1technation.com
vol 6
EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL
OCTOBER 2015
RIGHT TO REPAIR OVERCOMING OBSTACLES
12 Professional of the Month
Dustin Telford
Roundtable 38 The I.V. Pumps
76 What’s on Your Bench?
Highlighting the Workbenches of HTM Professionals
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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL
38
T HE ROUNDTABLE - I.V. PUMPS TechNation magazine reached out to experts within the industry to find out the latest on I.V. pumps. We gathered tips on how to extend the life of an IV pump and what features to look for when considering the purchase of new infusion therapy devices. New technology, appropriate service and other important topics were addressed. Next month’s Roundtable article: Anesthesia
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RIGHT TO REPAIR: OVERCOMING OBSTICLES The principle of market choice and competition has not skipped over the HTM profession and the ability of individual HTM professionals to control costs by simply doing their job. “We can fix it; let us fix it,” is the mantra of those who are frustrated by having their hands tied. This fight has become so contentious that it has even landed in the courtroom. The information and access to accomplish a repair should be unfettered; but that’s not always the case. Next month’s Feature article: AAMI Career Lader Update
TechNation (Vol. 6, Issue #10) October 2015 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.
OCTOBER 2015
1TECHNATION.COM
9
INSIDE
Departments PUBLISHER
John M. Krieg
VICE PRESIDENT
Kristin Leavoy
ACCOUNT EXECUTIVES
Warren Kaufman Jayme McKelvey Andrew Parker
ART DEPARTMENT
Jonathan Riley Jessica Laurain
EDITOR
John Wallace
EDITORIAL CONTRIBUTORS
Roger Bowles K. Richard Douglas Patrick K. Lynch Todd Rogers Manny Roman Cindy Stephens Karen Waninger
p.24 p.26 p.29 p.30 p.32 p.34
WEB DEPARTMENT
Betsy Popinga Taylor Martin
P.54 EXPERT ADVICE
ACCOUNTING
Kim Callahan
P.12 SPOTLIGHT
p.12 Professional of the Month: Dustin Telford p.14 Company Showcase: Phoenix Data Systems p.18 Department Profile: Advocate BroMenn Medical Center Clinical Engineering Department p.20 Biomed Adventures: Home Improvement
P.24 THE BENCH
p.54 p.56 p.58 p.60 p.62 p.64 p.66
ECRI Institute Update AAMI Update Tools of the Trade Webinar Wednesday Biomed 101 Shop Talk Career Center Ultrasound Tech Expert Sponsored by Conquest Imaging The Future Beyond Certification Karen Waninger Patrick Lynch Roman Review
P.68 BREAKROOM
EDITORIAL BOARD
Manny Roman: manny.roman@me.com Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com Eddie Acosta: A Clinical Systems Engineer at Kaiser Permanente, Northern California, Fastedy99@yahoo.com John Noblitt: Program Director at Caldwell Community College & Technical Institute in North Carolina jnoblitt@cccti.edu
p.68 Did You Know? p.70 The Vault p.74 Scrapbook p.76 MedWrench What’s on your Bench p.82 Parting Shot p.81 Index Like us on Facebook, www.facebook.com/TechNationMag
Follow us on Twitter, twitter.com/#!/1TechNation
MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com
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PROFESSIONAL OF THE MONTH
Dustin Telford, CBET, CRES, CLES, CHTM By K. Richard Douglas
I
t seems to be a story that often sounds like a broken record; the HTM professional who found his calling at an early age. They liked to fix things, take things apart or work with their hands. This would be a story to take with a grain of salt if it weren’t for the fact that it is so common among biomeds. So many discovered what would eventually be their vocation early in life.
One perfect example of this is the biomed, whose little brother Ian, used to break vacuum cleaners. “I would be the big brother fixing our vacuum cleaner before our mom got home from work,” remembers Dustin Telford, CBET, CRES, CLES, CHTM. “I taught myself to solder — not too well — when I was a kid. I loved my Radio Shack 101 electronics projects kit,” he adds. “I even taught myself how to program a TI-99 computer and other systems and languages to follow. Biology was also fascinating for me early on.” Telford wasn’t satisfied to grow up and become a biomed. He decided to drink in HTM like some people gulp down a can of energy drink. As Telford tells it; it’s more like a romantic comedy. It not only began with broken vacuum cleaners but also the attributes of many family members. “My family — a whole list of them — added a little bit to my chemistry including a mom who tirelessly works on social and communications issues, a down-to-earth dad who is a master craftsman and wisecracker, grandparents who probably encouraged my education and love for the sciences and hard work
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and so on,” Telford says. “In all seriousness, these people had an indirect or direct influence on what makes me tick in healthcare technology management or anything.”
TRAINING Telford attended the University of Utah and studied biology as a pre-med student. His career plans changed slightly as a course correction resulted in a new trajectory. “While house-sitting my friend’s parent’s home, an Army recruiter called looking for my buddy. He talked me into testing for, and checking out, the offerings serving the country,” Telford says. “Originally, I wanted to be a combat medic, which I thought would dovetail with my pre-med courses, and would only take me out of college for one to two quarters,” he adds. “When I was offered an enlistment, my options included combat medic and then this MOS (military occupational specialty) that really attracted the medical electronics and somewhat adventure-seeking guy; medical equipment repair.” At the time, Telford’s thinking was that this was a five-year career in a
Dustin Telford is seen at the university of Utah Hospital early in his HTM career
health care field while he worked on his college degree. “Within a week of starting the Medical Equipment Repairer school, I started thinking about a 10-year and then a lifetime career,” he says. “I attended the U.S. Army Medical Equipment Optical School in Aurora, Colorado, after basic training in Ft. Jackson, South Carolina. My training was recognized as one of the best programs available at the time and still is under joint service leadership,” Telford says. “Most of us who attended Fitzsimmons in those days still refer to it as Club Fitz, not because the training was easy or the program did not phase out a lot of folks, but the school was a lot more relaxed than what most military programs are and were.” Telford remembers that students were
Dustin Telfod’s career began in the US Armed forces that included a stop at the South Pole.
expected to be professional and conduct themselves as soldiers and students. On the other hand, they were allowed to find success through self-motivation by keeping up-to-date on their studies while enjoying their personal time.
NEVER A DULL MOMENT Since entering the field, he has had a good mixture of experiences and has enjoyed every role. “I have, or am currently, been a technician, a specialist, a field engineer, an educator, a clinical researcher, a clinical engineer, a manager, a soldier, a charitable service worker, a leader, and a member in children’s hospitals, professional associations, cancer hospitals, large hospital networks, trauma hospitals, universities, the military, the VA, with OEMs, with third-parties, and even as the lone biomed in Antarctica,” Telford says. We did say he decided to drink in the HTM profession. Currently, in addition to his work as a Field Service Manager with HSS assigned to Children’s Hospital Colorado and working as the hospital’s Biomedical Equipment Manager, he is also Director of Clinical Engineering for earthMed. He has been on several boards with AAMI, is president of the Medical Equipment & Technology Association
(META) and past president of the Mountain West Healthcare Technology Association (MWHTA). Asked what he would like TechNation readers to know about him, Telford emulates his wisecracking dad, before waxing philosophically. “My pin number is … ,” he jokes. “The first thing that I want readers to know about me is that I care. I care about my family, I care about my profession. I care about my community. And, I care about people.” “The second thing I would want readers to know about me, is that I wish some people cared more about things in their life,” he adds. Away from work and volunteering, Telford is an avid aquarist who collects tropical fish. “The first 10-gallon aquarium I owned was when I was in fifth grade and I have kept everything from sea-monkeys to monster fish. If there were a position open at Sea World, or better still Monterey Bay Aquarium, for a biomed, I would probably have jumped on this position before joining Children’s Hospital Colorado,” he jokes. He describes his family as “two great kids and a wonderful, beautiful wife.” “I could go on and on about this trio because they are my life outside of work
and they support my work,” he says. Getting involved in a career field, through many avenues, shows a commitment and caring for the profession. To that end, Telford has shown he cares a lot.
FAVORITE MOVIE: “Forrest Gump”
FAVORITE BOOK:
“The Hitchhiker’s Guide to the Galaxy”
FAVORITE FOOD: Spicy please
HIDDEN TALENT:
None that I want to share because people are afraid of their thoughts being read.
FAVORITE PART OF BEING A BIOMED: My customers and team.
WHAT’S ON MY BENCH
• Sticky notes • A Lego set my son made for me of HTM professionals • My iPhone • The MEMP – My bible in HTM • The Les Altes Practicum for Biomedical Engineering and Technology Management
SPOTLIGHT
®
COMPANY SHOWCASE
T
railblazer, pioneer and innovator are all words used to describe Phoenix Data Systems, Inc. – the trusted provider of the CMMS system AIMS (Asset Information Management System).
Phoenix Data Systems was formed in the early days of specialized software based on the urgent need for Michigan Hospitals to have a modern maintenance work order system. In 1984, after two years of design and development, the first AIMS was delivered to eight Michigan hospitals. Today, AIMS is used worldwide in 1,900 facilities. The company is currently developing its fifth platform change and designing software to carry AIMS users into the future. “AIMS’ success is based on a few core approaches,” CEO Ben Mannisto says. “We aggressively listen to our customers’ and users’ needs. Then, we quickly evolve AIMS to match those needs. We closely pay attention to healthcare industry changes and needs and advance our software accordingly.” Mannisto’s team has surpassed customers’ expectations on more than one occasion by delivering new features before the customers even knew they needed them. The company has grown along with its early customers. “In 1984, AIMS offered five modules; there are presently 28 modules, with 13 more under development,” Mannisto says. Phoenix Data Systems has been there
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since the beginning and that is just one reason for its continued success. “Stability and longevity; we have been developing AIMS for more than 30 years, giving us extensive experience and a reputation for quality,” Mannisto says when asked to describe the company’s strengths. “Phoenix’s customer service is superior to that of our competition. When a customer calls for software support, their call is always answered by a receptionist, and 95 percent of callers are immediately transferred to an in-house customer service team member.” “Our software is flexible and very robust in feature function. Flexibility is achieved by offering a componentbased system, so users purchase only what they require. Features and functions are built into the software on an ongoing basis by listening to our customers’ requests,” he adds. “Phoenix’s 30th Annual User Group will be held in October 2015. The User Group is one of Phoenix’s many venues providing an opportunity to listen to our customers’ needs so we may continue to evolve AIMS to meets those needs.” “Phoenix has long referred to our customers as our ‘family of AIMS users.’ Our open door policy provides
BEN MANNISTO CEO Phoenix Data Systems
“ We strive to give our users the features and functions they want in order to meet their growing needs. We are committed to creating software that works for AIMS users – now and in the future.”
Pheonix Data systems values customer feedback and uses it to develop features to better serve clients.
the opportunity for everyone to provide feedback – good or bad – so we can provide the best software, service and support experience for our users,” Mannisto says. This approach has led to many firsts for AIMS as well as the addition of many popular features. Once Phoenix Data Systems creates a specific feature for a customer it is not long before several other customers decide they need the same feature or a similar one that is soon created to work within the AIMS framework. Customized reports are one such offering. Phoenix Data Systems offers a library of about 200 report templates and that number continues to increase, as more are made available to meet customers’ needs. The NotifyMe feature is another popular feature that is an example of how listening to a customer can benefit the client, Phoenix Data Systems and the health care industry at large.
NotifyMe is a “proactive component that automatically sends email notifications for predefined conditions such as critical events.” Phoenix Data Systems is a trailblazer and pioneer in the health care universe with more than a dozen industry firsts and more likely in the near future. Some of the firsts for the company include NotifyMe, AEM Compliance, ECRI Institute Alerts Tracker/UMDNS Interface and HIPAA. Mannisto says the company strives to create “dynamically and quickly evolving software to meet the health care industry’s changing needs.” He adds that the company’s solutions are scalable making them appropriate for small, 50-bed hospitals as well as 10,000-bed multi-hospital health systems. Phoenix Data Systems knows that success must be earned and maintained along with a dedication to customers. “Phoenix’ growth has averaged approximately 20 percent a year across the company’s lifetime. We
expect that growth to accelerate as a result of new products that support industry demands for specific functions that are not currently available in the CMMS market,” Mannisto says. “We are much more aggressive in anticipating the time required to meet industry needs based on changes at CMS and The Joint Commission.” “For the last 30 years, our mission has been to provide innovative, user-friendly, fully supported CMMS software to the health care industry,” Mannisto says. “We strive to give our users the features and functions they want in order to meet their growing needs. We are committed to creating software that works for AIMS users – now and in the future. Implement AIMS and you will never need another CMMS.” FOR ADDITIONAL INFORMATION about Phoenix Data Systems Inc. and AIMS, call 800-541-2467 or visit www.goaims.com.
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DEPARTMENT PROFILE Advocate BroMenn Medical Center Clinical Engineering Department By K. Richard Douglas
T
here is a city in Illinois where you can be assured that things won’t be erratic; it’s Normal, Illinois. The city is home to Advocate BroMenn Medical Center, a 221-bed not-for-profit hospital. Including its predecessor hospitals, Advocate BroMenn is more than a 100 years old. A heart center was added in 2003 and a major addition was added to the main hospital in 2012.
Keeping the health system’s 6,695 pieces of medical equipment up and running smoothly is the Advocate BroMenn Medical Center Clinical Engineering Department. The four-man department includes Site Manager Roger Kyrouac, Radiology II and shop lead Gary Ofenloch, Biomed III Tony Messier and Biomed II Kane Lim. The department has always been in-house and was originally started in 1983 by Rob Koppenhoefer. The team was originally composed of four members with one eventually rising to the role of vice president of Support Operations. Another left and established the tech support team for State Farm Insurance and another was Roger Kyrouac, the department’s current manager. The biomed hired to replace the member of the team who left is now the director of facilities. “Clinical Engineering maintains a five-year capital plan and collaborates with appropriate leaders to update periodically throughout the year as part of our customer rounding,” Kyrouac says. The department may be small, but they are still involved in project planning, medical equipment evaluations and procurement, regardless of the source. They repair and maintain an inventory of equipment with an acquisition cost of $40,754,246. “All medical equipment entering our
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Advocate BroMenn Medical Center is a 221bed facility
system, regardless of ownership, is checked and added to our database as appropriate with clinical engineering involvement; coordination, installation and/or assistance as appropriate,” Kyrouac adds. “We utilize the TMS database from Four Rivers to primarily track devices, work requests and cost; several other data points secondary; [and] techs indirectly through usage of the database,” he adds. In addition to the main hospital, the clinical engineering crew takes care of a 26-bed critical access hospital and 19 physician offices/clinics. Collaboration and dealings with information systems and facilities is very cordial and the departments support each other. Integration with the information systems department is very good.
“We meet regularly and as needed; collaborate on all medical equipment related projects, procurements and service models; serve as each other’s wingman; have lunch together on a regular basis; and have developed strong professional relationships,” Kyrouac says. Service contracts go through a multipoint evaluation before getting a thumbs up or thumb down. Quotes first come to Kyrouac to evaluate. He then determines the service model to employ. Because of the department’s small size and the “remote status to the rest the system,” the determination is based on the service and technical demands of the device(s), the existing in-house skills and availability, manufacturer T&M versus contract options and optional third-party service(s). “The analysis is discussed with the owner department leader(s),” Kyrouac says. “If a contract is deemed beneficial, the request, analysis and quote are forwarded to my director and support center team for approval and processing.” “Clinical Engineering is an active member and resource on the Capital Approval Committee, the Construction/ Projects Team [and the] Physical Environment Committee,” he adds.
DECIDING ON THE BEST APPROACH “Change is the only constant and our shop has seen our share; right-sizing, down-
Gary Ofenloch works on a CT machine.
sizing and re-engineering to name a few. We have been part of two mergers, the first with another local hospital in 1985, which allowed us to grow substantially. The second with the Advocate Healthcare System in Chicagoland,” Kyrouac says. Kyrouac says that because the two health systems had such “common philosophies,” the department has had very few growing pains. “We are now positioned very well to move forward against the headwinds of health care reform. We are very blessed to be part of a much larger group of skilled, knowledgeable, creative and insightful leaders and technicians. We are engaged in several strategic plans to enhance our ability to better serve our health care ministry,” he says. Certainly, the department has done its share of holding the bottom line for its employer. Total annual budget to acquisition cost is an impressive 4.94 percent. The team is involved with a new surgical and patient care expansion project at a facility in Eureka, Illinois. They have been instrumental in the equipment selection process. The project is a critical access hospital that is 30 miles away from the main site. “There are two phases so far that I have had a great number of hours involved in and that is the equipment planning. We went through the initial equipment
Members of the Advocate BroMenn Medical center Clinical Engineering Department are Tony Messier, Gary Ofenloch, Roger Kyrouac and Kane Lim.
planning two years ago where we just set up some general guidelines,” Kyrouac says. “Then, this spring, we had a series of some very lengthy and comprehensive meetings where we had some vendors present a couple of times and we worked out more details. Those were pretty intense, not getting through all the details, but planning the exact types of devices and where we wanted them and how we wanted them to work within our structure,” he adds. The department will have yet another go-around to finalize on vendor selection.
PART OF A COOPERATIVE TEAM The BroMenn system has gathered enough experience to provide equipment guidelines based on the project model, but the department has a lot of input into workflow. This helps with the spatial concept versus the layout displayed in the prints. “Our construction leads are very good at that kind of thing as well,” Kyrouac says. “I unite the clinical piece to the construction piece. I can provide that additional liaison piece to our clinical folks.” They also recently completed a large monitoring expansion project to assure sufficient CO2 monitoring capabilities for new protocols. The project did not come without challenges. “One challenge was fully understanding,
from both clinical and clinical engineering standpoints, how the roll-up of devices is going to impact the patient care,” Kyrouac says. “If all you want to do is CO2 monitoring, then there are not many devices out there that you are going to find stand-alone and to get a monitor that has the full functionality of CO2. You are also getting multiple parameters that you’re not going to be using.” Kyrouac says that working with the vendors, to find the best fit and workflows for all areas, is a challenge that the department has tackled. The monitors, at the different locations, must tie into the EMR. In addition to working with vendors, Kyrouac says that the department is very fortunate to have a “very strong, positive working relationship with facilities, information systems and construction.” He says that it is so collaborative that the lines are often transparent. “Leading up to and after installation, facilities, IS and clinical engineering at our site are focused on what is the best possible service solution for this device or system,” Kyrouac says. More often or not, it is a collaborative thing. It is not whose bucket does it go into. It is; who is going to lead and then the others play supportive roles.” The Advocate BroMenn clinical engineering team helps to make the whole model work.
SPOTLIGHT
BIOMED ADVENTURES Home Improvement K. Richard Douglas
T
he do-it-yourself craze has been enough to support several big box store chains, along with their contractor customers. Manufacturers have produced many products with DIY’ers in mind. A number of cable shows have reinforced the confidence of DIY’ers everywhere that they can turn a lump of coal into a diamond.
Projects like installing laminate flooring or ceramic tile are well illustrated online. Putting up a kitchen backsplash or putting a new finish on a garage floor have been made extra easy through updates manufacturers have targeted at the handy homeowner. It’s not a surprise to find HTM professionals among the DIY community. For many; it’s second nature. One biomed who has put his DIY skills to practical use is Frank Caroselli, BMET III, who works at the Orange Regional Medical Center-Pavilion in Middletown, New York. Asked about where he got his training for doing DIY projects, Caroselli responds like many HTM professionals would. “I do have a degree in electrical technology and I had some formal education from some night classes I have taken over the years. Of course, there is just taking things apart; something my parents did not appreciate all the time. I give a lot of credit to my dad; we did a lot of projects together. Doing so allowed us to teach a lot to each other,” Caroselli says. There were other informal methods that contributed to Caroselli’s knowledge of all things related to home improvement. “I do watch a lot of home improvement
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shows like ‘This Old House’ and ‘This Old House Hour.’ My wife and I even worked on a house in our town featured on ‘Extreme Makeover: Home Edition’ a few years back for a family we know well. It was a lot of fun and felt so good being part of it. They also asked me to be part of a commercial they were filming, but when it aired I didn’t see myself. I know what they mean by winding up on the cutting room floor,” he says.
KEEPING THE HOUSE UP TO DATE As most DIY’ers come to realize, if you own a house, there are savings to be found in self-repair and modernization. Over the years, those inclined to tackle projects themselves learn a number of skills. If you pay attention to detail, familiarize yourself with the local building codes and know how to swing a hammer or use an reciprocating saw, then the DIY route may be the way to go. “I have done it all, as any homeowner learns; owning a house involves maintenance,” Caroselli says. “In our case, my wife and I purchased a home 19 years ago, built in 1954. I quickly learned the best way to manage some of the issues was to start from scratch. I gutted each room down to the studs, installing new
Frank Caroselli is a DIY guy at work and at home.
ductwork, electrical, plumbing, insulation, sheetrock, molding, doors and paint.” Of course, there are some projects that the home DIY’er doesn’t want to touch. Many would prefer to leave the plumbing and electrical tasks to the pros. That’s not the case with Caroselli; he feels comfortable tackling it all. While many a home repair person would be worried about twisting and breaking that copper pipe sticking out of the wall, Caroselli is undaunted. “I have done a lot of plumbing installs and repairs for myself as well as for family, friends, neighbors and past employment. I am a copper guy. I also work with some brass, PVC and black pipe. I don’t like the new PEX. I enjoy doing plumbing and electrical jobs,” he says. “Tearing walls down to the studs gave me the opportunity to see everything and reinstall it correctly and tailor it to my needs,” he adds. Caroselli brought the electrical up to day
Frank Caroselli looks over blue prints for his present building.
by upgrading the electrical service from 70 amps to 200. He even installed a central vacuum system. He didn’t stop there though. His other endeavors may surpass the skill set of the average DIY enthusiast. “I practically doubled my living space,” he says. “The additions I put in included blowing out my attic room, lifting the roof and adding three bedrooms, a full bath and an independent HVAC system. I also added in the living area; a 12x20 sunroom with a full basement and a separate mud/laundry room.”
UPDATING THE YARD The projects don’t stop indoors. While the outdoor projects can be a world apart from mastering indoor ones, that hasn’t stopped this DIY’er from being a whole house-whole property improver. “On the outside, I added a 12 x 30 raised deck off the sunroom with a full patio under it and a 12 x 12 deck off the mud room. As for landscaping, there are
walls built with fieldstone, landscaping ties and interlocking retaining wall blocks,” Caroselli says. “The retaining wall I built is about 30 feet long, five to six feet tall, that tapers down to one foot. Looking down on it [looks like] sort of a question mark shape,” Caroselli explains. “The block I purchased from our local Home Depot was from the commercial line and was drop shipped from the manufacturer on pallets delivered feet away from the work area,” he says. “The first course is the most difficult, but once that is completed, its mainly just stacking the 70 pound block in a row. Each row offset from the previous row. Some gravel, drainage pipe and fabric and you’re all set.” Living in New York doesn’t leave a whole lot of the year for enjoying a backyard pool, but that is the next item on Caroselli’s to-do list. “I am presently ready to break ground to install a 16 x 36 in-ground pool,” he
Frank Caroselli mixed vermiculite for a pool bottom he is adding to his house.
says. “Pools up here only get about five months of use. You could buy more time if you install a heater. The rest of the time, it is winterized and covered with snow.” Caroselli got lucky and found a guy with an excavator who digs for several local pool companies. The project will be Caroselli’s first attempt at an in-ground pool. He grew up with an above-ground pool and understands what’s involved with the mechanics of the filtration. “The assembly of the pool is going to be a family project. I’m installing a temporary fence. Next year, after the frost and the ground is settled and compacted and dry, I’ll do the concrete and fence work,” he says. He isn’t the only Caroselli with a knack for home improvement. “My brother (Vinny) is a contractor. I guess the home improvement is in our bloodline,” Caroselli says. “I see it in my children also.”
SPOTLIGHT
onsider Key Factors to C when Choosing lutions Provider an Ultrasound So a combined 300 Local engineers with perience years of ultrasound ex , sales, and training Multi-vendor service red and tested 1000s of quality assu parts in stock systems, probes, and r service Outstanding custome s Cost-effective solution 24/7 t or pp Live technical su ays speak directly No automation – alw with an engineer
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Buying Repairable 9800 / 9900 HV Cable Cores Call or email us the condition of the cable(s) and we will submit an offer to purchase the part. We will then inspect and test the part to see if it can be repaired. If it is deemed repairable, we will process the transaction and mail you a check the next day.
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1TECHNATION.COM
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ECRI UPDATE
Disinfection Robots: A front-line assault on hospital-acquired infections?
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attles may be lost or won on the hospital-acquired infection (HAI) front, but the war wages on as pathogens mutate to resist the latest antibiotics and disinfectants. HAIs are a significant problem. According to the U.S. Centers for Disease Control and Prevention (CDC), a survey of acute care hospitals found 1 in 25 hospital patients has at least 1 HAI on any given day and that 75,000 deaths per year are due to HAIs.
The thoroughness of terminal cleaning of patient rooms (i.e., thorough environmental cleaning and disinfection of patient rooms after patient discharge or transfer) in acute care hospitals is one area of focus to reduce HAIs and improve patient care. Recently, some hospitals have adopted portable enhanced environmental disinfection systems (robots) that feature ultraviolet-C (UV-C) light or hydrogen peroxide vapor (HPV) to complement infection control protocols already in place to battle hospital-acquired Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA), and other multi-drug-resistant organisms. Disinfection robotics evolved out of the need to reduce HAIs without incurring additional labor costs. While disinfection robots are new, the two methodologies for disinfecting rooms during terminal cleaning procedures — hydrogen peroxide and ultraviolet processes — are not. UV-C light has been used to decontaminate drinking water and air handling systems for many years, and UV-C and HPV have been used in clean room environments by the pharmaceutical industry for more than a decade. UV-C deactivates DNA and RNA, and HPV utilizes oxidative processes to kill microorganisms, including
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spores.
WHICH TECHNOLOGY TO CHOOSE: Ultraviolet light and hydrogen peroxide vaporization One supplier, Lumalier Corp. (Memphis, TN, USA), offers a UV-C system — the TRU-D® SmartUVC™ with its proprietary Sensor360™ — that calculates the UV time and dose required based on room size, geometry, surface reflectivity to UV-C, and equipment in the room. In a single-patient room, decontamination takes about 25 minutes for MRSA and 45 minutes for C. diff. The robot is wheeled into a room that has already undergone terminal cleaning. The machine is activated remotely because no one can be in the room during system use. A large circular shaft featuring long UV-C tubes shines UV-C light on all room surfaces and objects to kill pathogens. Published environmental-surface study results have indicated the technology eradicates pathogens, and Lumalier has stated that an ongoing study of the TRU-D system (funded by CDC) is comparing HAI rates after standard chemical cleaning plus UV-C disinfecting with the TRU-D. Another UV-C device, the Xenex®, by Xenex Disinfection Services (San Antonio,
TX, USA), uses pulsed xenon. According to Xenex, the system requires five-minute cycles in multiple positions in a typical patient room to kill C. diff., and in this time frame all other pathogens are eliminated. Several hospitals have released data on reduced C. diff and MRSA infection rates in conjunction with this pulsed xenon UV-C system. While the technology is important, it is also critical to implement a bundled approach to reducing HAIs. Education, enhanced hand-hygiene protocols, advanced cleaning procedures, and contact precautions all lead to a safer hospital environment. In addition to light technology, HPV can be used for disinfection purposes. Bioquell, Inc. (Horsham, PA, USA) markets its Q-10 robot system to healthcare facilities. The system uses two machines: the first unit releases a 35 percent hydrogen peroxide solution into the air, and the second aerates the room. The robots resemble portable air-conditioning units. As with the UV-C devices, this system features remote activation because no one can be in the room during use. In addition, air conditioning and heating vents, as well as spaces around the door, must be sealed during use. The process does not harm electronic equipment. According to the
company, a single-patient room without a bathroom takes 90 minutes to decontaminate. Whatever the technology, note that the available “no-touch” technologies such as UV-C light irradiation and vaporized/ aerosolized hydrogen peroxide can be used only for terminal room disinfection because they are hazardous to patients and staff. Also, the number of robots you decide to acquire should be determined according to your room turnover needs and the time required to disinfect.
COSTS AND REIMBURSEMENT While disinfecting robot technology is costly, there’s a direct correlation to reducing infection risk for inpatients, costs for treating HAIs, and patients’ length of stay. According to ECRI Institute’s SELECTplus pricing database, Bioquell’s Q-10 HPV system has an average price of approximately $47,000, the Xenex UV-C system costs approximately $81,000, and the TRU-D UV-C system costs $125,000. Service contract costs should also be considered as part of any lifecycle cost analysis. The U.S. Centers for Medicare & Medicaid Services (CMS) assesses hospitals’ readmission payment adjustments using three readmission measures endorsed by the National Quality Forum: heart attack, heart failure, and pneumonia. CMS is finalizing its proposal to add two new readmission measures, which will be used to calculate readmission penalties beginning in fiscal year 2015: readmissions for hip/knee arthroplasty and chronic obstructive pulmonary disease. Disincentives, such as lower reimbursement payments, are expected to continue, and any higher costs incurred due to HAIs may not be reimbursed at all. Introducing these technologies could have large positive implications for
infection prevention practices and capital and operational budgets. In addition, administrators could see a return on investment due to fewer staff-contracted infections and loss of work time. Implementing disinfection robotics might not only improve patient health outcomes, but also bring about significant savings and cost avoidance for healthcare systems.
KEY FACTS TO CONSIDER • Consider introducing disinfection robots into intensive care units and other high-infection-risk patient care areas, but understand these technologies do not obviate the need for other infection control practices. • Smooth introduction requires that infection control/prevention departments and hospital value analysis and technology assessment departments work together when considering whether to implement disinfection robots. • These technologies are costly. Consider trialing the robots to assess their optimal value in terms of type of technology and locations in which to use them. • For the trial, collect data on pre- and post-implementation hospital infection rates (including number and types of pathogens), patient clinical and infection information, readmission rates, disinfection time, and room downtime.
• If you move forward with acquiring the technology, decide how many to acquire, where to place them, and whether to purchase or lease them. • Create a phased-in implementation approach that includes staff training to ensure understanding of the technology and its implications for other aspects of infection control to ensure consistent infection prevention protocols. • Training staff for proper terminal cleaning, robotic cleaning, and infection prevention practices are key to a successful infection prevention program. A patient area may be disinfected well, but if a staff member does not follow appropriate infection prevention protocol, any patient area a staff member touches may be recontaminated. • Monitor the clinical literature for evidence of effectiveness. Most cleaning and monitoring modalities are not well studied in clinical settings. The evidence base is limited by weak study designs, lack of consensus around important concepts (such as cleanliness thresholds and delineation of high-touch surfaces), and reliance on nonclinical outcomes. • Watch for technology enhancements, including built-in UV-C and/or HPC disinfection systems, for newly constructed hospital areas and high-ion areas. THIS ARTICLE IS EXCERPTED FROM ECRI Institute’s 2015 Top 10 Hospital C-Suite Watch List. The full white paper contains more guidance on disinfection robots and other novel, new, or emerging technologies. To download the full C-Suite Watch List, visit www.ecri.org/2015watchlist. For more information on ECRI Institute’s evidencebased health technology assessment or consulting services, contact communications@ecri.org, or call (610) 825-6000, ext. 5889.
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AAMI UPDATE
A ‘Call for Action’ in Training BMETs in Low-Resource Countries
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killed biomedical equipment technicians (BMETs) are crucial to advancing healthcare in low-resource countries, according to a new report, which calls on a wide variety of stakeholders to come together to support the development of “scalable, replicable, and sustainable” training models for such professionals.
The report BMETs in Low-Resource Countries was prepared for the GE Foundation and the AAMI Foundation. It is a summary of a two-day meeting this past June in Toronto, Canada, at which 55 professionals from various backgrounds and across the globe engaged one another on how best to achieve the vision of effective training for BMETs in countries that need their services desperately. “Without technology that supports diagnosis and treatment, patients are vulnerable to needless pain and suffering, poor health outcomes, and even death,” reads the report. “Timely access to emergency care and the use of diagnostic and therapeutic tools reduces patient mortality. Yet much of the available equipment in low-resource countries is not functional.” Until there are more skilled BMETs on the ground to keep medical equipment running safely and effectively, developing countries will be stymied in their efforts to improve patient care, the stakeholders at the meeting concluded. Toward that end, the meeting participants identified six crucial next steps. They are: • Create an international advisory body to assure quality of BMET training based on core competencies. • Create a global alliance that focuses on the promotion of the HTM profession in low-resource countries.
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• Ensure the strict selection of BMET trainees/trainers. • Engage multiple stakeholders and funders to promote BMETs. • Create sustainable, scalable funding strategies for BMET training to improve public health outcomes. • Define metrics for BMET health impact/outcomes. The report notes there are considerable challenges to realizing the vision of effective training models, not the least of which is simply paying for such programs. “To date, secure funding for training has not been easy, and funding for community building will likely be more difficult to garner,” the report concludes. Still, the report strikes a “call to action” tenor, urging the HTM community and other healthcare-related professionals to “work together for this common purpose” and make a positive difference in the lives of countless patients around the world. A final report, which will include specific recommendations for the training models, is due this fall.
AAMI DEVELOPS HTM JOB DESCRIPTIONS AAMI’s Technology Management Council has developed a set of standardized and basic job descriptions that can be used by departments and programs that manage healthcare
technology. Each job description includes a suggested job title, and some include what may be a more commonly used title. The descriptions are intended to be used as a starting point and may be modified to suit the needs of managers or others who develop job descriptions. The basic descriptions developed by the TMC cover such items as education, public safety and regulatory requirements, equipment experience, and customer service. The job descriptions can be downloaded in either PDF or Word format at www.aami.org/ jobdescriptions.
AAMI SECURES PRESTIGIOUS ACCREDITATION ROLE An influential accreditation board has selected AAMI as its lead member society for bioengineering technology and similarly named programs, such as those for biomedical equipment technicians (BMETs). The Accreditation Board for Engineering and Technology (ABET) accredits college and university programs in applied science, computing, engineering, and technology. In practical terms, this means that AAMI will now be the professional society that sets guidelines and assists in accreditation efforts for associate and bachelor degree college bioengineering or biomedical engineering technology
PROO PROOF CHANGES NEEDED role with ABETAPPROVED is timely, as AAMI’s CoreCLIENT Competencies for the Biomedical SIGN–OFF: Equipment Technician document is being revised and PLEASE updated.CONFIRM THAT THE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS
A MENTORSHIP PROGRAM FOR YOU Are you a seasoned healthcare technology professional interested in guiding a newer peer? Are you a novice in need of insights and tips from a veteran in the field? AAMI’s mentorship program is for you. Launched earlier this year, the program matches AAMI members who are looking for guidance in specific areas with professionals who have expertise and experience in the same areas. The goals of the program are to help protégés develop the skills and knowledge necessary to succeed and grow in the healthcare technology field; to provide a venue for them to discuss issues or concerns that are unique to healthcare technology professionals; and to encourage long-term career planning. Mentors and their protégés generally spend about an hour or two a month meeting in person, over the phone, or via email. The number, type, and duration of meetings can vary depending on what works best for the mentor and protégé. More information is available at www. aami.org/mentorship.
SPELLING
GRAMMAR
TRIM 2.25”
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TRIM 4.5”
programs. Additionally, AAMI will provide evaluators to visit colleges to determine if their programs meet the criteria for accreditation. AAMI had been seen by many in the field as a more logical fit for this role than the previous lead society, which was the Biomedical Engineering Society (BMES). The latter is primarily an engineering organization, rather than an organization for BMETs and other technicians in the healthcare technology management (HTM) field. BMES supported efforts for AAMI to become the BMET lead society. “This is an exciting development, as it will help enhance AAMI’s commitment to HTM education and the future of our profession,” said Steve Yelton, an educator and a member of AAMI’s Board of Directors. “AAMI currently is involved with certification of BMETs, core competencies for college programs, and guidance in career planning and strategy. This will complete the cycle with AAMI becoming involved in assisting in the accreditation of college programs.” AAMI’s new role as an ABET member society in no way requires BMET educational programs to become ABET-accredited. Some programs choose to become ABET-accredited, while others do not because of costs and other factors. The news about AAMI’s new
The Right Fit For Your In-House Service Needs Philips multivendor service program brings to your department and organization far more than just repair service. Philips skilled trained technicians and program leaders help you with your imaging systems and biomedical equipment service and operational goals, regardless of manufacturer.
PROOF APPROVED
Visit us at www.philips.com/mvs to find out how you can improve both your in-house service delivery and your bottom line with Philips.
PROOF SHEET
CHANGES NEEDED
CLIENT SIGN–OFF: PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS
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WIDTH 7”
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p th urc Rec e ha ie pr se ve om w 5 oc he % od n y off e: ou yo Te m ur ch en N tio at n io n
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tretcher and table pad surfaces are damaged frequently over the course of their service life. Damaged surfaces pose a risk to patient safety due to possible fluid ingress.
CleanPatch is a FDA-registered medical surface repair product that restores damaged mattresses to an intact and hygienic state, allowing the surface to be properly cleaned. Two years of independent study has shown that CleanPatch is durable, cleanable, impervious to fluids, and does not harbor bacteria. It is already being used in hundreds of ORs to safely and effectively repair table pads between surgeries. MORE INFORMATION IS AVALIABLE AT: www.cleanpatch.ca.
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OCTOBER 2015
1TECHNATION.COM
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Webinar
Wednesday
WEBINAR WEDNESDAY Ultrasound Webinar a Hit By John Wallace, Editor
U
ltrasound remains a popular health care tool among patients and caregivers which means that downtime is costly. Matt Tomory, Vice President of Sales, Marketing and Training at Conquest Imaging, is an expert when it comes to the maintenance and repair of ultrasound systems. He recently shared his valuable insights via the TechNation Webinar Wednesday series with his presentation “Ultrasound Clinical Applications for Service Engineers.”
“ I am very grateful to have TechNation as a resource to help in my everyday needs as a engineer. In the hospital environment, a biomedical engineer comes across many challenges on a day-to-day basis.” - Q. Campbell 30
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Tomory has almost 30 years of experience in ultrasound service, training, technical support, research and development, sales, marketing and clinical applications. He even served as a field service engineer before becoming a vice president at Conquest Imaging. The thorough presentation, sponsored by Conquest Imaging, covered all the basics with helpful tips and insights, including how to understand the different terms sonographers use and the benefits of scanning one’s self or a phantom while doing preventative maintenance and troubleshooting. It was a valuable Ultrasound 101 class with tons of basic information for beginners as well as helpful reminders for more experienced biomeds and imaging service professionals. Tomory capped off the excellent presentation with a Q&A session that imparted even more expert knowledge on ultrasound devices to the more than 300 webinar attendees. The webinar was well received earning a 4.4 rating on a 5-point scale with 5 being the best possible
rating. Attendees complimented the webinar in post-webinar surveys. “This [webinar] was very informative. I will have more confidence troubleshooting image quality issues now,” Jeff R. wrote after watching the webinar. “Matt gave a very commendable presentation on the applicable principles for ultrasound,” Dennis P. wrote. The Webinar Wednesday series also received praise. “I am very grateful to have TechNation as a resource to help in my everyday needs as a engineer,” Quinton wrote. “In the hospital environment, a biomedical engineer comes across many challenges on a day-to-day basis.” “TechNation’s webinar series is a valuable piece of continuing education to the biomedical engineering professional and beneficial for ICC certification education points,” Richard S. wrote. TO REGISTER for the next free Webinar Wednesday session, visit 1TechNation.com. Recordings of previous webinars are available on the website.
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BIOMED 101
Digital Radiography – The transformation of medical imaging and diagnosis By Neil Oliver
D
igital technology has had a huge impact on modern life, revolutionizing how we perform simple tasks like taking a photo or watching TV, but perhaps the most significant impact has been its transformation of medical care. Like the transition from film-based to digital cameras, X-rays have advanced from a film imaging process to one based on digital technologies. Digital radiography greatly benefits the health care industry, but it also places high demands on medical equipment manufacturers. Here we will explore how smart batteries are designed to meet these challenges.
Diagnostic imaging remains an important tool for the detection and treatment of many disorders. In various clinical settings, an X-ray is often the starting point for diagnosis. During the process, a beam of X-rays is transmitted through the part of the patient’s body which needs further investigation. The X-rays are absorbed by the body in differing amounts, resulting in the familiar contrast seen in X-ray images.
FILM VERSUS DIGITAL Thanks to digital radiography (DR), medical imaging is being transformed by better detectors, more powerful computers, sharper displays, faster processing and more efficient archiving. The benefits are great and wide ranging; an image can be acquired in seconds and viewed on any computer monitor; it can be accepted or deleted at the click of a button; it can be easily shared with other medical professionals and archived in an online database. It also allows for greater precision, and the balance between image quality and radiation dose can be controlled more accurately – making it a safer process for the patient. Traditionally, the images were exposed
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NEIL OLIVER Technical Marketing Manager of Accutronics
onto photographic film, but with the advent of digital radiography an electronic detector is used instead. The image is then processed by a computer, rather than being chemically developed. The initial cost of a DR system, compared to the conventional film-based system, is high. However, hospitals save money by eliminating film costs and reducing the storage space required to archive the images. Because it is a faster and more efficient process, perhaps the biggest saving is time. Fewer operators are
required to man the service and patients can be seen more quickly. The basic principle is very similar to that of a digital camera. Both the conventional camera and its digital counterpart work by using a series of lenses that focus light to create an image. In the digital camera, instead of focusing the light onto a piece of film, it focuses it onto a semiconductor device that records light electronically. A computer then breaks this electronic information down into digital data. In digital radiology, amorphous silicon detectors are combined with a caesium iodine or gadolinium oxysulfide scintillator to convert X-rays into light. The light is channeled through the amorphous silicon photodiode layer where it is converted to a digital output signal. The signal is then read by thin film transistors or fiber coupled CCDs before being sent to a computer for processing and display. Introduced in the mid-1980s, DR has steadily gained in popularity. Like the digital camera, it rapidly began to compete with the more conventional film-based process and is moving toward replacing it altogether. In digital radiography, the X-ray source will often be built into a medical trolley. The battery allows the detector to be completely portable, so that if the patient
WHAT WE DO Service Contracts/ ACR Programs reaches its end of life, the hospital has to send the detector back to the manufacturer PM Plans for the power source to be replaced. This is a costly exercise that puts a vital piece of medical equipment out of service. The Site Audits/ solution is a removable, rechargeable Inspections battery, enabling the hospital to achieve Full Magnet Service continuous use. Ramping/Shimming However, batteries used in critical environments in this way must provide PROOF APPROVED NEEDED genuinely accurate fuel gauging toCHANGES ensure For all our services, visit our website that the remaining battery life indicators CLIENT SIGN–OFF: www.fieldmriservices.com are reliable. This provides the user with PLEASE THAT THE FOLLOWING ARE CORRECT predictive run time ofCONFIRM the device; giving 404.210.2717 fieldmriservices@gmail.com PHONE NUMBER WEBSITE ADDRESS SPELLING them the abilityLOGO to know how many images they can take. For clinical environments, Accutronics has developed multi-bay smart charger technology that means that multiple batteries can be charged at a time, resulting in a quick changeover and a device that can remain in continuous use. These innovative power products contain the latest smart battery technology, including active and passive protection circuits that prevent over-temperature, over and under-voltage, overload and short circuit. They are capable of accurate fuel gauging and are built to international regulatory standards, all features that are especially useful in the increasingly dynamic nature of modern hospital care. Because of the initial cost of a DR system, it is mostly being adopted in countries with a tier-one health system, however, digital technology is evolving at a rapid rate and becoming more flexible and affordable. More than two billion people in the world now have access to the Internet and five billion have mobile phones. Like the transition from film-based to digital cameras, it’s conceivable that digital radiography will also, one day soon, have a global appeal.
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is in a hospital bed, the trolley can be wheeled to them and the detector can be slipped underneath the patient to take the X-ray. Portable X-ray detectors need to be lightweight and slim but extremely robust. The comparison with the digital camera ends when it comes to the size of the detector required for each device. For example, the detector on your smartphone camera is about 3mm across, whereas a DR detector can be the size of a briefcase. Furthermore, the batteries within smart phones usually consist of a single Lithium ion cell whereas the large portable detector panels require a far more complicated multi-cell battery pack. Although the batteries for detectors need to be larger, they must still maintain a slender profile if they are to fit into the rear of the detector – the need for thinness in such a large footprint creates a number of challenges for the battery designer. The lithium ion cells used within such batteries are more commonly of the “pouch” type which cannot tolerate bending or twisting. The average thickness of a rechargeable battery for the DR market is now less than seven millimetres but has a footprint similar to a sheet of A5 paper and must be flat within 0.2mm. The battery case must provide enough torsional rigidity to prevent damage to the cells that may cause internal short circuit leading to overheating or fire. The use of modern plastics technology can aid in the design of such cases but clever mechanical design can also ensure that rigidity is built into the structure and still maintain the thinness that the market requires. Some digital radiography detectors contain an embedded battery similar to that used in handheld tablet devices, but the consequence is that, once the battery
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SHOP TALK
Conversations from the TechNation ListServ Q:
We are looking at taking an active role by working with our nurses to help them learn how to use the equipment and how to address common problems. Can anybody offer some tips? Has anybody else done this and had success?
A: A:
Try using sales guys for in-services.
I have had at least some success with this sort of thing. Generally, I find it better to go over any training or information first with the department manager so they can help resolve the issue with their staff. I then follow up by performing a general training presentation during department meetings.
Q:
What do others do for manual BPs? Do you test for accuracy? Is a PM called for?
A:
Is the needle centered in the small window of the manual manometer? You can in-line with a b/p checker you do not need a PM.
A:
Historically, we have just used the simple ‘cal. Box’ rule. Welch Allyn actually does call for “annual validation” in their literature. We have started tracking with a calibrated pressure manometer for those clinics and departments that specifically request.
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Q:
What is a great gift for a first-year biomed who recently started his/her first job? Is there an ideal piece of test equipment or something else that every biomed should have? What would you want?
A:
I would say either a Pronk SL-8 SimSlim patient simulator stick, a set of Torx security screwdrivers or a good Brother label maker.
A:
A nice quarter-inch SAE and Metric socket set along with a screwdriver set (Philips, Standard and Torx). And when I say nice, I am talking Craftsman, Snap-On or Mac Tools.
A:
The gift I would love to get is a tool kit that I got from Philips when I first started. The tool kit part number is 4522 500 66171. This toolkit has been with me now for about 10 years and it’s pretty much all I use on a day-to-day basis. I have added some additional pieces over the years, of course.
A: A:
Leatherman multi-tool.
There’s no better tool companion than the Leatherman Wave. In more than 15 years as a Biomed, its the first tool I reach for when responding to service calls.
OCTOBER 2015
A:
A good electronics technician tool kit would be nice, but they can be expensive. I would advise you to check out techni-tools website.
A:
A:
A precision screwdriver set both standard Philips- and flat-head as well as Torx. A screwdriver that is reversible between a #1 and #2 that flips around in the handle and can also be used as a nutdriver if the bit is removed (most of us have a Zoll one that came with our purchase of M-Series defibs about 8 years ago for assembly). A soldering iron station (couple different sizes of solder, a flux pen, solder suck, solder wick and tip cleaner). A socket set or sets (quarter-inch to half-inch drive). A long Philips- and flat-head screwdriver. A kit for repairing power plug ends (wire strippers and dikes). A cordless screwdriver. An anti-static bagless vacuum cleaner. A laptop computer. I believe if you have these tools, you can do most of what you need. As most have said, you can cut down on some tools by purchasing a decent Leatherman pocket tool.
A:
THESE POSTS are from TechNation’s ListServ. Go to www.1technation.com/listserv to find out how you can join and be part of the discussion.
A:
I second the Leatherman surge multi tool (Grainger P/N # 9UED0 Est $120). You can find them cheaper than Grainger. Also, a Mag light flashlight, LED, black, 245 L, AA (Grainger P/N # 19G664 Est $ 35-40). Again, you can find them cheaper than Grainger. Both are in a holster (Black, Clip Pock-its XL Utility Holster Grainger P/N # 1JUF3 $20) on my hip. If I do not have my Leatherman and flashlight when I leave home in the morning, I will go back.
A:
Streamlight LED flashlight.
I think the ifixit pro tech toolkit is very good. It is a wonderful kit to own for anyone involved in electronic repair. If this is a serious tech, you might consider giving him/her the “Affinity Reference for Biomedical Engineers” from GE Healthcare. It’s an update of the original from Marquette Medical, and is a nice reference. It’s not as entertaining as a T-shirt with biomed humor on it, but it’ll last longer.
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OCTOBER 2015
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ROUNDTABLE I.V. Pumps
T
echNation magazine reached out to experts within the industry to find out the latest on I.V. pumps. We gathered tips on how to extend the life of an I.V. pump and what features to look for when considering the purchase of new infusion therapy devices. New technology, appropriate service and other important topics were addressed.
Our roundtable panel of experts consisted of Pacific Medical Technician Manager Brian Barton, Soma Technology Inc.’s Ashish Dhammam, Iatric Systems Senior Vice President of Software Solutions Jeff McGeath, USOC Medical Lead Technician Shawn Nguyen, Elite Biomedical Solutions Vice President of Operations Nate Smith, Tenacore Holdings Inc.’s Bob Spidell and AIV Inc. Sales Director Jeff Taltavull.
Q:
HOW CAN A BIOMED EXTEND THE LIFE OF AN I.V. PUMP?
found. Also, cosmetic appearance shouldn’t be neglected, pumps can be maintained to work and look as good as new, and scuffed, dinged up pumps that look worn out won’t inspire confidence from patients or nursing staff.
Barton: You can repair and restore broken pumps or outsource repair and/ or service to a third party. Refurbished or used parts can be a cost-effective alternative. You can replace parts such as covers, cases and external cosmetics. You can perform regular service and software upgrades.
Taltavull: There are many ways to extend the life of your infusion pumps. Regular maintenance by trained professionals can keep your pumps running and easily spot small problems before they become major ones.
Dhammam: Performing regularly scheduled maintenance adds to the life of the pump. Basic troubleshooting instructions and training end users on proper usage, cleaning helps. McGeath: Best practices to extend the life of an I.V. pump include performing manufacturers’ recommended preventative maintenance, using OEM parts, and especially keeping the batteries charged by plugging the pumps into AC whenever possible. Nguyen: Periodically inspecting the pump for damaged mechanical parts such as doors and latches and conducting preventative maintenance on it as recommended by the manufacturer’s protocol. Oh, and keep it clean! Smith: The biomedical groups can extend the service life of a device by properly maintaining it. This involves servicing and
Q:
WHAT ARE THE MOST IMPORTANT FEATURES TO LOOK FOR WHEN PURCHASING I.V. PUMPS?
BRIAN BARTON
Technician Manager, Pacific Medical
testing the device for the intended use of the instrument. A thorough maintenance protocol will ensure the device meets the desired parameters. These groups can perform these services cost effectively by using a recognized and approved third-party provider. Spidell: Pump life can be extended for as long as the biomed has time and parts availability. For older pumps that are no longer supported by the OEM, alternate sources for parts and/or service can be
Barton: The way in which a pump is designed, its mobility, and how an I.V. pump integrates with the nurse’s workflow, largely impacts patient safety. Finding a pump that lowers user/ medication errors is arguably most important. Integrated, smart technology, and wireless drug libraries with data analytics, will prove most beneficial. Dhammam: It depends on the entity that is purchasing. For large hospitals, you have to make sure it is compatible with the infrastructure and software levels that are already in place. Wireless bands of transmission are important lately. For smaller places, cost of tubing may be the biggest concern.
THE ROUNDTABLE
are still lots of quality, refurbished units to be found. Dhammam: No! Many hospital systems have chosen to lease/rent/buy their I.V. pumps from rental companies and third-party vendors. This is an active practice that is only becoming more popular now. The pumps are not always new. In most cases, they are refurbished pumps that are moved from one place to another. As long as they are certified/ calibrated to OEM specifications, the quality can be guaranteed to be the same as new pumps. ASHISH DHAMMAM
JEFF MCGREATHE
Soma Technology
Senoir Vice President of Software Solutions, Iatric Systems
McGeath: Ease-of-use, safety and reliability are key components of any pump purchase decision. The ability to integrate with the hospital’s EHR system, as well as the overall cost of ownership, including disposable costs and ongoing license and maintenance fees, should also be heavily considered. Nguyen: Smart infusion pumps have become increasingly advanced and include close error software. This technology allows infusion pumps to perform functions that assist health care workers with programming and calculating dose and delivery rates. If used properly, these features help prevent I.V. medication errors and reduce patient harm. Smith: The most important feature to consider is the device’s ability to expand options as the needs of the patients and institutions change. Most of the current providers achieve this through software enhancements. Ideally these changes should be incorporated at the institution, and as efficiently as possible.
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Spidell: What’s the long term maintenance plan after the warranty? Will you have time to make repairs in house or will you be outsourcing some repairs? Will you have OEM training and be able to get all parts? How much does the OEM charge? What’s their turnaround time? Can a repair depot do it faster for less? Taltavull: The most important features to look for are the ones that will benefit your users the most. Infusion pumps today can provide a wide variety of infusion types, but you might only need it for a single function or set of functions. Knowing exactly what you need will help you find the pumps you require and not overspend on unnecessary features or equipment.
Q:
DO YOU HAVE TO BUY BRAND NEW PUMPS TO GET QUALITY I.V. PUMPS? Barton: It’s less a matter of quality and more a matter of how much capital the establishment has. If a hospital simply cannot afford the latest technology, there
NOVEMBER OCTOBER 2015 2014
McGeath: In general, yes, buying new pumps is often the best option, as they will have the most recent hardware and software updates, and integration capabilities. While there are third party re-sellers of pumps, these devices may/ may not be refurbished using OEM parts and don’t always contain the latest software versions. They are, essentially, used devices. Nguyen: No. Not all medical facilities have the budget to buy brand new. A reputable third-party vendor can be a great alternative. Smith: No, many options are available in the marketplace today. Most of these platforms can be or have been expanded to be comparable to new offerings. An institution can realize considerable savings when considering these truly viable options. Spidell: No, but I think it’s the best place to start if you have that kind of budgetary luxury. If not, you should try to find a trustworthy vendor to sell you quality refurbished pumps that are patient ready and backed by the best warranty. Taltavull: Absolutely not.
Q:
HOW OFTEN SHOULD REGULAR SERVICE BE PERFORMED ON AN I.V. PUMP? Barton: Obviously there is not one rule that pertains to all pumps. Ultimately, it depends on the type of pump, how it is being utilized in the facility, its history, and, of course, the OEM recommendations. Dhammam: Standard practice is every six months. Facilities where end users are not trained properly generally see service performed often on their I.V. pumps. SHAWN NGUYEN
McGeath: Annual PMs are recommended and considered a best practice, but the most important aspect is to follow manufacturer service recommendations. Nguyen: Annually. Smith: An overall performance assessment should be performed periodically considering several operational parameters. How the device will be used as well as the OEM guidelines should be considered. A review of performance; repairs or corrective actions throughout the service life should be part of this assessment. Spidell: Beyond regular PMs, I don’t think there is an answer for that. The life and experience of each pump is fairly unique and it’s not possible to predict damaging mishaps or malfunctions. I think it’s most important to have a trained and vigilant nursing staff that can identify problems as they arise. Taltavull: This depends on the model. At the very least, pumps should be inspected during your facility’s preventative maintenance (PM) periods. Some pumps may need more frequent
Lead Technician, USOC Medical
inspection. When in doubt, it is always beneficial to consult the user/ maintenance manual from the OEM.
Q:
HOW WILL NEW TECHNOLOGY AND OTHER ADVANCES IMPACT THE I.V. PUMP MARKET? Barton: Smart technology will be the norm. No question about it. At some point, because of the ability to reduce medication errors, the advantages of advanced alarming, history log data, and the ability of pharmacists to oversee the uploaded wireless drug libraries, are technologies that will become industry standards. Dhammam: BG band upgrades to wireless transmission has been a focus for I.V. pumps as with many other categories of medical equipment. BD/ Carefusion has focused on the complete solution including the monitoring of vitals through their smart pump solution. We are seeing more on-screen clinical advisories, therapy specific programming and increased number of drug libraries. Proprietary software and
NATHAN SMITH
Vice President of Operations, Elite Biomedical
service options are making pumps less easily serviceable by third-party vendors. McGeath: The majority of changes are likely to impact external versus internal applications. Of course, networking and encryption/authentication protocol changes may impact the wireless hardware and firmware on the device, but consideration should be given to hardware and/or software requirements and architecture necessary to install and maintain these external software applications. This could include minimum requirements for server hardware, operating software and database software, such as MS-SQL. While this doesn’t directly impact pump maintenance, it certainly impacts overall infusion (data) functionality from a system standpoint. A number of these same external applications may help the actual maintenance of the pump including, retention of data logs, alarm history and even the ability to locate the device. Emerging data protocols from the smart pump community include the ability to communicate device management data such as software revision, battery status, last service date,
THE ROUNDTABLE
etc. These operational data elements could vastly improve the biomedical engineering workflow. Nguyen: I think the sophisticated technology we have now for infusion pumps can help reduce medication errors, but I know it can’t prevent all programming and administration errors. Health care workers must use professional judgment and stick to established standards of care and operating procedures for safe medication administration when using this or any technology. Smith: As technology advances, new operational features and tools to assist the clinicians will become available. These features should assist the clinicians in improving the efficiency, efficacy and safety of patient care. A current platform that can expand to meet those advances is the most desirable. Spidell: I.V. pumps have been shrinking in size and weight making them easier to handle and move around. They can also be more difficult to find when needed. Wireless asset tracking can help biomeds locate pumps that are hiding when PMs are due. Taltavull: You will see pumps that become more flexible/adaptable and less one dimensional, as well as more connected. All of the new technology means that biomeds and repair companies will need to become better versed in the new technologies to ensure these new pieces of equipment are used/ serviced properly.
Q:
WHAT TYPE OF CREDENTIALS SHOULD THIRD-PARTY ORGANIZATIONS POSSES OR MAINTAIN? WHAT SHOULD BE CONSIDERED WHEN EVALUATING THIRD-PARTY ORGANIZATIONS?
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BOB SPIDELL
JEFF TALTAVULL
Tenacore Holdings, Inc.
Sales Director, AIV Inc.
Barton: It is imperative, before considering outsourcing repairs to a third-party organization, that ISO certifications have been verified, are up-to-date, and that OEM certifications have also been verified. Other than credentials, quick turn-around times on repairs and replacements should be incredibly important. Nobody wants to be without equipment. Also, when working with third-party organizations it is paramount to anticipate a quick turn time to ensure there is no lapse in patient care. Dhammam: How long have they been in business? What is their capability/ training/certifications to service infusion pumps? ISO certification is a big plus. Consider the volume of pumps they sell/ rent. Does this organization have a nationwide network for field service and support in addition to depot repair capabilities? Large GPO approved third-party vendors are good organizations to work with. McGeath: We may see pump vendors begin to create third-party certification
NOVEMBER OCTOBER 2015 2014
programs that allow the pump vendor to “certify” the third party’s software (be that a core EHR vendor or third-party integrator) for performance against its feature set. For now, a great source of information about the technical abilities of EHR and third-party integrators is the IHE-sponsored Connectathon events where the integration profiles have undergone extensive, week-long testing between different vendor software applications. See connectathon-results. ihe.net for additional information. Nguyen: Third parties should be certified by the OEM or by other credentialing entities. It is important that the third party is well versed in your particular pump manufacturer and model and that they have a proven track record of outstanding service on this equipment. Having systems in place like ISO 9001 is a must, this is a quality management system that helps to mitigate any issues that may occur with how repairs are performed. Smith: A quality third-party organization should possess the experience and follow the current practices of the I.V. industry. The credentialing should include, but not
spice up your
inbox (we know you want something more)
be limited to, the OEM product training offerings as well as the many professional certifications in the pertinent fields. We also believe experience in this field is important. Spidell: They should be FDA registered, have ISO certification, and OEM training on the equipment they service. Look for an organization that you can build a trusting relationship with, that is responsive to your questions and concerns and offers a solid warranty on their work. Taltavull: Pertinent certifications/ accreditations for the items the company sells, repairs and manufactures. When looking for a third-party vendor it’s always good to do your homework. See what your peers at other facilities and in your local associations are saying, chances are if they like the vendor you will as well.
Q:
WHAT ELSE DO YOU THINK IS IMPORTANT FOR TECHNATION READERS TO KNOW ABOUT I.V. PUMPS? Barton: Do your PMs regularly, update software as needed, and be sure to outsource repairs when they prove to be too much. There is no reason to shotgun repairs. At the end of the day, attempting to fix problems on your own, without the proper training, only serves to hurt those we are committed to helping. Dhammam: There are many new makes and models that are being released actively. The overall solution is important to large hospital systems, backwards approach with the end goal in mind would probably help simplify the right choice of the I.V. pump for these systems. There are inexpensive alternatives to buying new pumps through third-party vendors and this
should be considered in order to save on capital spending. McGeath: Current and future trends will continue to emphasize system integration via the hospital’s wireless network. Along with initial and ongoing device certification training, it would be beneficial for biomeds to become familiar with the wireless hardware contained within a device to understand not only how to troubleshoot but also configure these components. Wireless and encryption/authentication protocols are constantly being updated and a basic knowledge of wireless networks would be very advantageous. Computer literacy will also be a “must have” as new applications are developed and released that will help biomedical personnel configure, troubleshoot and even locate devices for service. Nguyen: Quality, efficiency, and longevity are the most important things to look for in an infusion pump. Make sure you’re properly educated and trained to service and maintain all infusion pumps used in your facility and always look out for updates and changes. Smith: When selecting a product, first consider the application and operational environment. Next, consider what the total cost of the device will be throughout the entire service life. Other factors to consider are selecting parts and service providers that can provide a tested and quality product and one that can answer the service needs for the life of the device. Spidell: Look for extra cost savings by using quality replacement cases from third-party vendors.
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I
n market economics, a popular theme is the concept of competition and its positive impact on the prices consumers pay. When airlines merge, it is not beyond the pale to anticipate higher prices as competitive pressures ease and the whim of a few major players dictates the fares and fees in that industry. It’s not a good day for the paying public when a few major players dictate the market’s pricing.
RIGHT TO REPAIR
“
edical equipment M repair is suffering from the same monopolization policies as other industries for the same simple profit motive. Repair can be very profitable, and much more profitable when there is no competition.”
There was a time when the backyard mechanic could easily figure out an auto repair. The lack of onboard computers and the straight-forward nature of the internal combustion engine of past years made narrowing down a problem the result of a few diagnostic steps. That ended with the introduction of more sophisticated electronics systems and monitoring systems in automobiles. This gave the dealership a decided advantage, along with the $130/hour labor rate. The macroeconomic principle of market choice and competition has not skipped over the HTM profession and the ability of individual HTM professionals to control costs by simply doing their job. We can fix it; let us fix it, is the mantra of many who are frustrated by having their hands tied. This fight has become so contentious that it has even landed in the courtroom. The information and access to accomplish a repair should be unfettered; but that’s not always the case.
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GAY GORDON-BYRNE
THOMAS GREEN
Executive Director of the Digital Right to Repair Coalitition and author
President of Paragon Service
Manufacturers argue that right to repair laws would weaken intellectual property protections. The argument is countered by those often affected, like ISOs, who argue that downtime impacts patients. Some manufacturers limit access to diagnostics as well. Legal actions are nothing new in the right to repair debate. Litigation in 1990 awarded some ISOs the right to use a manufacturer’s software in repairs. In 1998, the Justice Department settled an antitrust lawsuit with GE allowing 500 hospitals to service MRIs and CT scanners and lifting restrictions on software licenses. “In regards to servicing anesthesia systems, there have been two major lawsuits by independent service organizations protecting their rights to service the OEM equipment,” says Thomas G. Green, president of Paragon Service in Saline, Michigan. “The first was Red Lion versus Ohmeda (now GE Healthcare) which settled in 1999. The other lawsuit was Metropolitan Medical Services versus Drager Medical which settled in 2005. Both cases settled on an amicable basis as agreed to by all parties.” Green is a party to a current litigation as an ISO. As with so many other issues, that are
major concerns in the HTM community. The flexibility of hospital budgets plays a pivotal role as well. The cost of parts and training may be higher than a service contract. Which will the person making the purchasing decision decide on? That can work to the advantage of the manufacturer, but it can also work during negotiations and before finalizing capital equipment sales for the customer. Holding tight to the purse strings, before approving a purchase that must include training and/ or documentation is a bargaining tool. Manufacturers who offer different levels of contract coverage help to assuage some of the resistance to the high costs of cutting the HTM department out of their ability to tackle more projects. Shared service models, with the HTM department handling the PMs and front-line support, while the OEM provides a break on parts or labor can offer a compromise. There is also the question of true competence to repair. As one manager observed, “You don’t ever cross a line with equipment. You only go as far as your comfort zone, which includes your skill set and knowledge base. There are too many who will cross that line.” With that caveat in mind, we look at the experience of some in the HTM community when it comes to this topic.
“ JEFFERY RUIZ
Biomedical Engineering Manager, Holland Hospital
We also hear from an advocacy group that has given the topic extensive consideration. “If I buy a car, I can still do my own diagnostics with help of aftermarket tools or even go to what we would call third-party vendors,” says Jeffrey Ruiz, biomedical engineering manager at Holland Hospital in Holland, Michigan. “I have the right to troubleshoot or fix my car. I can get parts, service manuals or even go look up YouTube and see how to replace my wipers or headlights. I know that cars and medical equipment are different animals, but if I could go to YouTube to do a PM on a device, could you imagine the impact that would have?”
ADDRESSING RIGHT TO REPAIR “There is the possibility, when you purchase, [that] you demand the required documentation and information,” says Matt Du Vall, a biomedical technician at Treasure Valley Hospital in Boise, Idaho. “That only works as long as the purchasing agent does not bargain it away and if it’s not a substantial purchase.” “Your administration can also help if they are backing you,” Du Vall adds. “In the past, my department held up the
I have the right to troubleshoot or fix my car. [...] I know that cars and medical equipment are different animals, but if I could go to YouTube to do a PM on a device, could you imagine the impact that would have?”
authorization of paying on items until manuals were supplied. We have held the equipment in a store room and put it on the floor but it needed our manager’s signature for the payment to be made.” But these measures should not even be at issue in the first place according to Gay Gordon-Byrne, executive director of the Digital Right to Repair Coalition and author of the book “Buying, Supporting, Maintaining Software and Equipment: An IT Managers Guide to Controlling the Product Lifecycle.” She says that often the negotiation is limited by the controlling position the OEM happens to be in. “Medical equipment repair is suffering from the same monopolization policies as other industries for the same simple profit motive. Repair can be very profitable, and much more profitable when there is no competition,” she says. “Monopolization of repair is very easy when digital products are involved – all an OEM has to do is claim ‘proprietary’ software and ‘complicated’ equipment and voila – very few organizations attempt to negotiate better terms,” Gordon-Byrne says. “Medical equipment buyers are also fearful of making patient care errors – so the OEMs have an extremely powerful marketing message. It is only
marketing – not technological.” “The reason we are confident we can change laws to protect repair is that the claims supporting monopolization of repair are actually weak, if not bogus,” Gordon-Byrne adds. “Repair is restoration of products to function. It is not how IP or patents are stolen. The same objections were raised by auto manufacturers in opposition to Automotive Right to Repair – and then accepted when faced with legislation. Cars and MRI machines are very similar when it comes to their electronic components,” she adds. “Chips are chips regardless of the covers.” Gordon-Byrne says that patents are not at risk because patents are already public. She points out that it takes manufacturing without the permission of the patent holder to violate patents. She also makes the point that software (IP) is legal to backup and restore for purposes of repair. She says that “anyone intent upon copyright infringement can do so when products are working, and not wait for a hardware failure to make an illegal copy.” She also points out that those tasked with repair have no need for access to trade secrets. She says that many people assume that service documentation is a trade secret when it is not.
RIGHT TO REPAIR
“OEMs do not publish and distribute secrets to thousands of technicians,” Gordon-Byrne says. “Publication is the end of secrets.” “We have seen instances where a technician is more that capable of handling a service event, but is locked out because the vendor has a service key,” Ruiz says. “In the time to contact the vendor help desk, leave a message, wait for a call back and then schedule a time for the field service team to respond, we could have already had the device serviced, tested and parts identified for replacement. The down time during these events could be both costly and affect patient safety in the delay in servicing the equipment,” he adds. “Also, the hospital is the owner of the equipment, not the manufacturer,” Ruiz points out. “Therefore if the hospital wants to have their own in-house, or third-party, or multivendor service their equipment, the hospital should have the right to own their software, service manuals and service keys available for such service. I totally understand the manufacturers have their regulatory agencies to fall under, but in today’s world, hospitals are under the microscope themselves and need to have the right to reduce costs and down time by having these tools available to them.”
LEVERAGE USED WISELY As mentioned earlier, the point of purchase, or the period during negotiations, is the time to take advantage of leverage. When the HTM department is involved, obstacles to repair are more likely to be addressed.
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“
If a manufacturer balks at providing the service and technical manuals, the sale won’t be made; there are other manufacturers out there.”
“My facility has been great in the last few years about including the biomedical engineering department in the information gathering and decision making when purchasing new equipment,” says Dean Stephens, EET, CBET, supervisor of the Biomedical Engineering Department at Penn Highlands Elk hospital in St. Mary’s, Pennsylvania. “This has allowed us to mandate that service and technical manuals be included with the equipment as part of the purchase contract. If the new equipment is high-risk, manufacturer’s service training is required as part of the purchase contract,” he adds. Stephens says that if a manufacturer balks at providing the service and technical manuals, the sale won’t be made; there are other manufacturers out there. “The only exception to this, that I can come up with easily, is the hydrogen peroxide plasma sterilizer. Since it is the only one available and the manufacturer is such a prig about documentation and training,” he says. He abstained from naming names.
Staffing an HTM department, with a diverse skill set of HTM professionals, can remove any obstacles to repair with available resources. “The HTM departments are always eager to leverage the existing talent and take on medical equipment maintenance and related activities,” says Izabella Gieras, MS, MBA, CCE, director of Clinical Technology at Huntington Hospital in Pasadena, California. “In order to ensure seamless service, we need to consider the current resources we have [to] support the current and future opportunities, and thus people resources are often a challenge.” “With so many new opportunities, such as medical device integrations, clinical alarms and numerous safety and process improvement initiatives, we need to continue to seek appropriate talent to support these initiatives,” she says. “People and service resources as well as time management are the key considerations.” Even when the talent is on hand to do the repairs, a lack of access to needed information can occur when an OEM claims that the equipment is too complicated or that software is proprietary. “We have experienced this with some of the vendors. With some, we have limitations to what we can work on even after the HTM training has been completed and with others, there is no HTM training available at all. In those cases, we work with the vendors to develop cost-effective maintenance models for the equipment,” Gieras says. When the ability to fix the device is available through in-house talent, Gieras’ department has what they need
“
With some, we have limitations to what we can work on even after the HTM training has been completed and with others, there is no HTM training available at all. In those cases, we work with the vendors to develop cost-effective
IZABELLA GIERAS, MS, MBA, CCE
Director of Clinical Technology at Huntington Hospital, Pasadena California
maintenance models for the equipment.”
from point of sale negotiations. “We ask for the service documentation/manual as well as user manual as part of our purchasing agreements,” she says. “We often include this as part of our evaluation process to ensure we can compare ‘apples to apples’ when it comes to servicing the equipment after the warranty has expired. This also helps us develop the appropriate maintenance models to support the equipment during its useful life.” In addition to the documentation, training brings the ability to repair in-house. “Getting training in the purchase price of the equipment is the best way to get the information you need to support the equipment,” Du Vall says. “My manager would always demand OEM training for at least two staff. He usually only got one trained. There are times where training was in the price and the purchasing agent dropped it to save money,” he says. “[Since] we need to be OEM trained to service and buy parts for the equipment, we had to pay a larger amount for the training. The easiest and least costly way is if it is negotiated at the time of purchase. Be sure to play one
against the other ‘openly.’ If it’s above board, the chances are better to get a better price on it too.” Du Vall points out that there are times when an OEM has set prices and won’t budge. He says that this coincidently is on the equipment you really want to get. “Some things that also need to be negotiated are ‘fair price’ repair exchange programs,” he says. “This causes a problem with the inventory program, checking things in and out all the time. It cuts down time and having to stock parts, sending techs for training. It’s not my favorite thing to do, but it keeps the system running smooth.” Gieras says it’s a good idea to voice your opinion with the manufacturer as part of the evaluation process. “Sometimes this happens after the purchase is completed; however is included in the purchasing agreement,” Gieras says. “We have had opportunities to work with vendors who have customized HTM training for us as part of the negotiation process, which allowed us to be more flexible in the type of maintenance solutions we choose for the proposed equipment as well as
leverage the in-house clinical technology talent.” Beyond the macrocosm changes that come through negotiations at purchase, Gordon-Byrne says that more sweeping change in the right to repair debate can come through state legislatures. “Since repair is neither a matter of copyright nor patent, limitations on repair fall squarely within the purview of states regarding unfair and deceptive business practices, contract law, consumer protection, environmental protection, and commerce,” she says. Some changes have already happened on the automotive front. “The auto Memorandum of Understanding (MOU) is an excellent template for Digital Right to Repair (DRTR) because it requires all OEMs to make service documentation, tools, diagnostics, and firmware with all applicable corrections, available to independent mechanics on fair and reasonable terms,” Gordon-Byrne says. “These are exactly the problems facing BMETs and independent medical repair technicians with the exception of access to the OEM ‘parts desk,’ also on fair and reasonable terms,” she adds. “We added a parts requirement to DRTR to finish the puzzle.”
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CAREER CENTER Investing in Your Future By Cindy Stephens
H
ealthcare Technology Management (HTM) professionals are in a position to recognize and understand how healthcare technology is in constant change. Additionally, most health care employers know the importance of hiring or sustaining workers who are broadening their knowledge of the industry in order to stay relevant in their technical skills. Yet, it is very surprising to me to find many employees or candidates who are bewildered when they are laid off, not promoted, or not hired due to their lack of relevant or current technical skills.
Cindy Stephens Stephens International Recruiting, Inc.
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We understand how important it is for job seekers to have the appropriate education, training, and skills to get ahead in today’s high-tech industry. Employers are looking for employees who are eager and enthusiastic about learning and who take the initiative to achieve competency in a skill that is in demand. The surest way to be successful, productive, and satisfied is to place a priority on investing in your personal and professional growth. Your willingness and ability to invest in yourself may be the most profitable investment you ever make and will increase your value to your current and future employers. To be successful in your career, it is just as critical if not more so, to invest in your future and your career by keeping abreast of the changing technology in health care. It is especially important for seasoned workers to be competitive and ensure they stay up to date on the technological advances in medical devices. Complacency and doing things the way they have always been done can lead to being overlooked for promotion or considered for a new position. Invest in yourself with continuing
education and certifications. Don’t rely on your organization or your manager to schedule training for new equipment or new technology. You must not hesitate to take the initiative and learn on your own time and at your own expense, if necessary. Specialty training along with your experience will build your competence and your reputation. Although improving your skills doesn’t always mean investing in higher education, it is an option, and perhaps a necessary one depending upon your career goals. There are many avenues to invest in your knowledge and advance your skills. If your employer does not offer additional training, look to professional organizations, community colleges, and online technical training sessions to obtain higher education and certification. Advancing your education, obtaining advanced degrees, and achieving relevant certifications are all valuable investments. Keep abreast of technology by reading trade journals, magazines, and manufacturers’ literature. Take a weekend or evening training class at a local community college or technical school. Participate in webinars on new
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carrying the title of “CBET” is highly encouraged, and is respected within the technical community. As the field continues to work closer and closer with IT departments the demand for networking and A+ certification will continue to rise. Many organizations have taken the initiative by gearing training more toward the IT side of the house and for good reason. Anyone remember Y2K and the anxiety that caused? Companies will always be looking for BMETs that can bridge the gap between the departments. This trend is not new but will continue to rise as the ever-changing technology wheel keeps turning. You should approach your job and daily responsibilities with enthusiasm, dedication, initiative and commitment. Be prepared and diligent to do whatever it takes to be relevant and to get the job done. Employees with strong technical skills and equally strong communication skills will rise above the pack, especially when PUBLICATION they demonstrate that they are constant DEALER learners,MEDICAL capable of growth and TECHNATION improvement every day. with BUYERS GUIDE Along OTHER excellent technical skills, experience, and MONTH education, you must continue to remain competent in your field, and that requires continually learning and relearning. J F M A M J J A S To attain success in this career field, DESIGNER: JR you must be considered a valuable employee. You are your best asset. You are trained in the field and you have a solid, professional background to support your career path. You have a lot to offer your employer by virtue of your education and experience. You can be a tremendous success if you are willing to work at it. Stay relevant in Healthcare Technology Management by continuing your professional development. Invest in your future and broaden your career by continually expanding your knowledge and skills!
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equipment or read about new technology on manufacturers’ web pages and other technological sites, enroll in workshops, and attend conferences to expand your knowledge. Your position will bring you many challenges, will test your skills and, in some cases, will directly impact the care of the patients that you and your department serve. You provide a high level of technical expertise in the maintenance of clinical equipment and, in many cases, you will be the only avenue of support the clinical staff has to complete direct care to the patients they serve. As BMETs, imaging service technicians, and managers, you must understand the equipment application as well as the interaction the equipment has with the patient. Due to the diversity of the equipment, specialization is sometimes required, which brings additional training requirements and responsibilities. If you are not sure what training you need or how to get to the next step in your career, find a mentor or someone in a higher position in your career field who can provide some guidance or direction for your career path. Learning a new skill or enhancing your current technical knowledge is an investment in yourself that will keep you at the cutting edge of your field. As the BMET/HTM professional role continues to evolve, the educational and technical training requirements have expanded as well. Many health care systems are requiring a minimum of an associate or bachelor’s degree in biomedical technology, military-trained BMET program, or appropriate training at an accredited technical college. Many BMETs pursue professional certification, satisfying certain education requirements and passing an examination to become a Certified Biomedical Equipment Technician (CBET), a Certified Radiology Equipment Specialists (CRES), or a Certified Laboratory Equipment Specialists (CLES). In many cases,
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Ultrasound Service Inequality By Matt Tomory
J
ust this morning I was discussing a potential client with a team member who stated a prospective customer was currently being serviced by an organization that “performed preventative maintenance” on every device within the physician’s office from thermometers to sterilizers, refrigerators to ultrasound systems. The comment was made that they “are more economical” than we are so we should lower our rates to match if we want the business. I responded that the situation is backwards; we should not match rates, they should match our service. I expect what the customer was receiving was not a PM but an electrical safety test and perhaps a filter cleaning but what was alarming is that ultrasound was grouped in with these other devices.
MATT TOMORY Vice President of Sales & Marketing
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This illustrated a dramatic and increasing inequality in the ultrasound service world; there are times when I think ultrasound is perceived as the Rodney Dangerfield of the imaging world and “gets no respect.” True, reimbursements for ultrasound exams are lower than other modalities and for medical emergencies, ultrasound is relied on less that say CT, X-ray or MRI but that does not mean servicing and supporting ultrasound should be taken any less seriously. When I think of servicing any medical device, I imagine a loved one on the table being examined and diagnosed by the exam outcome of the device. When evaluating ultrasound service providers, it is important to discern if they are trained as experts in the modality and understand ultrasound systems and images. You also want to ensure quality, reconditioned and tested parts are utilized as opposed to
merely harvested ones that may have worked at the time of salvage. When Preventative Maintenance is needed, does the provider follow guidelines and regulations set forth by all the various accreditation and regulatory organizations (see last month’s TechNation article entitled “The Alphabet Soup of Ultrasound Accreditation Organizations”) overseeing ultrasound? Is everything done to mitigate downtime during the PM including full system backups, thorough internal and external cleaning, configuration captures, probe inspections and probe care process evaluations? I would like to help begin to swing the pendulum in the opposite direct and recognize the ultrasound modality for the truly modern miracle it is when it comes to patient care, safety and outcomes and treat it with the respect it deserves.
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THE FUTURE Buyer Beware! By John Noblitt
L
ast week, while traveling home from work I received a text message with an attachment from a former student. The text read, “Thought you might be interested in this.” Once I had time to view the attachment, which was a pop up ad from his Facebook page, I was fairly shocked. It was an ad for a biomedical “degree” and I use the word degree here very lightly. A college in a Southern state was advertising a six-month online biomedical education with classes starting every Monday.
John Noblitt M.A., Ed., CBE Caldwell Community College
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Two things immediately crossed my mind. How could they cover all the information in six months to prepare students for entry level employment when I struggle to cover in sufficient detail the necessary information needed in a two-year period? Also, how in the world can they start a new class every Monday? This peaked my interest, so I did a little research. When I got on the school’s website a few things jumped out at me. First, I could not find a course offering list for the program of study. They did have a link to a YouTube video which was labeled Program Review. I thought this was a good way to present the information becuase video is a good way to hold one’s attention. However, when I clicked on the link this message popped up, “This Video Is Private.” Private? Why would a school not want to share what courses are offered in a program of study? Giving this institution the benefit of doubt I
thought it could be a webmaster mistake. I thought I should see who is teaching the class and see if they could send me the class information. Upon further investigation on their website I learned there is no faculty listing for any of the programs they offer – another red flag. Further investigation unveiled that office hours (for the entire school) are by appointment only. You might say this information set off another red flag. The website provided some information including that the certificate program provides a realistic and up-to-date overview of a career in HTM. The website states the program utilizes “Electronics/Electrical, Digital, Mechanical, Computer and Internet Sciences, and learning is achieved by using a broad ranged approach, focusing on not just technical skills, but on management, organizational, logistics, compliance, research and other related topics.” At this point I’m thinking they have the best instructors in the world along with students who must have scored a perfect 2400 on the SAT. With only 494 students achieving a score of 2400 out of 1.66 million test takers, I’m thinking that is not the case. I noticed a few more red flags, including a $50 nonrefundable application fee to the school. The biomed program has an “optional” hands-on training component, the career placement help seems to be links to job boards and the school website states it is “Approved & Registered” by what seems to be some state
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agencies. It does not appear to be accredited by a recognized organization such as Southern Association of Colleges and Schools (SACS). Last, but not least, the website APPROVED makes it very difficult PROOF to find specific
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information about the course of study, CLIENT SIGN–OFF: FOR 2015 but there are many links to send CONFIRM THAT THE FOLLOWING ARE CORRECT application fees along withPLEASE the $6,995 LOGO PHONE NUMBER WEBSITE ADDRESS program fee. There is no mention of whether this fee covers books or anything other than tuition. However they do have payment plans starting at just $395. Also, a little further investigation revealed this was not the PUBLICATION only HTM educational outlet that MEDICAL DEALER seemed to be a little questionable.
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So why do I bring you this GUIDE BUYERS OTHER NOTES Visit us at information? Over the many years I AAMI BOOTH 631 have been teaching MONTH I get a majority of my students by word of mouth. Many of my new students Jknow F someone M A in M J J A S O N D Buy • Sell • Rent • Service the field. Whether it be a cousin, uncle, Trust… That’s what it all comes down to. DESIGNER: aunt, neighbor or someone fromJL church or another social outlet. People find out about this career field by someone telling them about it. So, if someone you know is interested in this career field, please let them know about some of the potential pitfalls in deciding which school to attend for Your Trusted source for all your patient monitoring Sales & Service their training. This will not only help the potential student, but it will also www.gophermedical.com What Makes Us Different: help ensure the new wave of HTM 1-844-2GOPHER (1-844-246-7437) After twenty-five years of experience in buying, sales@gophermedical.com professionals will be properly trained selling and servicing medical equipment, we’ve Steve Ziegenhagen, Owner and ready to contribute in today’s earned our clients’ trust. Our sales & acquisition team originate from a biomedical engineering health care environment.
BEYOND CERTIFICATION What is a CHTM? By David Scott
O
ne of the mostasked questions about certification renewal is “How many points do I need?” That’s an easy one. The answer is 15 points over a three-year period. Which usually brings up the next question: “How do I get that many points?” This brings me to one of my favorite subjects – biomed associations.
David Scott CBET, Study Group Organizer, CABMET
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One of the best ways to get certification points is to be involved with your local biomed or HTM association. It is also important to get involved. For being a member of a local association you can earn half a point per year. Which doesn’t sound like much, but over three years that is 1.5 points just for being a member. You can be a member of more than one, too! I am a member of my local association (CABMET) and I am also a member of the Armed Forces Biomed Society (AFBS). Between the two, I earn 3 points in the three-year period. I earn those points just for being a member. But, it doesn’t make sense to be an inactive member. If the association is local, attend some of the meetings. You can earn half of a point for each meeting you attend. In CABMET, there are four meetings a year plus the two-day symposium. That can equal up to 3 points per year just from attending meetings. I can count each day I attend the symposium. There are also educational courses. The courses count for a half point each, but if you do that then you can’t count half a point per day attendance and half per course. It is either one of the other. Let’s take a look at how this adds up: Association Membership = half point per year Meeting attendance = 3 points (half point per meeting x 6 meetings per year including symposium) points Total for 3 years = 10.5 points! Ten points is the most you can count in the Professional Society Participation/ Memberships category. So just by being a member and attending meetings you can earn the most points available in that
category. But, there are more ways to get points through the association. You can volunteer to be part of a committee, be an officer, write an article for the association newsletter or present at a local meeting. These presentations fall under the Publications/Presentations category and another 10 points are available for that category. You can get 1 point for writing an article for a local newsletter and half a point for a presentation. The activities you do by being involved in your local association add up quick especially when you consider the three-year period. Add in two articles in the local newsletter for the three-year period and you get 2 more renewal points. Combine that with the 10 points from the other category and you have a total of 12 points. If you are working in the field you get one point per year for work experience. That will give you 15 points for the three years without going to any manufacturer schools or any other training. I always recommend that people record everything they have done in the threeyear period. Don’t stop when you get to 15 points. Keep going! Here’s a link to local and national HTM associations: http://goo.gl/vU3kkO. Many states have societies and some have more than one or more than one chapter. Some cover a region and some allow you to attend meetings remotely or watch recorded meetings. If you check around with other medical professionals, you will find that most of them belong to a professional society. You should join one today and start accumulating points toward certification renewal.
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KAREN WANINGER No Doubt By Karen Waninger
T
o be successful in this profession, and in life, it is important to be perceived as confident. From my observations and experiences, it appears that others are more likely to ignore, question or even challenge the decisions of someone who appears less than certain of his or her own course of action. Do not doubt your ability to be a contributing member of your team. Instead, take a serious look at what you can do to influence how others perceive you. The HTM profession is full of people who are analytical, maybe even cynical, and looking for anything they can question to begin with. Don’t give them any added ammunition for making you the target, especially if you are in, or aspiring to move to, a management role.
KAREN WANINGER, MBA, CBET MBA, CBET
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Notice I used the word “management” there instead of “leadership” when referring to a formal position description or job title. This distinction goes back to my belief that leadership is a characteristic of an individual, and therefore may be found in anyone, in any position, in any organization. I have an expectation that “managers” of all levels are also leaders. Now that I think about it, though, that must be an unrealistic expectation. I am an optimist and I keep expecting the best of people and situations, but there is a difference between being optimistic and being in denial … that may have to be a topic for a future article. I want to get back to the subject of confidence. Here are a few different examples of the meaning of “confidence” as it may relate to the HTM profession: 1) Self-assuredness, or your perception of your ability to perform to a certain standard; 2) Belief in the ability of other people, expecting others to behave in a trustworthy and competent manner; 3) Keeping certain information secret or restricted, sharing only between a few people. When I researched the term confidence as it relates to engineering, there were articles about reliability engineering,
confidence intervals, confidence bounds, and I even discovered one article that used the terms “forward confidence” and “reverse confidence.” That was intriguing. Not the article – it was boring – but I liked the whole concept of forward and reverse confidence. The article refers to the most common engineering type application of the term, the assurance that specific sequences of actions will repeatedly result in the same outcomes, as “forward confidence.” For example, if you are playing a video game and you achieve the desired result, you can repeat exactly those same actions and win at that level every time. Reverse confidence, however, would be more like the way I play. Every time I die, I can look back and see that there was some different decision or action that caused it each time, but the end result was still the same. I have confidence that if I play a video game, regardless of the decisions I make during the game, the little video dude will die. Reverse confidence is determined to exist when the same outcome (death in the video game) is analyzed and some consistent contributing factor (I am horrible at video games) is identified from the results. Reverse confidence seems a little bit like the old saying that “hindsight is
always 20-20 vision.” When dealing with human nature, though, forward confidence is a little more difficult. In general, it is natural for people to be a little nervous about making decisions that can have significant impact on themselves or others. It is important, in most situations, to not let that nervousness, or uncertainty, prevent you from arriving at a conclusion. Also, it is important to be aware of how others perceive you, during and after your decision making process. If you are hesitant with follow-through, allowing yourself to be substantially distracted or persuaded by questions or comments from other people, you will generally not be viewed as having confidence, or a position of authority in that situation. It is appropriate to be respectful of the ideas from members of your team, and to allow questions for the purpose of clarification and shared understanding as you are in the process of making decisions. Failure to allow bidirectional communication, in many situations, will lead to the perception of arrogance. It is a great skill to be able to maintain some kind of outward representation of assurance based on knowledge and experience, without allowing it to be perceived as arrogance. People will be drawn to confidence, whereas arrogance will drive people away. Self-respect is a prerequisite for earning the respect of others. Likewise, having confidence in others will increase their own
self-confidence. For a group of people to work well as a team, it is necessary for everyone to feel they have something to contribute as well as something to gain from the experience. If you want to do some light and easy reading on this whole concept of believing in yourself, check out “Building SelfConfidence for Dummies” by Kate Burton and Brinley Platts. From within the HTM profession, A. Ray Dalton has written a great book called “Proceed with Confidence.” If you feel you are ready for a more intense message, perhaps “Quiet Strength” by Tony Dungy is more your style. It’s never wrong to keep looking for more information on any topic. Along with that, however, it is important to be able to make decisions as needed to function effectively in your career, as well as in your personal life. There are many situations where we are required to make decisions in a timely manner, with whatever information we possess at the time. If you are successful in being confident without being arrogant, you won’t ever eliminate all of the internal doubt, but you will have asked yourself enough questions to get the key answers and be able to keep moving forward. DISCLAIMER NOTICE: All comments, ideas, opinions or suggestions expressed herein are those of the author and are not in any way representative of the author’s employer or of any organization in which the author may be associated.
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Why You Need Lots of Job Levels for BMET By Patrick Lynch
T
here is a problem in hospitals today. And it is one that we can cure fairly simply. It relates to job satisfaction and career advancement by the working BMET.
PATRICK K. LYNCH, CBET, CCE Biomedical Support Specialist for GMI
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You see, most HTM programs have at most 3 levels of BMET – BMET I (entry level), BMET II (general BMET, and BMET III (the senior BMET). Above this, there may be supervisors or imaging positions. I even saw one shop that had only a single title (and pay grade) for BMET. And some of the BMETs had been at the hospital for almost 30 years. Imagine being in the same job grade, and same job title for 30 years! Most people would move on to bigger and better things, with the lure of growth, promotion, and more money. Staying in the same job grade for many, many years only helps a program keep the BMETs who are either under motivated or who do not possess the skills to move up. But does adding more job levels solve this problem? Yes, it does, and here is how. Imagine the 30-year career of a BMET. If there are only three job grades, he or she is destined to spend an average of 10 years in each job grade, with only the average cost-of-living annual increases each year. Nobody with any drive or motivation is going to be satisfied with that for long. Now, image a program with 10 job
levels for BMET. Each one has its own job description, which breaks down the specific requirements, duties, skills, and responsibilities (and pay) for the person in that job grade. By definition, a person moving through the system can expect to spend maybe an average of three years per job grade. Each step up will come with a pay raise. And each step up will come with an additional level of skill and responsibility which will benefit the hospital. Another positive benefit is that each BMET always has his or her eyes on the horizon. There is something new that they can achieve. They are encouraged to constantly learn, progress, and prepare themselves for the next step up. And much of this preparation is on their own time, not at the hospital’s expense. Simply creating an atmosphere of forward looking, learning and constant progression can have immense positive benefits on the entire culture and attitudes of the shop and personnel. I recommend starting with the AAMI standard job descriptions. Then break those down into many smaller subsets, so that the steps are smaller, more rigidly defined, and specifically documented. Add in various IT capabilities. Try to create a path that provides BMETs a long and beneficial path that also grows their skills in the way that the hospital needs. When you have them sketched out, schedule a meeting with human resources to discuss the plan and enlist their help in finalizing the job descriptions. Good luck. Please let me know what luck (or difficulty) you have implementing this.
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THE ROMAN REVIEW
No Clear Option By Manny Roman
I
n a recent television program, the boss of the business said, “When there is no clear option the best thing is to do nothing.” This put my remaining brain cells to work. What exactly does this mean? How well did the individual research his options before arriving at the conclusion that there was no clear option? Did he give consideration to the consequences of inaction?
MANNY ROMAN CRES, Founding Member of I.C.E. imagingigloo.com
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Unfortunately, I stopped watching the show to ponder the answers to the question and did not, as a result, see how it all turned out. So, as I normally do, I will explore the statement further on my own. For the statement to make any sense we must assume that a thorough examination of the situation was conducted. The objectives and the desired outcomes had to be well established. The vision of the desired outcome had to be very clear and well defined. All those concerned must have been consulted and their ideas and suggestions must have been explored. We also must assume that a “best option” is not acceptable. It must be a “clear option.” I have made many decisions in my life, with a few turning out well, however, I don’t recall ever having a “clear option.” Mine were always the perceived best option under the present circumstances and with the present body of knowledge. I have often stated that a decision is only right or wrong once the actual decision is implemented and the results are established. A clear option would require a clairvoyance that I don’t possess. I don’t think many do have that ability. No matter what you do to try to divine the correct option, there will always be unperceived and unexpected circumstances that may just make that clear option a clearly bad choice once made. The search for this elusive option, in my opinion, is one of the biggest mistakes
a leader can make if it freezes the organization. We maintain the present situation by inaction even though we searched for options that were perceived to be necessary. A better statement may be that “When there is no clear option to change the present state, the best action is to stop and do nothing more.” Just continue to march in the present situation and accept it. This brings to mind; If things cannot be accepted, they must be changed. If things cannot be changed, they must be accepted. In contrast to the only act when there is a clear option mentality is the “Do something, even if it’s wrong” mentality. I had a boss years ago who was a valued mentor to me even though we disagreed a bunch. He hated inaction from his people and would encourage and even demand that people not freeze in their decisions. He would prefer to correct undesired results than to not do anything at all. What my boss failed to see was that the people were afraid to make decisions because the repercussions of a bad outcome were always unpleasant, not from him, from his partner. His partner did not recognize that these were opportunities to train people rather than an opportunity to chastise them. My boss was also the one that taught me that a good leader does not allow his people to avoid their responsibilities by dumping their decisions on him. He always asked people to explore options and bring him three options and a well thought out recommendation. This is great advice for all of you who manage or lead people. Let’s go back to the clear option thing and assume that something caused us to want to change the present situation. If I had to decide between “clear option or no choice” or “do something even if wrong” the clear option is to do something (and hope it’s not wrong).
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THE VAULT
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1. 3.
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The Clinical Engineering Association of Illinois (CEAI) recently held its annual conference at the Drury Lane Conference Center in Oakbrook Terrace, Illinois. The annual conference once again included exceptional educational opportunities, great speakers and a variety of networking opportunities. Speakers at the 2015 conference included AAMI President and CEO Mary Logan, AAMI COO Steve Campbell and George Mills from The Joint Commission. For more information about the 2015 conference, visit the CEAI website at www.CEAIweb.org. Photography provided by Kurien Mathew of Hatch Capture.
1. Vendor Exhibit Hall in the Grand Ballroom 2. Annual Scholarship Lunch Banquet & Election of Officers 3. From left to right: Nikki Serwetnyk, Lijo George, Suraj Soudagar, Gary Barkov, Christopher Bryant & Aleksandar Popivoda
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Paige Wissel was one of the three biomedical engineering students to receive a scholarship at this year’s conference.
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GBIS recently held its annual technical conference. The event attracted 14 vendors and about 100 attendees, according to GBIS Vice President Vice President Mike O’Rear. A Meet and Greet kicked off the annual event the night before the conference with a buffet dinner and beverages at the Courtyard Atlanta Executive Park/Emory. The technical Conference was held Saturday, Aug. 15 at Children’s Healthcare Office Park in Atlanta. The event boasted a complete schedule of classes, a keynote address and a busy exhibit hall where vendors displayed their products and information about their services. For more information about GBIS, visit the organization’s website at gbisonline.org.
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INDEX 2D Imaging………………………………………… 55 Ph: 800.449.1332 • www.2dimaging.com
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Pronk Technologies………………………………… 5 Ph: 800.609.9802 • www.pronktech.com
4med…………………………………………………44 Ph: 888.763.4229 • www.4med.com
Global Medical Imaging…………………………… 2 Ph: 800.958.9986 • www.gmi3.com
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AIV Inc.……………………………………………… 16 Ph: 866.656.0755 • www.aiv-inc.com
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Gopher Medical, Inc.………………………………59 Ph: 1.844.246.7437 • www.gophermedical.com HTTM/Health Tech Talent Management………… 52 Ph: 757.563.0448 • www.HealthTechTM.com ICE/Imaging Community Exchange……………… 79 www.imagingigloo.com Integrity Biomedical Services…………………… 4 Ph: 877.789.9903 • www.integritybiomed.net
Bayer Healthcare…………………………………… 7 Ph: 1844.MVS.5100 • www.mvs.bayer.com
InterMed Biomedical……………………………… 72 Ph: 800.768.8622 • www.intermed1.com
BC Group International, Inc. …………………… BC Ph: 888.223.6763 • www.bcgroupintl.com
J2S Medical, LLC……………………………………… 17 Ph: 844.DIAL.J2S • www.J2Smedical.com
BETA Biomed Services………………………………59 Ph: 800.315.7551 • www.betabiomed.com
JD Imaging Corp.…………………………………… 33 www.RadiologyAuction.com
BMES/Bio-Medical Equipment Service Co.……… 71 Ph: 888.828.2637 • www.bmesco.com
KEI Med Parts……………………………………… 27 Ph: 512.477.1500 • www.KEIMedPARTS.com
Biomedical Equipment Services Co. LLC………… 57 Ph: 208.888.6322 biomedical.equipment@yahoo.com
KMA Remarketing Corp.…………………………… 57 Ph: 800.411.4101 • www.KMABiomedical.com
Conquest Imaging………………………………… 11 Ph: 866.900.9404 • www.conquestimaging.com Cool Pair Plus……………………………………… 71 Ph: 800.861.5956 • www.coolpair.com Digirad Corp.………………………………………… 27 Ph: 877.902.2688 • www.digirad.com Dunlee……………………………………………… 8 Ph: 1.630.585.2100 • www.dunlee.com ECRI Institute……………………………………… 78 Ph: 610.825.6000 www.ecri.org/biomedicalbenchmark Elite Biomedical Solutions………………………… 36 Ph: 1.855.291.6701 www.elitebiomedicalsolutions.com
ReNew Biomededical……………………………… 57 Ph: 844.425.0987 • www.renewbiomedical.com Maull Biomedical Training………………………… 31 Ph: 440.724.7511 • www.maullbiomedical.com MedEquip Biomedical………………………………80 Ph: 877.470.8013 • www.MedEquipBiomedical.com MedWrench………………………………………… 35 Ph: 866.989.7057 • www.medwrench.com Ozark Biomedical……………………………………65 Ph: 800.457.7576 • www.ozarkbiomedical.com Pacific Medical LLC………………………………… 37 Ph: 800.449.5328 www.pacificmedicalsupply.com Philips Healthcare………………………………… 28 Ph: 800.229.64173 • www.philips.com/mvs
Engineering Services……………………………… 23 Ph: 330.425.2979 ex:11 • www.eng-services.com
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Field MRI Services, Inc.…………………………… 33 Ph: 404.210.2717 • www.fieldmriservices.com
Prescott’s, Inc.……………………………………… 28 Ph: 800.438.3937 • www.surgicalmicroscopes.com
INDEX
Rieter Medical Services……………………………69 Ph: 864.948.5250 • www.rietermedical.com RTI Electronics……………………………………… 67 Ph: 800.222.7537 • www.rtigroup.com Sage Services Group………………………………44 Ph: 877.281.7243 • www.SageServicesGroup.com Soaring Hearts Inc………………………………… 16 Ph: 855.438.7744 • www.soaringheartsinc.com Soma Technology, Inc.…………………………… 36 Ph: 1.800.GET.SOMA • www.somatechnology.com Southeast Nuclear Electronics……………………69 PH: 678.762.0192 • www.southeastnuclear.com Southeastern Biomedical………………………… 63 Ph: 888.310.7322 • www.sebiomedical.com SBE/Southwestern Biomedical Electronics…… IBC Ph: 800.880.7231 • www.SWBiomed.com Stephens International Recruiting Inc.………… 52 Ph: 888.785.2638 • www.BMETS-USA.com Summit Imaging…………………………………… 53 Ph: 866.586.3744 • www.mysummitimaging.com Tenacore Holdings, Inc.…………………………… 73 Ph: 800.297.2241 • www.tenacore.com Tesseract…………………………………………… 67 Ph: 404.719.5994 • www.tesseractUSA.com Tri-Imaging Solutions……………………………… 61 Ph: 855.401.4888 • www.triimaging.com Trisonics……………………………………………… 22 Ph: 877.876.6427 • www.trisonics.com USOC Medical………………………………………… 45 Ph: 855.888.8762 • www.usocmedical.com Valcon Partners……………………………………44 Ph: 815.477.1000 • www.valconpartners.com
OCTOBER 2015
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“ Even if you’re on the right track, you’ll get run over if you just sit there.” -Will Rogers
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