, you will always be laughably surprised at how petty they are. This exercise is how you do just that: unmask the demons that will cause you to bomb the interview. It’s important that you write and write some more. The most difficult issues that must be faced are also the ones that are typically the most deeply suppressed. Repeatedly writing, even writing the same thing over and over causes fatigue in the creative centers of the brain and eventually the brain will just want to come clean and true concerns will come out. There is some really good news included in this. If you spend time preparing as I’ve noted, you really don’t have to prepare for anything else. OK, if you’re ambitious, you would be doing yourself a favor by brushing up on some of the common behavior-based questions and answers. Tip: those are the ones that begin with, “Can you give me an example of a time when … ” Another tip: behavior-based questions are framed to be difficult and the example doesn’t have to be very relevant. The answer simply needs to demonstrate that you listened to the question and you are paying attention as you go through life. There you have it. The one simple tip that can give you a massive edge over other candidates. If you practice for the difficult shot, all of the other shots will be easy. Now, before you forget, take out that piece of paper and put it in the fire.

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In the Beginning…. By Matt Tomory

wish to begin this article by wishing all our readers out there in digital and print a wonderful and prosperous New Year and hopes that your holidays were joyous and peaceful. Now on to ultrasound, I want to go back to the basics to get new readers up to speed and provide a refresher for our more seasoned visitors.

MATT TOMORY VP of Marketing & Sales, Conquest Imaging

1TECHNATION.COM

JANUARY 2016

Ultrasound physics may not be the most glamorous subject but without a clear understanding, you do not have the foundation all other ultrasound service knowledge is built upon. So how do these miraculous devices work? Essentially, a system generates a high-voltage pulse with a transmit board which then travels to the transducer where it vibrates (a) crystal(s). This transforms the electrical energy to mechanical (sound) which enters the body. These waves are reflected off various parts of the body and return to the transducer where the crystals are excited by the wave and the energy is transformed back into electrical. This signal is amplified by the receive section of the system and shades of gray are assigned to various echo intensities and displayed as images. There are many factors which contribute to image formation and quality but we will begin with the basics. Let’s examine frequency and its relation to ultrasound image formation. When you increase the transmit frequency of a transducer, two things happen; image quality or resolution increases and penetration decreases. The opposite occurs when reducing the frequency of a probe. When I began ultrasound service in 1986 (I know, most of you are thinking I don’t look that old☺), all transducers had a single frequency

and to change it, you had to enable a different probe. Today, probes have many frequencies to suit most body parts and types. The general rule is to use the highest frequency possible for the body part/type you are interrogating. Other adjustments related to penetration are gain and transmit power. The FDA regulates how much mechanical energy or transmitted power a device can couple into the body and, like most radiological devices, you want to follow ALARA (As Low As Reasonably Achievable) when adjusting transmit power. Gain adjustments are made on the other side of the equation by raising or lowering the amplification of the received signal from the body. The cool thing is that most systems automatically increase gain as transmit power is decreased. In fact, I have performed experiments on my abdomen by seeing how low I can go on the transmit side and still get a diagnostic image and for me the result was only 25 percent of maximum output (your mileage may vary). We have just touched on the basics, but we are happy to present a more comprehensive overview to you or your team on basics, ultrasound image formation/applications or anything ultrasound. For more information, please contact me at mtomory@conquestimaging.com or visit our new website at www. conquestimaging.com. Happy New Year!

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1TECHNATION.COM

THE FUTURE

AAMI Becomes Lead Society for Biomedical Educational Program Accreditation By Steven Yelton

AMI has been elected to be the lead society for Biomedical Engineering Technology (BMET) college program accreditation by the Accreditation Board for Engineering and Technology (ABET).

Steven Yelton HTM Professor, Cincinnati State Technical and Community College

1TECHNATION.COM

JANUARY 2016

AAMI will now be the professional society that assists in the accreditation of associate and bachelor degree BMET programs. Simply put, ABET accreditation is voluntary where colleges invite ABET program evaluators to visit their programs to determine if they meet the criteria for ABET accreditation. AAMI has developed the Healthcare Technology Accreditation Committee (HTAC) to oversee its role as the lead society for ABET. AAMI takes over this role from the biomedical engineering Society (BMES). BMES will remain the lead society for Biomedical Engineering programs. BMES supported the change and both organizations felt that this arrangement was a better fit for the profession. BMES is primarily an engineering organization rather than an organization for BMETs. AAMI has several roles in the accreditation process. AAMI will select and assign the previously mentioned program evaluators (PEVs). AAMI will also coordinate campus visits for accreditation purposes and will help set the guidelines required for programs to be accredited. AAMI will have a seat on ABET’s board of delegates. A little history: For many years AAMI has been working very closely with educators, BMETs, and employers to

assist in providing quality BMETs to meet hospital, third-party, and OEM needs for qualified biomedical technicians. For many years, AAMI’s Technology Management Council (TMC) has sponsored an Educators Roundtable at its annual meeting. Educators – as well as technicians, engineers, managers, etc. – are invited to participate in a moderated roundtable discussion regarding the current and future needs of these groups. Many great deliverables have come from this group. A recurring topic of conversation at these roundtables was that it would be great if AAMI could share it’s resources and expertise on the future needs of the HTM industry by getting involved with the accreditation of academic BMET programs. AAMI has been working for a long time to determine a good fit for it to become involved with program accreditation. Since AAMI is not in the business of accrediting programs, working with ABET seemed to be an excellent way for AAMI to contribute. This new role will benefit all BMET programs regardless of whether they are ABET accredited or not. AAMI has developed a vast array of “tools” to help educational programs as well as employers and students, determine strengths and weaknesses. AAMI offers

use for existing programs and some newly many documents including “Core started programs are using it in the early Competencies for the Biomedical stages of curriculum development. This is Equipment Technician,” “AAMI Career a resource that would be very difficult to Development Guide” and the “BMET produce without AAMI’s expertise in Study Guide.” In addition, AAMI convening experts in the field with a University offers continuing education, common mission. and now BMET program accreditation BMETs and employers may use the assistance is offered. AAMI’s board feels core competencies guide to evaluate skill that this will help to enhance AAMI’s sets. For instance, a technician can use commitment to biomedical education. this guide to openly examine his or her The “Core Competencies for the own skill set as compared to what this Biomedical Equipment Technician” guide diverse group of industry experts feels is is a great resource for educational necessary in today’s environment. Upon institutions, BMETs, and employers. A examination, the technician may see committee of diverse individuals from the gaps in education that may be filled. An HTM field developed this document. The employer may use it to determine skills Core Competencies guide will be updated and competencies that should be and examined to assure that it contains expected of a new employee or to current information. The guide is evaluate existing employees and develop complete to the associate degree or staff development plans. entering technician level with plans to PROOF APPROVED CHANGES NEEDED The HTAC committee plans to utilize expand it in the future. the “Core Competencies Guide for the Since the guide has been nationally CLIENT SIGN–OFF: Biomedical Equipment Technician” to vetted, educational institutions are develop new and evaluate existing encouraged to use it to design or evaluate PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT competencies required for BMET their curriculums. Many biomedical LOGO PHONE NUMBERprogramWEBSITE ADDRESS accreditation. programs have downloaded this guide to

If current or aspiring BMETs utilize the resources available through AAMI, they will be able to evaluate their career path with the “AAMI Career Development Guide,” evaluate gaps in their training using the “Core Competencies for the Biomedical Equipment Technician,” prepare for certification by using the “BMET Study Guide,” and then pursue certification using AAMI’s certification program within the “AAMI Credentials Institute.” These resources round out an impressive toolkit for the BMET, BMET employer, and BMET educator. STEVEN J. YELTON, PE, CHTM, is a professor/ professor emeritus at Cincinnati State Technical and Community College where he teaches biomedical instrumentation courses. He is a member of AAMI’s Board of Directors, AAMI’s Foundation Board of Directors, Vice Chair of AAMI’s Technology Management Council, Chair of AAMI’s HTAC committee and is a member of the ABET Board of Delegates.

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What’s wrong with the world? By Patrick Lynch

ust as I was getting ready to write this column, I received an email through LinkedIn. It was from a BMET I don’t know, but who writes me every once in a while for advice. His letter (heavily edited below) is pretty shocking. Please read it and continue with my comments after it.

PATRICK K. LYNCH, CBET, CCE

“Hello Patrick, Once again, thanks for connecting with me over LinkedIn. Let me tell you a little about myself. I graduated from a three-year college program from a college in my hometown. I moved away from home and got employed at a hospital as a Biomedical Tech in 2010. Since then I have been married, have 2 children, and just turned 28 years old. I have been trying to complete my bachelor’s degree in management online. I am now a member of AAMI and our local biomedical association. I am pursuing the CBET certification. I am also looking at various schools regarding their MBA programs. “Now, if I might ask some advice from you. What advice would you give a young-ish Biomed, working in a unionized department, who wants to pursue professional development, in the midst of constant opposition? My concern is not only for myself, but also for other young graduates getting into the career. Here’s some background for the question (and I don’t wish to shame/ slander my colleagues, but ... ) I recently encountered great opposition to bettering myself as a Biomed. My department is union, and at my main hospital, I am the youngest employee. Hurtful words like “you are a bench worker. Stop trying to be more. Your only job is to fix equipment.” The tone was such that it belittled my worth, and how dare I aspire for more – I am not worth more than

1TECHNATION.COM

JANUARY 2016

what I already am! There is no interest in my department to become certified, even when my manager encourages it. There is such animosity against those that strive to ‘meet the bar’ with peers around the world. Just yesterday, I was told that I come off arrogant, stubborn. I have a concern, not just for me, but for future Biomeds that will graduate. Even if I don’t hear back from you, I do thank you for reading this message, and wish you all the best. Sincerely.” The entire tone of this letter disturbs me. I don’t think it is a union thing, although there is a slight possibility that it may play a role. There is definitely a culture in this shop that wants to keep people from excelling. The older workers seem to want to keep everyone younger than them from rising to any higher level. This, in some perverse way, must validate that they themselves never rose any higher in their jobs and provide them an excuse. My advice to this young man was to ignore his ignorant coworkers, keep his talk about his formal schooling to a minimum, and look for every opportunity to get the hell out of that toxic environment. I understand that the attitude of these other workers may not directly impact their job performance, but this attitude is not healthy. If anyone has any comments or other advice, please place it on the TechNation Listserve at 1TechNation. com/listserv.

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JANUARY 2016

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THE ROMAN REVIEW

Satisfaction and Motivation By Manny Roman

long, long, time ago, in a management course at Cochise College in Arizona, I was introduced to the work of psychologist Frederick Herzberg. He’s the guy that proposed that there are two factors that influence people at work, aptly named the two-factor theory (and also as the motivator-hygiene theory) of motivation. I recently came across a reference to the theory in an article on motivating a team.

MANNY ROMAN CRES, Founding Member of I.C.E. imagingigloo.com

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JANUARY 2016

Essentially, the theory states that there are issues in a workplace that can demotivate people. These are things like inadequate pay, uncomfortable physical environment, perceived job insecurity, etc. When these items, called hygiene factors, are missing they will tend to demotivate people. When these hygiene factors are present, however, they do not serve as motivators. The factors that motivate people are things like job recognition, promotion possibilities and autonomy in how the work gets done. These things do not necessarily demotivate when absent but will motivate when present. The conclusion is that satisfaction and dissatisfaction are not opposites. The opposite of satisfaction is no satisfaction. The opposite of dissatisfaction is no dissatisfaction. Author Daniel Pink lists three factors that motivate people: autonomy, mastery and purpose. Autonomy is the ability to be selfdirected in our work. This allows us to make meaningful decisions regarding the completion of our work. The satisfaction and the motivation come from knowing that we accomplished something of value. Mastery refers to the satisfaction of our inner drive to get better at whatever we do. This can only be achieved when

the tasks are not too easy and not too difficult. Too easy is boring and too difficult is unrealistic and unachievable. People are motivated by working on Goldilocks tasks which are not too easy and not too hard. Purpose refers to the feeling that what you do is part of a greater outcome. When we feel that what we do brings value to something greater than ourselves, it is easy to get up in the morning. We look forward to going to work to continue adding value to the greater cause. This is why we in this industry are all so very proud of saying that we are in health care, which is for the good of humanity. Every leader should be aware that their people can be demotivated very easily by removing some of the above hygiene factors. That is why we give people desks, chairs, bathrooms, the right test equipment, etc. That is why people should be paid enough to “take money off the table.” Providing employment is not itself enough to engage people to act in the best interests of the organization. Neither is concentrating on providing the hygiene factors. To motivate team members means to empower them to engage in their work and to view themselves as valuable to the organization. Leaders

make their team members feel good about their jobs and work. I recently wrote about recognition. When we publicly and privately recognize achievement it drives people to achieve more. By privately, I am talking about one-on-ones, which is the single most important way that leaders can be sure to address business issues, personal issues and ensure that everything is on track with each individual. I am amazed at how many managers tell me that they are too busy to conduct one-on-ones with their people. How is it possible to be too busy to communicate with your people? Communication is key. In today’s cost-cutting environment it appears that management is taking the attitude that people are lucky to have a job and that should be motivation enough. There is no need to engage people because the threat of losing their job should make people do a good job. I contend that even under the most difficult environment for the managers, there are things that they can do to become leaders. Organizational constraints should not be an excuse to not provide the things people need to eliminate the hygiene factors. These constraints should not apply to how leaders treat people and communicate with them. Poor managers blame the organization and those above them for the conditions people work under. Leaders find ways to push the right buttons for each individual to allow them to self engage. Which are you? I am neither since I am semi-retired now and write crazy articles once a month.

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System feels for lumps in the brain Since antiquity, physicians have palpated the body – feeling with their hands for hidden problems. Modern devices can do that more accurately, probing for mechanical vibrations.

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Computer uses ‘noise correlation,’ a computation technique borrowed from seismologists, to plot dense and soft areas in brain

Source: Stéfan Catheline of University of Lyon (France), Proceedings of the National Academies of Science, NASA, National Institute of Dental and Craniofacial Research (U.S.) Graphic: Helen Lee McComas, Tribune News Service

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JANUARY 2016

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1TECHNATION.COM

THE VAULT

o you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your chance to prove it! Check out “The Vault” photo. Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will be entered to win a $25 Amazon gift card. To submit your answer, visit 1TechNation.com/vault-january-2016. Good luck!

LAST MONTH’S PHOTO A 1950 ADRIAN X-Ray Shoe Fitter. The photo was submitted by Dale Jarzembak from RSTI.

SUBMIT A PHOTO Send a photo of an old medical device to editor@mdpublishing.com and you could win lunch for your department courtesy of TechNation!

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JANUARY 2016

To find out who won a $25 gift card for correctly identifying the medical device, visit 1TechNation.com.

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BULLETIN BOARD

new resource where medical equipment professionals can find all the information needed to help them be more successful! The easy to navigate Bulletin Board gives you access to informative blogs, expos and events, continuing education opportunities, and a job board. Visit www.MedWrench.com/BulletinBoard to find out more about this resource.

Q&A with BC Biomedical on their newest SA-2500 Safety Analyzer Q: What differentiates the SA-2500 from your other Safety Analyzers? A: What really makes the SA-2500 stand out from our other safety analyzers is automated testing. All of our previous models are controlled manually. With that SA-2500â&#x20AC;&#x2122;s included software, users are able to design their own autosequences on a PC or laptop. The software SA-2500 Safety Analyzer it comes with even allows users to create their own database so they can save all their testing information in an accessible location.

View the full Q&A www.medwrench.com/BCgroup

Career Opportunities Job Position: BMET 1 Location: Florida and South Carolina areas Job Description: As a Junior BMET this position works under close supervision of a Biomedical Engineer Technician. The position is primarily responsible for preventative maintenance, repairs, and safety testing. Usually less than 4 years experience. If interested please email resumes and cover letters to: jobs@intermed1.com

1TECHNATION.COM

JANUARY 2016

CONTINUING EDUCA TION

Visit www.MedWrench.c om/BulletinBoard for m ore details and to register for these upcoming classes .

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Experts in Siemens Medical Imaging

Siemens Multix TOP/PRO w/ Polydoro s SX, LX, & IT Generator Training Course February 1-12

Ultrasound Bas ics- March 1

Get Soc ial with Me dWrench!

ourse DI Service C f o ls a ti n e ss E April 4-15

UPCOMING EVENTS New Years Day

Annual Family Vacation in Hawaii!

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MLK, Jr. Day!

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Visit www.MedWrench.com for more details about our events.

BREAKROOM

ALPHABETICAL INDEX AIV…………………………………………… 53

Gopher Medical……………………………… 29

Quantum Biomedical………………………… 57

Ampronix……………………………………… 6

ICE/Imaging Community Exchange………… 39

ReNew Biomedical…………………………… 26

BC Group International, Inc. ………………

IMES/International Medical Equipment & Service………………………… 25

Rieter Medical Services……………………… 59

BETA Biomedical…………………………… 48

Integrity Biomedical………………………… 70

BioMedical Equipment Service Co.………… 26

InterMed Group……………………………… 61

BMES/Bio-Medical Equipment Service Co.…………………… IBC

RTI…………………………………………… 33 Southeastern Biomedical…………………… 61

Interpower Corporation……………………… 4

Southwestern Biomedical Electronics…………………………………… 7

Conquest Imaging…………………………… 11

J2S Medical………………………………… 53

Stephens International Recruiting Inc.……… 29

Cool Pair Plus………………………………… 48

KEI Med Parts………………………………… 48

Technical Prospects………………………… 57

ECRI Institute………………………………… 49

KMA Remarketing Corp.……………………… 51

Tri-Imaging Solutions………………………… 20

Ed Sloan & Associates……………………… 26

Maull Biomedical Training LLC……………… 55

USOC Bio-Medical Services………………… 21

Elite Biomedical Solutions…………………… 3

MedEquip Biomedical……………………… 39

Valcon Partners……………………………… 59

Engineering Services………………………… 14

MW Imaging………………………………… 40

Zetta Medical Technologies……… 15, 41, 63

First Call Parts………………………………… 29

Pacific Medical LLC………………………… 8

GMI…………………………………………… 2

Pronk Technologies………………………… 5

BC Group International Ph: 314-638-3800 www.BCGroupStore.com

Gopher Medical Ph: 877-246-7437 www.gophermedical.com

Valcon Partners Ph: 815-477-1000 www.valconpartners.com

AUCTION/LIQUIDATION J2S Medical Ph: 844-342-5527 www.j2smedical.com

BEDS / STRETCHERS KMA Remarketing Corp. Ph: 814-371-5242 www.kmabiomedical.com

Rieter Medical Services Ph: 800-800-5402 www. rietermedicalservices.com

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JANUARY 2016

BMES (Bio-medical Equipment Services Co. LLC) Ph: 800-626-4515 www.bmesco.com

First Call Parts Ph: 800-782-0003 www.firstcallparts.com

Gopher Medical Ph: 877-246-7437 www.gophermedical.com

InterMed Group Ph: 386-462-5220 www.intermed1.com

ReNew Biomedical Ph: 844-425-0987 www.renewbiomedical.com

Southeastern Biomedical, Inc. Ph: 828-396-6010 www.sebiomedical.com/

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Ampronix, Inc. Ph: 800-400-7972 www.ampronix.com

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Southwestern Biomedical Electronics, Inc. Ph: 800-880-7231 www.swbiomedical.com

CT / COMPUTED TOMOGRAPHY Ed Sloan and Associates Ph: 615-448-6095 www.edsloanassociates.com

IMES/International Medical Equipment & Service Ph: 704-739-3597 www.IMESimaging.com

ReNew Biomedical Ph: 844.425.0987 www.renewbiomedical.com

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Ampronix, Inc. Ph: 800-400-7972 www.ampronix.com

Pacific Medical Ph: 800-449-5328 www.pacificmedicalsupply.com

Rieter Medical Services Ph: 800-800-5402 www. rietermedicalservices.com

USOC Bio-Medical Services Ph: 855-888-USOC (8762) www.usocmedical.com

MRI

KEI Med Parts Ph: 512 -477 1500 www.keimedparts.com

RTI Electronics Ph: 800-222-7537 www.rtigroup.com

Technical Prospects Ph: 877-604-6583 www.technicalprospects.com

Tri-Imaging Solutions Ph: 855-401-4888 www.triimaging.com

Zetta Medical Technologies, Inc. Ph: 800-991-1021 www.zettamed.com

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ENDOSCOPY J2S Medical Ph: 844-342-5527 www.j2smedical.com

Company Info

MONITORS / CRTs

CARDIOVASCULAR Technical Prospects Ph: 877-604-6583 www.technicalprospects.com

Call 800-906-3373 Se rv ic e

Company Info

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SERVICE INDEX

Cool Pair Plus Ph: 800-861-5956 www.coolpair.com

Ed Sloan and Associates Ph: 615-448-6095 www.edsloanassociates.com

IMES/International Medical Equipment & Service Ph: 704-739-3597 www.IMESimaging.com

KEI Med Parts Ph: 512 -477 1500 www.keimedparts.Com

Zetta Medical Technologies, Inc. Ph: 800-991-1021 www.zettamed.com

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NUCLEAR MEDICINE 53

INFUSION THERAPY AIV Ph: 888-656-0755 www.AIV-Inc.com

Elite Biomedical Solutions Ph: 855-291-6701 elitebiomedicalsolutions.com

J2S Medical Ph: 844-342-5527 www.j2smedical.com

GMI Ph: 800-958-9986 www.gmi3.com

InterMed Group Ph: 386-462-5220 www.intermed1.com

ONLINE RESOURCES ICE/Imaging Community Exchange www.imagingigloo.com

INDEX

J2S Medical Ph: 844-342-5527 www.j2smedical.com

PACS RSTI Ph: 800-229-7784 www.rsti-training.com

PATIENT MONITORS

Southeastern Biomedical, Inc. Ph: 828-396-6010 www.sebiomedical.com/

Southwestern Biomedical Electronics, Inc. Ph: 800-880-7231 www.swbiomedical.com

USOC Bio-Medical Services Ph: 855-888-USOC (8762) www.usocmedical.com

AIV Ph: 888-656-0755 www.AIV-Inc.com

PET

BETA Biomedical Ph: 800-315-7551 www.betabiomed.com

Zetta Medical Technologies, Inc. Ph: 800-991-1021 www.zettamed.com

Biomedical Equipment Services Co. E: biomedical.equipment@ yahoo.com

BMES- Biomedical Equipment Services Co. LLC Ph: 800-626-4515 www.bmesco.com

Elite Biomedical Solutions Ph: 855-291-6701 elitebiomedicalsolutions.com

Gopher Medical Ph: 877-246-7437 www.gophermedical.com

Integry Biomedical Ph: 877-789-9903 www.integritybiomed.net

J2S Medical Ph: 844-342-5527 www.j2smedical.com

MedEquip Biomedical Ph: 877-470-8013 www.MedEquipBiomedical.com

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POWER SYSTEM COMPENTENTS Interpower Corporation Ph: 800-662-2290 www.interpower.com

RADIOLOGY Technical Prospects Ph: 877-604-6583 www.technicalprospects.com

RECRUITING Stephens International Ph: 870-431-5485 www.bmets-usa.com/

TELEMETRY AIV Ph: 888-656-0755 www.AIV-Inc.com

Biomedical Equipment Services Co. E: biomedical.equipment@ yahoo.com

ReNew Biomedical Ph: 844.425.0987 www.renewbiomedical.com

Elite Biomedical Solutions Ph: 855-291-6701 elitebiomedicalsolutions.com

Rieter Medical Services Ph: 800-800-5402 www. rietermedicalservices.com

Gopher Medical Ph: 877-246-7437 www.gophermedical.com

Pacific Medical Ph: 800-449-5328 www.pacificmedicalsupply.com

J2S Medical Ph: 844-342-5527 www.j2smedical.com

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JANUARY 2016

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Company Info

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Company Info

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SERVICE INDEX

Want to be listed in this index?

MedEquip Biomedical Ph: 877-470-8013 www.MedEquipBiomedical.com Pacific Medical Ph: 800-449-5328 www.pacificmedicalsupply.com Southeastern Biomedical, Inc. Ph: 828-396-6010 www.sebiomedical.com/

Southwestern Biomedical Electronics, Inc. Ph: 800-880-7231 www.swbiomedical.com

USOC Bio-Medical Services Ph: 855-888-USOC (8762) www.usocmedical.com

GMI Ph: 800-958-9986 www.gmi3.com

J2S Medical Ph: 844-342-5527 www.j2smedical.com

MW Imaging Ph: 877-889-8223 www.mwimaging.com/

X-RAY

Engineering Services Ph: 888-364-7782 x11 www.eng-services.com

First Call Parts Ph: 800-782-0003 www.firstcallparts.com

InterMed Group Ph: 386-462-5220 www.intermed1.com

J2S Medical Ph: 844-342-5527 www.j2smedical.com

RSTI Ph: 800-229-7784 www.rsti-training.com

Southeastern Biomedical, Inc. Ph: 828-396-6010 www.sebiomedical.com/

TRAINING

TUBES / BULBS

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RTI Electronics Ph: 800-222-7537 www.rtigroup.com

Technical Prospects Ph: 877-604-6583 www.technicalprospects.com

Conquest Imaging Ph: 866-900-9404 www.conquestimaging.com

Ed Sloan and Associates Ph: 615-448-6095 www.edsloanassociates.com

www.maullbiomedicaltraining.com

ULTRASOUND

Pronk Technologies Ph: 800-609-9802 www.pronktech.com

Maull Biomedical Ph: 440-724-7511

Company Info

Ampronix, Inc. Ph: 800-400-7972 www.ampronix.com

TEST EQUIPMENT BC Group International Ph: 314.638.3800 www.BCGroupStore.com

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Company Info

Pa ge Pa rts

Call 800-906-3373

RTI Electronics Ph: 800-222-7537 www.rtigroup.com

IMES/International Medical Equipment & Service Ph: 704-739-3597 www.IMESimaging.com

Technical Prospects Ph: 877-604-6583 www.technicalprospects.com

Tri-Imaging Solutions Ph: 855-401-4888 www.triimaging.com

Tri-Imaging Ph: 855-401-4888 www.triimaging.com

INDEX

JANUARY 2016

1TECHNATION.COM