TechNation - April 2015

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VOL 4

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

APRIL 2015

BIG DATA

AND ALARM MANAGEMENT Marshaling a Brain Trust to Find Answers

26

Biomed Adventures Cheering on Biomedical Engineering

44

The Roundtable Patient Monitors

80

What's on Your Bench?

Highlighting the workbenches of HTM Professionals

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

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THE ROUNDTABLE - PATIENT MONITORS TechNation asked experts about patient monitors to find out the latest advances in these important medical devices. Our panel of experts also shared information on servicing patient monitors and what to look for when purchasing these devices.

Next month’s Roundtable article: Ultrasound

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DATA AND ALARM MANAGEMENT- MARSHALING A BRAIN TRUST TO FIND ANSWERS The Joint Commission, AAMI and the ECRI Institute are not the only ones concerned about alarm management. TechNation shares insights into this problem and ways that different experts are addressing the issues while searching for solutions. We also examine the role big data plays when it comes to alarm management.

Next month’s Feature article: Guide to AAMI Conference

TechNation (Vol. 6, Issue #4) April 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

APRIL 2015

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INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy Warren Kaufman Jayme McKelvey Andrew Parker

ACCOUNT EXECUTIVES

ART DEPARTMENT

Jonathan Riley 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

Department Profile: Baylor Scott & White Biomedical Engineering Department p.16 Company Showcase: USOC Biomedical Services p.20 Professional of the Month: Scot Copeland,BSITSEC, MCP, SEC+ p.22 Company Showcase: Pacific Medical p.26 Biomed Adventures: Cheering on Clinical Engineering

P.30 THE BENCH p.30 p.32 p.34 p.36 p.38 p.41

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

P.60 EXPERT ADVICE

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p.60 Career Center p.62 Ultrasound Tech Expert Sponsored by Conquest Imaging p.65 Beyond Certification p.66 Karen Waninger p.68 Patrick Lynch p.70 Roman Review p.72 The Future

Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us

P.76 BREAKROOM

Manny Roman: manny.roman@me.com

Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com Eddie Acosta: A Clinical Systems Engineer at Kaiser Permanente, Northern California, Fastedy99@yahoo.com John Noblitt: Program Director at Caldwell Community College & Technical Institute in North Carolina jnoblitt@cccti.edu

p.76 p.78 p.80 p.83

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DEPARTMENT PROFILE Baylor Scott & White Biomedical Engineering Department

By K. Richard Douglas

B

aylor may be a name that many associate with college football, but it is also part of the name of one of the country’s leading health care systems; a system with more than 35,000 employees. Baylor Scott and White Health is made up of 46 hospitals in north and central Texas. The system has a number of clinics and imaging centers as well.

The health system is a marriage of the former Baylor Health Care System and Scott & White Healthcare.

It is the largest not-for-profit health care system in Texas. The two institutions each began more than a century ago. Scott & White was begun by two physicians and Baylor began as a Christian institution.

Bed count varies hospital to hospital, but the Baylor University Medical Center is the largest facility in the system with more than 900 beds.

With nearly a hundred techs, the system’s biomedical engineering department can move mountains when it has to.

The department’s north Texas group manages over 73,000 assets and the central Texas staff manages over 40,000 assets.

The department’s leadership team includes directors David Braeutigam, MBA, CBET; and Dale McGraw. The directors are joined by a team of six managers that include Luke Sharkey; Daniel Irving, CBET; Carol L. Wyatt, MPA, CBET; Tim Huffman, BSBA, CBET; Karl Faber, CBET; Ronnie Phelps and Randy Green, MBA, ACHE. The four team leads are Joe Nanquil; TaKeisha Roddy, MBA, CBET; Dennis Duck, CBET and Terry Whitworth. The team also includes clinical engineers Richard Swim and Gina Contreras.

“There are always active projects and

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Scott & White Hospital-College Station is one of the 46 hospitals the biomedical engineering department serves.

all our techs have an opportunity to work on projects. We lead or assist on projects as small as installing an additional central monitor at a nurse’s station to building replacement hospitals to building new hospitals and every installation, replacement, upgrade, etcetera, inbetween,” says Carol Wyatt, MPA, manager of Biomedical Engineering, Biomedical Technology Services.

“We like for the techs to be involved for several reasons: [It provides a] change of pace for the tech, improves their skills, buy in is better when the techs are engaged [and] the techs have to support the equipment long after the project is completed,” she explains.

NEW HOSPITAL CHALLENGE Unquestionably, one of the biggest tasks for any HTM department is assisting with the building of a new hospital. That project is compounded when there is an old hospital, full of equipment, that it is replacing.

“The largest project would be leading the biomed piece of the pie for the replacement hospital Baylor Scott and White-Waxahachie,” Wyatt says.

The new hospital is a 300,000 squarefoot facility located on 52 acres of land in Waxahachie, Texas. It was the first new facility built to carry the new combined organization’s name. It is initially designed to accommodate 129 beds with room for future growth capabilities and carries LEED certification.

“Not only did the biomed department assist with selection of equipment, coordinating installation, testing and inventorying of over 2,200 pieces of equipment,” Wyatt says. “[But] they had to maintain and service the equipment at the old hospital at the same time. The new hospital opened December 6, 2014.

Opening a new hospital is a monumental task, but add to it maintaining the old hospital at the same time and it’s even a greater triumph,” she adds.

Wyatt says that juggling a new and old hospital relocation comes with its own set of unique issues “like keeping both hospitals operating during a move; and what equipment gets replaced and what gets moved,” she says. “TaKeisha Roddy, team lead, and Jose Muraira, BMET, did an amazing job with the Baylor Waxahachie replacement hospital.”

SHARING KNOWLEDGE An internal training regimen has been another undertaking for the department.

This project has allowed new biomeds to

The Baylor Scott & White Biomedical Engineering Department’s management team poses for a photo. The north Texas and central Texas groups combine to manage more than 100,000 assets.

get the proper orientation.

“We found that [with] techs training new techs, although they did a great job, there were some inconsistencies in the training,” Wyatt says. “So, we compiled a Daily Operations Book for every new tech and reviewed it at biomed orientation; typically eight hours of training. We are seeing more consistent behaviors since we started doing this.”

Problem solving gets a methodical review in the department. Wyatt remembers one example of this that she was directly involved with. She first explains how problems are discovered: “We find out by rounding and talking to the nurses, PCTs, doctors [or] department managers. Once we know about an issue, we discuss it among our team members and plot a course of action. We try the plan and re-evaluate after a specified amount of time; and adjust where necessary,” she says.

“One example that comes to mind is, during the night the house supervisors can’t find the nurses because they are in patient rooms. I found out about this in a nurse managers meeting. I knew the nurse call system we use had nurse badge location tracking abilities,” Wyatt recalls.

“I thought I could install the tracking program on the house supervisor PC and they would be able to locate nurses

when needed,” she says. “After a little research, I found out I could indeed install the program on the house supervisors PC and they could use the badge location tracking program. So I did. It’s been about a month and so far so good.”

Co-existing and collaborating with the information services folks is routine.

“Biomedical Engineering is a department within Baylor Information Services,” Wyatt says. “We work closely with our IS departments, not only with support, but many times, many [work] together on projects; and we work closely with IS on PHI.” Wyatt explains that the department believes in giving back to the HTM community. Several members of the department have contributed articles to trade publications.

“David Braeutigam, director of biomedical engineering, is the vice chair of the United States Certification Commission (USCC),” Wyatt says of her boss.

She is a board member of the Texas State Technical College (TSTC) biomedical equipment technician program and the R.L. Turner High School biomed program. Tim Huffman, manager of biomedical engineering, BRMC Grapevine and BMC Irving has done many podcasts for AAMI.

Mike Lindahl repairs an EKG unit.

Their BMETs and senior BMETs have been active in sharing their knowledge and experiences.

“Derik Davis, Jesse Rodriguez, Othaniel Williams, Carl Jones, Hector Gonzalez and Paul Martinez have all published articles,” Wyatt says.

Getting the word out about the profession to the next generation of HTM students is another area the team has been involved in.

“Twice a year, the biomed team attends a Carrollton Farmers Branch ISD fifth-grade career fair and speaks to approximately 500 fifth graders about what it’s like to be a biomed tech,” Wyatt says.

Besides getting the word out about the HTM profession, some team members go beyond their typical biomed responsibilities when the situation calls for it.

“Mike Lindahl, CBET, Baylor Medical Center Carrollton happened upon a woman in labor when making rounds in the OR area on the first floor,” Wyatt explains. “Mike rushed to the front lobby desk to get a wheelchair and rushed back. As quickly as he could, Mike got the lady to Women’s Center on the second floor just in time for her to deliver a beautiful baby boy. I don’t believe they named the baby Mike.”

SPOTLIGHT

COMPANY SHOWCASE USOC Bio-Medical Services

U

SOC Bio-Medical Services is a leader in the medical device industry determined to know its customers, provide high-quality services, build solid customer relationships and maintain vendor neutrality. The company’s core values, as stated in its mission statement, are quality, integrity, innovation, accountability, collaboration and leadership.

team strives to help biomeds Ali Youssef founded who may not specialize in USOC Bio-Medical Services specific types of equipment in 2009 to offer “simple with the daunting task of solutions for complex maintaining not just patient devices” – namely, monitoring devices, but biomedical, respiratory, and every piece of hospital durable medical equipment. equipment. The company His goal to create an partners with the BMET efficient and reliable repair community and is a key company that focused on actor present at all biomeds continues to biomed tradeshows all motivate him and the entire over the USA. team at USOC Bio-Medical For more about USOC, Services. His 12 years of we sat down with the experience in the patient ALI YOUSSEF leadership team and asked monitoring equipment CEO USOC Medical them to share their insights industry provides an expert into the company’s background on which to services, goals and draw on to continue to approach to meeting exceed customer customers’ needs. expectations.

Today, USOC employees about 50 people who provide biomedical Please share a little bit about your equipment repair solutions to health care company’s history and how you facilities, clinics and medical companies of achieve success. all types and sizes. The company’s USOC: One of the keys to USOC’s success commitment to providing high-quality, lies in its commitment to understanding cost-effective equipment and services is not just the equipment, but each customer’s reflected in its ISO 9001:2008 certification. unique situation, level of expertise and USOC, located in Irvine, California, has needs as well. The company has achieved a proven approach designed to keep medical success by understanding the pressures equipment running in peak condition at a today’s health care professionals face. Its guaranteed cost savings. The company is innovative practices and expert engineers used as a reference by the market for patient have allowed USOC to reduce the price of monitoring equipment repair and for patient monitoring service without refurbished devices. Additionally, the USOC sacrificing quality.

Q:

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The USOC team strives to help biomeds with the daunting task of maintaining every piece of hospital equipment under their care. The company partners with the BMET community and is a key actor present at biomed trade shows all over the USA. (Photo courtesy of Errol Higgins.)

Q:

What are some advantages that your company has over the competition?

USOC: We are more than a repair facility for our biomeds, we act as a partner to help facilitate the biomeds through the repair process. We create a partnership with them.

We are the biomed shop for our biomeds as well as technical support (24/7). We understand more than anyone else our biomeds’ needs as our CEO is our lead technician/head engineer and a biomed. We have leveraged our experience to create a unique model of repair facility meeting quality, standard, and turn time. Our quality is the reason why we have the confidence to offer a 12-month warranty for

The new customer portal allows clients to manage their repairs, create a Return Goods Authorization (RGA), follow the different stages of the repair, and have a complete dashboard of all their repairs with USOC Bio-Medical Services.

each repair. We want to facilitate our biomeds’ daily tasks by creating a customer portal (USOC e-link) used not only for repairs. We have an emergency kit for our biomeds. The emergency kit consists of the most popular items that break down and can be used as an exchange program to pick items from when they break down.

Q:

What are some challenges that your company faced last year? How were you able to overcome them?

USOC: We were able to overcome challenges in 2014 and provide the quality service our customers have come to expect. We were able to respond to an increasing demand for our services and continue to serve our customers.

We have managed our growth from three people to 46 employees within a few years and have reached a maturity level that we are proud of, especially when it comes to our processes and standards. The ability to maintain our technical standards among our technicians in order to keep our quality, standards and procedures are really important for us. We often send equipment back to customers that did not need a repair or that needed a minor repair free of charge. No other repair companies do this. Each repair is crucial.

“What we do is assist the hospital with the repair and maintenance of devices that bring sick people back to health and potentially save lives,” said USOC Bio-Medical Services CEO Ali

Youssef. “It doesn’t get more serious than that. I often hear from staff at the hospitals that the most important thing to them is the quality of patient care.

USOC has a lot to do with the quality of care the patients receive.”

Q:

Please explain your company’s core competencies and unique selling points.

USOC: USOC provides biomedical equipment repair solutions to health care facilities, clinics and medical companies in the USA and Canada.

Here’s how it works: The hospital calls for troubleshooting and, if necessary, sends equipment in to us. We test, diagnose and repair it at our facility and then send it back to them. We offer a warranty that allows the biomed to send the equipment back free of charge if there are any problems. We also offer continuing troubleshooting over the phone. If the equipment needs to be sent in for repair, USOC Bio-Medical Services will program a loaner based on the hospital’s data and expedite it there.

Q:

What product or service that your company offers are you most excited about right now?

USOC: Our new customer portal which will allow all our clients to manage their repairs, create a Return Goods Authorization (RGA), follow the different stages of the repair, and have a complete dashboard of all their repairs with USOC Bio-Medical Services.

Q:

What is on the horizon for your company? How will it evolve in the coming years?

USOC: The future for USOC Bio-Medical Services includes health care/vendor software design and integration. We want to diversify our offerings to include software, parts and training. We want to be the leader when it comes to third-party patient monitoring related devices all over the USA. We want to respond to our increasing demand all over North America by opening new subsidiaries.

Q:

What is most important to you about the way you do business?

USOC: Our vision is empowering better patient health with technical insights. Our three goals are to promote a healthier world, build value and create an inspiring workplace. Our five-point strategy to achieve our goals are innovative growth, drive operational excellence, simplify the organization, focus on technical information services and deliver great products and services. An important part of the USOC Bio-Medical Services environment is our behavior, which is customer focused, performance oriented, united as one team, transparent and agile.

The core values at USOC Bio-Medical Services are quality, integrity, innovation, accountability, collaboration and leadership.

FOR MORE ABOUT USOC BIO-MEDICAL SERVICES, visit them online at www.usocmedical.com.

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PROFESSIONAL OF THE MONTH

Scot Copeland, BSITSEC, MCP, SEC+ Technologically Prepared

By K. Richard Douglas

T

he evolution of health care, with more medical devices integrated into networks, has seen many veteran HTM professionals retrain and adopt. This has often involved taking electronics competency and supplementing it with network knowledge.

Scot Copeland, BSITSEC, MCP, SEC+, a clinical systems specialist, lead, with the biomedical engineering department at Scripps Mercy Hospital in Chula Vista, California, adopted to the changing landscape.

“I had a friend way back when who got a job with a third-party biomedical company after he got out of the Navy,” Copeland remembers. “After I was discharged into the U.S. Marine Reserves as a radio repairman, he suggested I might want to try it out as they were looking for another tech. The job I had at a government aerospace contractor couldn’t compete with the pay so I tried it out.”

“I was immediately hooked by all of the technologies and the personal satisfaction of repairing equipment that helps people,” he says.

That was how it all began for Copeland.

His early training came by way of the USMC. As a radio repairman, he served in the 4th Tank Battalion, a reserve unit based in San Diego.

“The training consisted of a strong and condensed basic electronics curriculum, followed by radio theory and fundamentals, and then specific training

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on the types of radio systems we would encounter at our duty stations,” Copeland says. “The military basic electronics is what gave me the best start for biomed.”

Starting out his biomed career as a field service technician for an ISO in San Diego in 1982, he later became the shop manager for a 400-bed facility in 1989.

“Since then, I served at a local imaging service provider as a biomed/radiology system repair tech and at a nationwide third-party as a respiratory specialist for their contracts in Southern California,” Copeland says.

Copeland joined his current employer in 1995, starting as a biomedical lead technician in charge of “administering the Medical Equipment Management Plan for one of the hospitals in our group.”

“In 2007, I was CompTia certified as a Net+ Certified Professional as we began to evolve our services to support medical devices in the network environment,” he says. “I became the first Clinical Systems Specialist at Scripps Health specializing in networked medical devices and systems.”

The network training has positioned Copeland well with the realities of the HTM profession today.

“I am the go-to guy for networked-type

Scot Copeland specializes in networked medical devices.

medical device systems for all of Scripps Health. In 2013, I graduated from college with a bachelor’s of science degree in IT security and we are now headlong into implementing a medical device security program at Scripps,” he adds.

“I am now part of the Medical Device Information Security Committee, the Information Security Steering Committee and Information Technology Risk Management Committee,” he adds. “We are including and streamlining some of the IT policies to specifically include medical devices and systems as well as expanding our biomed policies to include the IT attributes of the medical devices we support.”

Scot Copeland enjoys playing guitar in his off time. He even designs and sell guitars.

Scot Copeland was named the CMIA Professional of the Year in January.

Copeland says that Scripps has partnered with [the] Center for Medical Interoperability (C4MI) and have assessed their capabilities to implement ISO/IEC 80001-x with the intent to do so as much as can be done.

In January, the California Medical Instrumentation Association held its annual symposium. Copeland was presented with the CMIA Professional of the Year Award, sponsored by Welch Allyn, at the event.

“I was highly honored to accept,” Copeland says. “My 2014 presentation documents and technical paper on Interoperability and Security have been included in the AAMI University.”

NETWORKED REALITIES The HTM field has evolved and biomeds like Copeland are prepared for the new challenges it presents.

“In addressing the information security aspects of our field, over the past few years, we have found that it is a whole new world we need to tool up for,” he says.

Copeland says that HTM was founded on the ability to evolve along with, and be able to support, any technologies that came along in the clinical environment, but this one is proving to be a big leap. He say that because of this, many are having a hard time grasping the whole subject and understanding how to move forward.

“The resources are limited. No longer can an equipment manufacturer provide all the support you need to make your

equipment safe, effective and secure because the security has to do with your networking environment,” Copeland says.

“The manufacturer knows nothing about that, nor do any regulatory agencies,” he adds. “Those who know about your networking environment have no clue about medical devices and systems. In teaching some education sessions at AAMI, and elsewhere, I have found this not just here at Scripps, this is a nationwide subject for everyone and it is difficult to find support and leadership for the effort.”

FAMILY AND PASTIMES Playing guitar is a passion of Copeland’s.

He has played with his church’s worship team for many years. He even designs and builds guitars that can be purchased online at www.copelandguitars.com.

“My wife and I have a couple of Harleys and we love to trailer them across the country touring our beautiful National Parks and visiting family,” Copeland says. “I have three children and three grandchildren that I am proud to be associated with.”

Despite getting in on some cutting-edge training for a biomed and crafting cool guitars, Copeland reminds readers that he is no different than the next biomed.

“I’m just a regular guy. My guitars and bikes are shiny, but I throw my clothes on the bedroom floor, and my wife gets mad at me, just like everyone else,” he says.

FAVORITE BOOK: the Bible

FAVORITE MOVIE:

“Tombstone” (or Blue Collar Comedy DVDs)

FAVORITE FOOD:

“I like all of the Thai and Indian and Szechuan you can get uptown, but nothing beats a giant politically incorrect grilled rib eye steak!”

HIDDEN TALENT:

I can play the guitar solo from the Pink Floyd song “Time.” View here: http://youtu.be/7loeVoiHyEI

FAVORITE PART OF BEING A BIOMED:

I really feel that we make an important contribution to our community every day and I am proud to be part of such a talented and dedicated profession.

Every time that the on-call tech calls me in the morning to tell me what he took care of for me in the hospital during the night, it reminds me of the sacrifices we make and how important they really are.

I am inclined to be the best I can to support our clinical systems and medical devices because it is my family and friends that may need them.

WHAT’S ON MY BENCH

My Computer: Can’t do without Google.

Phone with wireless headset: Everything is a conference call now.

Coffee cup: Need high-octane fuel Electric Screwdriver: I become so dismayed when I get into a situation where I have to use a regular one.

My badge: Can’t get anywhere — or eat lunch in the cafeteria — without it.

SPOTLIGHT

COMPANY SHOWCASE Pacific Medical

P

acific Medical opened its doors over a decade ago when President and CEO Andy Bonin started the business because he saw the need for quality equipment in the medical repair industry. His goal was to provide outstanding customer service while meeting industry needs.

Pacific Medical has established itself as a trusted name in the health care industry that specializes in monitors, modules, telemetry, infusion pumps, suction regulators, fetal transducers, SpO2/ECG/ Temp/NIBP cables, O2 blenders, endoscopes and gas analyzers with ISO certifications 9001:2008 and 13485:2003 that further strengthen its credibility.

The company’s approach has also fueled accelerated growth. Pacific Medical has experienced a 50 percent increase in total sales from last year.

“We are a quality-focused, customerfacing organization which understands and delivers innovative solutions for the greater good of our customers and biomeds. This approach, in-turn, ensures the safety of millions of patients worldwide,” Bonin says.

“Pacific Medical carries the largest patient monitoring inventory in the industry and is recognized for its cuttingedge customer service response team,” Bonin adds. “Today, Pacific Medical has expanded its repair competencies which now cover multiple equipment modalities.

Our success has been driven by our commitment to be the absolute best with a core group of repairs.”

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Pacific Medical recently purchased a new building to accommodate the rapid surge in its telemetry business.

The future is bright for Pacific Medical as its employees continue to focus on excellence.

“Pacific Medical’s mission is about giving back to the customer, community and team. We also feel our mission and job is not just service, but to lead and partner with key biomed industry partners while providing them with solutions based on their specific needs,” Bonin says. “The executive management team is committed to hearing and serving our biomed partners and working together to the end result as a strategic partnering team.”

“Pacific Medical strives to outperform its peers through operational excellence, in accordance with providing a dynamic and challenging environment for employees to excel,” Bonin says. “Our vision is to continue to strengthen our position as the recognized industry leader, with the ability to sustain life through reliable medical equipment services.”

Pacific Medical is constantly reinvesting in itself by ramping up a robust inventory of parts and complete off-the-shelf ready units to outfit a large hospital. Also, Pacific Medical recently purchased a new building to expand its telemetry business.

“The new building was acquired as a solution to support the rapid surge of Pacific Medical’s telemetry business and to provide for future growth,” Bonin says. “The telemetry department offers dedicated repair areas for the different types of telemetry devices, including a separate room for testing and quality control.”

“Pacific Medical is forward-thinking and understands the critical nature of timely telemetry repairs and the industry demand for increased efficiency and streamlined repair processes,” Bonin says. “We created the new building to address the needs of our customers while meeting the increased volume in our telemetry business. We experienced a significant influx of repair volume from our customers and we needed to provide a solution to keep up with the demand. The new building allows us to decrease turn times, increase efficiency and overall customer satisfaction.”

The recent expansion also provides room to meet other needs.

“We also now have the extra space for the assembly of complete transmitter units on the shelf for purchase that can ship within the same day. We also created a dedicated department that offers a complete

Pacific Medical employs more than 80 people and continues to grow.

inventory of accessories including our disposable patient ready packs,” Bonin says.

Pacific Medical’s telemetry repair capacity has quadrupled since the new building opened, expanding its capability for testing hundreds of telemetry units per day. Pacific Medical is now able to complete the entire telemetry repair process within 48 hours.

“Today, Pacific Medical has expanded its repair competencies which now cover multiple equipment modalities.

Our success has been driven by our commitment to be the absolute best with a core group of repairs.”

Again, the company’s success is a result of the foundation Bonin established to provide quality equipment.

“Pacific Medical’s core competencies are quality, innovation, customer service, flexibility and outstanding turn times,” Bonin says. “The heart and soul of our

success is showcased in our satisfied customers. We go above and beyond to meet our customers’ needs and provide the solution for lower-cost, high-quality solutions.”

Pacific Medical’s philosophy has carried over into biomedical departments who have contacted the company to partner with them and provide services over several facilities.

“We work with our customers to drive down their operational costs through volume discounts that include repair services, parts acquisition and accessories,” Bonin says. “As the organization has fully integrated their repair process into its CRM system, it creates a seamless platform for partnering organizations.”

Expert quality repairs are what customers want and Pacific Medical is there to deliver. The company carries a huge patient monitoring inventory of recertified equipment for sale along with OEM compatible accessories and parts from all major manufactures.

“We understand the difficult balancing act between cutting costs and trying to maintain a patient safety-first directive,” Pacific Medical Director of Sales Eric Hatteberg said. “Many vendors choose to use lower-quality parts and employ unskilled technicians. We, on the other hand, have spent considerable time and resources educating our engineers to understand repairs at the component level.”

The fast pace at which the industry is growing is matched, if not exceeded, by the

A Pacific Medical technician repairs a telemetry transmitter.

rate at which new technology enters the marketplace and becomes a must-have for health care providers.

“The pace at which new technology is being introduced into health care delivery has grown exponentially in the past decade and we always have our finger on the industry’s pulse for every change. We are proactive versus reactive,” Vice President of Operations Damon Kelly says. “Pacific Medical takes into account that the medical technology in use today requires a very different type of technical role that includes integration and networking.”

Bonin says Pacific Medical is continuously on the lookout for ways to make life easier for customers.

“Pacific Medical is always looking for more solutions to take our products to the next level,” Bonin says. “It doesn’t stop at telemetry, and we are always looking to stay one step ahead. Our job is not just to service, but to lead and partner with our hospitals and biomed teams to meet their budget, on time and with a turn time of less than 48 hours.”

In short, Pacific Medical fosters a sense of community with its employees creating an innovative and team-oriented organization that champions support and solutions for its customers.

FOR MORE ABOUT PACIFIC MEDICAL, visit them online at pacificmedicalsupply.com.

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BIOMED ADVENTURES Cheering on Biomedical Engineering

By K. Richard Douglas

T

here it was, under the clear blue skies and 70 degree temperatures at the University of Phoenix stadium in Glendale, Arizona; the start of Super Bowl XLIX. With the retractable roof open, the players, fans, national and international media were preparing to watch and participate in the historic event. As the Seattle Seahawks and New England Patriots took to the field, one HTM student was among the spectators.

She wasn’t in the stands and she wasn’t in a suite. She wasn’t even one of the eager fans who dished out four or five or even seven thousand dollars for a ticket. She was on the sidelines holding a pair of pom-poms.

In front of more than 70,000 fans in the stadium that day and 100 million more watching the game on TV, were the players on both teams and their respective cheer squads. The HTM profession was represented on the New England side of the field.

Alyssa Merkle is a professional cheerleader for the New England Patriots. She is also a clinical engineering student at the University of Connecticut.

Merkle has nearly a 3.8 grade point average and will graduate in May. “I became interested in clinical engineering through research about it. I found the program online for UConn and started to do my research about what clinical engineers did,” she remembers. “I loved that they were mostly hospital based and really helped in patient safety. I knew I wanted a hands-on experience to see if I was actually interested in the type of work that clinical engineers did. That is when I started contacting hospitals all around Connecticut that were affiliated with the clinical engineering program.”

Choosing Hartford Hospital, and shadowing a current student who was

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interning there, Merkle decided to learn more by volunteering over the summer.

“After my summer with the department, I knew I was very interested in the type of work I had done all summer and that I wanted to try and pursue clinical engineering as a career starting with applying for the masters program here at UConn.”

“I selected the program at UConn for a few reasons,” Merkle adds. “I knew the school had a good reputation for its engineering school, which was important to me. I also knew they had a five-year BME masters program, which was intriguing to me when I was choosing schools.”

Merkle also tried out for UConn’s dance team and made the squad. That had really cinched her decision.

“I graduate in May of 2015 and would go directly into graduate school. If I make it into the clinical engineering program, I will be in school and working in a hospital for two more years and then will start pursuing a career at a hospital shortly after,” she explains.

Working at the hospital brought about many experiences that gave Merkle a sense for the HTM field.

“My large project of the summer was a blood pressure cuff build and roll up,” she says. “We built about 30 per week and would roll them up to every single patient room in the hospital. This was

New England Patriots cheerleader, Alyssa Merkle, is a clinical engineering student at the University of Connecticut.

my favorite project as I got to see the work flow of the whole hospital as well as interact with patients and see just how our help really controls their safety within the hospital.”

It was the dance team at UConn that had something to do with entry into professional cheerleading.

“I got to school freshman year and started getting more into football with the people that lived in my dorm building,” she says. “I also had a friend whose step-mom was previously a Patriots cheerleader. I was intrigued by the whole thing, so when a girl on my dance team asked if I would go with her to tryouts, I jumped at the opportunity.”

“I started working really hard to get myself physically and mentally in the mindset to tryout and then I just went for it and wound up making the team,” she adds.

While managing volunteer work, school studies and NFL cheerleading

Alyssa Merkle works on her senior project in an engineering lab. (Photo courtesy of Peter Morenus, University of Connecticut.)

practice might seem like a real challenge, Merkle says she fits it all in because it is all important to her and she loves what she does.

we were really something special and that was a cool feeling. Just being able to promote our football team and ourselves in such a highly watched way was something to be proud of.”

“ After my summer with the department, I knew I was very interested in the type of work I had done all summer and that I wanted to try and pursue clinical engineering as a career starting with applying for the masters program here at UConn.”

IN THE NATIONAL SPOTLIGHT Many people would be happy with their own 15 minutes of fame. Biomed Adventures may fit the bill for many, but Merkle has already seen those 15 minutes in spades.

“The whole Super Bowl weekend was completely surreal to me,” she says. “I loved every single second of it. From the minute we got there, we were treated like

Cheering in front of the crowds at Gillette Stadium is one thing for a Patriots’ cheerleader, but what comes with Super Bowl participation is a whole different thing.

“Being able to be a part of things like the ‘Today’ show, ‘Good Morning America,’ ‘E,’ ‘Access Hollywood,’ the ‘Puppy Bowl’ and actual game day was surreal. The opportunities that my team

and I got to experience over that weekend were things that I would have never in my wildest dreams thought I would have ever been a part of. I am so thankful for my team and the opportunities that I have had this past season. I wouldn’t trade a minute of what I’ve done for anything else,” Merkle says.

“My mom and dad had always taught me that if I wanted to get something done, I just needed to put my mind to it and I could do it,” she says. “I have proven that to them and myself over the years and I am always looking for the next challenge and opportunity. I enjoy figuring out how to time manage everything and being able to do all of the things I truly love.”

The HTM profession can cheer on its newest member, especially when they see the drive and determination that she possesses.

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‘ ENOUGH.’

Reducing overuse of cardiac telemetry monitoring

O

verutilization of a medical technology can be a thorny issue: Instances of overuse can be difficult to detect. And they can be problematic to resolve once identified because the path to a solution can require changing perceptions about the costs versus the benefits, and also modifying behaviors. But breaking the pattern of overuse is important, especially if the problem could undermine the safety and quality of patient care. This was the challenge faced by Christiana Care Health System (Wilmington, Delaware), where the issue was overutilization of cardiac telemetry monitoring. To tackle the problem, Christiana Care developed a highly effective initiative — a project that earned the organization the 2014 Health Devices Achievement Award from ECRI Institute.

Keys to the success of Christiana Care’s initiative included the formation of a well-functioning multidisciplinary team and the team’s ability to develop a process change that (1) did not significantly interfere with physician autonomy and (2) could be “hardwired” into an already existing workflow.

THE CHALLENGE Christiana Care’s overutilization problem grew as an unintended consequence of a previous improvement initiative. Fifteen years ago, the health system determined that the ability to provide cardiac monitoring outside the ICU would offer several advantages: It would help address a shortage of monitored beds, it would improve monitoring and the response to alarms, and it would improve the continuity of care by reducing transfers from one care area to another.

To that end, the organization set a goal of being able to monitor any patient in any bed at any time. Christiana Care achieved that goal through an improvement initiative called the Flexible Monitoring Program. This program has added the capability to transmit ECG and other

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patient signals from wearable telemetry monitors via a wireless signal to a centralized monitoring room. There, the ECG signals and tracings are interpreted by trained monitor technicians, who communicate notable events to the nurses via dedicated phone lines.

For patients at risk of heart events, cardiac telemetry monitoring is a valuable tool. However, what developed over time following the launch of the Flexible Monitoring Program was the widespread use of cardiac telemetry monitoring for low-risk patients. For these patients, the technology offered little or no clinical value. In fact, Christiana Care determined that in addition to requiring resources, the use of telemetry monitoring for low-risk patients actually created multiple challenges to the delivery of safe, highquality care.

For example, telemetry alarms that had activated for avoidable or clinically insignificant conditions created frequent interruptions, distracting nurses from necessary clinical care duties and increasing the potential for error. Also, artifacts displayed on the waveform would, on occasion, be misinterpreted as representing

serious arrhythmias, sometimes leading to the activation of urgent cardiacconsultation or rapid-response teams or unnecessary follow-up testing.

In addition, wearing the telemetry pack with its associated wires is an encumbrance for the patient.

“We want to get patients up and around,” explained Andrew Doorey, MD, a cardiologist on the telemetry redesign team. “When wrapped in wires, patients simply can’t move like they’d like. It’s very frustrating for them.”

Furthermore, being tethered to the telemetry pack can increase the risk of patient falls, especially among the elderly.

And it can disrupt patient sleep. For reasons such as these, “nurses were emphatic that telemetry can be horrible for the patient experience” — an observation that cardiologists did not appreciate at first, Doorey noted.

In short: Christiana Care concluded that “more is not always better.” More

James P. Keller Jr., ECRI Institute’s vice president, health technology evaluation and safety, presents the 2014 Health Devices Achievement Award to Christiana Care Health System for its cardiac telemetry redesign initiative. Pictured, from left to right, Roger Kerzner, MD; Sharon Kleban; Chris Coletti, MD; Chris Carrico; Andrew Doorey, MD; Robert Dressler, MD; James P. Keller Jr.; Donna Mahoney; Michele Campbell; Brittney Henning and Tamekia Thomas.

monitoring and more spending do not necessarily translate into better patient outcomes. The health system needed to reconfigure its telemetry monitoring program to provide more effective, and more cost-effective, patient care.

THE SOLUTION Christiana Care formed an interdisciplinary team to examine the issue. The team — which included physicians, nurses, administrators, IT professionals, and others — established a goal of reducing the use of cardiac telemetry in non-ICU settings.

First, the team evaluated the current telemetry processes and reviewed data collected just prior to the team’s formation: Call logs from the Flexible Monitoring Center were analyzed to categorize the types of calls that were received and to estimate call volume. A time-motion study (a method for observing job tasks to improve work-process efficiency) was conducted to evaluate nursing time spent on telemetry activities. An analysis of the cost to deliver telemetry was performed, taking into account both the efforts of the Flexible Monitoring Center and the nursing time associated with telemetry activities.

Data from this evaluation showed that in this 1,100-bed system, 355 patients per day were receiving cardiac telemetry, each requiring an average of 20 minutes of nursing time to manage the administrative,

equipment, and patient care needs associated with the technology. Nursing activities included reviewing telemetry strip results and orders, responding to telemetry alarms, adjusting leads, changing batteries, and accompanying some patients on transports off the patient care unit.

Significantly, the evaluation revealed that cardiac-arrhythmia-related emergencies accounted for less than 1 percent of the calls from the Flexible Monitoring Center to caregivers. The vast majority of the calls (70 percent) resulted from technical problems — specifically, lead or reception problems (60 percent) and battery-related issues (10 percent).

The evaluation also estimated the cost of telemetry to be approximately $53 per 24 hours of patient monitoring.

Based on its analysis, the team developed three strategies to address factors that were identified as contributing to the overutilization: 1. Alignment with national guidelines for telemetry use.

2. Redesigning nursing processes.

3. Rethinking medication leveling policies.

The team at Christiana Care offered the following observations for project success: • The manner in which the nationally accepted professional society guidelines were adopted provided sufficient clinical flexibility so that physicians could order

cardiac telemetry when they judged it was appropriate to do so, preserving physician autonomy and facilitating their acceptance of the change.

• Obtaining buy-in was supported by the fact that the process changes enhanced nursing clinical decision making, reduced wasteful steps, and rectified clinical inconsistencies (e.g., those associated with the medication leveling policy).

• “Hardwiring” a process change into an existing workflow proved to be an effective intervention for sustained change. (Education alone, by comparison, tends to be a weak intervention.)

• Extensive communication with stakeholders is crucial to support change.

THIS ARTICLE is excerpted from a digital story posted 1/4/15 on ECRI Institute’s membership website. The full article features additional background information, specific strategies for success, and details on lessons learned. Submissions are now being accepted to the 2015 Health Devices Achievement Award.

TO LEARN MORE, visit www.ecri.org/ Pages/Health-Devices-Award_Winners.aspx; or call (610) 825-6000; or e-mail communications@ecri.org.

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In addition, the bins are sized to fit evenly across standard-size wire and steel shelving units, providing added utility for optimizing storage spaces. Universal hanging bins are available in seven sizes and four colors.

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AAMI UPDATE

Document Highlights Post-Market Risk Management

A

AMI has unveiled a white paper that spells out six specific risk principles that the medical device industry and the U.S. Food and Drug Administration (FDA) ought to consider in post-market risk management.

The 15-page “Risk Principles and Medical Devices: A Post-Market Perspective” is available at www.aami. org/hottopics/risk/AAMI/020615_ AAMI_risk_white_paper_draft.pdf. It is intended to articulate “a shared view of risk” with the ultimate goal of better coordination and understanding between manufacturers and regulators when it comes to post-market activities, such as medical device recalls.

“It is hoped that a shared view will minimize the differences in analyses of risk and resulting conclusions reached by industry and CDRH (Center for Devices and Radiological Health) related to appropriate remedial actions,” reads the paper, which was developed by AAMI in coordination with a working group of industry representatives and federal regulators. “A common and consistent approach to risk will optimize and expedite patient care.”

The draft paper’s release comes ahead of an anticipated spring public workshop on the subject of post-market risk management by the CDRH, the arm of the FDA responsible for oversight of the medical device industry.

The focus on risk principles stems from

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a belief shared by the working group members that there can be little, if any, progress in making headway on sometimes contentious post-market quality and safety issues until there is agreement on what industry and the agency should keep in mind in the first place.

“We hope this white paper enriches the vital conversation on risk management,” said AAMI President Mary Logan. “More collaboration and understanding on expectations between industry and regulators can only mean a smoother process with post-market compliance issues and will help to enhance patient safety.”

The six risk principles identified in the white paper are: 1. Evaluation and Judgment. The emphasis here is making an “informed” judgment by looking at an assortment of data, including (but not limited to) experience with the device, company standards, the history of similar devices, and potential planned mitigations.

2. Loss of Benefit Assessment. In short, “multiple benefit/risk scenarios” must be considered “in order to arrive at the optimal outcome.”

3. Populations. Are there subpopulations included in the “indication for use” at greater risk or benefit than the overall population?

4. Use Environment and Clinical Assessment. The context of the environment in which the device will be used must be part of the evaluation.

5. Communication. Risks and problems associated with any given device “should be communicated effectively to relevant stakeholders.”

6. Recovering Loss of Benefit and Mitigation. What can be done to “return the benefit of the device to acceptable levels”?

Logan emphasized the importance of collecting comments from all stakeholders on the ideas expressed in the paper. The deadline to submit comments, which may be emailed to Logan at mlogan@aami.org and Lauren Clauser at lclauser@aami.org is May 20, 2015.

“Now is the time for all participants in post-market compliance activities to weigh in and help to harmonize expectations between the FDA and industry,” Logan said. “The more feedback we receive on this draft paper, the better the end result will be.”

The working group’s discussion identified a number of other next steps.

They include deciding how to “weigh” the risk principles; how to handle the recall of products with compliance issues (technical violations); how to make precedents more transparent so that industry can learn from them; and to what extent an existing standard on risk management to medical devices (AAMI/ ANSI/ISO 14971) should be changed to include more post-market issues to help both industry and regulators.

The white paper includes many other next steps, as well as details on the risk principles themselves. The working group was comprised of representatives selected by three national industry trade associations – AdvaMed, the Medical Imaging & Technology Alliance (MITA), and the Medical Device Manufacturers Association (MDMA) – as well as representatives selected from the FDA and AAMI. The white paper is but one example of

TRIM 2.25”

AAMI recently hosted 12 experts to discuss certification expansion for sterilization professionals.

AAMI’s leadership in focusing attention on the issue of risk management in the medical device world. The spring edition of Horizons, AAMI’s biannual supplement, will focus on the issue, as will a joint AAMI/FDA summit planned for Sept. 29-30, 2015.

Working with subject matter experts, AAMI is developing plans to offer new certification in industrial sterilization, a reflection of the growing importance of this specialty.

“These professionals, while very important to our industry, saw their roles arise spontaneously and rather organically. This is the first time their roles really have been defined,” said Joe Lewelling, vice president of standards development and emerging technologies.

A lot of work remains, but the goal is to deploy the industrial sterilization certification in the fourth quarter of this year.

The effort began in earnest in late January when AAMI hosted a group of 12 subject matter experts to map out the parameters of the certification.

“The task was enormous given the landscape of industrial sterilization technologies,” AAMI Credentials Institute (ACI) Director Jan paul Miller noted. “The discussions were focused and always directed to finding the best way to assess the competence of candidates who will sit for this exam.”

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Created this past November, the ACI will replace both the International Certification Commission for Clinical Engineering and Biomedical Technology and United States Certification Commission. Its mission is to serve as the trusted source for quality professional development and credentials for health care technology-oriented professionals and entities in higher education, industry and health care delivery.

Guided by Miller and James Hellrung, a research associate at Applied Measurement Professionals, a subcontractor for ACI, the group created an operational definition of an industrial sterilization scientist, as well as the areas of expertise in which the individual must be competent Initially, the group considered adopting a generalist approach for this certification. However, after intense discussion, the experts settled on three separate certifications, each with a common core of knowledge related to industrial sterilization: ethylene oxide, dry heat and radiation.

Once a wider group validates the logical job task analysis, a detailed content outline will be created. Other subject matter experts then will author items for the test. More than 40 industrial sterilization experts have signed up to work on the industrial sterilization certification. The next step is to train the writers and develop acceptable test questions.

BIOMED 101

OEM Service Restrictions Create Need for Training HTM Staff

A

By Dale Hockel

s the health care climate continues to put enormous pressure on hospitals and physicians to reduce spending without impacting outcomes, so too are service providers feeling the pressure to cut costs while maintaining optimal service. To compete in this environment, every vendor offering services to the health care industry is being asked to cut prices at every corner without compromising on quality and service. As a result, original equipment manufactures (OEM) are looking for ways to stay competitive on price and to look for other ways to turn a profit. A good comparison to this environment is the airline industry. No one wants the airlines to compromise quality or service to cut costs, but the businesses cannot survive without an increase somewhere in the value chain. Therefore, the industry has resorted to tacking on extra fees for baggage, premium seats, food and beverage, and the list goes on.

Like added charges for baggage, one of the strategies in place by OEMs of medical equipment as of late has been deals with training. Whether putting restrictions on training, raising the price on training, or not offering training at all, hospitals are left with no choice but to pay above the service contract for any preventive maintenance (PM), repairs or service on medical equipment. What many don’t know is that there is in fact a cost-effective choice: purposefully investing in your in-house HTM staff by negotiating training opportunities upfront during the capital purchase negotiations and seeking out third-party partners to help build out internal capabilities through powerful training programs.

Negotiation with manufacturers can help save additional dollars in both the short and long run. In most purchases, hospitals should opt for short-term maintenance and warranty and rely on trained staff to service the equipment.

Aligning with the hospital’s values and goals, decide whether it is better to pay a higher price for a better warranty and service contract options, or do you need to get a lower cost with less coverage and rely on your internal staff? If your staff is

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properly trained, you may not need a warranty and can negotiate lower costs for sale of the purchase. If staff is not fully trained, the best short-term solution is negotiating training opportunities during the purchase agreement so the HTM staff can receive proper training directly from the OEM. Another viable option would be to negotiate training and roll down provisions if a short-term service contract is necessary.

For the long term, the goal should be to move toward a best in class high-yield program that is independent from costly OEM service and contracts. To achieve this, hospitals must invest in developing a comprehensive program to train its own staff and offer career paths for each individual to advance and grow. It is proven that effective and appropriate training can save time and money as well as possibly extend the life of the devices; not to mention a trained staff is one that is engaged and feels like he/she is able to use their talents to contribute to the continuum of care.

The biggest hurdle to training staff lies is finding the time to dedicate and money to invest. The reality is the money saved on expensive service contracts and long repair

DALE HOCKEL FACHE, MBA, is senior vice president, operations, TriMedx, Indianapolis

times can be saved to invest in training onsite staff to service, maintenance and repair devices as well as anticipate the life cycle of equipment. It’s very likely the staff is more than qualified and capable of carrying out the job as long as the proper training is received.

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In the current model of HTM departments with high service contract dependency, there is typically just one technician for all levels of expertise. This gives technicians no motivation to advance skills or even be promoted. With training and opportunity for advancement, technicians will be recognized and compensated for their level of skill and expertise.

Opportunities to be trained and to advance your career go a long way to re-engaging staff and eliminating costly attrition from a less motivated and disengaged department. And by increasing the skill level of staff onsite, the overall cost of service contracts and related repair and downtime are decreased significantly saving thousands of dollars a year.

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SHOP TALK Parts Strategy Q:

Who is in charge of purchasing parts for repairs at your facility?

Do the biomeds order the parts themselves or do they have to go through somebody else at the hospital to get parts ordered? What is the best approach?

A:

I give the spare parts requirement with technical specifications to a section in the purchase department of my organization which is responsible for procuring medical and surgical items to be used in the organization. Most of the times they turn back to me to ask for the list of suppliers that may be in the capacity to supply those spares. Also, they ask me the approximate price of the spare parts. I don’t think this is a better approach considering the fact that most of the members in the purchase department have less knowledge on medical equipment and may not be in a position to lock onto the right source for the right spare and turn back to me a number of times causing unwanted delays.

A:

Both vocations I have been at, we, CE, enter the order into a system and then purchasing cuts the purchase order number and orders it for us.

A:

Biomed orders our own parts. We have our own purchase orders and, when needed, our own credit cards.

If left up to purchasing there would be delays, incorrect parts and general confusion.

A:

In our system, CE opens purchase orders for parts ordered. Some

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items are done centrally, but for the most part, CE does the parts ordering.

A:

As a general rule, biomed specifies the part number and manufacturer, but materials generates the purchase order and places the actual order. If there is an urgent need, or extenuating circumstances, then we will place the order directly.

Q:

Consider this scenario and give me the best possible solution. How to tackle a manufacturer that doesn’t allow you to install a battery from a third-party vendor for his device? The battery in question is not covered under warranty or comprehensive maintenance contract and is worn out. Also, the rate quoted by the manufacturer is three times that of the third party. The device under consideration is a ventilator. What if the manufacturer threatens me that he will void the warranty or CAMC if I go for a third-party battery? I will need a lot of batteries for the fleet of ventilators from the same manufacturer. Third party means a significant cost savings to me. I am adhering to the voltage rating and the ampere hour rating as per the manufacturer specification.

A:

The first question, is whether a medical device is still under a manufacturer’s warranty or under a manufacturer’s maintenance agreement – there may be contractual requirements for use of only the OEM’s parts. When considering an alternative battery, the third party must meet the same regulatory requirements as the original equipment manufacturer. The third party

should be registered with the FDA, Health Canada or the regulatory bodies of other countries. They should also have a quality system in place demonstrated by ISO certification and a complaint management system. You can request data from a third party, such as numbers of product complaints, failure rates, details of the inspections by regulatory agencies, ISO certificates, etc.

A well-designed and manufactured third-party battery for a medical device should have no different performance from the OEM’s battery.

A:

I want to be clear here. Has the manufacturer done something to prevent you from using a third-party battery or are you trying to get something from them saying it is OK to use a third-party battery? If it is the latter then I doubt they can. In a recent review meeting with FDA on 510K filing on a piece of lab equipment they wanted to know what we were doing to prevent the operator from making changes to our compiled code. We had to explain that compiled code isn’t the same as a text or Word document. The point is, there may be something in their filing that prevents them from authorizing use of batteries that they didn’t test.

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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APRIL 2015

WEBINAR WEDNESDAY Educating Biomeds Worldwide

By John Wallace, Editor

W

ebinar Wednesday continues to be a popular destination for Biomeds. More than 500 people registered to attend the Feb. 11 webinar “Electrical Safety Essentials: How to Stay Ahead of the Curve” presented by Jerry Zion from Fluke Biomedical.

A group of Biomed in Guyana attend the February 11 Webinar.

The webinar attracted a worldwide audience, including a group of biomeds from Guyana. Guyana is a sovereign state on the Caribbean coast of South America.

The biomeds tuned in from the nation’s capital city of Georgetown.

“There were 9 attendees including myself,” Roy Morris, CBET, Biomedical Engineer with International Children’s Heart Foundation said. “I also set up one from St. Lucia, too.”

“I am a Biomedical Engineer for International Children’s Heart Foundation based out of Memphis. We perform heart surgery for children with congenital heart defects while teaching the health care professionals to care for their own children’s heart problems,” Morris added.

“We will be starting our first ever pediatric heart surgery in Guyana on April 25 to May 8. I was there to ensure we were going to be ready. I had been asked to start up a training program for their eight biomeds.

The first thing I did was to sign them up to the webinar. They loved the training and are excited that they will be getting future training programs.”

Zion has more than 35 years of experience working in many capacities for various medical device manufacturers and has spent the last decade at Fluke

THE BENCH

Biomedical pioneering the global training program. He is an AAMI certified biomedical equipment technician and holds a bachelor’s of science in electrical engineering technology from Purdue University. He also obtained a master’s in management in science and technology from the Oregon Graduate Institute.

In the webinar, Zion discussed the essentials of electrical safety, including global standards – requirements and limits; test procedure – safety tests and conditions; and test sequence – physical inspection and beyond. The presentation was followed by a flood of great questions during a Q&A session.

Attendees praised the session and the amount of quality information relayed during the second webinar of 2015. “(It was a) very good webinar, a lot of great information, especially for the new guys,” Albert H. wrote in a postwebinar survey.

“This is a great resource and I appreciate TechNation and the various vendors for providing this information and making it readily available for the biomedical community,” Ken M. wrote.

“Wonderful webinar. I am going to use Fluke’s white pages. I also need to make sure we are performing safety

tests properly,” Mike B. wrote after Zion’s session.

One attendee was excited after the webinar because it started a conversation in the biomed shop that led to further learning among the entire team.

“It is always great to go back and review information that is so critical in our line of work. It also opened up new discussion topics about electrical safety in our department. Thank you so much,” Maria M. said.

“I continue to applaud TechNation, all of its staff, on their efforts and to the presenters who volunteer their time to present this webinar series of present and future technologies and vital information.

The ability to continue to be educated will only strengthen the HTM field as we move forward in such a critical and complex field,” Albert R. wrote.

A recording of the webinar and information about upcoming webinars can be found online at iamtechnation.com.

FOR MORE INFORMATION about upcoming webinars visit IAmTechNation. com and click on the “Upcoming Webinars” tab at the top of the page. For sponsorship opportunities, email webinar@mdpublishing. com or call 800-906-3373.

APRIL 2015

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ROUNDTABLE Patient Monitors

T

his month TechNation asked experts about patient monitors to find out the latest advances in these important medical devices.

Our panel of experts also shared information on servicing patient monitors and what to look for when purchasing these devices.The panel is made up of Steve Bebb, senior global director, product marketing, patient monitoring, Philips Healthcare; Andy Bonin, president and CEO of Pacific Medical; Stan Grzesiak, BMET, regional director at Medical Electronics; Michele Shahbandeh, owner of Integrity Biomedical Services; Stephen Davis and Shawn Nguyen, lead biomed technicians with USOC Medical; and Steve Ziegenhagen, president of Gopher Medical.

Q:

HOW CAN PURCHASERS ENSURE THEY ARE MAKING A WISE INVESTMENT IN PATIENT MONITORS?

BEBB: Purchasers should look for established suppliers who have a proven track record as a supplier of high-quality, reliable equipment.

BONIN: Biomed professionals need to be forward thinking and plan out 3-5 years for long-term patient monitoring solutions. Planning for equipment while meeting long-term needs should also fit within the future technology of the hospital. The clinical engineering departments must be set up with mission-critical technical training that is consistent across the hospital for investments in-patient monitoring. This training should also include equipment training and detailed literature on parts and services offered by the manufacturer or vendor.

DAVIS: The purchaser should research exactly what they will be using the monitor for to ensure they are paying for exactly what they need. Such as options, ease of use for the nurses/doctors, if training on the monitors is included, and if a warranty is given.

GRZESIAK: If I didn’t know about patient monitors and was asked to make this type of purchase, I would check with different manufacturers and check

their record. How long have they been in business?

What facilities are using their products?

NGUYEN: Whether it’s bedside monitors or portables, patient monitors come in different varieties to suit the requirements of any hospital and small clinics. They allow continuous monitoring of a patient and health care professionals are informed of changes in the general condition of a patient. I believe these vital sign monitors have a good return on investment when it comes to quality health care and is sustainable to the degree that current and future patients can be treated adequately.

ZIEGENHAGEN: By researching the equipment manufactures and using online tools and websites that will allow them to access evidence-based information to enable more educated decisions on medical equipment, unbiased insight into the proper technology at the best price for their hospital, and strategic guidance to help their hospital cut costs of care and, in the end, improve the quality of outcomes. Hospitals need to consider the upfront cost of interfacing to their existing network, clinician notification and communication systems. Some equipment manufacturers offer a 5-year warranty to get attention of the senior management and biomedical engineering departments. Also, consider asking for long warranty periods.

THE ROUNDTABLE

GRZESIAK: Match the exact parameters desired with how it’s going to be used.

Look at space limitations. Check parts and service availability.

SHAHBANDEH: Simplicity of use. Have a system that is capable of combining the latest with the earliest models.

STEVE BEBB

Senior Global Director, Product Marketing, Patient Monitoring, Philips Healthcare

Q:

WHAT ARE THE MOST IMPORTANT FEATURES TO LOOK FOR WHEN IT COMES TO PATIENT MONITORS? BEBB: When it comes to patient monitors, it’s important to look at full flexibility, both in terms of the ability to scale functionality up or down as appropriate, a simple and common user interface across the entire portfolio as well as the ability to integrate seamlessly into the hospital’s IT infrastructure.

BONIN: Standardization and compatibility to IT’s existing network.

Looking at the product life cycle is important. OEM support and third-party support should be taken into consideration and also parts availability and software updates. We also see the importance of monitors built with innovative technology including advanced wireless integration and communication, networking capability and increased storage capability to full system integration. Integration is important so that monitors are also readily upgraded with advances in

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ANDY BONIN

President and CEO of Pacific Medical

technology. The demand for all monitors to talk and interact with one another in line with the other systems is very important. Full systems integration helps reporting to central locations and existing systems as well. All patient monitoring solutions should come with the streamlined capability of tying into a hospital’s IT system and remote patient monitoring outside the clinical environment to minimize costs and shorten hospital stays.

DAVIS: This really depends on the needs of the department, such as ambulatory, surgery, E.R., etc. The purchaser should discuss this with the head of the department to ensure that they are purchasing exactly what they will need.

NGUYEN: Medical staff have traditionally relied on five vital signs to access their patients: temperature, pulse, blood pressure, respiratory rate and oxygen saturation. These common features are important when it comes to patient monitoring. Portability and good battery life are a plus, too.

ZIEGENHAGEN: The most important features to look for are wireless communication, hardwire infrastructure and bed-to-bed communications. Many equipment manufacturers are offering these multiple features and health care providers need to consider the long-term impact on their infrastructure. The ease of integrating to the hospital’s existing EMR/EHR system, network and nurse call systems need to be considered.

Monitor modularity – upgrade ability (onsite or factory) making sure that when it comes to upgrades, the manufacturer offers upgrades to existing equipment.

Q:

HOW CAN HTM DEPARTMENTS BE SURE TO OBTAIN THE BEST PATIENT MONITORS FOR THEIR FACILITY? BEBB: HTM departments should contact other organizations to share experiences using equipment from different manufacturers. Before making a decision, HTM departments should make sure that the supplier provides ongoing and timely support in the event of an issue.

BONIN: Integration is important for the HTM departments when looking for patient monitors. All patient monitoring systems should be evaluated with the current system technology to make sure they are easily integrated across the hospital. HTM managers must make sure that their input and specifications are heard in the beginning and that they roll into the final equipment decisions. Fitting seamlessly into expanded, real-time integrated options, coupled with a wealth of clinically relevant information from the hospital’s intranet and applications is also important. Finding a repair vendor that offers quality refurbished equipment coupled with ISO certifications and OEM-trained personnel is a bonus as well.

DAVIS/NGUYEN: If purchasing equipment from a third party, the purchaser must make sure that the vendor is certified in the OEM products (Philips, GE, Spacelabs, etc.) Provide as much information to the sales rep as possible and, if possible, speak with a technician at the facility and work with them to help ensure that you get exactly the right product for them.

GRZESIAK: The best monitors for any facility can be obtained when the budget for such a purchase is established, and a bit of research is completed.

SHAHBANDEH: Demonstrations by top manufacturers are always a great way to see what they offer.

STAN GRZESIAK

ZIEGENHAGEN: I would recommend health care facilities consider forming an equipment committee including, but not limited to, purchasing, clinical department users, biomed, IT and senior management. By doing this, it will help drive the equipment selection process more efficiently by having everyone’s input. Plan on-site demonstrations, evaluations and site visits – by working with the equipment manufactures and/or dealers, scheduling demonstrations/ evaluations and even site visits for the equipment selection committee team will assure they are making the right decision.

Q:

HOW CAN A FACILITY WITH A LIMITED BUDGET MEET ITS PATIENT MONITOR NEEDS? BEBB: While initial purchase price is clearly important, many suppliers can offer attractive financing programs or other mechanisms to optimize the overall longer-term cost of ownership. It’s important to consider the ability and track record of the supplier to allow the system to be kept up to date over time.

BONIN: With the economic budget visibility, more and more hospitals are looking into used/refurbished equipment.

HTM’s role also now turns to investing more in research of options for refurbished newer technologies so they can maximize on low cost, and quality

MICHELE SHAHBANDEH

BMET, Regional Director at Medical Electronics

Owner of Integrity Biomedical Services

equipment from a trusted vendor.

Biomed departments should look for a trusted and established vendor who specializes in patient monitor equipment.

It is also important to find a vendor that has a large industry selection of parts and inventory availability for after the sale or after sale support service.

DAVIS/NGUYEN: The best way for a facility with a limited budget to still meet its patient monitoring needs would be to purchase used/refurbished equipment with a good warranty from a reputable third-party vendor with certified technicians that also offer technical support, installation and training, if necessary.

GRZESIAK: A facility with a limited budget must be creative when making patient monitor purchases. There are several reputable vendors that sell refurbished equipment. Again, research is necessary … and strongly advised!

SHAHBANDEH: Purchase from a reliable company that offers cost savings and warranties when dealing with refurbished/preowned equipment. Look for an ISO-certified company, accountability and quality.

ZIEGENHAGEN: Consider purchasing refurbished equipment from a reputable

company that specializes in patient monitoring equipment that will back your equipment purchase with a warranty and technical support.

Q:

HOW CAN HTM DEPARTMENTS MAKE SURE THEY WILL RECEIVE PROPER TRAINING AND LITERATURE WHEN PURCHASING PATIENT MONITORS? BEBB: HTM departments should contact other organizations to learn about their experiences. A high-quality supplier will ensure that this topic is discussed extensively and fine tuned to individual requirements during the pre-sale process.

BONIN: Planning for equipment training at the time of purchase must be established and include a training plan with detailed materials/literature. This training should be scheduled and also include parts and services overviews done by the manufacturer. A technical training plan should be part of the deal upfront and include a focused metric of measurement that is consistent across the hospital.

THE ROUNDTABLE

STEPHEN DAVIS Lead Biomedical Technician at USOC Medical

DAVIS/NGUYEN: Most literature for patient monitors is available online as a PDF. As far as receiving proper training on a new patient monitor, I would look at the vendor that they are purchasing the monitors from and make sure that they offer proper training on all of the items that they sell. Also they should make sure that the training they offer is given by certified technicians.

GRZESIAK: Proper training and literature must be negotiated prior to any equipment purchase. The web can be a good source for some literature as well.

SHAHBANDEH: Company’s like ours can schedule in-service on the equipment.

ZIEGENHAGEN: By working with purchasing/material management to make sure the sales contract or agreement includes the proper training and literature (on-site or off site) at the expense of the equipment provider, operators and service manuals (paper and electronic versions) are recommended.

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SHAWN NGUYEN Lead Biomedical Technician at USOC Medical

Q:

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

BEBB: Given the huge investments that hospitals today are making in state-ofthe-art IT infrastructure, it’s essential to look for companies that can demonstrate their ability to fully integrate and support their systems within this infrastructure. This includes interoperability with equipment from other manufacturers, as well as seamless integration with the EMR. BONIN: Compatibility and standardization make for a more efficient hospital.

DAVIS/NGUYEN: There is a large variety of patient monitors and brands today that give the end user a lot of options to look at. Like anything else, I would say that it is important for the purchaser to do their research and talk to the doctors and nurses and talk to the

STEVE ZIEGENHAGEN Gopher Medical

vendor that they are using to make sure they are purchasing the proper monitor and manufacturer that will overall fit their needs in the hospital.

GRZESIAK: Find out what the facility needs first. Check a manufacturer’s history or website. Check with other local facilities’ biomedical engineering departments. Don’t always buy the cheapest product, you and your facility may regret it.

SHAHBANDEH: Make sure they have a company who offers quality, cost and great customer service. Once the monitor goes out of warranty, you want to have a qualified technician and company performing the repairs.

ZIEGENHAGEN: Training – by making sure they receive the appropriate training by the manufacture and or dealer. If buying refurbished, do your research about the company to make an informed and educated decision.

THE ROUNDTABLE

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BIG DATA

AND ALARM MANAGEMENT Marshaling a Brain Trust to Find Answers

By K. Richard Douglas

I

magine the chaos for firefighters in a firehouse if the alarm rang incessantly. What is worse, imagine if only a small percentage of the alarms were real emergencies.

The firefighters would be exhausted after only a day or two and their mental preparedness would surely suffer.

MARIA CVACH, DNP, RN, FAAN

Assistant Director of Nursing, Clinical Standards at Johns Hopkins Hospital & Chair of AAMI’s Clinical Alarms Steering Committee

“ We need multiparameter device analysis to decide when an alarm should sound versus crossing a threshold momentarily. This means that we need for devices to use more than a single threshold breach to determine when to sound.”

-Maria Cvach

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After reacting to the onslaught of false alarms, the reaction of the firefighters would eventually be like dealing with the proverbial boy who cried wolf. The danger posed by this situation is that when a legitimate emergency comes along; it can be a life-or-death situation. This holds true in the hospital setting.

The hospital is no Aesop’s Fable; it’s a place where constant awareness is demanded. Clinical alarm safety deserves the attention of all the stakeholders because the most vulnerable stakeholder is the patient.

A cacophony of alarms can hide the real emergency.

It is likely that none of this is news to anyone reading this article. The issue is a frontrunner among issues that will be addressed by experts across the health care spectrum this year and in the future.

On ECRI Institute’s “Top 10 Health Technology Hazards for 2015,” the top spot was “Alarm Hazards: Inadequate Alarm Configuration Policies and Practices.” In 2013, The Joint Commission (TJC) issued Sentinel Event Alert Issue 50, “Medical Device Alarm Safety in Hospitals.”

AAMI’s National Coalition for Alarm Management Safety held its initial meeting in April of 2014. Like cybersecurity, EMRs and dealing with newer regulations from CMS, the topic of alarm management requires new thinking and the adoption of intelligent guidelines.

Although a majority of alarms will never require clinical engagement, the risk to patient safety requires that attention be paid to all of them. Many will be sounded with no basis for an urgent response. There are some recurring reasons for these nonsignificant alarms.

As TJC and AAMI have pointed out, many alarms result when “conditions are set too tight; default settings are not adjusted for the individual patient or for the patient population; ECG electrodes have dried out; or sensors are mispositioned.”

With devices monitoring a patient’s blood pressure, heart rhythm, blood oxygen level or ventilator status, the variables become a

consideration. Normal blood pressure for a person in their 80s may be different than that for someone in their 30s, for instance.

Alarms on cardiac monitors, pulse oximeters, ventilators, CPAP/BiPAP devices, infusion pumps, feeding pumps, bed exit alarms, chair exit alarms, vacuum assisted closure devices, hypo/hyperthermia machines, SCD machines, intra-aortic balloon pumps and continuous renal replacement therapy devices all add to the orchestra of confusion.

The Joint Commission’s National Patient Safety Goal (NSPG) on alarm management recognized that the story from the fable is rooted in a real problem. No real alarm can ever be missed. At the same time, the multitude of false alarms tire out clinicians to the point of mental exhaustion; alarm fatigue.

The old adage; “no man is an island,” has application in this instance. No hospital should be an island when an issue effects thousands of hospitals. The issue has created a paradigm that finds patient safety at its core everywhere.

MINING FOR TWEAKS The challenge of managing alarms becomes somewhat more vexing when you compound it with the goal of integrating big data into a solution. The move from paper to electronic records was a monumental task in itself and many health care providers aren’t there yet. Data mining this growing universe of information, and assigning it an additional, and new utilitarian purpose, is the next chapter in the health care environment evolution. If just one nurse can be spared one headache, it is a step in the right direction.

The monumental amount of data collected these days has helped to provide some key insights into what can be done to reduce the number of alarms that don’t require immediate attention.

Looking forward, there are changes that must be incorporated into the protocols of hospitals everywhere.

“ Admittedly we went back a few times to make adjustments to protocols and monitoring set ups before we felt we had achieved the best case scenario for patient care while presenting a more effective and efficient alarm environment,” -Steven Bowers

STEVEN BOWERS, CET

Manager of Biomedical Engineering at Rex

“Major changes are needed to improve alarm management. Vendors need to improve alarm specificity — the trueness of alarms,” says Maria Cvach DNP, RN, FAAN, assistant director of nursing, clinical standards at Johns Hopkins Hospital and chair of AAMI’s Clinical Alarms Steering Committee.

“This may mean better alarm algorithms that manufacturers use to test their devices; and incorporating short delays prior to an alarm sounding to allow for alarm auto-correction when a HR or Pulse Ox momentarily changes due to artifact or patient movement,” Cvach says.

“We need multi-parameter device analysis to decide when an alarm should sound versus crossing a threshold momentarily. This means that we need for devices to use more than a single threshold breach to determine when to sound,” she says.

Like many health care systems, Rex Healthcare in Raleigh, North Carolina, took action to address the alarm management challenge.

“We began with collecting and reviewing

our equipment database with select individuals from various areas of clinical responsibility; the committee then determined which systems and equipment should be targeted for improvement and which clinical areas having these systems would benefit most from our efforts to enhance the overall clinical alarm environment,” says Steven Bowers, CET, manager of Biomedical Engineering at Rex. “The obvious choices for us became the critical care areas of Cardiac Intensive Care Unit, Medical Intensive Care Unit and Cardiac Thoracic Intensive Care Unit. We conducted alarm assessments and collected actual alarm data previous to imposing any intervention to validate our decision to focus on these clinical sites and departments,” he says.

Once they were validated, the biomedical engineering team ordered and acquired updated software for its monitoring assets, installed, tested, and then worked closely with clinical staff and vendors to drill down for the best alarm protocols for each area.

“Admittedly we went back a few times to make adjustments to protocols and monitoring set ups before we felt we had achieved the best case scenario for patient care while presenting a more effective and efficient alarm environment,” Bowers adds.

He says that soon after the changes were made, the department began sampling and taking data off its network to provide a clear picture of what the initiative had achieved.

“While everyone working in the ICUs had noticed a considerable change to their

working environment, the data reports concluded that we had exceeded expectations. Our clinical ICU staff all report a much more staff- and patient-care-friendly environment and one that delivers a more safe, effective alarm notification system overall,” Bowers continues.

Indeed, during a 14-day review period, both pre- and post-intervention and after software upgrades, alarms had dropped anywhere from 26 to 48 percent in the units where the problem was confronted.

CLINICIAN SUGGESTIONS FOR HTM What can HTM professionals do to aid their clinical counterparts in managing alarms in their facility?

Speaking as a nurse, Cvach finds these things helpful: 1. Providing us with regular data to see how we are doing with our alarm management strategy 2. Establishing back-up alarm management systems — secondary alarm notification systems — to ensure that alarms are heard.

3. Working collaboratively with nurses to customize default parameter settings based on the population served 4. Being a resource to acquire information from vendors regarding how to improve alarm management 5. Suggesting new strategies for future improvements.

BIG DATA AND ALARM MANAGEMENT

because of the medications they are taking, if the nurses didn’t customize the alarm setting for that patient, the low heart rate alarm would ring continuously for a non-actionable alarm,” she points out.

“So, licensed nurses use their knowledge and experience to make this determination.

When needed, they can confer with other experienced nurses/MDs to help make the decision. The important thing is that when the alarm is going off, it means that an action is needed. If the nurse hears an alarm, and it is non-actionable, it needs to be readjusted for that patient.”

HTM HAS BEEN ACTIVE JEFFERY HOOPER

Director of biomedical engineering at Children’s National Medical Center in Washington, D.C.

IZABELLA GIERAS, MS, MBA, CCE

Director of clinical technology at Huntington Hospital in Pasadena, California.

“ In general, with the knowledge that the HTM departments across the country have on medical equipment, it is imperative that these departments be part of the clinical alarms initiatives in some form or another and many are leading these initiatives.”

-Izabella Gieras

THE CAREGIVER’S ROLE From nursing’s perspective, there are steps that can be incorporated into current protocols. One such practice, according to Cvach’s research, is for nurses to make “modest changes to monitor default parameters and empowering nursing staff to customize alarms for patient need resulted in large reductions in clinically insignificant alarms and a quieter environment.”

How does the nursing staff know how to tailor an alarm to a particular patient and what parameters are employed?

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“Nurses working with monitored patients receive in-depth training on arrhythmia recognition and management and are well trained to understand what arrhythmias are actionable for patients,” Cvach explains.

Cvach points out that nurses are also trained to critically analyze an individual patient to determine if the default monitor threshold settings — heart rate, BP, RR Pulse ox — make sense for that patient.

“For instance, if the monitor default heart rate settings are 50-120 bpm, but the patient has a baseline heart rate of 45

The HTM department has much to offer when it comes to data mining and report creation to aid in the alarm management dilemma. As more standardized protocols are adopted, this can be one of the areas of contribution from clinical engineering.

“At Huntington, Clinical Technology is the leader of the Clinical Alarms Management Committee and works very closely with all key stakeholders to support the NPSG,” says Izabella Gieras, MS, MBA, CCE, director of clinical technology at Huntington Hospital in Pasadena, California.

Huntington Hospital is part of the National Clinical Alarms Coalition, according to Gieras, which was established by the AAMI Foundation, Healthcare Technology Safety Institute (HTSI).

“In general, with the knowledge that the HTM departments across the country have on medical equipment, it is imperative that these departments be part of the clinical alarms initiatives in some form or another and many are leading these initiatives,” Gieras adds.

She says that her department has been able to reduce the overall alarm traffic, along with the accompanying caregiver fatigue, by evaluating alarm configurations.

“We are also updating our clinical alarms policies to align ourselves with the requirements of the NPSF and our discoveries,” she says.

“From pumps, we send monthly reports

to an alerts review committee consisting of physicians, pharmacists and clinical analysts,” says Jeffrey Hooper, director of biomedical engineering at Children’s National Medical Center in Washington, D.C. The reports show the “number of soft and hard limit over-rides by drug type, [the] number of ‘guardrails’ over-rides when user determines to run outside the built-in protocols and the main goals are to assure ‘guardrails’ [are] being used and that all drugs are included in library,” he says.

Hooper also offers examples of monthly reports generated from monitors and provided to a multi-disciplinary alarm committee. These show the number of total alarms by type and by unit, the average number of alarms per patient per day per unit and the average response time for critical alarms, he says.

He also says that from Nurse Call, they send monthly reports to nurse managers for units showing the number of codes and response time and the average response for pillow speaker response to [the] time a nurse goes into [the] room.

Hooper also points out that their department has been doing this for about six years, so some of the newer initiatives are not yet changing what they do.

“However, it is an evolution as the data becomes stale and we have to ‘re-vitalize’ it to be sure it is valuable to the users,” he says. “We also store a lot of data for research purposes.”

SOLUTIONS AND THE FUTURE What are some solutions to this vexing problem? Cvach has some suggestions that will move the ball down the field.

“We need to rethink why patients are put on monitors to begin with,” she says. “If it is for arrhythmia monitoring, then standard physiologic monitors are OK. If it is for evaluation of vital signs such as HR, BP, pulse ox; perhaps we need surveillance monitoring which looks at trends in these measures over time, versus alarming for an isolated threshold breach.”

“When a purchase is made for monitors,

SHASHI AVADHANI

Regional Vice President at Crothall Healthcare Technology Solutions.

“My goal as an HTM professional is to continue to educate as well as work with nursing and organizational leadership in the hospitals to address this very important aspect of alarm fatigue, and to increase the effectiveness of patient care.”

we need regular upgrades to these devices,” Cvach adds. “Because these are multimillion dollar purchases, the software needs to be upgraded routinely. And manufacturers need to be able to integrate with other devices (vendor neutral) to assure that hospitals can develop an alarm management strategy for the patient, no matter which vendor they purchase equipment from.”

Cvach also says that manufacturers need to develop better training guides — made for nurses, not engineers — and have practice tips on the device for reducing alarms and use of the equipment.

“Although AAMI-HTSI continues to contribute greatly to this very critical area of addressing alarm fatigue, there is still a lot of work required to educate the clinicians as well as organizational leadership as to the real problem of alarm fatigue and the reason that The Joint Commission set up the National Patient Safety Goal,” says Shashi Avadhani, regional vice president, Crothall Healthcare Technology Solutions.

“I have experienced numerous facilities where the understanding of the NPSG is quite different from what it was intended to achieve. I would definitely say that the AAMI-HTSI webinars went a long way, but there still remains a lot to be achieved,” Avadhani adds. “My goal as an HTM professional is to continue to educate as well as work with nursing and organizational leadership in the hospitals to address this very important aspect of alarm fatigue, and to increase the effectiveness of patient care.”

In general, Cvach remains optimistic that all stakeholders can make improvements as attention remains focused on solutions to this issue.

“I believe the future is bright if we can get manufacturers, hospitals and engineers/IT to collaborate in partnership to make alarm management a priority,” she says. “We should learn from other industries who have done this successfully [such as] aviation [and] nuclear plants.”

-Shashi Avadhani

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CAREER CENTER

By Todd Rogers

T

his past weekend my family and I traveled about 5 hours away to watch our son play in a sports tournament. Before I left, I was talking with my boss about the trip and I told her that I was a little nervous about the trip up and back. I won’t name names but let’s just say that one of the other travelers in my car isn’t exactly enthusiastic about trip navigation – even with the help of a GPS and a smartphone. And I’m one of those drivers who rarely messes with devices while driving.

TODD ROGERS Stephens International Recruiting, Inc.

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My boss tells me to think positively and things will be just fine. That got me to thinking about what it means to think positively. Did you get that? I guess you could call it “meta-positive thinking.” I spent the first leg of my drive thinking about many things. One of those things was a refresher on positive thinking. I hear people telling one another that you need to think positively about this. In fact, I hear that kind of mantra from myself from time to time. There is even a field of psychology called “positive psychology,” and it deals with developing and sustaining positive thoughts and actions across the span of one’s lifetime. Any way that you slice it, thinking positively about things is a moniker that permeates Western culture but I’m not so sure that people understand exactly what that means.

In a career-sense, what does “think positively” actually mean? How does someone practice positive thinking? Is there any benefit to thinking positively or is it just a catchy subject of countless self-help books? I’ll tell you what “think positively” means to me. I will also tell you what I do to practice it and how I got started with the habit. As it stands right now, when information reaches my brain, lots of things happen. One of the very first things that happens involves finding all of the current and potential positive attributes that could come from that information.

Stuck in bad traffic? This isn’t what I hoped for, but now I have some extra time to listen to whatever I want to listen to.

Someone says something mean to me. This is a chance to test my resolve at taking the high road. I hit my thumb with a hammer (say bad words first) I can’t undo the deed so after the pain dissipates, I will use the experience to get better at hammering.

This may seem odd to some but I can assure you that when I reflect on things, it’s in a positive manner.

Not a day passes that I don’t encounter someone who’s the exact opposite when it comes to thinking. I encounter people who’ve allowed themselves to become pre-programmed with a negative filter and who use negative terminology when describing even gleeful events. These are people who say things such as, “Well, I won the lottery; that’s going to really screw up my taxes.” Or someone who might say, “Sure, they won the game but they looked awful on defense.” I can usually spot this kind of thinking in only a few minutes of exposure to someone. As someone who used to see things with a negative spin attached, it is far better to have the positive view. Here’s how I got started with my optimistic interpretation.

It’s all about the language. Language is a system of sounds, symbols, words, etc … that when added together, reflect thoughts and ideas. I don’t know about you, but in

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DATE my head all of my ideas are processed using the English language. Those billions of neuro-transactions that happen in my head from one moment to the next, if you could capture them on paper, they would be written in English. About a year ago, I started to observe that I used a lot of words that talked about what I would not do, or what I didn’t like.

I tried an experiment. Every time I caught myself using a negative, I tried to see how I could have the same thought, but in a positive angle. Where I used to think, “I don’t like tuna casserole,” now I might say, “There are things that I prefer more than tuna casserole.” It was about the most impractical and clumsy way of thinking about things and quite frankly, I felt foolish. But, I committed myself to changing how I thought about things and the first step on that journey was to make basic changes in how I processed inbound information. I couldn’t just automatically start thinking positively about things. I really didn’t have much of an idea of what positive thinking was like. But, I did know what positive and negative words were. I trained myself to stop using negative words. The only thing that I had left were positive words. This started with simple things (see tuna casserole example above).

Pretty soon, I started hearing myself say things with a positive spin on them. I felt a little foolish at first, but what was initially

clumsy became habit. Now, the positive words flow effortlessly. They are part of the dialog that goes on in my mind and they are very much a part of what comes out of my mouth (or keyboard).

After I had practiced the use of positive language, it actually became difficult to have a negative view on things. The words to describe things positively were simply more accessible to my mind and so I naturally gravitated towards using what came easier. Possibly it is out of laziness, but why put in extra effort at something when the path with less effort will carry you further and make things more pleasant in the short term and the long term? I know people who seem like they were put on Earth simply to be bitter. But, my conviction is they only seem that way because that is what they have practiced long enough for the bitterness to come easily. Even those people can adjust to a positive tone. They just have to try.

So, there is no multi-step solution to this. There is a one-step solution: start using positive words to describe things to others. You don’t need to announce your effort. Keep it private and start today by describing things to yourself and to others in a positive tone and before long, it will be exceedingly difficult to do otherwise.

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What in the the Heck is that Noise?

By Matt Tomory

O

ne of the most frequent, and difficult, problems we encounter in ultrasound service are related to noise in images. This can occur in 2D, color Doppler (CD), pulsed wave Doppler (PW) or continuous wave Doppler (CW). Finding and eliminating the source of the noise can involve some detective work and out-of-box thinking.

MATT TOMORY Vice President of Sales, Marketing, and Training

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As with all troubleshooting, the process of elimination is employed.

Begin by isolating the system and any device attached to it.

Does this noise only occur with a specific probe? If so, replace it and confirm the problem has been resolved.

Does it occur with a specific port? Try another one.

Verify that the ground is intact by performing a ground continuity test and ensure all system covers and shielding are making good contact and have clean contact surfaces. Are there any peripherals connected to the system via power, video, network or RS232 cables?

Disconnect them one at a time to see if the noise disappears.

If the noise is still present, we must now look outside of the system and into the environment it resides in. Are there any devices in the room that may be on the same circuit such as gel warmers, fans, fluorescent lights, coffee makers, clock radios, etc.? Try unplugging or turning them off one at a time to see if the noise is eliminated.

Perhaps the noise is the result of noisy power or emission by some device close

by. Try to move the system to another part of the facility and verify whether the noise is still present. I once worked on a noise problem that was intermittent and it turned out that every time the elevator passed the floor the system was on, noise would be induced into the image.

The facility ground may be the culprit as well. Even though you have a solid ground circuit from the system to the wall, how is the ground from the wall to earth ground? I had another system noise issue where I suspected a bad ground so I connected a car jumper cable from the system ground to the cold water pipe of the sink in the exam room and the noise disappeared. It turned out that the building ground was poor and the solution was to take a garden hose and trickle it on the ground pipe for the building overnight (true story).

If the noise persists, the problem may be internal circuit boards or power supplies so troubleshoot accordingly.

Image noise issues can be extremely difficult to isolate, but by following the basic troubleshooting steps outlined here you can make the task substantially easier.

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BEYOND CERTIFICATION

Benefits of Conference Attendance

By Dave Scott

W

e have discussed attending conferences briefly in previous articles. There are several renewal points available through attending conferences.

David Scott Founding Memeber of imagingigloo.com

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There are a few ways to break down conference attendance. You can count each day you attend for a half point per day or you can claim each educational session you attend. There are several conferences available each year. They are an easy way to get your maximum 10 points in three years for the education category.

The big tradeshow/conferences are the AAMI Conference and the biannual MD Expo. The AAMI Conference is usually held in early June. The location changes each year. So it is nice to attend when it’s in your area or close to your area of the country. It is the biggest conference of its type for our profession. This year it’s in my hometown of Denver, Colorado. If you are attending this year and see me there please say “Hi.” I would like to hear from you.

The MD Expo has more availability. It occurs twice a year and usually there is an East Coast or eastern Expo and a West Coast or western Expo. They occur in the spring and fall. The spring 2015 Expo just ended, it was in Nashville. The fall MD Expo will be in Las Vegas in October. It’s not too late to make plans now!

Last year MD Publishing, the parent company of the MD Expo and TechNation magazine, added an imaging expo. There will be an Imaging Expo in Indianapolis again this year. The Imaging

Expo will be held July 22-24. For details, visit MDExpoShow.com.

Another big difference that I have seen in the two conferences is the AAMI Conference has more OEMs. AAMI has some of the latest technology from the OEMs that is either new to the market or not quite on the market yet. MD Expo has a lot of Independent Service Organizations (ISOs). ISOs are companies that can help you source parts and repairs usually for less money than going through the OEM. Both conferences have plenty of ISOs at them. Every hospital I know of is talking about ways to save money these days. So, not only can you get education through the educational sessions, you can also meet vendors that can save you money. On top of that, you can meet other techs and managers from around the country and build your own professional network.

Let’s not leave out your local biomed association. Here in Colorado we have an annual show called the CABMET Symposium. We have an educational track and we also have a trade show. It is much smaller than the bigger national shows.

There are several area or state associations that have annual meetings. If you are up to it, you can present at a show like this.

Presenting is a good way to get points too.

A presentation at a state or local show can earn you half a point per presentation.

Remember the renewal period is three years, so if you go to a conference every year or every other year this will go a long way in getting points toward renewing your certification.

Until next time, keep your journal up to date.

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KAREN WANINGER Do You See What I See?

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By Karen Waninger

hat comes to mind when you hear someone talking about the need for “transparency?” In many different environments now, that seems to be a readily accepted buzz word. Whether in government, business, or individual relationships, that word seems to somehow be tied to an image of success.

KAREN WANINGER, MBA, CBET Founding Memeber of imagingigloo.com

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According to one definition I read recently, the term business transparency means “clear, unhindered honesty in the way one conducts business.” While I believe that is very important, I don’t think that definition goes far enough to explain what really needs to happen for transparency to exist. Writer Victor Lipman expanded on that concept in a Forbes.com article (http://www.forbes. com/sites/victorlipman/2013/12/11). He shared survey findings that revealed how the cost of transparency is almost zero, and yet it greatly impacts the bottom line of the business in a positive way when it does exist. The study explained that if employees believe and trust management, they will work harder for the good of the organization. For that to be realized in practice, the employees need to be able to see what they are expected to be working toward. They have to understand the mission, vision, and objectives of the organization as well as the key processes that drive the organizational outcomes.

That leads to the real question. What does transparency really mean to each employee? I have observed in business, much as in all life experiences, that what may be transparent from one vantage point is often completely obscured to those who are in a different place. That concept is easy to understand if you think about it.

Consider the view in the suites above the

finish line at the Indy 500, compared to the race experience for those seated in the infield bleachers along the backstretch.

Both are exciting places to be, but the entire race experience is completely different for the fans. One person may describe the best part of the race as the moment when three cars came racing down the backstretch and went into the turn three wide battling for position. The other may say the highlight was the photo finish. Either description could be an example of complete honesty, but neither would accurately describe the race overall.

Similarly, in any organization all views are necessary for transparency to exist.

Whether your role is “on the front line” or you hold a position with a “view from the top,” all input is equally important.

How are we supposed to overcome these kinds of differences in what is visible within any business? It doesn’t happen without individuals from all parts of the organization making a commitment to listen and learn about what is happening in all other areas of the business. It may not be possible to actually put people in different positions for a period of time to allow them to observe first-hand what happens outside of their normal area, but there are other ways to achieve similar results.

Think about the Indy 500, and how many different cameras and reporters are

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placed all around the track, to try to deliver a complete view of the race for the fans watching on the Jumbotrons at the track or watching the race on television from anywhere in the world. In business, we don’t necessarily have cameras to record what is happening, but we can use similar types of communication. Take pictures of the different work activities to share with new employees. If the work flow in one area is impacted by the results that come from some other area, use process maps to identify those upstream and downstream activities. Make the information easily visible to employees so they know what impact their work may have on the final results, as well as how their tasks affect the ability of others to perform effectively. If reports contain data that is important for one or two areas of the organization, what data could or should be added to make the same report an effective method of communicating a single, more meaningful message to all employees?

Before I understood the issues related to different views from different perspectives, I thought that everyone should be able to see the same problems and therefore would want to work on the same solutions. For example, I have seen several instances where some corporate initiative placed a significant added burden on the front line service delivery teams, and no one at the administrative level seemed to care. Likewise, there have been times when suggestions for seemingly simple process changes were met with significant amounts of resistance by the field, for unknown reasons.

As I have enjoyed the opportunities to

interact with individuals from all aspects of the HTM profession during the past several years, it has become increasingly clearer that we simply do not see the same things, or at least we do not all have the same perception of the things we do see.

That does not represent a lack of desire for transparency, nor does it represent any intent to be dishonest in most cases. It is something that can easily be corrected, in most instances, once recognized.

We each must accept the responsibility to be open to viewing any situation from some perspective other than our own.

That is especially crucial when the instinctive reaction to a suggestion or expectation may be negative or defensive.

Instead of allowing that initial response to drive what happens next, make a conscious effort to first verify that everyone is seeing the same thing. Once those pictures from the different perspectives around the track all start to be visible on the Jumbotron, everyone can grasp a more complete representation of the circumstances.

Any place on that race track, on any lap, can have a dramatic impact on the finish. For organizations where the employees are able to see what it really takes to get to the finish, they will all be more likely to work harder to get there, and the result will be a win for everyone involved. So, no matter which seat you are in, seek to acknowledge and apply the vision from the other vantage points.

Transparency requires an overlay of all views to create the full picture of the organization.

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Is the Internet rewarding poor quality?

By Patrick Lynch

D

oes anybody remember Craftsman tools? Superior tools, guaranteed for life. Never buy the same part again because you had a great product, and a company who stood behind it. Sure, you paid a little more for the Craftsman name and quality, but there never was a question that it was worth it.

PATRICK K. LYNCH, CBET, CCE Biomedical Support Specialist for GMI

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Now, you can buy anything on line.

The Internet and Google can find multiple sources for anything you want to buy. And the main buying metric seems to be price. Everyone seems to assume that all products are created equal. Only if all products are equal does buying solely based on price make sense.

But all items are not created equal. I bought an iPhone charger cord for $1.27 from China, instead of $19.99 from AT&T. Actually, the price was so good, I bought five. Of the five that I bought, three did not work, and one lasted only three weeks. I am afraid to trust my iPhone to the fifth one.

It is similar with medical repair parts.

There are a hundred places that you can buy a specific part or circuit board. Some are more expensive, some are cheaper.

All of the boards are original manufacturer’s product – nobody makes original circuit boards. Everyone repairs broken boards. Even the manufacturer.

So, if not price, what factors should you consider when faced with multiple options and varying prices for repair parts for medical equipment?

First and foremost, almost never buy from the manufacturer. They are always the most expensive. Just compare it to the cost of parts bought from the original manufacturer of your automobile. And I have heard of studies where the out-of-box failure rates from the original manufacturer are greater

than from a good third party.

Next, probably don’t buy the very cheapest – it may well be sold by a person with a spare unit in their garage, with no way to test the function of the part, or accurately determine its compatibility in your system.

Now that we have removed the high and low sellers, it is time to examine the company. After all, it is your past experience with them combined with their industry reputation that determines the quality and likely functionality of the part that you are ordering.

Let’s face it, quality costs money.

Redundant testing of parts, technical support, and a full staff of qualified technicians adds to the cost of doing business. Someone who simply pulls a part out of an old machine has none of these costs.

When you look for quality medical parts, I strongly encourage you to look at the company, ask about their quality control, and ask other biomeds about them. And don’t always go with the lowest price – it tears down the better providers and, in the long run, can only hurt the industry.

I work for a company which prides itself on higher quality and lower failure rates. But we are not always the lowest price. This article is an attempt to explain that the buying on price alone can be a false economy. Other factors should be examined.

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THE ROMAN REVIEW

You can trust me

By Manny Roman

I

recently attended a webinar on how to build trust in five easy steps. The presenter provided a very entertaining and convincing presentation. The five steps did in fact seem easy and should provide a very good framework for establishing trust-filled relationships.

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

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He defined trust as behaving in such a way that causes others to feel comfort dealing with you. He stated that others don’t care about titles or position, they care about the person in them. This is a good statement since it describes trust in terms of behavior and since behavior can be learned then trust can be learned. The presenter states that a critical component of establishing trust is ego suspension. So when attempting to establish trust, it cannot be about yourself, it must be about the other person. The presentation then began explaining how to get someone to trust you in a somewhat specific situation.

I was a little disappointed because it was advice for a one-time encounter, however here are the five steps.

In the first step, you determine what it is that you want the other person to do or tell you and why they should do it or tell you.

It establishes your goal for the encounter.

Once you know what you want from the other person, the rest of the encounter is about the other person. By the way, these are all preparatory steps to be performed prior to the encounter.

The next step is to ascertain the individual’s priorities. What drives them and gets them up in the morning. This allows you to frame your proposal in terms of their desires.

“determine why you feel that this is a situation where trust is needed. Determine the type of trust that is needed. Establish the degree of needed trust and what your belief system says about this particular situation.”

Then, ascertain the individual’s context.

This is how they view the world through their particular wants and needs so you can build trust the way they prefer.

Step four is to make sure that they feel better for having met you so they feel that they have achieved a win-win situation.

The final step is to “craft the engagement.” This means that you put all of this knowledge and research to work in your proposal. Make sure to use phraseology that supports their goals and that it is all about them.

Done. Do the above steps and people will more readily tell you what you want or do what you want them to do. He does point out that you must genuinely like people or it will show. He also states that without trust, there can only be manipulation.

All the above was for a one-time, or each-time, encounter where you are in need of something from the other person. What about trust in general? Here are my two pennies worth of wisdom.

Trust is a very personal concept. By this I

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mean that what trust means to me, is not the same as the meaning that you or anyone else applies to that word. So, the best way to describe trust is to speak on the degrees of trust. This way we can take into account the personal bias and modifications applied by individuals.

Trust is a belief in the reliability, truth, ability, or strength of someone or something. Being a belief, trust then must be based on experience. So if trust is a belief usually tempered by the personal experiences of the individual having that belief, the trust may not be well-founded.

(Google “Ladder of Inference” to see why beliefs may be all wrong.) You often hear of people betraying someone’s trust in them.

Why were they trusted in the first place?

Our experiences, and the emotional tags we attach to these experiences, may lead us to trust someone merely because they look like someone we do trust. “She looks like my Aunt Josie. Aunt Josie was always good to me and kept her promises. I could trust her.” This is an emotional bonding type of trust.

There are many types of trust. There is unconditional trust, such as a child may have in a parent. As the child grows, that trust begins to diminish as their bonding and influence world expands. If you have teenagers, you know exactly what I mean.

Their friends get smarter and you get dumber, right?

There is conditional trust such as when your boss tells you that if you get this project done right and on time you will get a promotion. These conditions, and his authority, cause you to trust his bold promise. He then squashes you like a grape

by finding a reason not to promote you.

“I’m sorry, but all promotions have been frozen for the next 37 years.”

There is situational trust such as trust in a health care provider. He has a diploma on the wall from the University of Trust Your Doctor so you trust in him to make decisions in your best health interest. We don’t want to change the situation by a second opinion because we won’t know who to trust then.

There is the misled by information trust (I couldn’t come up with a cute title). This is where that commercial tells you that if you drink this brand of beer and eat this brand of pizza, you will be surrounded by great looking happy and adoring people. Trust them. They have videos.

There is necessity trust which happens when your car breaks down on I-15 on your way to Las Vegas. You are stranded on the side of the road in the desert. A funny looking 1960s hippie guy stops and offers to take you to the nearest gas station.

You trustingly get into his Volkswagen bus for the 200-mile ride to Primm, Nevada.

So why am I telling you all this? Well, I am recommending that before you go blindly trusting anyone or anything in the future you determine a couple of things.

First, determine why you feel that this is a situation where trust is needed. Determine the type of trust that is needed. Establish the degree of needed trust and what your belief system says about this particular situation.

Be a little more cognizant of the trust you give and you will have less anxiety knowing that you did your homework. They will still betray your trust, but you will feel less anxiety. You can trust me on this one.

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THE FUTURE

AAMI Continues to be active in HTM Education

By John Nobblitt

M

any readers of TechNation are aware of AAMI’s core curriculum project that was for the most part completed last year. I say for the most part as it’s still a little uncertain as to what level competencies are to be taught for different degree levels such as a two-year associate in applied science degree or a four-year bachelor’s of science degree. However, these core competencies will help guide employers and educational institutions regarding what can be expected from a graduate progressing into the HTM profession after school.

With the continued implementation of the core competencies project AAMI continues to be very proactive in the educational realm of the HTM profession. This year will be a very active year for AAMI, education and credentialing as the December 2014 edition of the AAMI News points out there are big changes on the horizon.

Many of the new changes will fall under the newly developed AAMI Credentials Institute (ACI), guided by new Director of Certification Jan paul Miller. Miller is quoted in the AAMI News, “certification will look similar to AAMI’s standards programs.” On the list of targeted accomplishments AAMI wants to enact this year, four new certification exams, becoming a lead member society for Accreditation Board of Engineering Technology (ABET) and to have all certifications accredited by American National Standards Institute (ANSI). The ACI, as a ABET lead member society, will review postsecondary curricula in biomedical technology. These cumulative actions have the potential to raise the profession and certification status of the HTM community to unprecedented levels.

The ACI will replace ICC and USCC.

JOHN NOBLITT M.A. Ed., CBET

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The Board of Examiners for biomedical equipment technology will still operate under the ICC and USCC, but will be divided into four development committees. Each committee will be responsible for each certification area.

These areas being CBET, CRES, CLES and the new areas of HTM manager credentials. These new manager certifications are said to be a Certified Quality Systems Manager (CQSM) and a Certified Healthcare Technology Manger (CHTM). These two new certifications are scheduled to be offered beginning spring 2015. If all goes to plan, two more new certifications will be in place by the 2015 fall testing dates. These certifications will be in sterilization and information technology. I’m sure much more information about the new certifications will be coming throughout 2015 and the upcoming years.

I applaud AAMI for its commitment and vision in the education and certification standards for the HTM profession. As an educator I am very familiar with ABET. ABET is the recognized U.S. accreditor of college and university programs in applied science, computing, engineering and technology.

Having an ABET accredited program in

this guy

BMET helps ensure certain levels of education are maintained, but as with any accrediting program implemented, costs are associated.

With an online preliminary search, the costs associated with ABET certification for a community college could be around $8,000 and a yearly fee of nearly $700.

This seems like a very small amount of money, but for a community college facing smaller enrollment numbers and dwindling budgets this is another hurdle many BMET programs will need to address in the very near future. The ABET certification process is about an 18-month process and like any certification process is quite involved.

First, a program must show it has an assessment process for educational objectives and student learning outcomes. The program must demonstrate it has an improvement loop for continued improvements and the program must demonstrate these criteria with student work examples. Once these criteria are established the college must

formally request to be accredited. Once the school requests to be accredited, an accreditation policy and procedure manual must be written and each year a self-study must be reported to ABET. This seems pretty standard, but for a one-man program like myself, where does one find the time to provide the required documents? These financial and time constraints for accreditation are very real and could put some very good BMET programs in a tough situation.

This does not even touch on what type of requirements ABET and ACI may put on a college as to what equipment a graduate must be exposed to and the added expense of adding the technology to be taught.

These are just a few of the fears this BMET program director is facing.

However, I do believe the process is worth the investment. I hope educational institutions will see the benefit and commit the resources to become fully certified.

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Can you uncover ECRI Institute’s Top 10 Health Technology Hazards for 2015?

1. A_ _rm _az_r_s 2. D_ _t int_ _r_ty 3. M_x up _f _V l_ _es 4. In_d_q_ _te r_ _r_c_s_ing 5. V_ _t_la_or disco_n_cti_ns 6. Pat_e_t han_l_ng de_ice _se e_ _ors 7. D_se cr_ _p 8. R_b_tic s_rg_r_ 9. Cy_e_sec_rity 10. R_c_ll mana_em_nt

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For steps to prevent these hazards, download ECRI Institute’s free 2015 Top 10 Health Technology Hazards report at www.ecri.org/2015hazards.

Answers: 1. Alarm hazards 2. Data integrity 3. Mix-up of IV lines 4. Inadequate reprocessing 5. Ventilator disconnections 6. Patient-handling device use errors 7. Dose creep 8. Robotic surgery 9. Cybersecurity 10. Recall management

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A stack of TechNation magazines that I keep for reference.

Biomeds without boarders donation poster The ACCE Clinical Engineering Advocacy Award, the second awarded to me.

A humidor for my cigars in case I want one before I go home.

Pat Lynch Chief Do-Gooder Global Medical Imaging

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ON:

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Bruno Mars sign is from Philips Training class where everybody said I looked like the singer so the instructor flipped my name card over and wrote Bruno Mars.

PTS 2000 used for doing PFTs on 840 ventilators Ultrasound of my daughter who was born on Dec. 16, 2014.

Photo of my wife and myself at my first NFL game. We went and watched the Redskins play the Seahawks in Seattle when I lived there.

Photos of my two favorite “comfort” volunteers, Max and Freeda, at the hospital.

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INDEX AAMI…………………………………………………50 Ph: 1.703.525.4890 • www.aami.org/ac

Gopher Medical…………………………………… 37 Ph: 844.246.7437 • www.gophermedical.com

Seaward Group USA/Rigel Medical……………… 5 Ph: 813.886.2775 • www.seaward-groupusa.com

AceVision Inc.……………………………………… 39 Ph: 855.548.4115 • www.acevisioninc.com

Government Liquidation………………………… 3 Ph: 480.367.1300 • www.govliquidation.com

Soma Technologies, Inc.…………………………… 28 Ph: 1.800.438.7662 • www.somatechnology.com

AIV……………………………………………………40 Ph: 88.656.0775 • www.aiv-inc.com

Health Tech Talent Management, Inc.…………64 Ph: 757.563.0448 • www.HealthTechTM.com

Southeastern Biomedical…………………………69 Ph: 888.310.7322 • www.sebiomedical.com

AllParts Medical…………………………………… 39 Ph: 866.507.4793 • www.allpartsmedical.com

Integrity Biomedical Services, LLC………………49 Ph:877.789.9903 • www.integritybiomed.net

Southwestern Biomedical Electronics, Inc.…… 43 Ph: 800.880.7231 • www.swbiomed.com

Ampronix…………………………………………… 18 Ph: 888.700.7401 • www.ampronix.com

InterMed Biomedical………………………………69 Ph: 800.768.8622 • www.intermed1.com

Stephens International Recruiting Inc.…………59 Ph: 888.785.2638 • www.BMETS-USA.com

AMX Solutions………………………………………58 Ph: 866.630.2697 • www.amxsolutionsinc.com

KEI Med Parts……………………………………… 28 Ph: 512.477.1500 • www.KEIMedPARTS.com

Tesseract…………………………………………… 79 Ph: 703.437.4230 • www.tesseractUSA.com

ATS Laboratories……………………………………59 Ph: 203.579.2700 www.atslaboratories-phantoms.com

Maull Biomedical Training………………………… 79 Ph: 440.724.7511 • www.maullbiomedical.com

Tri-Imaging Solutions……………………………… 25 Ph: 855.401.4888 • www.triimaging.com

MedEquip Biomedical……………………………… 42 Ph: 811.470.8013 • www.MedEquipBiomedical.com

USOC Medical………………………………… 16-17, 19 Ph: 855.888.8762 • www.usocmedical.com

Axess Ultrasound…………………………………… 51 Ph: 855.242.9377 • www.axessultrasound.com Bayer Healthcare Services………………………7, 64 Ph: 1.844.MVS.5100 • www.mvs.bayer.com BC Group International, Inc. …………………… BC Ph: 888.223.6763 • www.bcgroupintl.com BC Technical ………………………………………… 4 Ph: 888.228.3241 • www.bctechnical.com BETA Biomedical Services………………………… 37 Ph: 800.315.7551 • www.betabiomed.com BMES/Bio-Medical Equipment Service Co.……… 63 Ph: 888.828.2637 • www.bmesco.com Capital Medical Resources LLC…………………… 67 Ph: 614.657.7780 www.info@capitalmedicalresources.com Conquest Imaging………………………………… 11 Ph: 866.900.9404 • www.conquestimaging.com Dunlee……………………………………………… 13 Ph: 1.630.585.2100 • www.dunlee.com ECRI Institute……………………………………… 75 Ph: 610.825.6000 • www.ecri.org/alarmsafety Engineering Services……………………………… 6 Ph: 330.425.9279 • www.eng-services.com Field MRI Services………………………………… 67 Ph: 404.210.2717 • www.fieldmriservices.com Global Medical Imaging…………………………… 2 Ph: 800.958.9986 • www.gmi3.com Global Risk Services…………………………………40 Ph: 630.836.9000 x.110 www.globalrisksservices.com

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Medical Imaging Solutions International……… 35 Ph: 800.603.6501 • www.misisyringes.com MedWrench………………………………………… 77 Ph: 866.989.7057 • www.medwrench.com/join5 Ozark Biomedical…………………………………… 24 Ph: 800.457.7576 • www.ozarkbiomedical.com Pacific Medical LLC………………………… 12, 22-23 Ph: 800.449.5328 www.pacificmedicalsupply.com

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Perkins Healthcare Technologies………………… 8 Ph: 877.923.4545 • www.perkins-ht.com Philips Healthcare………………………………… 33 Ph: 800.229.64173 • www.philips.com/mvs Prescott’s Inc.……………………………………… 42 Ph: 800.438.3937 • www.surgicalmicroscopes.com Pronk Technologies………………………………… 29 Ph: 800.609.9802 • www.pronktech.com Quantum Biomedical……………………………… 39 Ph: 855.799.7664 • www.quantumbiomedical.com Radcal Corporation…………………………………30 Ph: 1.626.357.7921 • www.radcal.com Radiology Data……………………………………… 71 Ph: 303.941.4457 • www.radilogydata.com

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RTI Electronics………………………………………58 Ph: 800.222.7537 • www.rtielectronics.com

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Sage Services Group……………………………… 73 Ph: 877.281.7243 • www.SageServicesGroup.com

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Copyright © 2014 Covidien. All rights reserved. Reprinted with the permission of the Surgical Solutions business unit of Covidien Copyright © 2014 Conmed. All rights reserved.

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