TechNation - September 2014 by MD Publishing

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EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

SEPTEMBER 2014

HOW TO BUILD A BIOMED ASSOCIATION INSIGHTS FROM THOSE WHO KNOW

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vol.9

Biomed Adventures Rocky Mountain High

The Roundtable Flexible Endoscopy

What's on Your Bench? Highlighting the workbenches of HTM Professionals

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38 44 TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

THE ROUNDTABLE - FLEXIBLE ENDOSCOPY Endoscopes are medical devices can be used to investigate symptoms, confirm a diagnosis or provide treatment. TechNation questioned some industry experts about the newest technologies and asked them when it is a good time to invest in new devices. Next month’s Roundtable article: Anesthesia

HOW TO BUILD A BIOMED ASSOCIATION How do you launch a successful biomed association? TechNation asks successful leaders how they created their organization. They share tips how to connect with AAMI and other outside sources for valuable organizational tools. There are many factors when it comes to building a great HTM association from scratch and we share the insights on how to make it work. Next month’s Feature article: Asset Tracking

TechNation (Vol. 5, Issue #9) September 2014 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.

SEPTEMBER 2014

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INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Sharon Farley Warren Kaufman Jayme McKelvey

ART DEPARTMENT

Jonathan Riley Yareia Frazier Jessica Laurain

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas Myron Hartman Patrick K. Lynch Todd Rogers Manny Roman Cindy Stephens Matt Tomory Karen Waninger

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Sue Cinq-Mars

P.14 SPOTLIGHT

p.14 Professional of the Month: Tedd Koh p.16 Department Profile: Providence Hospitals Biomedical Services Department p.20 Association Profile: HTMA-MW p.22 Biomed Adventures: Rocky Mountain High

P.26 THE BENCH p.26 p.28 p.31 p.32 p.34 p.36

AAMI Update ECRI Institute Update Tools of the Trade Shop Talk Biomed 101 Shop Talk: GE

P.52 EXPERT ADVICE

p.52 Career Center p.54 Ultrasound Tech Expert Sponsored by Conquest Imaging p.56 The Future p.58 Patrick Lynch p.60 The Roman Review

P.62 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

p.62 p.64 p.66 p.70

Did You Know? The Vault What’s on Your Bench? Parting Shot

p.69 Index

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

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PROFESSIONAL OF THE MONTH

Tedd Koh, CBET, CRES, CCNA, A+ By K. Richard Douglas

he “pay it forward” concept has caught on across the country in various forms. Those who pay it forward are a true blessing to the recipients of their time, talent and generous spirit. Some people pay knowledge forward and provide others with the fruits of their studies and experience. One of those people is HTM professional Tedd Koh. Koh works at the Olive View Medical Center, a Los Angeles County facility in Sylmar, Calif. He started in the profession while living in Korea. “In 1987, I had started to work for a medical equipment manufacturer in Korea as an R&D manager,” Koh says. “My company had produced electrical stimulators, such as low frequency and ultrasound stimulators. Back then, I did not know anything about medical devices, thus I had to study these new types of devices and was able to design simple electrical stimulators.” He completed a biomed course at Los Angeles Valley College. Part of that course covered electronics. “I had learned basic theory of various medical devices such as EKG, defibrillator, ventilator, X-ray and so on. During the course, we had some hands-on experiments to do, but it was not enough,” he says. “It was a two-year program and I had completed the course in 2008.” Koh has worked as a field service

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Tedd Koh and his wife are seen after a expedition.

engineer handling GE and CR X-ray machines as well as portable X-ray at Fuji Medical Systems USA. “I was a BMET II at CHLA and Marina Del Rey hospitals and I am now a Medical Electronic Tech at Olive View UCLA Medical Center,” he says. With CRES certification, Koh’s area of specialty is imaging. He has also kept up his skills to service computercontrolled devices and has recently earned his CompTIA A+ certificate. He

SEPTEMBER 2014

also specializes in networks, and is Cisco Certified Network Associate (CCNA) certified.

TAKING ON CHALLENGES “We have very limited resources here. But I can use Internet and vendor websites to collect information. Then, I built an electronic library of service manuals and knowledge base,” Koh says. “All our staff can share this information because I placed the information on our network drive.” There have not been opportunities for vendor training, but Koh’s employer does have service contracts for Cath Lab, CT, MRI and PACS. “Except for those devices, our biomed shop takes care of all services, PM, repair and other type of services. For example, one Philips central station was down last Sunday night. But no one at our shop is trained on this,” Koh explains. “I walked in on Monday and one of my co-workers was working on the computer. But he wasn’t having any luck. I called Philips and got some brief instructions, then I pulled a new hard drive from our storage and cloned it from another station,” he adds. “Then, I changed the computer name and configured the network settings. Then, I tried to connect it to the server. It was not successful in the beginning, but it was finally connected and downloaded all the configurations from the server and installed the application software

FAVORITE BOOK I loved to read novels by Dan Brown such as “The Da Vinci Code.”

FAVORITE MOVIE I saw “Spiderman II” recently. It was pretty good.

FAVORITE FOOD I like Japanese and Korean food, particularly sushi and noodles

HIDDEN TALENT I can speak Korean, some Japanese.

FAVORITE PART OF BEING A BIOMED

Tedd Koh poses next to a marker showing the elevation of 10,064 feet after climbing “Mt. Baldy.”

“I love this job because I am part of a lifesaving area. Many doctors and nurses heavily depend on our devices. I feel a very strong responsibility, that’s why I strive to do my best when I perform my job.”

WHAT’S ON MY BENCH? and drivers for thermal printers. Then, it worked finally.”

LEISURE TIME Away from work, Koh pursues pastimes that offer up a dose of exercise. “Yes. I like to hike, thus my wife and I joined the Alpine Club in Los Angeles. We are climbing different mountains every Sunday. I had climbed many mountains already, including some that are more than 10,000 feet high. My other hobby is playing table tennis.” Koh and his wife have two sons. “My first son just graduated from Cal Tech and my second son will go to university this fall,” he says. “He will study at MIT and his major will be computer science. My wife helps my kids and me.”

When he was nominated as professional of the month, it was noted that Koh is very generous with his knowledge. In true “pay it forward” style, Koh explains what he would like to achieve with what he has learned. “Well, I want to share my knowledge and experience with others, thus I have been conducting study groups since 2009, such as a CBET class, A+ and NET+,” he says. “I am now doing a NET+ class at Glendale Adventist Hospital. My goal is to grow together, not only myself.” “OEMs keep launching new devices with advanced technology. Thus, we have to keep our knowledge updated,” Koh says. “ I hope your readers of TechNation will come to know me as their good biomed friend.”

Hot Chocolate: This hot drink makes for a peaceful mind. The database that I built: I keep updating this and reorganizing it. Then, it is accessible when I need to review manuals before I start my job. EKG Simulator: This is my toy. I carry this all the time, even if the service call is not related to EKG. You never know if the caller did not mention one more problem, and I’ll I have my tool handy. Small Notepad: I write in this after my job is done before I input it into the computer. I keep it for my future record even though we have a computer. My Smart Phone: I take pictures or video for evidence or explanation purposes.

SPOTLIGHT

DEPARTMENT PROFILE Providence Hospitals Biomedical Services Department By K. Richard Douglas

n 1938, the Sisters of Charity of Saint Augustine, founded Providence Hospital’s main campus in downtown Columbia, S.C. The hospital includes the Providence Heart and Vascular Institute and Providence Orthopedic in Columbia. Providence Hospital’s main campus is a 247bed facility in downtown Columbia. A six-person biomed department handles the duties of maintaining approximately 5,500 pieces of equipment for several locations. The department consists of Mary Coker, CCE, CBET, director of biomedical services, four biomedical technicians, including one BMET III, two BMET IIs, a BMET I and a radiology specialist. The team’s techs specialize in radiology; general, C-arms, ultrasound, interventional and CT, as well as anesthesia/ventilators, perfusion and telemetry. The department was not always an in-house entity. “Historically, Biomedical Engineering was outsourced,” Coker says. “About five years ago, a commitment was made to build an in-house program. It meant rebuilding infrastructure — CMMS, tools, skill pool — as well as changing the user preconceptions.” “Skill pool has been one of the more difficult challenges because of the size of the hospitals. Skill building is also dependent on local vendors that you can utilize to ‘fill in the gaps.’ Test equipment is another aspect that drives your ability to support, so it requires

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(the) balancing of volume, cost, and time,” Coker says. “Since the two Providence hospitals are specialty hospitals, this also presents challenges — two completely separate surgical areas in the cardiac hospital with very unique equipment — but it also reduces the spectrum of needed support skills (no OB),” she says. The department provides support to two hospitals; Providence Hospital and Providence Orthopedic Hospital. They also support Providence Physicians, South Carolina Heart and Vascular Center and Moore Orthopedic Center. Some of these facilities include multiple locations. All the department’s members belong to the Healthcare Technology Management Association of South Carolina (HTMA-SC). Coker was recently elected treasurer of the organization.

RECENT PROJECTS In addition to the regular duties the team gets called to do, they have tackled some special projects recently. They were involved in the realignment of the clinical care unit to obtain greater care

SEPTEMBER 2014

delivery efficiencies. This involved moving six care departments as well as the redesign and installation of patient monitoring systems. “To gain clinical care efficiencies, six units moved their physical location, and scope of service was modified,” Coker says. “Monitoring and other equipment needs were assessed in collaboration with Biomedical Engineering. To keep costs down, Biomedical Engineering needed to plan and execute redeployment and modification of existing equipment.” “Some new equipment was purchased. The biomedical engineering team had not tackled a monitoring network install before. David Hawks, BMET II and the team director, developed the project plan together to reconfigure 70 newly monitored beds,” she adds. The department is also a team member of a capital asset process project. This involved the verification of the asset ledger, redesign of capital acquisition process and capital detail data integration into an existing financial database. Coker says that her team also handled a project that came about because the nursing units had mobile manual vital signs stations that no one made anymore but the nurses/doctors wanted to continue to use. A department tech designed and fabricated new units. “For him to build and weld a mount for it to work on something like an IV pole, it took a little experimentation,”

she explains. The department also utilized their knowledge to make the best use of available resources. “Central monitoring space was inefficient, but there was not a space within the hospital to move the unit,” Coker says. “Our department reconfigured the monitors, computer, UPS, and printers to provide a better workspace.” “Since this is a specialty hospital, the majority of people are monitored telemetrically,” Coker explains. “All that’s watched by a central monitoring room; and it’s grown. Unfortunately, there is no new space at this time that we can move them to, so we needed to rethink the existing space.” “Originally, the computers for each monitoring system was at their feet, along with the UPSs. There were just so many wires. We’re talking about at least 17 monitoring systems in this room coming from different departments,” she says. “They also monitor the other hospital that we have which is 11 miles away; the orthopedic hospital. And, you can’t shut it down. The nursing staffing that would have been needed to make that project work would have been horrendous.” “So, we had to do it while we were live with patients. The team had to mock up how much time the project would take and then stage one computer change at a time,” Coker adds. “We installed new racks away from the monitor technicians to house

Members of the Providence Hospitals Biomedical Services Department pose for a group photo.

all of the printers and computers. The cords are managed in raceways and labeled. In addition the alarm speaker system had to be reworked. My staff can now easily get to the equipment for maintenance. Another part of the project included changing the existing carpet to carpet squares which will make any future facility repairs easier. The result is a much improved environment for the monitoring technicians and safer for the patients.” Coker recalls another project that the team was able to accomplish. “Telemetry processes for admissions, and the clinicians tracking of the transmitters, was not optimal. Biomedical Engineering worked with nursing directors and central monitoring to create a better workflow,” she says. The hospital has many telemetry transmitters that are frequently idle since the transmitters are assigned to each bed. Biomed is working on

having the transmitters distributed from central monitoring so they can be used more efficiently and equipment can be tracked more closely. “The most difficult part of this workflow change is the logistics of physically getting the telemetry transmitter to the nursing unit. Admissions to units come from a multitude of avenues and if there is a heavy admission period it could slow workflow, which can’t happen,” Coker explains. The department continues to brainstorm with the clinical teams to continue to make improvements. With the economic realities of running a hospital today, the team knows that efficiency is a necessity. In the evolving world of networked devices, this HTM team works alongside their IT counterparts. “We work with IT on projects, have few turf issues, and each team respects each other’s expertise,” Coker says.

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ASSOCIATION PROFILE HTMA-MW prepares for larger annual conference By John Wallace

he American Midwest has long been an important region with a mix of agriculture and industry supporting the economy. Healthcare is also an important part of the economy. The men and women who maintain the medical equipment at the hospitals and medical centers throughout the region are an important part of the communities they live in. They are also developing a strong community amongst themselves. The Healthcare Technology Association of the Mid-West (HTMAMW) was established in the 1980s. After growing quiet the association has experienced a robust reawakening with a more active membership that continues to grow. Chris C. Coleman, CBET, serves as the president of HTMA-MW and pointed out that a regular schedule has helped the association meet the needs of its members. “Our association has roots dating back to the early 1980s, but our most recent resurgence into what we are today happened almost five years ago when we started having regular meetings or events every other month,” Coleman said. “We have close to 100 members and a contact list nearing 200 with people who have been with us in the past and are still invited to all events.” He said the association exists for the members – it is all about serving their needs. “The goal of our association is to promote a sense of community amongst healthcare technology professionals in our area,” Coleman

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explained. “We want to learn together, network, and share solutions to common issues.” It is easy to join the HTMA-MW and benefit from the perks, including educational opportunities that come with the membership. “Any healthcare technology professional of any discipline can join. The easiest way to join is at www.HTMA-MW.org or to come to a meeting,” Coleman explained. “Individual memberships are $25(per year) or one can become an organizational member($150) if their whole shop is interested.” “HTMA-MW is a professional organization that has a relaxed and fun atmosphere,” Coleman added. “We have meetings on the second Tuesday of the odd numbered months with a special social event in July and elections meeting in December.”

LEADERSHIP The ability of the HTMA-MW to gain traction and grow as it serves HTM professionals in Kansas City and the surrounding area is not something that just happened. The

SEPTEMBER 2014

CHRIS C. COLEMAN, CBET, President of HTMA-MW

organization has benefitted from keen leadership with a strong sense of purpose. The leaders over the past few years have added regularly scheduled meetings and other events that have

Members of the HTMA-MW recently participated in a two-day training session on the Covidien ForceTriad energy platform.

“We want to learn together, network, and share solutions to common issues.”

helped the group blossom. It is now continuing on that path in hopes of reaching more HTM professionals. The more active members the group has the more it benefits every member because it adds more experience and knowledge to be shared. The current leadership includes Coleman and the other officers elected during a special meeting late last year. “We hold elections for the coming year each December in a special meeting,” Coleman said. For 2014, Chris C. Coleman was elected president, Chris Hawkins vice-president, Tyler Tryon secretary, Harold Golden treasurer, Brad Griswold education officer and Gabe Jamison webmaster.

2014 SYMPOSIUM AND VENDOR EXHIBITION The growth experienced by the HTMA-MW also means the organization will have a bigger and better event for members and vendors this year. The 2014 Symposium and Vendor Exhibition will include all the bells and whistles. Coleman points out that previous symposiums pale in comparison to the 2014 event scheduled for October 25 at the Crowne Plaza Hotel in Kansas City, Mo. “HTMA-MW’s 2014 Symposium and Vendor Exhibition will be a huge step forward from what we have done in the past,” Coleman said. “It is hard to compare to our past vendor fairs. We’ve moved from the top floor of an electronics supply

warehouse to the Crowne Plaza in downtown Kansas City.” “This year we will include training opportunities, 20-plus vendors, presentations, lunch with a keynote speaker and door prizes. All of this will be free to registered attendees,” he added. REGISTRATION for the 2014 Symposium and Vendor Exhibition can be completed online at www.HTMAMW.org. For more information, contact Tim Cordes at 816-805-2484 or Kevin Hashman at 913-575-3744.

SPOTLIGHT

BIOMED ADVENTURES Rocky Mountain High By K. Richard Douglas

t higher altitudes, the body has to take deeper breaths and a greater number of breaths to acclimate. People often feel a shortness of breath as a result for a couple of days. Sound sleep can be compromised and exercise is made more difficult. Low humidity can lead to dehydration.

Hees started out working in field service for Catholic Health Initiatives servicing the CHI hospitals in the greater Denver area, and decided to take the in-house position at Summit Medical Center for a more stable environment. Plus, he adds, “the enticement of all the activities the high country holds” made it hard to resist.

This is an environment that can challenge anyone. With all the trials the average HTM professional has to deal with everyday, you would think that adding the thin air of extra high altitudes would not be welcome. Think again. Bryan Hees is a biomed with St. Anthony Summit Medical Center in Frisco, Colo. The medical center is a Level III Trauma Center. Summit has served the residents of Summit County and the surrounding area since 1978. It is also the mountain base for Flight for Life Colorado with a helipad that can accommodate two helicopters. There are currently only two biomeds who service the high altitude ski area hospital, Summit Medical Center, and ski area resort clinics; Copper Mountain clinic, Keystone Clinic, Breckenridge Clinic and Breckenridge’s Peak 8 Clinic. Hees digs life above 9,000 feet. He is an avid outdoorsman and is in his element in some of the country’s highest altitudes.

UNIQUE CHALLENGES

PREPARING FOR MILE-HIGH HTM Like many biomeds, Hees first learned of the HTM profession while visiting a hospital. In this case, he was a patient. “I was hospitalized after a fall when climbing. During my hospital stay, a biomed came into the room I was in to work on the equipment and we got to talking about work and what he did on a daily basis. It got me interested enough (that) I checked into it and decided to pursue it as a career,” he says.

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BRYAN HEES, St. Anthony Summit Medical Center

“I went back to school and got my associate (degree) in Biomedical Engineering Technology followed by my bachelor’s and am working towards my master’s in Healthcare Management,” Hees adds. “I do currently hold OEM (manufacturer) certifications in several fields including anesthesia, ventilators, C-arms, networking and monitoring systems (and) ultrasound and on the job trained in most modalities of imaging, life-support, and monitoring systems.”

SEPTEMBER 2014

Working in an environment that can have extreme conditions does pose challenges that aren’t always found elsewhere. “Our winters can last up nine months, during which (time), our ski clinics are running full blast. Getting to these clinics entails driving steep mountain passes on roads covered with snow and ice,” Hees says. “Most days, our roads have up to four to six inches of snow and ice, which is where you pretty much have to learn to ice skate with your vehicle to make it where you want to go,” he adds. “Just getting to our clinics can be very stressful at times with traffic to the resorts and towns.” On ski days, the town is double the capacity of its normal threshold and traffic jams occur due to accidents. Hees had to act fast one bad snow day. About a foot of snow fell in 30 minutes as he was called to duty. “One such fun adventure came from this as I was called to fix some equipment on a clinic up on the mountain at Peak 8 clinic,” Hees recalls. “With overfull parking, the only way to get there was to grab my tool bag and a ticket on the gondola, ride it up the mountain to the ski patrol outpost clinic, where I proceeded to fix said equipment.” Being one of only two available biomeds can mean being called to duty at any time.

“I was spending Christmas Eve evening with my wife and daughter in town checking out the Christmas lights and doing some last-minute shopping at the local outlet malls when I got an manic call from one of our surgical techs, who was repeating everything a very worried anesthesiologist was saying,” Hees remembers. “There was a patient on the table, he had no O2 stats and was bagging said patient. I quickly collected my family, jumped into our SUV and sped up the interstate. Unfortunately, due to an accident on I-70 due to adverse

Bryan Hees, a biomed at St. Anthony Summit Medical Center, often faces ice- and snow-covered roads on his commute to work in Colorado.

“ I was hospitalized after a fall when climbing. During my hospital stay, a biomed came into the room I was in to work on the equipment and we got to talking about work and what he did on a daily basis. It got me interested enough (that) I checked into it and decided to pursue it as a career.” conditions, we had to turn around (and) retrace our route. So, by the time I got there, the anesthesiologist had calmed down enough (that) we worked through to find the issues and fixed them quickly, so they could finish the case with a good outcome.”

ENJOYING THE HIGH COUNTRY You might think that Hees would retreat closer to sea level when not on the job. That is anything but the case. Leisure time will find him shreddin the slopes. “Shredding or ‘shreddin,’ as the locals say, is a term used for skiing or

snowboarding down the ski slope or backcountry mountainside during perfect conditions, leaving a trail cut by your skies or board — cutting up the mountain side and the snow,” he says. “We have some of the best backcountry mountain biking in this county. Our trails are designed to punish and give you that great rush of excitement all rolled into one. Most trails will take you along mountain peaks with breathtaking views, down mountain sides with excellent jumps, turns, and switch backs that can get you seriously hurt if you don’t pay

attention,” Hees enthuses. In addition to skiing and mountain biking, Hees says that the kayaking is the best anywhere. “My favorite runs include Ten Mile Creek and the Platte River. All of which are extremely dangerous for the amateur kayaker, with several deaths each year,” he says. “Even though the hunting has gone downhill as of late, it still rates some of the best with the largest elk herds in the U.S. You get to spend beautiful fall days in the deep backcountry chasing some of the most majestic creatures on earth,” Hees says. “Plus you get to do some awesome flyfishing during your hunts.” He also enjoys backcountry snowshoeing, although he cautions that the sport can be dangerous due to the potential for avalanches in the area. Along with working at high altitude, Hees and his family live at high altitude also. He even learned that the house they rent is owned by some famous celebrities. In short, Hees says he is happy to live, work and play in the mountains. It helps to work somewhere when you are in your element.

SPOTLIGHT

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SEPTEMBER 2014

AAMI UPDATE

AAMI Calls for Clarity in FDASIA Comments

proposed federal framework for regulating health information technology (IT) has elicited one common theme from a variety of stakeholders: We need more clarity.

The draft report, titled FDA Safety Innovation Act(FDASIA) Health IT Report: Proposed Strategy and Recommendations for a Risk-Based Framework, was released in April by the U.S. Food and Drug Administration, Office of the Coordinator for Health Information Technology (ONC), and the Federal Communications Commission (FCC). The three agencies then spent several months collecting feedback. “Although AAMI doesn’t typically submit comments to regulatory agencies, health IT represents a significant patient safety issue that needs to be addressed from a multidisciplinary, non-advocacy lens,” said AAMI President Mary Logan. AAMI heralded the report as a “reasonable first step” toward providing regulatory clarity for health IT, but added that more action is required. “Clarity in this area is urgently needed — the difficulty in knowing what health IT products are subject to which regulation creates chaos for health IT developers and producers, inhibits investment in the field, and hinders the advancement of technology,” AAMI said. In its comments, AAMI also stressed the value of bringing systems engineering principles into healthcare. These principles have been used successfully in a variety of high-reliability industries. “AAMI recognizes that regulation of health IT is the focus of the FDASIA report, but was surprised that the implementation of systems engineering

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principles is not afforded more attention.” It is critical that the healthcare industry embraces systems engineering, AAMI noted, pointing to a recent report from the President’s Council of Advisors on Science and Technology that echoed this call. In their framework, the agencies recommend the creation of a Health IT Safety Center, a public–private entity designed to promote health IT as a key component to ensuring patient safety. ONC would create the center and would work with the FDA, FCC, Agency for

Safety Institute (HTSI) as a model that the center could emulate. Many of the issues HTSI works on — including the prioritization of physiological alarms and improving the monitoring of patients on opioids — intersect with health IT. AAMI suggested the foundation and HTSI serve as founding partners of the center and participate in its governance structure. AAMI’S COMMENTS are available at www.aami.org/news/2014/070914_AAMI_ Response_FDASIA_Report.pdf

GUIDE DESIGNED TO HELP DIALYSIS FACILITIES As the largest funder of dialysis therapy in the United States, the Centers for Medicare & Medicaid Services (CMS) requires that providers comply with certain performance criteria to ensure the safety of patients with

“Clarity in this area is urgently needed — the difficulty in knowing what health IT products are subject to which regulation creates chaos for health IT developers and producers, inhibits investment in the field, and hinders the advancement of technology.” Healthcare Research and Quality, and other health IT stakeholders to promote “a sustainable, integrated health IT learning system.” AAMI praised the effort, but noted that as the report is currently worded, governmental actors would play a bigger role than the private players. The comments highlighted the AAMI Foundation’s Healthcare Technology

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end-stage renal disease (ESRD). However, there are differences between CMS requirements and a suite of International Organization of Standardization standards adopted by AAMI. To help explain the key differences, as well as how facilities can respond, AAMI has released Dialysis Water and Dialysate Recommendations: A User Guide. The guide’s editor, Glenda Payne, is director

of clinical services for Nephrology Clinical Solutions. Previously, she was a member of the CMS core faculty for training surveyors responsible for surveys of dialysis facilities. “Altogether, this work makes an important contribution to reducing conflict between the surveyors and the surveyed and will help advance the cause of patient safety,” wrote Richard Ward, past user co-chair of the AAMI Renal Disease and Detoxification Committee, in the guide’s forward. The idea for the updated resource came as a result of an evolution in AAMI standards. In 2008, CMS published a major revision of its conditions for coverage to incorporate almost all of ANSI/AAMI RD52:2004, Dialysate for hemodialysis. However, in 2011, AAMI adopted a suite of standards that revised RD52. Subsequently, AAMI issued Technical Information Report 43, 2011, Ultrapure dialysate for hemodialysis and related therapies, which revised and replaced RD52. These changes meant the CMS conditions for coverage no longer mirrored AAMI standards. “Discrepancies involve both performance criteria, such as the maximum allowable levels for bacteria and endotoxin in water and dialysate, and recommended approaches to maintaining compliance with the fluid quality standards, with the current AAMI standards emphasizing compliance through the development and implementation of a facility-specific quality management program,” according to the document. To help reduce confusion, the guide provides a table of differences that defines the discrepancies between the CMS regulation and interpretive guidance and the newer suite of standards that AAMI adopted. “I hope this guide will help all dialysis providers

move to the use of higher quality water, and thus provide better quality treatment for dialysis patients,” said Payne. The publication is available for $205, or $120 with AAMI member discount, as a book or in PDF format. Purchasers can also buy both the book and PDF as a set for $310, or $185 with AAMI member discount. TO PURCHASE The guide, go to my.aami.org/store/.

FEDERAL RECOGNITION OF HEALTHCARE TECHNOLOGY MANAGEMENT URGED AAMI has asked the U.S. government to recognize healthcare technology management as a professional field in its official occupational classifications, as well as add “clinical engineer” and “clinical systems engineer” to its roster of job titles. In comments submitted to the U.S. Office of Management & Budget (OMB) for its standard occupational classification (SOC), AAMI says that the names and titles have changed amid “explosive growth of technology used in healthcare.” Federal recognition of the terms, AAMI says, would help to clarify roles and responsibilities. “There has been confusion and misunderstanding about the current classification for the field of healthcare technology management,” AAMI said in its comments, adding that the field includes a range of professionals, including clinical engineers, biomedical equipment technicians, radiology equipment specialists, and others. The OMB should revise the SOC system to reflect this growth, AAMI urged. The SOC system is used by federal statistical agencies to classify workers into occupational categories. All private, public, and military occupations are classified under the system, which

provides information on employment levels, trends, pay and benefits, demographic characteristics, required skills, and other information, according to an OMB notice in the May 22 Federal Register. Individuals, businesses, researchers, educators, and policymakers may use the data to conduct analyses. The 2010 SOC revision is in effect, and the OMB has said it is considering a revision for 2018. In its comments, AAMI proposed that “Healthcare Technology Management— Engineers” be listed under the category “17—Architecture and Engineering Occupations.” The comments include a description of the nature of work performed by these professionals, including the coordination and acquisition of new healthcare technology, development of preventive maintenance schedules and guidelines, and review of safety alerts and recall notices. The job titles of clinical engineer and clinical systems engineer do not appear in the current SOC, but AAMI suggest including the titles under the HTM-Engineers occupation. AAMI described the primary employers of these professionals, including healthcare delivery organizations and medical device companies, as well as the rigorous education required to obtain these positions. In addition, AAMI called on the OMB to change the name of the occupation “Medical Equipment Repairers” to “Healthcare Technology Management-Technicians.” This occupation would be reclassified under “17-Architecture and Engineering Occupations,” moving it from “49-Installation, Maintenance, and Repair Occupations. AAMI’S FULL COMMENTS are available at www.aami.org/news/2014/072114_SOC.pdf

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DE-SLICING CT SYSTEM CLASSIFICATIONS

ith the growing technical developments in CT, the traditional practice of categorizing systems by the number of slices they can produce has become inadequate. Slices are axial images (two-dimensional cross sections) reconstructed following data acquisition, and in today’s scanners, the number of slices obtained during a study depends largely on the study protocol chosen by the radiologist, and much less so on the technical limitations of the hardware. In addition, there are significant differences between the designs used by different manufacturers (especially in the more advanced systems), making apples-to-apples comparisons difficult. NEW INNOVATIONS CALL FOR NEW CATEGORIES CT systems are now divided into four categories: 16-channel, 20- to 40-channel, 64- to 80-channel, and premium. (ECRI Institute expects that the premium category will need further revision as CT technology continues to advance.) In addition to the number of channels/rows/slices, this categorization takes into account criteria such as coverage, advanced applications, and acquisition capabilities.

“ROW” AND “CHANNEL” ARE BETTER THAN “SLICE” The number of rows and channels is a better way to describe CT hardware than the number of slices. More important, these terms better characterize the strengths and limitations of the technology. Here’s what these terms mean: • Row refers to the arrangement of discrete elements across the detector. CT detectors are available with up to 320 rows today, each containing hundreds of elements. • Channel refers to the electronics that convert the analog signal produced by the detector to a digital value and transmit it to the reconstruction computer. Each channel represents a

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physical pathway through which signals can be sent; channels are one of the limits of CT functionality. The number of channels is the maximum number of unique detector rows that can be used to acquire data during a single acquisition (though the total number of detector rows on the scanner may be greater than the number of channels that can be used, as explained in the next section), while the number of slices is the number of unique slices acquired per rotation.

ROWS, CHANNELS, AND SLICES IN DIFFERENT SYSTEMS In most sub-64-channel systems, the number of channels and the maximum number of slices are the same, but the number of detector rows is greater. This allows users to choose slice thickness. For example, a 16-channel CT system has more than 16 detector rows. There are 16 rows in the center of the detector that are narrower and are used to acquire thinner slices; during such acquisitions, the detectors along the outer edges of the array are not used. If, on the other hand, thicker slices are selected, the entire width of the detector is used, but the thin rows in the center of the detector are merged to match

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the thickness of the slices obtained from the wider ones. This means that when thinner slices are obtained, a narrower area of the detector array is used, and consequently a shorter section of the patient is imaged with each rotation. If greater anatomical coverage is required, thicker slices may have to be used. In either case, 16 channels will be used to transmit the information. In systems that fall within the 64- to 80-channel category, on the other hand, the number of detector rows, and the number of channels are identical. On these systems, there are 64 to 80 detector rows, all of them the same width. This means that, regardless of how many rows are being used, the narrowest slice information is always being obtained, even if thicker slices are recon-

structed from that information. So unlike on 16-channel systems, the narrowest slices can always be acquired without reducing the coverage per rotation, thus reducing the scan time. Some CT systems use advanced sampling techniques to generate twice as many slices than there are detector rows or channels. But doubling the slice count may not result in thinner slices and improved resolution. Instead, the slices overlap, making the images less susceptible to certain artifacts, and making any 3-D reconstructions smoother (i.e., the “stair-step” artifact — in which smooth surfaces lose their continuity — will be reduced). The top CT tier consists of more highly developed models that we call premium systems. Most CT manufacturers offer premium systems. These models have more functionality — for example, wider-coverage detectors, multiple detectors, or dual-energy acquisition options. In many cases, the additional acquisition options

afforded by the advanced technology are not yet widely used in clinical settings. Also, each manufacturer has very different ideas about the future of the technology, so there are many differences between the systems and their capabilities.

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THIS ARTICLE is an excerpt from a Health Devices article posted on ECRI Institute’s Health Devices System, Health Devices Gold, and SELECTplus membership websites on March 19, 2014. The full article includes more guidance on CT system classifications and detailed classification tables. The article also includes detailed diagrams explaining rows, channels, and slices. More detailed cost information for these systems can be provided by ECRI Institute’s SELECTplus Capital Equipment Pricing Tool. To purchase this article or to learn more about membership programs, visit www.ecri.org, contact clientservices@ecri.org, or call (610) 825-6000, ext. 5891.

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SEPTEMBER 2014

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SHOP TALK

Conversations From the TechNation Community Q:

Can anyone tell me if there is a TJC standard or other regulation that requires the logging of warming cabinet (blanket warmer) temps? This question seems to come up at my hospital once or twice a year, and to the best of my knowledge there is no such requirement. Our warmers are all labeled with max temp settings of 130 degrees for blanket only compartments and 110 degrees max for compartments used for liquids and/or a combination of blankets and liquids, as recommended by ECRI.

This has been a source of friction between nursing staff and the HTM or facilities people for many years. At my employer, the staff kept turning the settings up toward 140 or higher because the blankets “… just felt better.” We finally settled on 130 degrees for the blanket warmers, based on an AORN “Recommended Practice.” See the “Perioperative Standards and Recommended Practices”: AORN journal, 2013;217-242. And Facilities Engineering put plastic guards on the front panel to restrict access to the controls! But I don’t know of any enforceable “standard” for these.

I have also been in the situation where Biomed was told that a blanket warmer is “broken” because it’s

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not getting warm enough and asked if we could somehow make 130 degrees warmer without increasing the temperature. I have also been asked to turn the temperature down on OR lights ... so there you have it.

Looking for specific feedback regarding reliability, service support, training, cost, install quality, user satisfaction, patient satisfaction and overall impression of Rauland Responder 5 vs. Ascom Telligence nurse call systems integrated with Versus RTLS.

We have the Telligence system in most of the hospital, with the reporting component, as well. We have gotten good support from the distributor for Louisiana (Executone of Louisiana). I lost my technician that had been to the school and it will be after Oct. 1 before I can get someone to school. Therefore, we are having to depend on the distributor more than I would like. We had some issues with audio not working and Executone had to replace some equipment under warranty. Overall, I have been pleased with the Telligence system. I don’t know what it will be like now that Ascom bought it.

SEPTEMBER 2014

We have the Rauland Responder V in our hospital. It is a solid

product with good support locally (North Carolina). We do not have any ongoing issues. I give it a good user satisfaction. We have the capability to do more than we are currently utilizing.

We have Hill Rom NNC and NCM. I cannot recommend either. They are very expensive and high maintenance.

We have been converting to the Rauland 5 Nurse Call System throughout our facility and their support is first rate. The system is compatible with most smartphones, sip, etc. It also is compatible with interactive TV (medical grade). I have seen their operations and manufacturing in Chicago and they are first rate. They are also currently working on medical equipment integration and now have wireless available which can save tons of money on infrastructure wiring modifications for older facilities.

Glens Falls Hospital still uses Rauland systems (Responder III, IV and V). Overall, we have been very satisfied. Ronco Communications provides sales and service on our Rauland products. Their service support has been excellent. The reliability of the system has been pretty good both in software and hardware. Although, we do get failed bed stations once in a

while. As far as user and patient satisfaction go, I think that communication and a good service strategy are key. With the integration of paging and code blue servers on the IT side, effective problem resolution involves Clinical Engineering, IT, and nursing along with the system vendor. Also, my son works as an FSE for Ronco Communications and has been trained by Rauland. I have had a virtual behind the scenes tour of the Rauland products and support structure and I am impressed. I can’t comment on the Ascom Telligence since I have no experience with it. For asset tracking, we use GE Agiletrac here at GFH.

There is a thread from last month on this topic, but I would like to start the conversation again. In the tiny release of information that we have had the following paraphrase from George Mills was presented in an article: “Power strips may be used in patient care areas, however, if they are part of the equipment assembly or otherwise integrated into equipment by a manufacturer.” Do others interpret this to mean that if the Stryker OEM surgery cart has an integrated power strip, then it is OK to use? That is how I am interpreting this. To carry this further, what about non OEM carts that have integrated power

strips (i.e. a GCX cart or something)? And lastly, what are your thoughts on carts that have isolation transformers mounted in them? Can that really be considered an RPT? I am thinking not. In the previous post, others had mentioned permanently mounting HG strips, therefore rendering them no longer “relocatable.” I have a hard time buying that this would fly with a surveyor. What are your thoughts on the above? Has anyone been surveyed since June?

According to NFPA 99-2012, section 10.2.3.6, “Two or more power receptacles supplied by a flexible cord shall be permitted to be used to supply power to plug-connected components of a movable equipment assembly that is rack-, table-, pedestal-, or cart-mounted, provided that the following conditions are met: • Permanently attached, • Sum of ampacity does not exceed 75 percent of rated, • Cord meets NFPA 70, • Electrical and mechanical integrity is regularly verified, • Means are employed to assure that extra devices are not added. Also see NFPA 99-2012 10.2.4 Adapters and Extension Cords. They are also allowed.

Taking the Mills statement one step further, what if the manufacturer does not install the correct UL rated power tap on the cart? Who is responsible then?

This all started with a hospital in San Francisco. I spoke with someone who questioned the CMS surveyor in the San Fran area. He indicated that he would only be concerned if they were hanging in mid-air and appeared to be a maze of unkempt cords. Neatness, ID tagging them, and affixing them to a large object seems to be the key. Likewise, changing all power cords to 25 feet in length removes the need for about 80 percent of outlet strips and extension cords.

THESE POSTS are from TechNation’s ListServ. Go to www.1technation.com to find out how you can join and be part of the discussion.

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BIOMED 101

You May Be Compliant, But Not Secure. Here’s Why. By Earl Reber

eat belt laws can’t guarantee you won’t get hurt in a car accident, even if you comply. Neither can a driver’s license in good standing with the DMV. Likewise, compliance with HIPAA, Meaningful Use and other federal regulations can’t ensure the patient data under your care is secure.

Take Target, for example. The retail giant made the news in December 2013, for a major security breach affecting credit card numbers, expiration dates and security codes for 40 million customers and other personal information for up to 70 million people. Prior to the breach, Target was PCI compliant, having aced an audit for the Payment Card Industry standards just a couple of months before all hell broke loose. For cybersecurity experts, Target’s data breach reflects the reality that compliance can’t guarantee security — not even close.

SO WHAT’S THE DIFFERENCE? Below is a snapshot of how compliance and security stack up: Compliance • Conformity with official requirements. • Standards set by a third party with no knowledge of your organization. • May be open to interpretation. • Compliance violation costs: as high as $1.5M per implementation specification. • You can be 100 percent compliant. Security • Protection from harm. • Standards tailored and tested internally

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to address the organization’s specific needs and evolving challenges. • Clear and specific to organization. • Security breach costs: frequently 10-20 times more than penalties as lawsuits, lost business and PR crises mount. • You cannot be 100 percent secure. Don’t hospitals have both compliance and security covered? Actually, no. Having performed more than 20,000 risk assessments on medical devices containing patient data, we’ve witnessed countless security and compliance oversights with a real potential to take down a provider’s operations, finances, and delivery of care. But that shouldn’t come as a surprise. HIPAA violations affecting 500 or more records are up 138 percent since 2012, says the U.S. Department of Health and Human Services.

EARL REBER Executive Director, eProtex

SO WHERE’S THE DISCONNECT? There’s much to say here, but let’s start with the misperception that security beyond basic compliance is a luxury, not a need. Although you’ll be hard pressed to find someone who openly admits to that mindset, you’ll find evidence for it in the form of insufficient security resources or a slew of higher-priority initiatives.

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Perhaps the main reason is the issue of invisibility: when security works well, nothing bad happens (which is exactly the outcome you want). But then, because nothing happens, security is viewed as a needless expense. Until, of course, something does happen, like it did for Target.

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SO WHERE TO START? What does it look like to go from just implementing minimum deterrence elements so you can check off compliance requirements, to being adequately secure? Below are characteristics of effective, risk-based security: • Compliance is viewed as a part of security, not a substitute for it. • Avoidance of compliance violations or fines does not dominate decision making. An enterprise-wide systems security and risk management approach does. • Leadership approaches security processes in terms of acceptable risk levels, not a compliance checklist.

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Wherever you are in the security spectrum, there are only three possible ways you can respond to risk: 1. Acceptance: You accept the risk is real and do something about it. 2. Transference: You find ways to place the risk on someone else’s shoulder, like an insurer. 3. Rejection: You cover your eyes, redirect your attention elsewhere, and act as if the risk doesn’t exist.

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Ultrasound Fundamentals As you examine your current attitude and efforts, which security approach best describes yours? We understand you have challenges — lots of them. Common obstacles include limited resources, both financial and human; a lack of knowledge about where to start and what level of security is appropriate; and a false sense of security that may come with compliance. You’ll be ahead of the curve just realizing that following the letter of the law alone will not achieve security. Rather, both compliance and security can be achieved together by continually assessing threats and vulnerabilities, and implementing practices to minimize or eliminate those threats.

REFERENCES: www.healthcareitnews.com/news/hipaa-data-breaches-climb-138-percent

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With GE Healthcare Q:

GE Healthcare Service created a buzz at the annual AAMI conference in Philadelphia. What caused all the excitement?

At AAMI, GE Healthcare showcased a suite of new and enhanced offerings designed to address some of healthcare providers’ most pressing operational challenges: infrastructure connectivity, getting the right service parts as quickly as possible, avoiding ultrasound downtime related to damaged probes, and synthesizing data to help them optimize their assets. These solutions can help healthcare providers improve operational efficiency in the midst of a changing regulatory environment, industry consolidation and evolving patient populations.

How can GE Healthcare help address hospitals’ desire for stronger support and risk management, especially when it comes to some of the latest technologies?

GE Healthcare’s new offering, Clinical Engineering Technology Management (CETM), is an end-to-end infrastructure connectivity service that assists IT and Clinical Engineering with design, deployment, maintenance and management of mission critical networks, wireless networks, distributed antenna systems and devices that connect and provide critical patient data to healthcare providers and hospital IT systems. The new service is in direct response to hospitals’ demand for stronger, more evolved support and risk management

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given the burgeoning use of mobile and other networked devices, as well as complex regulatory requirements. GE Healthcare’s CETM Service helps hospitals bridge the gap between their IT and Clinical Engineering departments by enabling collaboration between resources and providing ongoing, proactive counsel on risk management of wired and wireless networks that have integrated medical devices or when changes occur either to the network or integrated medical devices. This support continues throughout each phase of the lifecycle of a medical IT network.

What is the best way for HTM professionals to acquire parts and data for GE devices?

Service Shop is GE Healthcare’s new online resource that provides clinical engineering teams with access to GE parts and information for equipment, such as ultrasound, anesthesia, maternal infant care, cardiology and patient monitoring devices. It allows healthcare teams to search, verify and order parts and accessories efficiently via any web-connected device. The easy-to-use interface allows review of previous orders and sharing of carts, saving time and effort and helping to avoid ordering errors.

Ultrasound technology seems to be advancing quickly, yet probes continue to be an area of concern for clinical engineering departments. What is the GE Service solution for ultrasound probes?

SEPTEMBER 2014

RICHARD NEFF Vice President & General Manager, GE Healthcare, US & Canada

GE Healthcare’s new AssurePoint* (AP) Probe Performance provides support services to clinical engineering programs to help lower ultrasound service cost while minimizing risk exposure. AP Probe Performance provides a complete probe management solution by combining the high quality probe repair of Unisyn with the support technology of FirstCall*, a proprietary device that tests the probe’s performance, Trophon**, a complete ultrasound transducer disinfection system, InSite* remote services and productivity tool; and training and education offering on probe handling and care.

Repairs are only part of the HTM professional’s workload. How does GE Healthcare assist with asset management?

GE Healthcare has revamped its asset management platform, iCenter*, to enable customers to better optimize their GE and non-GE biomedical and diagnostic assets through its ability to find information faster and analyze data and create reports more easily. These improvements mean that customers get instant access to critical

information – such as asset status, location, maintenance history, use and planning – with fewer clicks. A built-in analytics engine provides for more visual and intuitive data depiction along with enhanced user security, ultimately enabling improved decision making for care-providing teams and helping to support more efficient hospital operations. An integrated guided tour helps customers quickly acclimate to the new platform with minimal training. The enhanced iCenter is the company’s platform for future

online service applications and is designed for scalability to accommodate a customer’s future needs. *GE, the GE Monogram, AssurePoint, FirstCall, InSite, and iCenter are trademarks of General Electric Company. **All third party trademarks are the property of their respective owner. FOR MORE INFORMATION, please visit www.gehealthcare.com

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ROUNDTABLE

FLEXIBLE ENDOSCOPY

ndoscopy means to look inside something and usually refers to peering into a body for medical reasons such as diagnosis or treatment. Unlike the majority of medical imaging devices, endoscopes are inserted into an organ to view it. These medical devices can be used to investigate symptoms, confirm a diagnosis or provide treatment. TechNation reached out to industry experts to find out the latest on flexible endoscopes. Philip Doyle, Director of Marketing, Gastroenterology, Olympus America Inc.; Charles Neff, Vice President of Operations with MedServ International Inc; and Jeff Maben, Flex Repair Division Manager at Mobile Instrument Service & Repair Inc. took time to share their insights.

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN FLEXIBLE ENDOSCOPY AND IN THE FLEXIBLE ENDOSCOPY MARKET? Doyle: The introduction of a universal endoscopy platform has been considered a game-changer for endoscopy. The video processor and light source of the system can be used with both flexible and rigid endoscopes and camera heads, allowing a single platform to support multiple departments, from surgery to pulmonology to gastroenterology. Maben: Itâ&#x20AC;&#x2122;s an exciting time in the flexible endoscope industry with growing technological innovations promoting enhanced diagnosis and treatment methodologies. Advancing

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SEPTEMBER 2014

technology is enabling clinicians to gain greater access to the GI system which is facilitating increased disease detection capabilities. Expanding capabilities afford facilities the ability to improve infection control to decrease the number of healthcare-associated infection (HAI) occurrences which incidentally helps to contain rising healthcare costs. Additionally, there’s an immerging focus on flexible endoscope reprocessing technology with emphasis on continuing education on proper reprocessing procedures to also help improve infection control. Neff: There is an ongoing advancement in imaging technologies that aims to improve visualization of the vascular network and surface texture of the mucosa and therefore are improving tissue characterization, differentiation, and diagnosis. These include technologies like chromoendoscopy, narrow band imaging, FICE and autofluorescence endoscopy and point enhancement or virtual histology technologies like endocytoscopy and confocal endomicroscopy. Additionally endoscope manufacturers are beginning to release high pixel count CMOS imaging sensors to replace higher cost CCD sensors.

HOW WILL THOSE CHANGES IMPACT THE FLEXIBLE ENDOSCOPY MARKET IN THE FUTURE? HOW WILL THEY IMPACT MAINTENANCE? Doyle: Universal endoscopy technology will play a key part in helping to address facilities’ efficiency goals and strategic spending because it meets the needs of several departments within a larger healthcare facility. The singleplatform concept enables streamlined and flexible equipment deployment; simplified logistics, training, and biomed support; and backwards compatibility, together resulting in improved turnover time and reduced service expenses. Maben: Across the nation, facilities are faced with rising healthcare cost concerns that are compounded by reduced government funding and

WHAT TECHNOLOGIES ARE WORTHY OF THE INITIAL INVESTMENT? HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE FLEXIBLE ENDOSCOPY NEEDS OF TODAY?

PHILIP DOYLE Director of Marketing, Gastroenterology, Olympus America Inc.

facilities are looking to service providers to assist in reducing costs. A partnership between businesses and customers can offer the benefit of continuing education on proper scope care and handling procedures, proper scope reprocessing methods, and the implementation of routine preventive maintenance inspections to reduce user damage and help save on repair costs. Keeping existing equipment in peak condition will extend the life of the equipment saving capital budget dollars as well as provide repair cost containment. Ask any administrator or any clinician the best method to reduce infection or reduce repair costs and they will tell you it is prevention. I think we’ll see more aggressive preventive maintenance programs throughout the healthcare industry. Neff: The overall impact of improved visualization is to enhance the diagnosis outcome. At the outpatient facility level, technologies like narrow band imaging and FICE will be readily available. At the specialist or cancer center level, most or all of the virtual histology technologies will be available. Since most of these technologies are built into the manufacturers’ video processor systems, and not into the endoscope, the overall cost of repair should not be significantly impacted.

Doyle: Manufacturers are always evolving endoscopy equipment to provide the most cutting-edge technology for diagnosis and therapy. Some Original Equipment Manufacturers (OEMs) may offer flexible leasing and financing options for customers to make even the most advanced equipment budget-friendly. To determine what initial investments to make, work with the manufacturer’s professional service team to develop an intelligent plan for upgrading your facility’s inventory based upon equipment usage and the number of years in service. This analysis can help establish a roadmap for which equipment to upgrade and when, based upon your allocated budget or other important factors. Maben: Facilities must invest wisely to get the best value out of declining repair dollars without sacrificing quality. The investment must be pertinent to the medical mission to meet healthcare treatment needs. While purchasing new equipment has advantages of obtaining the latest technology it also carries a significant price tag. Make those dollars work for you by investing in technology that improves continuity of care and reduces infection control risks. One of the best ways to stretch your budget dollar is to prevent equipment damage through ongoing care and handling training with follow up on monitoring of processes to ensure lasting costsavings results. The implementation of routine business reviews will help both the facility and service provider to assess optimal budgetary spend efficacy is achieved. Neff: Base systems for all major endoscope manufactures come with a full featured technology set. At a minimum, a system should be equipped with some type of narrow band imaging either mechanical (Olympus) or electronic (FujiFilm, Pentax) in functionality.

THE ROUNDTABLE

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING FLEXIBLE ENDOSCOPY? Doyle: Buying certified pre-owned from a Food and Drug Administration OEM is significantly different from purchasing a pre-owned endoscope from an Independent Service Organization (ISO). When purchasing a certified preowned(CPO) endoscope from an OEM, the refurbishments completed will bring the tool back to its original “like-new” specifications, using original manufacturer parts and components. ISOs are not regulated by the FDA, and are only responsible for returning the refurbished item to “within a reasonable approximation of the manufacturer’s specifications.” It is important to note that many OEMs do not sell the proprietary parts that enable endoscopes to function the way they were designed and FDA-approved to function – which is why many Automated Endoscope Reprocessor(AER) manufacturers will not guarantee the results of their reprocessors when used with endoscopes refurbished by ISOs. It’s always recommended that endoscopes in need of repair be returned to the OEM for servicing. Many OEMs offer service contracts to keep repair costs down and loaner equipment to reduce downtime. Maben: The heightened financial burden smacking healthcare facilities in the face is forcing facilities to review how every dollar is being spent. In my opinion, a reputable third-party company holds the best overall value to meet or exceed purchasing or service needs. Ensure your service provider has the ability to customize service agreements to meet the facility’s needs and expectations, help implement proactive onsite continuing education on care and handling training, and monitoring of ongoing preventive maintenance programs. When considering purchases, ensure you are working with reputable vendor that utilizes USP Class VI medical grade parts and materials that are compatible with modern reprocessing methods. Neff: It is important to understand your needs and requirements. It is easy to purchase new equipment that has no

1TECHNATION.COM

CHARLES NEFF Vice President of Operations with MedServ International Inc.

technological difference from your current equipment. You must be knowledgeable about your current equipment’s capabilities to properly evaluate purchasing the “latest and greatest” that may or may not change your patient outcomes.

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR WHEN DECIDING WHETHER TO GO WITH AN ORIGINAL EQUIPMENT MANUFACTURER OR A REPUTABLE THIRD-PARTY FLEXIBLE ENDOSCOPY PROVIDER? Doyle: How the endoscope is refurbished plays a vital role in how the endoscope is reprocessed. Many OEMs do not sell the proprietary parts that enable endoscopes to function the way they were designed and FDA-approved to function. Should a piece of the endoscope not work properly and there is no manufacturer replacement part for purchase, the ISO would likely substitute some other part for the part the OEM spent years perfecting, which may pose a risk to patient safety. While OEM CPO endoscopes are validated by the majority of AER manufacturers, AER manufacturers appear to be uncomfortable with guaranteeing the results of their reprocessors when used with endoscopes refurbished by ISOs. Before purchasing an ISO-refurbished endoscope, facilities should check with

SEPTEMBER 2014

their AER manufacturer about whether the endoscope will be validated to minimize risk in the event of a lawsuit. Maben: Third-party companies can save on repair spend by as much as 30 to 60 percent annually. Most facilities’ scope inventory consist of multiple manufacturers but OEMs are usually limited to service contracts for their name brand, whereas an established third-party company has the ability to repair many product lines without bias or conflict of interest. Another benefit of a reputable third-party company is that it can have the technical expertise to provide dependable high-quality durable repairs for all OR services. Ask your repair vendor if you can tour their facilities and speak directly with their technicians to see how the repairs are being done; seeing is believing. Neff: When choosing to use a reputable third-party it is important to understand their capabilities. Regardless of what they say no third-party can do everything the manufacturer does and knowing these limits upfront set expectations properly for all parties. Knowing what parts are new and what parts or recovered/remanufactured allows you to understand what you are paying for. A reputable third-party should always communicate clearly and stand behind the work performed and be available to reply to any quality concerns in a timely manner.

IS IT POSSIBLE TO KEEP UP WITH THE LATEST FLEXIBLE ENDOSCOPY ADVANCES AND IMPROVEMENTS WITHOUT BUYING BRAND NEW? WHAT ARE SOME OF THE NEWER TECHNOLOGIES AVAILABLE? Doyle: Manufacturers are always evolving endoscopy technology to improve diagnostic and therapeutic capabilities for the benefit of physicians and their patients. This makes new equipment more appealing. Some newer imaging technologies include high definition (HDTV), Dual Focus (optimizes imaging system on-demand for better close-up viewing of tissue), Narrow Band Imaging technology (now brighter and twice the viewable distance to enhance the visibility of vessels and

other tissue for more accurate biopsies) and wide-angle view capability. Other improvements include wider working channels for therapeutic applications and advancements in flexibility and control for maneuvering more easily throughout the digestive tract. While new endoscopes offer the most advanced technology on the market, when budgets won’t allow the purchase of new endoscopes through leasing or financing options, CPO endoscopes can offer access to previous-generation technology for purchase at a fair price. Maben: With a little effort, it is possible to keep up with technical advancements without buying brand new equipment. There are several outlets that have the ability to locate newer equipment and sell it as refurbished. This allows hospitals to gain access to the latest technologies while avoiding OEM pricing. Also keep in mind that most new endoscopes are compatible with older model video equipment and this backwards compatible equipment can help facilities upgrade scopes while waiting for more funding to afford the latest video processor. You may not have access to all the new technologies until you get that new processor but at least you can spread out the damage to your budget without losing any of your current capabilities. Neff: For some time now the base systems for all major endoscope manufactures come with a full featured technology set including some type of narrow band imaging either mechanical (Olympus) or electronic (FujiFilm, Pentax) in functionality. In some cases it is as simple as adding a compatible scope to your existing system to gain this functionality.

HOW CAN PURCHASERS ENSURE THEY ARE MAKING A WISE INVESTMENT IN FLEXIBLE ENDOSCOPY? HOW CAN THEY ENSURE THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS? Doyle: Before making an endoscope purchase, one can start by uncovering the specific diagnostic and therapeutic needs the current equipment is not meeting, and also evaluate which

website. The local manufacturer representative is a good source of information. Training should come from each unique equipment manufacturer’s personnel to assure compliance with the OEM’s standards. Training records should be provided to the account as a permanent document.

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT FLEXIBLE ENDOSCOPY?

JEFF MABEN Flex Repair Division Manager at Mobile Instrument Service & Repair Inc.

capabilities the facility is looking to improve upon. This research will help determine what investments the facility should prioritize. Also, it is important to consider what benefits and service the manufacturer will offer throughout the entire life of your equipment – not just at the point of sale. The initial attraction of a low price or single novel feature can be tempting, but the on-site training, education and support necessary to learn and maintain the equipment can be costly afterthoughts if not included with the purchase. Maben: Make sure any investment in technology lives up to its advertisements. Ask around, talk to doctors or staff that have had experience with the new equipment. Look for technology that is designed for efficiency or damage prevention during reprocessing. When you do get that new equipment, don’t stop with the information provided by the sales rep. Check online, ask your repair rep (not the guy that sold you the equipment) and talk to other industry experts to ensure you get all the education necessary to handle and reprocess your new equipment. Neff: Purchasers should always look to the manufactures website, both locally and internationally, to better understand the equipment they are considering. In many cases the literature can be requested on the

Doyle: When it comes to making a purchase decision, education will prove invaluable. Research the manufacturer’s track record, the durability of the equipment and the manufacturer’s post-sale support. The investment should go beyond just the purchase of the equipment – the manufacturer should be a partner in ensuring staff is properly trained and the equipment is well maintained. Maben: The most important thing to remember is that all companies (thirdparty and OEM) have different strengths and weaknesses. Some companies will have better quality, some with better pricing, some better education and so on. This is important not only because of the services for which you are seeking but also when determining educational needs, maintenance programs, and cost savings. Just because someone can offer the best price doesn’t necessarily mean they offer the best service or combination of services. Neff: It is important for biomeds to be involved with the installation and setup process of the new equipment. By working with the OEM installation team, the biomed can better understand how the systems are configured, wired and made ready to go into service. Biomeds should also attend all initial “OEM inservice” training to understand the pre-procedure setup, the postprocedure scope pre-cleaning, leak testing, washing, disinfecting and post-disinfection drying. These basic skills will better prepare the biomed for troubleshooting issues should they occur.

THE ROUNDTABLE

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HOW TO BUILD A BIOMED ASSOCIATION INSIGHTS FROM THOSE WHO KNOW By K. Richard Douglas

In the pages of TechNation, we have highlighted the good work and many beneﬁts of HTM associations and societies throughout North America, including one in Canada. The core focus of most of these groups is to educate their members, provide opportunities for networking and to oﬀer presentations by vendors and industry leaders.

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ome groups hold an annual conference that includes guest speakers, events and good food. HTM associations range from small groups to large multichapter organizations.

Few people know more about starting and guiding HTM associations than Pat Lynch, CCE, CBET, fACCE, CHTS-PW, CPHIMS. He is the go-to person with a wealth of experience when it comes to negotiating the many considerations of establishing a new group. Lynch says that AAMI offers a resource for those looking to take the plunge and get an organization off the ground, but he has also been empowered, through his employer GMI, to help any group seeking assistance. “My company funds me to travel wherever needed to talk, organize, enlighten, and do much of the organizational legwork,” he says. “Having a person who is available to walk the leadership through all of the myriad issues is extremely important.” AAMI also offers a biomedical society leaders discussion group to allow for an exchange of ideas. On their website, AAMI says the discussion group assists leaders with “managing their organizations, including recruitment of members, developing quality programming for meetings, (and) communicating with members.” In addition, AAMI also has a page of resources on their website called “Idea Exchange: Biomedical Societies,” which covers a host of topics and provides links to resources covering everything from membership application samples

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PATRICK K. LYNCH

GUS SAKIS

CBET, CCE, Biomedical Support Specialist for GMI

2011 and 2012 statewide chairman of the board for CMIA

“ Everything begins with an idea.” – Earl Nightingale to tax issues, meeting planning, scholarship awards to organizational considerations. The AAMI information provided a blueprint for the Armed Forces Biomedical Society (AFBS). The group’s leader had discovered that some research had been performed before he took the helm, and then he found the AAMI information. “I asked for the information and began working on a plan to establish a committee. This is when I was introduced to the AAMI document titled ‘How to Establish a Biomedical Society,’” “says AFBS President Diego Gomez-Morales. “I could not believe how detailed this document was. I followed this document step by step during our initial meeting so the committee would stay focused. I had to be firm

APRIL 2014 2014 SEPTEMBER

and consistent in following this document because I felt it provided us with a structured timeline.”

THE FOUNDATION BLOCK The late motivational speaker and radio legend, Earl Nightingale, once said that “everything begins with an idea.” An old Chinese proverb says that “the journey of a thousand miles begins with one step.” One big step in establishing a new HTM association is the decision to do it and the action needed to make it a reality. “Local interest is essential. I can help them through the organizational steps, but I will not be there to lead the association month to month. There has to be a local passion,” Lynch says. “The start is to announce an organizational meeting. It is usually a dinner

BARRETT FRANKLIN

JOHN ALVENUS

FRED JARAMILLO

immediate past president of the New England Society of Clinical Engineering

CBET, president of the Florida Biomedical Society

the former president of the Colorado Association of Biomedical Equipment Technicians

meeting. All major hospitals in the area are encouraged to attend, by special invitations over the phone. Special work has to be done to encourage employees of ISOs to attend. They usually are not big participants of local associations, but can benefit just as much as hospital employed biomeds.” The California Medical Instrumentation Association (CMIA) has been around since 1972. The association has nine chapters spanning the country’s most populated state. “The bottom line is willing volunteers,” says Gus Sakis, the 2011 and 2012 statewide chairman of the board for CMIA. “People willing to step up and do the work required to keep the CMIA going. Memberships; both individual and corporate, are a very important effort and require annual monitoring. Corporate sponsors; we could not exist and do some of the things we do without them. They are the financial backbone of the CMIA.” Sakis says other important components include “meetings, setting a schedule, arranging for presentations, education, food and beverage is time consuming.”

He says that regional events take even more work. “With booth/table sales for exhibitors, registration, and most important education.” And he says that statewide symposiums require even more work, and like every other facet of an HTM association, require people willing to step up and do the important work. Most HTM associations started with a small group of people who wanted to bring together biomeds to share what they know and provide opportunities for rubbing elbows with hiring managers and getting a look at the newest medical equipment. “It is almost impossible to get local biomeds interested in a yet-to-be-created association. Everyone wants to wait until there is something established before they commit to supporting it,” Lynch points out. “We have tried to rev up widespread interest in establishing an organization. These put the cart before the horse and all have failed. The better way is to be content with a few — 6 to 12 — interested individuals, set up the association, and then invite people to attend.”

This initial core group of people, who make an early commitment to the new organization, is part of a constant and recurring theme in the development of a new association according to those who know. “Every society will need a group of people who not only have the time, but are willing to put the time in, for it to succeed. If you look at any of the most successful societies around the country, you will note that all of them have a core group of leaders. That is not to say the leadership cannot change over time, but you always need a core group to keep the organization moving,” says Barrett Franklin, immediate past president of the New England Society of Clinical Engineering (NESCE). “The best advice I can give is to start with a core group of dedicated individuals who are passionate about their profession,” says John Alvenus, CBET, president of the Florida Biomedical Society (FBS). “Find the people who enjoy their job and are willing to help others. Our organization, FBS, has been very fortunate to have several of these dedicated individuals.”

HOW TO BUILD A BIOMEDGOING ASSOCIATION MOBILE

Once this core group has been assembled and local HTM professionals have been invited to a meeting, it is important that other early participants share the new group’s mission. “Locate and recruit like-minded dedicated HTM professionals,” says Fred Jaramillo, the former president of the Colorado Association of Biomedical Equipment Technicians (CABMET). “Develop a mission so the team is on the same page (and) enlist support from a mentor.” “Develop vendor relations to financially/ clerically support the association, but not so much where vendors control the organization. All organizations should be member-ran. Put together a constitution and by-laws,” Jaramillo adds. “There needs to be a review of the geographic area/territory that you want to consider including in your association. What are the borders of the neighboring associations to create the region you want and not to infringe on the associations around you?” says Dave Francoeur, regional vice president for Crothall Healthcare.

Franklin says. “As an example, NESCE typically has five to seven members supporting the executive actions of the organization and typically brings together more than 50 people for meetings and more than 200 for symposia.” Franklin also suggests that other established organizations can provide guidance. “To anyone trying to start a society, I would suggest reaching out to the leadership of successful societies, potentially attending an established society meeting if possible, as well as pulling resources from AAMI, which has been very supportive through annual regional society roundtables at the AAMI conference,” he says.

GROW AND PROSPER Jaramillo recommends keeping meetings to a reasonable length. “Do not let meetings run over time. If necessary stop the meeting at the published time and tell people that want to stay they can stay and let others go that planned on leaving at a certain

“Make sure the folks that play leadership roles are leaders” – Dave Francoeur “You also have to consider the area may be too big for individuals to actively participate,” he adds. “Decide what your organizational structure will look like. Big enough so a few are not doing the work of many, and not so big that people can’t participate and feel included. Make sure the folks that play leadership roles are leaders.” “You always need to have a large enough, and interested group for the society as a larger entity, to sustain,”

1TECHNATION.COM

time,” agrees Dave Scott, who has run CABMET’s famed study group for years.”Some people drive from long distances and that needs to be taken into account.” Scott has partnered with other associations nationwide to extend the benefits of the CAMBET Study Group to a larger audience. “CABMET offers partnership with other associations,” he says. “That way other associations can join our certifica-

APRIL 2014 2014 SEPTEMBER

DAVE FRANCOEUR Regional Vice President for Crothall Healthcare

tion study group and use CABMET’s program, but run it as their association’s group. This team approach has worked out great for other associations.” This effort is just one example of how inter-association cooperation can be a building block of successful groups. The lessons learned by other associations can provide a guide to new organizations. This lesson-learned approach is something Lynch brings to the table from the start. “At the organizational meeting, my favorite thing is to present an overview of some of the associations from around the country; different philosophies, different geographies, different meeting frequencies,” Lynch says. “I also profile associations that have failed. We discuss the fatal flaws that led to their demise and review proposed by-laws and organizational structures that will prevent this from happening again.” “One other key to success is to be consistent on where you host the meetings,” Alvenus says. “It should be a central location to draw the most attendees. We have ours in central Florida at Disney every year.”

DAVE SCOTT

CHRIS COLEMAN

CHRIS WALTON

CABMET Study Group

CBET, President of the Healthcare Technology Management Association of the Mid-West

CBET, MS, treasurer of the Washington State Biomedical Association

“By having things for the other members of the family to do, while the attendee is in class, helps everyone enjoy themselves,” he explains. “A new association should start small and build on its success for future years. The best way to interest the current biomeds in attending the symposium is to offer classes they are interested in learning about.” Alvenus suggests getting the vendor, if possible, to offer the same training they put on at their facility and provide BMETs with a factory training certificate. “This goes a long way toward getting the buy-in from their supervisors and managers,” he says. “When the managers and directors are on board they will send the biomeds. The best advice I can give a society looking to start a new chapter or state organization is to attend a successful society’s meeting; get to know their officers and ask questions.”

Management Association of the Mid-West. “This year we’ve brought in Pat Lynch of GMI to speak to us about cost to service ratios in future equipment management planning and Don Allen, Director of Biomedical Engineering at Mercy Hospital in Joplin, Mo., to talk about how that department dealt with getting hit by a tornado,” Coleman says. “Both of these presentations directly relate to biomeds.” Coleman says that for the past four years, in June or July, the HTMA-MW gets tickets to a minor league ballgame and they have a big tailgate preceding it. What approach works for getting the newest HTM professionals involved in an association or society? “Probably the most important is by aligning ourselves with the local colleges who have biomed tech programs,” states Chris Walton, CBET, MS, treasurer of the Washington State Biomedical Association. “In our case, there are three; North Seattle College, Bates Technical College, and Spokane Community College,” Walton says. “We provide scholarships

for all three schools and we hold our annual symposium at North Seattle. I also go out to the college and give lectures to incoming students and to their program about the biomed field in general. During that talk, I urge them to get involved in our association, and I even take copies of your magazine (TechNation), and hand them out. The reason is that they need to know that they can learn a lot about the profession by reading these journals.” “It is also very important that some of the instructors at these schools also urge their students to participate,” he adds. “About 20 percent of our members are students. They eventually will begin working in the HTM field. These students come to the meetings to try to get internships at local hospitals and companies, to network, and to learn. It is a win/win for everyone.” Sakis summarizes the one component that is the inevitable foundation of every one of these groups. “From my experience, the most important things needed to grow and maintain a biomed group — or HTM group — is people,” he says.

MORE INSIGHTS “Last summer, we organized a two-day training session on the Covidien ForceTriad energy platform for our members,” says Chris Coleman, CBET, president of the Healthcare Technology

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CAREER CENTER

Gracefully Declining a Job Offer By Cindy Stephens

any job seekers feel bad about declining a job offer after spending time in the interview with someone they really like and respect. I have been asked by several candidates how to decline a job offer they do not want to accept. One candidate said he felt almost disloyal when he turned down an offer because it just was not good timing for him, but he really wanted to be considered in the future for this company. I told the candidate that declining a job offer is not about being disloyal, but it is about being honest and professional.

CINDY STEPHENS Stephens International Recruiting, Inc.

1TECHNATION.COM

Following your interview, always ask when a decision will be made and by what date you are expected to act on an extended offer. While you are going through the decision-making process, be sure to keep in contact with your potential employer and the recruiter. An open line of communication will allow you to negotiate any aspect of the offer more effectively. Once you have decided to accept an offer, inform the hiring authority immediately and confirm all arrangements in accordance with the employer’s policies and procedures. Don’t put this on social media sites until you have let the other employers who have also offered you employment know of your decision. It is understandable that when offered a new and challenging position you will be excited. You have worked hard and deserve it, but it is important to keep your integrity and professionalism intact. Don’t quit your current job, either, until you have received a confirmed written offer and start date. With all the competition for job openings many job seekers feel lucky to receive any offer, but sometimes for whatever reason, you may need to decline an offer. As soon as you have determined you are unable to accept a job offer, whether you have

SEPTEMBER 2014

accepted another position or have realized that the job is not for you because of location, compensation, or other reasons, contact the hiring authority and recruiter as soon as possible. Respect and consideration is important in declining a job offer and we encourage everyone to decline the offer promptly and honestly. The hiring authority will need to offer the position to someone else and you don’t want to hold up the process. If you handle it gracefully and honestly, you leave a lasting impression as a professional person with integrity. You want to keep your options open and avoid closing the door on any future opportunities. Make sure you speak directly with the person about it. Do not leave a voicemail message nor send an email message to decline the offer. If you cannot speak directly with the hiring authority, then leave a message that you want to speak with them regarding the offer. While you are delivering the rejection, whether in person or on the phone, remain diplomatic and positive. Be very courteous and thankful for the opportunity, thanking the person you’re calling as well as others in the company who were also helpful to you. Take the time to show how much you appreciated their time to interview you, and how much you appreciate the offer. Be honest and direct when you tell them regrettably that you cannot accept the offer. Do not lie about your reason for not accepting the offer. You will be seen as more credible if you remain positive and appreciative when you explain that you have decided not to take the position. Provide a brief explanation as to the reason you cannot accept the offer at this time. If you feel you might be interested in the future, tell them that, and ask if you can keep in touch with them. If you had a negative experience during the interview process or with the company

itself, keep that to yourself, but state that the timing was not right or that the job did not meet your career goals at this time. If you have found a better opportunity, let the hiring authority know that you found another position that meets your requirements and really appreciate their time and the opportunity to learn about their company. Once you have discussed it with the hiring authority, continue to keep it professional and positive. Thank the person again for their time and effort. Follow-up the call immediately in writing, again with the goal of keeping it professional and maintaining a positive and appreciative tone. A handwritten

demonstrate your maturity, professionalism, and acknowledgement of how much time and energy was invested in you and the recruiting process. The recruiter will understand and by having this discussion, you can share some of your reasons for accepting another position or declining the presented offer. This provides the recruiter valuable feedback and will also bring closure to the process. It is important that you be positive, humble, and appreciative of the offer. Do not voice any negativity about the organization. Gracefully declining a job offer is also about reputation. Not everyone is considerate in applying for jobs or

If you take the time to communicate in a professional and graceful manner, you will gain the respect of the employer whose offer you rejected. This will work in your favor long term should you be interested in job opportunities in the future with the organization. thank you note goes a long way. However, if you write or email a letter declining the offer, keep it short, honest, and very positive. Remember to thank the recruiter and, as appropriate, any other company official for their time and consideration. If you take the time to communicate in a professional and graceful manner, you will gain the respect of the employer whose offer you rejected. This will work in your favor long term should you be interested in job opportunities in the future with the organization. Also, if you were working with a recruiter, immediately inform them that at this time you are declining the job. This will

declining job offers. It is a small world, especially in the Healthcare Technology Management career field. We have had Human Resource professionals tell us how some candidates are coming to them to leverage promotions in their current position. This leveraging can hurt a candidate in future career opportunities. If you burn a bridge, it does not take long for it to be known in the industry. Regardless of the situation or reason for declining a job offer, declining an offer gracefully and in a professional manner is an act that reveals much about your character and can possibly set up a successful career move in the future.

EXPERT ADVICE

ULTRASOUND TECH EXPERT