TechNation - August 2015

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VOL 6

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

AUGUST 2015

COMPARISON SHOPPING A LOOK AT PURCHASING OPTIONS

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Biomed Adventures Forming Glass and Metal

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The Roundtable Rigid Endoscopes

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What’s on Your Bench Highlighting the Workbenches of HTM Professionals

䨀漀椀渀 漀甀爀 匀甀洀洀攀爀 漀昀 䰀漀瘀攀 䔀瘀攀渀琀 戀攀昀漀爀攀 椀琀ᤠ猀 琀漀漀 氀愀琀攀⸀ 䨀漀椀渀 漀甀爀 匀甀洀洀攀爀 漀昀 䰀漀瘀攀 䔀瘀攀渀琀 戀攀昀漀爀攀 椀琀ᤠ猀 琀漀漀 氀愀琀攀⸀ 眀眀眀⸀瀀愀挀椀昀椀挀洀攀搀椀挀愀氀猀甀瀀瀀氀礀⸀挀漀洀⼀猀甀洀洀攀爀漀昀氀漀瘀攀攀瘀攀渀琀 眀眀眀⸀瀀愀挀椀昀椀挀洀攀搀椀挀愀氀猀甀瀀瀀氀礀⸀挀漀洀⼀猀甀洀洀攀爀漀昀氀漀瘀攀攀瘀攀渀琀 ⌀瀀愀挀椀昀椀挀洀攀搀椀挀愀氀 ⌀猀甀洀洀攀爀漀昀氀漀瘀攀 ⌀瀀愀挀椀昀椀挀洀攀搀椀挀愀氀 ⌀猀甀洀洀攀爀漀昀氀漀瘀攀

倀䄀䌀䤀䘀䤀䌀 䴀䔀䐀䤀䌀䄀䰀 䰀䰀䌀 簀 ㌀㈀㤀㠀㄀ 䌀愀氀氀攀 倀攀爀昀攀挀琀漀Ⰰ 匀愀渀 䨀甀愀渀 䌀愀瀀椀猀琀爀愀渀漀Ⰰ 䌀䄀 㤀㈀㘀㜀㔀 簀 㠀 ⸀㐀㐀㤀⸀㔀㌀㈀㠀 簀 眀眀眀⸀瀀愀挀椀昀椀挀洀攀搀椀挀愀氀猀甀瀀瀀氀礀⸀挀漀洀 倀䄀䌀䤀䘀䤀䌀 䴀䔀䐀䤀䌀䄀䰀 䰀䰀䌀 簀 ㌀㈀㤀㠀㄀ 䌀愀氀氀攀 倀攀爀昀攀挀琀漀Ⰰ 匀愀渀 䨀甀愀渀 䌀愀瀀椀猀琀爀愀渀漀Ⰰ 䌀䄀 㤀㈀㘀㜀㔀 簀 㠀 ⸀㐀㐀㤀⸀㔀㌀㈀㠀 簀 眀眀眀⸀瀀愀挀椀昀椀挀洀攀搀椀挀愀氀猀甀瀀瀀氀礀⸀挀漀洀

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

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THE ROUNDTABLE - RIGID ENDOSCOPES The importance of rigid endoscopes regarding treatment and diagnosis procedures remain despite recent news regarding the proper cleaning of these devices. TechNation reaches out to manufacturers and technicians to find out the latest about rigid endoscopes.

Next month’s Roundtable article: Computed Tomography

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FIGHTING FOR OPTIONS: A LOOK AT PURCHASING OPTIONS There is more than one way to buy a part. We look at options HTM departments have when it comes to purchasing parts. Is it better to have a parts procurement specialist or to empower a biomed to buy parts? Should you always use the OEM or is an ISO the best option? We look at the pros and cons of different approaches.

Next month’s Feature article: Training Options for HTM Professionals

TechNation (Vol. 6, Issue #8) August 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.

AUGUST 2015

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INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Andrew Parker

ART DEPARTMENT

Jonathan Riley Jessica Laurain

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

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

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Kim Callahan

EDITORIAL BOARD

Manny Roman: manny.roman@me.com Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com Eddie Acosta: A Clinical Systems Engineer at Kaiser Permanente, Northern California, Fastedy99@yahoo.com John Noblitt: Program Director at Caldwell Community College & Technical Institute in North Carolina jnoblitt@cccti.edu

P.12 SPOTLIGHT p.12 p.14 p.18

Company Showcase: Tri-Imaging Solutions Professional of the Month: Edward Hurd Department Profile: Pardee Hosptial Biomedical Engineering Services Department p.20 Company Showcase: PartsSource p.24 Biomed Adventures: Forming Glass and Metal

P.26 THE BENCH p.26 p.28 p.31 p.32 p.34 p.37 p.38

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

P.56 EXPERT ADVICE

p.56 Career Center p.58 Ultrasound Tech Expert Sponsored by Conquest Imaging p.60 The Future p.63 Beyond Certification p.64 Karen Waninger p.66 Patrick Lynch p.68 Roman Review

P.70 BREAKROOM p.70 p.72 p.74 p.78

Did You Know?

The Vault What’s on Your Bench Parting Shot

p.77 Index Like us on Facebook, www.facebook.com/TechNationMag

Follow us on Twitter, twitter.com/#!/1TechNation

MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

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Proud supporters of

AUGUST 2015

N ND IO U EE AT SO SE FR LT RA OU SU LT -H N E U IN CO AT ICE R V IG R M SE

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COMPANY SHOWCASE Tri-Imaging Solutions

T

ri-Imaging Solutions is only a few years old, however its rapid growth continues to be fueled by its industry expertise and top-notch customer service.

The company is recognized for high standards and

depth in providing imaging parts and technical support across a wide variety of OEMs and modalities. Another company hallmark is its combination of technical ability and point of sale service support.

Tri-Imaging Solutions was established in early 2013 by Eric Wright, Josh Raines and John Holberg primarily as a GE and Toshiba CT parts and support company. Their collective backgrounds and industry experience facilitated a steep growth curve. In September 2013, Jen Davis and Dan Faulkner joined the team bringing added resources in sales/ customer service and warehouse/ logistics experience.

The growth rate was a challenge for the young company in the beginning, which is one reason why Tri-Imaging made the decision to actively pursue the experience and technical capabilities provided by JET Imaging.

In September 2014, John Drew and Wanda Legate merged their service support company, JET Imaging, with Tri-Imaging. Kim Presley was also brought onboard to help with sales and customer growth.

“JET Imaging aligned perfectly with our business model. It was a

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John Drew and Eric Wright repair a part on a CT machine in the new Tri-Imaging warehouse.

young but strong business, with incredible experience and reputation.

This only strengthened our strategy for growth, helping us build our expanding brand,” Eric Wright said.

“It made sense to combine personnel and services to offer unmatched

opportunities for the imaging community.”

Broad knowledge over a wide range of imaging modalities gives TriImaging the ability to provide expert insights to its customers. The company benefits by utilizing an exceptional team of 14 strategic employees with a combined 155 years of relevant industry experience.

“This level of expertise is one of our greatest values to the customer,” Legate said. “We are able to effi ciently provide quality parts and support services which translates to increased hospital equipment uptime benefitting the department, the doctor, the hospital and most importantly – the patient.”

The company continues to grow at a fast rate. Tri-Imaging is currently moving into a new facility, tripling its space as it continues to increase its current GE and Toshiba CT footprint, while expanding other modalities, (X-ray, cath, and mammo) and manufacturers to its inventory.

“This expansion will allow us to add breadth and depth to our existing offerings,” Legate said.

Tri-Imaging’s goal is to “Empower the Engineer.” This team is committed to the success of the engineer, a customer’s most valuable resource.

“This is our sole focus,” Legate said. “Providing quality imaging parts is just a portion of the value we want to offer, especially with all of the health care changes and uncertainty. We understand the best way to cut cost is to run efficiently.

How better to do that than with

Tri-Imaging’s new office building and warehouse is located in Madison Tennessee.

From left to right: John Drew, Wanda Legate, Josh Raines, Jen Davis, Eric Wright and Kim Presley

“Our goal and mission is to help our customers be successful by providing and developing new tools and techniques to add resources for the engineer, their most valuable asset.” – Wanda Legate your own team? Whether it is an in-house hospital group or service company – we are able to provide support in areas to strengthen, grow and most importantly save them time and money!”

“Technical training is currently in development and it will be second to none. Our highly experienced team will provide technical support and parts, to help diagnose errors and minimize customer downtime,” Wright said.

Tri-Imaging is very excited about the technical training program they will roll out in 2016! Training will address and alleviate some of the concerns regarding the pending shortage of trained engineers. Recent

talk at industry tradeshows, webinars, online forums and everywhere industry professional meet, indicates a growing concern regarding a shortage of engineers entering the technical field. This is further magnified by the estimate that as many as half of the technical engineers and managers will be retiring over the next several years.

This would deeply impact clinical engineering teams and magnify the void between the new and experienced engineer.

With the addition of John Drew to lead the way, they will be offering more than the typical model-specific training. Phase classes and online offerings will help managers efficiently

invest in their engineers to build a team based on their equipment service needs.

“Having spent more than a dozen years in training, plus the last two years in support services, I better understand the gap between training and what the real world engineer needs,” Drew said. “As we listened to our clients wants we knew we had to take a unique and different approach to training. It is always good for the industry to have a choice.”

“Our goal and mission is to help our customers be successful by providing and developing new tools and techniques to add resources for the engineer, their most valuable asset.” Legate explained.

In addition to providing technical support, technical training, and parts, Tri-Imaging also has a robust diagnostic imaging equipment division. This division manages deinstallations, installations, room moves, and the buying and selling of diagnostic imaging equipment.

FOR ADDITIONAL INFORMATION about Tri-Imaging, visit the company’s website at www.triimaging.com.

SPECIAL ADVERTISING SECTION

SPOTLIGHT

PROFESSIONAL OF THE MONTH Edward Hurd

By K. Richard Douglas

W

orking as an imaging engineer for more than 35 years might seem like something that would get old, but it’s still fulfilling for Edward Hurd, who works with the Clinical Engineering Services Department as a Radiology Engineer III at Advocate Sherman Hospital in Elgin, Illinois.

“The challenges of installing and repairing complex imaging systems, designed to aid medical professionals in the care and treatment of patients,” is what Hurd says got him interested in the HTM profession. He thought it would be a fulfilling experience on a professional and personal level.

Hurd has seen it all in his many years as an imaging engineer. Nowadays, he regularly reads network books as well.

Hurd works on a number of modalities including CT scanners, cardiac cath lab, nuclear medicine, general X-ray, C-arms, portables, fluoroscopy, ultrasound systems, mammography, PACS, Kodak laser printers and CR readers. Although he works on most modalities, Hurd specializes in digital cardiac cath-labs.

After receiving a degree in electronics technology, Hurd had an opportunity to work as an installation engineer for Philips Medical, based out of Shelton, Connecticut. That was in the early 1980s. The experience provided a lot of hands-on training and additional training that lasted for 13 months.

“I assembled over 20 systems prior to leaving for a field engineer position in Southern California,” Hurd recalls.

At the time, the move back to Southern California worked out well for Hurd, who was born and raised there.

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His work had him doing installations throughout California, Arizona and Nevada. He spent five or six years doing installations before he moved over to the service department.

He moved from Philips to Cohr/ Masterplan when they started doing imaging. He was part of the group that first started the X-ray imaging group.

There were only three engineers when it began. He then worked for Aramark.

He ended up returning to Masterplan and eventually moved to Michigan and worked for Trinity Health. Remaining in the Midwest, he took his current position with Advocate.

“Ed is an excellent, knowledgeable tech. He takes his work very serious. He currently is an imaging tech who knows cost savings is key for the hospital’s performance. He works everyday to perform the best service for his customers,” says Nicole Serwetnyk, parts procurement specialist in the Clinical Engineering Department at Advocate.

THINKING IT THROUGH Like most HTM professionals, Hurd has seen his share of challenges.

“The challenges that I have encountered along with many of my fellow biomeds and imaging engineers would be the slow and sometimes rapid changes in the health care industry. The

EDWARD HURD Radiology Engineer III at Advocate Sherman Hospital

ability to meet the machine uptime percentages with somewhat reduced budgets and parts costs,” Hurd says.

“I see many of the major OEMs – GE, Philips and Siemens – offering more shared service agreements to sustain their market share and profit margins,” he adds.

Hurd is involved with a new CT scanner project. He is also involved with coordinating between the networking and hospital people when they installed a new Philips Allura FD20 cath-lab for problem-free service. His experience

Edward Hurd is an imaging specialist with knoledge about just about every modality.

allows for extensive knowledge of these systems and he says he has worked on GE, Siemens, Toshiba, Philips, Continental and Picker equipment over the years.

Although Hurd says that he has not had any major challenges in the relatively short time he has been with Advocate, he did help solve a mystery that helped with a vexing problem with a Rimage image store unit.

There was a network problem where the system was “dropping off in the middle of patient transfer of files.” The biomeds had contacted the vendors, reloaded and contacted their own IT support.

Hurd had recently graduated from DeVry with a degree in networking and he thought to go to a couple of technical websites and discovered that the settings for the network configuration card were not correct for their site. After five or six weeks, the device had been able to burn only one disc and then required rebooting. After making the changes, it would run for another five or six weeks with only a hiccup, but a reboot solves the problem. With Hurd’s software changes, the problem was resolved.

Hurd believes in lifelong education and believes learning new technologies is important for growth. He says that since everything has to interact in the 21st Century networking is a reality in hospitals today and it requires constant training.

“Everything is so firewall, so antivirus driven, so software platformdriven and you have these virtual networks and everything has to interact.

It’s amazing what has to happen from when you take an X-ray until when it goes in a server for some doctor to read it 50 or 60 miles away; the technology involved,” he says.

READY FOR THE FUTURE When not on the job, Hurd plays chess and video games. He also enjoys wine tastings and collecting, visiting museums, jazz and hiking.

“I also enjoy traveling and model train sets,” he adds.

Hurd says that readers should know that he is a passionate and dedicated engineer who repairs machines that save lives.

“There is no better feeling on a personal level. And, my longevity in the field, 35-plus years, has been fulfilling and rewarding. I look forward to the upcoming changes in technology from the OEMs and the constantly evolving health care industry,” he says.

With this engineer, the image is clear; there’s always more to learn when old school meets new technology.

FAVORITE MOVIE: “Training Day”

FAVORITE FOOD: French and Italian

HIDDEN TALENT:

I play some piano and clarinet.

FAVORITE PART OF BEING A BIOMED:

“Knowing that my position is critical for patient care and treatment along with facing various technical systems and the challenges they pose [and] having a collection of specialized skills and abilities. Seeing the results of your work saving lives immediately after a down CT scanner, X-ray or cath-lab is repaired.”

WHAT’S ON MY BENCH An energy drink Three phones A pager Medical Dealer magazine Wireless laptop PC Small tool bag

SPOTLIGHT

Buying Repairable 9800 / 9900 HV Cable Cores Call or email us the condition of the cable(s) and we will submit an offer to purchase the part. We will then inspect and test the part to see if it can be repaired. If it is deemed repairable, we will process the transaction and mail you a check the next day.

Email photos and requests to: info@eng-services.com

Also Supplying your GE & OEC Cables at a Price you can Afford

9900, 9800 Receptacle Cables

330.425.9279 X.11 Kenneth C. Saltrick www.eng-services.com 16

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AUGUST 2015

9900, 9800 Interconnect Cables

PARTS • TRAINING • EQUIPMENT • SUPPORT

LET US EMPOWER YOUR TEAM! Tri-Imaging Solutions is a replacement parts, equipment, service support, and technical training company. We provide quality tested imaging parts, buy-sell-move equipment, and provide technical support. All replacement parts come with a 90-day warranty. Available 24/7/365.

855-401-4888 www.triimaging.com sales@triimaging.com AUGUST 2015

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DEPARTMENT PROFILE

Horizon CSA Biomedical Engineering Services Department at Pardee Hospital

By K. Richard Douglas

T

wenty-two miles south of Asheville, North Carolina, the city of Hendersonville is nestled in the western North Carolina mountains. The city is in Henderson County and sits just 15 miles north of the state’s border with South Carolina. The city was officially recognized as the county seat in 1847 and includes many historic buildings, situated in seven historic districts.

In one of those districts, known as the Hyman Heights/Mount Royal Historic District, the city’s first hospital was built.

Patton Memorial Hospital had 13 rooms, including one for operating and a staff of four physicians. Many of those physicians settled in the same area. The hospital opened its doors in 1913 and 40 years later, patients were moved to the city’s new hospital; Margaret R. Pardee Memorial Hospital.

Among the workers who call this beautiful location home, are the HTM professionals with the Biomedical Engineering Services Department at Pardee Hospital. The department’s services are provided through a third-party service provider; Horizon CSA LLC. “The hospital, however, doesn’t view us as a vendor. We are treated by everyone from administration, nursing, imaging techs, to the shipping and receiving department as a valued member of the health care provider team and a trusted advisor,” explains Biomedical Engineering Services Director Matt Yates, CBET, ISE V. The seven-member team believes that they can add more value by being

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scrutinized by their colleagues in administration, directors and other hospital staff.

“By conducting surveys that evaluate several different criteria regarding our performance, behavior, and responsiveness, it gives hospital staff a straightforward approach to keeping us accountable and helping us with process improvement initiatives,” Yates says.

In addition to Yates, the team at Pardee includes BMET III Dave Piercy, BMET II Chad Marrow, BMET II Barry Hudgins, BMET I Carl McMurray, Brian Russell, ISE IV, CRES, and David Campbell.

The department is responsible for over 4,200 assets at the main campus. Pardee Hospital also includes 18 practices, two urgent care, three rehab centers, a cancer treatment and research center, a wellness center and a health education center.

Managed by UNC Health Care, Pardee Hospital is a not-for-profit community hospital founded in 1953. It is the first and only hospital in North Carolina to be accredited with the International Organization for Standardization (ISO) 9001:2008 for quality health care standards.

BEYOND THE USUAL PROJECTS When urgent projects come along and there is a need to expedite a resolution, coordination and cool minds prevail among the HTM professionals. Yates describes a recent example.

“The central monitoring system on our ‘step down unit’ was failing. The manufacturer was involved and still could not maintain constant operation. We obtained quotes for a replacement, coordinated quick meetings with nursing, IT, materials management and administration,” Yates says.

“The manufacturer of the system we chose rushed to get it together and had it drop shipped to the hospital. The system was received in the afternoon and quickly delivered to the ‘unit.’ We were installing the antenna system while the reps were setting the system up. All of this took place from a Friday morning with the system installed and complete on the following Thursday,” he adds.

Yates says that the entire progressive unit needed to be moved to another floor with the HTM team coordinating everything with nursing, engineering and IT. The whole move, including patients and monitoring system, was accomplished in a matter of hours.

Problem solving by HTM professionals can result in creative solutions also.

“We were having an issue with the SPO2 trunk cables on our vital signs monitors being constantly broken from being wrapped tightly around the stand,” Yates says.

“The hospital was having a safety fair for the employees and we decided that we could reach the largest group by

Members of the H ​ orizon CSA Biomedical Engineering Services Department at Pardee Hospital​include, from left to right, ​Chad Marrow, Barry Hudgins, Matt Yates, Carl McMurray and Dave Piercy.

participating,” he adds. “We took pictures of the cables wrapped on the stands and pictures of properly stored cables. We put these on a poster board for display. Our problem all but went away in a very short time.”

QUICK RESPONSE BY A WELL-TRAINED TEAM Service contracts are managed through the department.

“High-end [and] radiology systems are assigned a specific identification number and placed into our software system,” Yates says. “Each item then is tracked for repairs, PMs, recalls, etcetera. Our system generates a PM work order in correlation with the schedule of the manufacturer.

This in turn allows us to insure that the equipment maintenance schedule is adhered to. New service contracts are reviewed prior to approval.”

The department also reviews equipment purchases.

“One of the more considerable impacts that our department has made is being included in the capital equipment

procurement process. No equipment is purchased without our input and approval,” Yates says.

“All medical equipment is managed by the department, including any equipment under contract with OEM vendors. This provides a comprehensive program for the medical equipment as well as keeping other department managers informed on their respective equipment status, repair cost, recalls, and replacement needs,” Yates adds.

Data is managed through a Horizon proprietary software product called Sunrise.

“The software allows us to generate reports needed to manage the equipment and the ability to adapt if there is something special for a specific piece of equipment,” Yates explains. “We have consistently used Sunrise to support us during DNV and CMS inspections and have always had positive results and positive comments made as to the quality documentation of the medical equipment program.”

Yates says that the department stays closely connected with hospital staff and

department heads, allowing them to “keep an accurate inventory and place more of an emphasis on real time data.”

He says that this has enhanced the team’s ability to act faster and keep downtime to a minimum.

“This is crucial in creating positive patient outcomes from an equipment uptime standpoint,” he says.

Career development is a priority for Horizon CSA. The approach includes developing a plan each year for each employee to advance their formal education.

“The training of each technician is specific to the technical needs of the equipment inventory as well as the desire of the individual engineer’s personal and professional growth objectives with an average annual training budget of $10,000 per employee,” Yates explains.

The department also attends AAMI and NCBA symposiums regularly. The biomedical engineering services department at Pardee is a trusted member of the team and they prove their worth every day.

SPOTLIGHT

COMPANY SHOWCASE More than just parts

D

on’t let the name fool you. While medical replacement parts are at the core of their business, the Cleveland, Ohio-based company has reinvented clinical parts procurement with intelligent, innovative technology and workflow solutions.

PARTSSOURCE: PROVEN AND PATENTED SUPPLIER PERFORMANCE PartsSource services clinical engineering, facilities management, purchasing and supply chain within acute and post-acute facilities in addition to Independent Service Organizations (ISOs), MedTech Original Equipment Manufacturers (OEMs) and after-market suppliers.

PartsSource is also a market leader in health care product and service eCommerce software through its in-house built and operated online marketplace for medical device maintenance and repair parts – The PartsSource Catalog.

COMPANY EVOLUTION Founded in 2001, PartsSource is the leading provider of replacement parts solutions for health care. Throughout the past 14 years, the company has over 200 employees and is responsible for several groundbreaking industry firsts. These innovations include a patented suite of technology solutions featuring an algorithm-driven procurement engine and supplier-

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ranking model, a medical parts marketplace offering one-stop shopping for over 3.5 million replacement parts and a mobile application providing portable access to the marketplace.

PartsSource empowers its customers to drive costs out of the health care delivery system while improving outcomes. In addition to automating the highly complex workflow associated with procurement, the company delivers the industry’s only online, fully integrated parts procurement marketplace. PartsSource facilitates more than 300,000 transactions annually by connecting thousands of suppliers and OEMs to over 3,300 acute care facilities and another 2,400-plus non-acute facilities worldwide.

A NEW WAY TO LEVERAGE PARTSSOURCE – FULLY MANAGED SERVICE MODEL PartsSource takes a customer-first approach by tailoring their offering based on needs. Some customers use PartsSource ‘bundling’- mixing and

matching purchases from multiple modalities and services. For providers who would like to realize even greater cost savings, seamless systems interface, the power of PartsSource’s wealth of industry data and more, the company has implemented a fullymanaged service model. This comprehensive, managed procurement program incorporates technology and expertise to create a seamless work environment for clinical engineering and facilities management while delivering the best price, advanced data analytics and a customizable catalog.

TECHNOLOGY The company is a leader in technology serving thousands of customers efficiently in a continually shifting marketplace that is constantly impacted by new innovations which alter the process of acquiring products.

PartsSource’s online marketplace has more than 3.5 million products for users to search, buy and track all purchase activity with an integrated mobile solution compatible with iOS and Android. Customers can use the

Traditional Parts Procurement: Repair Encounter

Tech searches 1,000s of OEMs or suppliers, waits on pricing

Tech decides price, warranty, return, quality terms

Tech individually manages part tracking

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23

BIOMED ADVENTURES Forming Glass and Metal K. Richard Douglas

T

here is one common element that unites the cathedrals of Europe with the tiniest churches across America. Stained glass windows catch the sunlight, adding a mood and reverence that often tells a wordless story.

The old-age craft, like many similar trades, has largely disappeared from the landscape. It is a time consuming art that must be practiced using age-old techniques and methods.

Getting the cuts in the glass just perfect, as shapes emerge from glass, soldering carefully and even forming copper foil around various shapes are all a part of the art.

“My wife was collecting carousels and there was a stained glass studio in a nearby city that was named Carousel Studios. We made a trip to see what carousels they had and found out that not only did they create stained glass art but they also taught classes,” remembers David Dalton, a BMET II with Tallahassee Memorial Healthcare (TMH).

“We ended up signing up for a class.

There are two types of stained glass creation. The leaded method and the copper foil method. We decided to use both in our first pieces. The leaded method is usually used in larger pieces like windows, while the copper foil method is used in lamps, sun catchers and kaleidoscopes.”

The couple’s class and introduction to stained glass was back in the late 1980s or early 1990s.

Dalton learned early on that the hardest tool to perfect is the scoring tool. He says that there is a delicate

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David Dalton is a BMET II with unique hobbies.

balance in mastering it.

“Not enough pressure scoring the glass and it won’t break. Too much pressure, and it will shatter when you go to ‘break’ or separate the glass,” he says.

“You use several different pliers to help you break the glass. Runners help the break ‘run’ along the line that you scored. ‘Breakers’ help you snap the glass at the break and ‘nibblers’ help you take away tiny bits of glass with each pinch,” Dalton

explains. “After choosing your project and the glass you want to use, you first use the scoring tool, runners, breakers and nibblers to get the rough shape of each pattern piece in your project.”

“Then each piece in your project is smoothed and the shape perfected by a wet grinder. After each piece is ground, you will either wrap these pieces with copper foil or lead came and then solder them together,” he adds. “There will be breakage and mistakes but with each piece you cut and grind and connect with solder, you gain the confidence in using each tool of the stained glass trade.”

Crafting a work of stained glass has to have some inspiration and that inspiration was often formed from real life experiences. Dalton says that there are patterns available for many shapes and then others are free hand.

“Inspiration comes from places I been and experienced in my life,” Dalton says. “You can see my work at the Masonic Lodge in Tallahassee, two very large stained glass windows for two different churches, a business logo and several private residents around town.”

He has also done some work with a builder. Most of Dalton’s clients come by word of mouth or because somebody has seen his work. Dalton says that good work can last for generations versus the mass produced versions often seen in retail stores.

POUNDING ON AN ANVIL It may seem a little odd that someone who is used to working with

David Dalton does blacksmith work at Mission San Luis in Tallahassee, Florida.

David Dalton, left, holds a piece he worked on as a blacksmith.

He is pictured with his teacher, Jim Croft.

something as delicate as cutting small pieces of glass would also spend time swinging a hammer and bending metal, but that is Dalton’s other pastime. He also has an interest in the blacksmith trade.

“After seeing several different blacksmiths growing up, I wanted to give it a try. I didn’t know where to start, but I found out that Mission San Luis in Tallahassee, Florida where I live offered beginning blacksmith classes,” he says. “I registered and took the class. The instructor, because this was a 1600 Spanish Mission, taught me how blacksmiths would have practiced their craft back then.”

The first project Dalton made would have been a lamp holder back in the 1600s. Today, the same design can be used as a flower pot holder. He has also worked on spoons and an S-hook.

He just starting trying his hand at blacksmithing earlier this year.

Unlike the many years he has spent getting experience with stained glass work, he is still early in the learning curve with this hobby. He hasn’t moved on to the metal fabrication techniques that employ welders, which is the more modern incarnation of the trade.

NURSE CALL TO HTM Like other HTM professionals, Dalton spends the bulk of his waking hours working on medical equipment.

He has only been a biomed for a few years, but he spent more than eight years installing nurse call systems.

His current boss saw his work ethic and invited him to join the team at TMH. He speaks highly of the department where he works.

“We are the true definition of a

David Dalton and his wife worked together to create this work of stained glass.

team at our hospital. Even though all of us have our specialties, we all try to cross train each other so no matter what piece of equipment has a problem; any one of us can fix it,” Dalton says. “I’m a certified installer and programmer on Rauland Responder 5 Nurse Call and I have a certificate from DITEC on steam sterilizers and boilers and also on Belimed sterilizers. I also have a certificate from Atlanta Biomedical Company for their syringe pumps.”

Dalton says there are some similarities between stained glass and blacksmithing. He says care is taken when working with glass because it is a fragile material, overheating a piece of metal can make it just as fragile. It takes skill and experience to know how to work with both, as this biomed knows well.

SPOTLIGHT

ECRI UPDATE

Middleware Is Everywhere: Can It Help You Meet the National Patient Safety Goal on Clinical Alarms?

M

iddleware is on the minds of health information technology (HIT) experts everywhere. The term has wormed its way into the lexicon of the health care industry as the use of personal communication devices (PCDs) in health systems increases. But what exactly is middleware? How are PCDs, like smartphones, being used to change the face of alarm management?

Until a few years ago, health care alarms were typically localized. They either emanated from the medical device itself or, in the case of physiologic monitors, came from both the monitor and its central station. Can the use of middleware change how alarms are sent out and managed? Will it be able to create a personal notification environment for clinicians that is as simple to use as texting?

Middleware has been described as software that allows for communication and data management between two different systems. Used especially in IT networks, middleware provides messaging services so that different applications can communicate – it tries to glue everything together. While middleware can also facilitate the automation of clinical documentation, perform remote surveillance, and perform data aggregation for retrospective review and analysis, the information below focuses on how its use can revolutionize alarm management and notification.

resulting in deaths and 12 in permanent loss of functions. TJC then issued the 2014 National Patient Safety Goal (NPSG) for hospitals and critical-access hospitals. The NPSG focuses on managing alarms more effectively to reduce alarm fatigue and is to be implemented in two phases: • Phase 1: During 2014, health care providers were required to identify the alarm hazards that organizations will address based on their individual situations.

• Phase 2: As of January 1, 2016, organizations will be expected to have developed and implemented specific policies and procedures to combat hazards and educate staff.

ALARM MANAGEMENT AND NOTIFICATION

SYSTEM DESIGN

In 2013, the Joint Commission (TJC) published a Sentinel Event Alert citing 98 reports of alarm-related events over a 3.5-year period, with 80 of those events

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Alarm management is very complex, and making the most of emerging technologies like middleware may be a critical part of how your hospital responds to the NPSG. A middleware solution can help organizations collect alarms and data for analysis and in turn help them recognize problematic alarms.

Using PCDs to manage alarms can turn the complex alerting process into a simple one – or at least a less complex one. Alerts and alarms from different applications and medical devices may be routed to the

middleware. The middleware can relay the alarms to the communication system that then propagates the messages to PCDs carried by medical personnel. Voice-over IP (VoIP) phones, Wi-Fi phones, smartphones, and pagers can now receive alarms that were once limited and localized. With the advance in technology, these PCDs can now also receive specific information related to the alarm device or alerts from different sources, which can lead to better alarm management.

MIDDLEWARE’S CRITICAL FUNCTIONS Middleware performs critical functions, such as: • Prioritization of alarms • Assignments (staff assignments, schedules) • Alarm escalations • Routing assignments - Individual: the system sends the message to an individual only - Group: an alarm condition, such as a code blue, is set to propagate to a team • Report generation and information logs • Complex event processing: combines messages from multiple sources to infer

events or patterns that suggest more complicated circumstances Properly implemented, these systems can expedite alarm notification and response times, improve alarm management, reduce alarm fatigue, and create a quieter healing environment for patients by directly notifying clinicians or caregivers via PCD and sending multiple alerts to a PCD from different alarm sources.

Of the many critical functions the middleware performs within an alarm management system, the following require great attention: - Prioritization: The alarm management system must have a built-in prioritization capability. More than one alarm may emanate from a single device, and guidelines must clearly state which alert takes precedence.

Accurate mapping of priorities is necessary for the system to work effectively.

- Escalation: Alarm escalation schemes are critical to the successful implementation of an effective system.

It is essential to narrow down which alarms and alerts are to be transmitted via the middleware to the PCD. Proper implementation of an alerts system takes into account how alarms are escalated and to whom they are sent.

Failover redundancies should be built in, and alarms should automatically be escalated within a certain time frame if the primary caregiver does not acknowledge an alarm.

- Reporting: Reducing the number of problematic alarms requires robust alarm management strategies and data analysis. Alarm systems using

middleware are built to collect just that type of data. They can create reports specific to a particular care unit, to an individual device, or even based on a particular alarm priority level. This ability is vital, as it allows organizations to parse their data to find problematic alarm areas. This level of reporting can also arm an organization with audit trails to track alert delivery and response times.

Alarm reports generated through a system’s middleware help educate a facility’s staff and helps them understand how to customize the type of alarms they receive.

-Managing assignments: Using middleware in your alarm management system allows staff to create appropriate correlations between caregivers and their assigned patients, between caregivers and their PCD, and between caregivers and their backup “buddy,” which can include other members of their group who can provide coverage, the Code Blue Team, and others.

Working with your middleware vendor and your alarm consultant is important to discuss the types of care models that are already established in your organization.

Nursing care delivery models like centralized monitoring, decentralized monitoring, or a hybrid of the two will affect your choice of how your system is designed and what middleware is required.

Alarm middleware is highly complex and very customizable. Because the cost of these systems depend on their configurations, it’s not uncommon for a hospital to spend more than $100,000 to implement them. To make sure you are

getting the right system for your hospitals and their nursing care delivery models, it’s imperative to have a good design team in place. A good multidisciplinary team should include not only members of the clinical staff, but also IT, facilities, and biomedical engineering.

One of the biggest considerations the team must focus on is testing the middleware alarm management system. It is imperative to exhaustively analyze the system to ensure that alarms are transmitted and received properly. A “sandbox” testing environment should be set up to evaluate how well the escalation scheme functions when priority level alarms are sent. A testing environment can help identify potential glitches during software and hardware upgrades. Alarm integration is one technology in which performance improvements can be great – or devastating. Deep analysis, planning, and testing are essential to success.

THIS ARTICLE IS EXCERPTED FROM ECRI Institute’s 2015 Top 10 Hospital C-Suite Watch List, which includes more information on what to do to meet the National Patient Safety Goal. Download the watch list for free at www.ecri.org/2015watchlist. Want to know more about middleware vendors?

Purchase the recording of ECRI’s middleware vendor webinar at www.ecri. org/middleware. To learn more, visit www. ecri.org; call (610) 825-6000; or e-mail communications@ecri.org.

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AAMI UPDATE

AAMI 2015 Wraps Up with Record Attendance

T

he AAMI 2015 Annual Conference & Expo, an unrivaled event for healthcare technology management (HTM) professionals, had a banner year with more than 2,000 people registering for the event – a new record.

The Denver event, AAMI’s 49th annual conference, featured a wealth of education sessions and speakers.

The event kicked off with an opening general session from cybersecurity expert Billy Rios, co-founder of Laconicly, which provides training and professional security services. He warned that attackers are becoming increasingly sophisticated.

“I’ve been attacking and defending computers all of my adult life,” said Rios.

“But this is definitely a young person’s game, and it’s hard to keep up. You will face someone better than I.” Tejal Gandhi, M.D., president and chief executive officer of the National Patient Safety Foundation, spoke during the Dwight E. Harken Memorial Lecture, saying that while it is a given that patient safety is an important aspect of health care delivery, more work remains to be done to ensure that optimal care is delivered.

“We really need to change the culture in health care so people are comfortable speaking up,” Gandhi said.

Asking patients what is important to them can go a long way toward

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improving clinical outcomes and helping in the management of chronic conditions, she added. She detailed four other potential areas for improvement: care across the continuum, the workforce, transparency and metrics, and the use of health information technology.

On the final day of the conference, George Mills, director of the Department of Engineering at The Joint Commission, told a packed room that healthcare technology management (HTM) professionals can play a key role in curbing an easily preventable cause of patient deaths.

According to Mills, 770,000 patients are affected by hospital-acquired infections each year. Of that number, approximately 80,000 die. “Who thinks that’s an acceptable number?” he asked.

While it may seem like a simple solution, hand hygiene can play a major role in preventing these infections, he said. This emphasis needs to be ingrained in the culture of HTM departments, he stressed.

Mills also described the use of predictive medical equipment maintenance, saying it could be a big help to busy HTM professionals.

In terms of equipment maintenance strategies, Mills recommended starting with manufacturer recommendations as a baseline, then revising as needed from that point, with the key caveat that the process used is “defensible.”

Although Mills noted that predictive maintenance can be a boon for HTM professionals, it cannot be viewed as simply a “set it and forget it” type of action; predictive maintenance strategies require ongoing re-evaluation and follow-up.

AAMI PUBLICATIONS, BLOG SCORE AWARDS Capping off a record-breaking year, AAMI has won honors for publication excellence in a nationwide competition that drew more than 1,800 entries.

The Awards for Publication Excellence (APEX), bestowed by Communications Concepts, Inc., pay tribute to publishers, editors, writers and designers who create print, Web, electronic and social media.

The organization, which advises publication and communications program on best practices, honored AAMI with three awards this year. Combined with the results of two other national competitions for publications and social media resources, AAMI has collected eight awards this year – the most ever.

“We’re delighted that our publications and resources are winning national recognition,” said Sean Loughlin, AAMI’s vice president of communications. “Our staff editors know that these resources are important to our members, and we want to give them the best content possible. It’s important to note that our publications rely heavily on the contributions of many volunteers in the AAMI community, and we are so grateful for their efforts.”

In the APEX competition, AAMI News took honors in the one- to two-person produced newsletter category. BI&T (Biomedical Instrumentation & Technology), AAMI’s peer-reviewed journal, won for an interview with Ann Prestipino, senior vice president with Massachusetts General Hospital in Boston. In her moving interview, she recounted the day of the Boston Marathon bombings and how her facility dealt with the flood of patients. Finally,

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Last month, AAMI took home four awards from the American Society of Healthcare Publication Editors (ASHPE) contest, which recognizes “excellence in publications development and editorial performance.” BI&T nabbed two awards, while AAMI News and Horizons, a biannual supplement to BI&T, each earned one.

This is not the first time AAMI publications picked up multiple awards in a single year. Last year, AAMI picked up six awards in two national competitions, including four from ASHPE.

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he Electrical Safety Manual 2015, authored by consultant Matt Baretich, outlines the key components of an electrical safety program for medical devices and how to implement such a program. It also provides an overview of important codes, standards, and regulations that affect medical devices.

The updated manual places an emphasis on ensuring that electrically powered devices are as free as possible from hazards. It notes that electrical safety has been enhanced over the years with improvements to the design of medical devices and stronger maintenance programs. Two big updates are the inclusion of material regarding facilityrelated electrical safety – particularly information on isolated power systems – and the 2012 update to the National Fire Protection Association 99 Health Care Facilities Code.

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Webinar

Wednesday

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By John Wallace, Editor

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hirin Khanna, a leading force behind product innovation at Fluke Biomedical, recently shared her vast knowledge regarding infusion pump testing with the TechNation community via the free Webinar Wednesday series.

In “5 Ways to Optimize your Infusion Test Strategy – How to increase productivity and manage risk” Khanna discussed the growing number of infusion pumps being used in the United States and how to tackle more tests while increasing productivity and reducing risk. Each webinar attendee was eligible for 0.1 credits for the ICC.

were a big part of the webinar as Khanna reviewed accepted procedures and how the IDA-1S and IDA-5 infusion device analyzers from Fluke Biomedical can assist with testing requirements. A brief video about the two infusion device analyzers is currently available on the TechNation website at www.1technation.com/5ways-to-optimize-your-infusion-test-

“ Webinars continue to be extremely helpful to our current needs in staying on top of technology advancements and changing work practices.”

- Albert R. Khanna examined the latest in infusion pump testing, demonstrated how to leverage test automation to increase productivity and avoid common errors associated with infusion pump testing.

Interactive polls during the webinar helped Khanna address specific concerns of attendees regarding their infusion pump testing needs and preferences. Flow and measure testing

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strategy-how-to-increase-productivityand-manage-risk/.

Khanna gave a thorough presentation hitting on the pros and cons of different accepted testing procedures, including the graduated burette, beaker balance and electronic analyzer testing methods for flow. She also addressed the benefits and weaknesses of different tests for volume accuracy.

More than 200 people attended the webinar sponsored by Fluke Biomedical and gave the presentation a 4.0 rating on a fivepoint scale with 5.0 being the best possible score.

The ability to attend educational sessions from the comfort of the Biomed shop is just one reason HTM professionals love the webinars series.

“Webinars continue to be extremely helpful to our current needs in staying on top of technology advancements and changing work practices,” Albert R. wrote in his post-webinar survey.

“Keep them coming. I am currently trying to set up a professional development club within my department and this would be a good resource to get the continuing education we all desperately need,” Bart O. wrote.

A free recording of the webinar is available online.

More than 2,500 people have attended a Webinar Wednesday session in 2015 with an average attendance of 313 attendees per webinar.

TO REGISTER for the next free Webinar Wednesday session, visit 1TechNation.com. Recordings of previous webinars are available on the website.

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BIOMED 101

Professional Liabilities of a Biomedical Engineering Department

By Eddie Acosta

T

he Food and Drug Administration (FDA) has specified that there are nearly 1,700 different categories of medical equipment devices. The variety of medical equipment devices is immense and differs drastically from blood pressure monitors, thermometers, pacemakers and heart valves, to medical lasers for dermatology, radiographic and fluoroscopic X-ray machines and therapeutic and diagnostic ultrasound equipment. Despite the fact that these medical equipment devices can vary from simple hand use equipment to highly technological units, they all are intended with the objective of saving or improving lives.

Unfortunately, any one of these medical devices can malfunction due to defects or failures that prevent these medical devices from working properly. Also, if this equipment has not been correctly maintained, it can negatively intensify the condition of a patient.

I recently attended a course on medical law and ethics and was informed that negligence “is the failure or omission to perform professional duties to an accepted standard of care, such as a reasonable person would do.” The class also detailed that an unintentional tort “happens when a person has no intentions of injuring a patient.” Health care professionals can be sued for a variety of situations, but most lawsuits are brought forth due to the unintentional tort of negligence. There is the propensity that more than one person or group can be held liable for negligence when a medical equipment device fails to operate properly and injures a patient.

Biomedical engineering departments support medical equipment devices and they do not expect the medical devices they maintain to cause injury. But there is the possibility that medical equipment devices can be inadequately or poorly maintained with substandard quality materials that can inflict injuries to patients. Hospitals and health care providers use medical equipment that is maintained by biomedical engineering departments or service repair companies for medical procedures on patients. They can be held liable if the medical equipment device malfunctions and

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causes injuries to a patient.

Hospitals can be held liable for medical equipment failure for many different reasons. For example, hospitals can be liable in negligence or medical malpractice if they fail to maintain medical equipment properly.

They also can be liable for failure to properly train medical professionals in operating the equipment. If they fail to properly train hospital staff in using medical equipment and that leads to the careless operation or improper use of the equipment, this can cause the hospital to be liable.

Health care providers can also be liable for failing to test medical equipment prior to using it on patients. It is normally accepted that the equipment furnished by a hospital for a patient’s use should be operational and safe for the uses and purposes intended under the conditions.

One practical way to avoid and prevent negligence with the use of medical equipment is to have a comprehensive preventive maintenance program and medical equipment operational training when equipment is installed and continual training as staff comes on board.

A recent medical equipment incident of an electrosurgical unit (ESU) that was investigated was used on a patient that

EDDIE ACOSTA, CBET, CLRT Clinical System Engineer, Kaiser Permanente, TechNation Editorial Board

underwent a sinus and tonsillectomy procedure. A grounding patient pad had been placed on the patient’s thigh for the possible use of mono-polar current. The surgeon used an uninsulated forceps in bipolar, with a metal suction coagulator and a metal mouth gag. Even though monopolar current was never used the patient received burns to the internal commissure on both sides of their mouth. The injury was

described as very painful, with a lengthy recovery, and plastic surgery was likely. The ESU device was examined with the forceps, the non-insulated body of the entire forceps have radio frequency (RF) applied to them when activated. As a result it was possible to have a patient burn from the side of the handle with direct contact, especially if it occurred over an extended amount of time.

This could have also limited the bipolar forceps effectiveness and possibly require more power to effectively coagulate the intended area. With the description provided, it was not possible to determine the exact cause of the burn but there was likely some RF leakage from the side of the forceps during use.

Use of the uninsulated forceps should be limited to areas where no unintended patient contact with the forceps body is likely. The report described all the available bipolar forceps offered by the manufacture and it identified the options for tip type for both the insulated and the non-insulated forceps. The ESU was fully inspected and HF tested, no field corrective action was warranted since no device failure was found and the burn likely occurred due to a use error and additional information and training was recommended for the use of insulated and the non-insulated forceps.

Medical equipment devices are intended to be used in very specific methods and have manufacturer’s instructions for their use.

The manufacturers of these medical equipment devices also provide operational training for proper use and maintenance training to properly maintain the equipment. If doctors or other medical professionals do not follow the manufacturer’s instructions for the intended use or ignores warnings concerning the medical device, they may be liable for negligence. They may also be liable if they were aware of potential hazards of the device and they failed to advise the patient of the dangers.

In addition, if the medical equipment device was not being maintained correctly, or if there is an issue with negligence in use of the device, the doctor or other medical professionals may be liable for negligence

and a medical malpractice lawsuit will be probable. If the manufacturer of the medical equipment device is at fault for an injury, a product liability claim can be processed rather than a medical malpractice claim.

Malpractice claims point blame on a particular entity, product liabilities are more concerned with protecting consumers from dangerous products. The supplier of medical devices that distribute or sell them – such as

service of medical equipment. The sale of refurbished equipment causing bodily injury, wrong calibrations of medical equipment causing injury or even death, or destruction of equipment as a result of your servicing are examples of events that are not covered by most insurance policies. The appropriate insurance coverage should be acquired for protection against lawsuits due to these events.

“ I f you provide equipment for use or service and repair medical equipment, you can be liable for negligence for damage or injury that results from servicing the equipment. Therefore, many hospitals and medical businesses are demanding that service repair companies maintain insurance coverage that protects both the service company and the client against these types of incidences.”

drug stores or medical supply stores – can also be held liable. A product liability lawsuit may be brought if a defective medical device is sold by the supplier and they may also be a liable party in a lawsuit along with the manufacture.

In conclusion, where a hospital Biomedical Engineering department or service company controls and maintains medical equipment, to the moment a medical professional or physician uses it, it will usually be held liable for unapparent defects in the product. If you provide equipment for use or service and repair medical equipment, you can be liable for negligence for damage or injury that results from servicing the equipment. Therefore, many hospitals and medical businesses are demanding that service repair companies maintain insurance coverage that protects both the service company and the client against these types of incidences. Most standard insurance packages exclude coverage from incidents resulting from the

Additionally, hospitals, service companies and manufacturers of defective medical products can be held liable for product defects and commonly the plaintiffs will sue the manufacturer, the service company and the hospital. Despite the fact that actions against hospitals for defective products generally allege negligence, lawsuits against the manufacturers of medical equipment devices are usually brought as product liability actions. If a product manufacturer is no longer in business, a plaintiff’s only alternative may be to sue the hospital or service company. A comprehensive preventive maintenance program and making sure service documentation is in order can limit liability. Providing service training to engineers and documenting that they are trained, and ensuring that adequate liability insurance is provided, can prevent or reduce the liability to a patient incident.

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AUGUST 2015

WEBSITE REDESIGN

New, redesigned TechNation website boasts added features Staff Reports

T

he TechNation web development team announces the launch of the brand new, redesigned TechNation website at www.1TechNation.com!

MD Publishing Founder and President John Krieg said the new website is designed to give the readers of TechNation magazine more of what they want by incorporating more videos and highlighting the popular Webinar Wednesday series.

The site also features industry news updates and makes everything easier to find.

Some of the benefits of the new TechNation site include all TechNation magazine articles, including the latest digital issue and an archive of previous issues.

The Webinar Wednesday series is available with information about upcoming presentations available to members of the HTM community. The site also includes recordings of previous webinars. All of the webinar material is available free of charge thanks to sponsorships.

THE BENCH

Informational videos are a new element on the TechNation homepage with more expected to be added in coming months. These are informative and entertaining videos pertinent to HTM professionals.

The great TechNation blogs are featured on the website with insights from industry leaders, including Manny Roman, Abbe Meehan, Al Moretti and Frank Magnarelli.

Biomeds help other biomeds on the TechNation website via forums with user groups, including a social network community. The TechNation Listserv is also a popular feature of the TechNation community. Sign up to interact with other professionals by offering advice and finding answers to issues.

The Web Development team asks that visitors alert them of any issues on the website via email at web@mdpublishing.com.

Thanks in advance for being a part of our new TechNation website community at http://1technation.com. To become a member of the site, visit http://1technation.com/ become-a-member/.

AUGUST 2015

1TECHNATION.COM

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SHOP TALK Q:

I had a question for those BMETs and managers who are already in the field. I am soon to graduate with an associate of science degree in biomedical engineering technology and have the opportunity to continue my education. I would like to know which of these two degrees would get me in the door/further in my career. Both would take the same amount of semesters to complete.

1. Bachelor’s of science in engineering technology with a concentration in electrical engineering 2. Bachelor’s of applied science in information technology management I would think the engineering technology degree would be better, but have been told throughout the program I am in that a lot of troubleshooting is getting into the network side of infrastructure. Any opinions or advice would be greatly appreciated.

A:

Unless you plan on pursuing an engineering degree and change from being a BMET/CBET to a biomedical engineer, I would definitely pursue the IT degree. If you can, obtain as much knowledge as you can regarding networking with patient monitoring and data transfer. You can’t go wrong having an IT background for a tool.

A: A:

1TECHNATION.COM

A:

As an HTM director, I would give this advice. Determine your career path. Do you wish to be a clinical engineer? Certified Clinical Engineer (CCE) requires an engineering degree.

Regardless of the direction of our industry we do still need engineering skills. Some organizations do require CCE at the director and above level. That being said, unless you have determined that CCE is your future, IT is a more appropriate degree and offers a BMET more opportunity. In many organizations, HTM leadership is reporting to IT via CIO or CTO. That is the case in my organization.

In my role of director of HTM, I have additional IT duties outside of traditional HTM. If your goal is departmental leadership and above, my advice would be to get a bachelor’s of science in an IT field followed by an MBA with a concentration in IT management. Learning networking fundamentals is critical to success for today’s BMETs. Understanding the business aspect of things is critical for those desiring leadership roles.

A:

I strongly agree. I find I am becoming less of a repairer and more of an equipment babysitter!

A:

I agree!

Based on the direction the industry is heading my recommendation would be for the IT path. As time moves on I find that I use my applied electronics knowledge

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less, and my computer hardware and networking knowledge more.

AUGUST 2015

I would agree if your plans are to work in a hospital biomed department. My background is laboratory equipment. In general, these days the equipment is electronically very stable. The techs spend more time on networking than repairing. If you are considering going to

work for a manufacturer then I would suggest the engineering path. The best engineers that I have ever known are ones who started in the field. They had a much better understanding of how equipment is used versus how it is intended to be used.

A:

It seems to me that most want to see experience and for you to become CBET certified. I would say that if you have the opportunity at this point to try to apply for a job and get started.

Unless you want to get school over quicker and take more classes. I am not saying that the more education that you get is not better, but sometimes the question is asked in interviews to why you chose a four-year program opposed to a two-year program.

Most do this to one day have the opportunity to go into management or become directors. This will not happen in less than five years more than likely. So, if it were me, I would get into the field if at all possible, continue your education, and have it finished in a few more years. Then, you will have about five years of experience or so when you finish school and will have the chance to explore more options. Also, depending on where you land a job, some pay a percentage of your schooling if you continue your education.

On a side note, to directly answer your question, I would go for the clinical engineering one, and take a couple of network classes individually. Clinical engineering is more directly related to what we are doing, but, as you said, networking is becoming a more day-to-day part of the job, especially when IT is reluctant to assist you in equipment that “does not belong to them.”

Q:

I am very interested in the Certified Healthcare Technology Manager (CHTM) certification. Is anyone interested in forming a virtual online study group to prepare for this test? I am looking for those committed to actually taking the test and participating in the group.

A:

I just took this exam this morning.

While I will not disclose the exact questions I may remember, I will be glad to discuss the general nature of the exam and the areas of expertise needed.

A:

I would be interested. I have been seriously considering pursuing CHTM certification, but know very little about the test.

A:

I would like to discuss the exam as well as which areas I would need to bush up on.

A: A:

I am interested in the test and the information that is available.

I would be interested in studying for this exam as well if we can get something together.

A:

I’d be interested as well. A study group would likely be a good option.

I am interested!

I am also interested.

To all those who have expressed an interest in forming a CHTM study group, I believe the first step should be collecting and sharing of contact information so that we can communicate as a group. If you’d like to send me (john. walsh@rwjuh.edu) your email address and hospital/company information, I will

A:

Thanks for taking the initiative in doing this. I requested study information from the career center at AAMI while in Denver and there was nothing available. I did purchase “A Practicum for Healthcare Technology Management” book at the AAMI store. It looks like good reference material.

PROOF APPROVED CHANGES NEEDED

PROO

A:

I also am very interested in this CLIENT SIGN–OFF: certification for CHTM. How would we setPLEASE this up?CONFIRM THAT THE FOLLOWING ARE CORRECT

A:

LOGO

PHONE NUMBER

I would be interested in learning more about this new certification as

well.

A:

I think it is great. Remember, there are only 100 questions total, so there will only be a few in any one area.

Pay attention to EBIDA. Also, pay lots of attention to Cost of Service Ration (COSR).

A: Q:

ADDRESS

SPELLING

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WHY PAY MORE?

I am interested in a study group.

I feel Arjo is gouging me on patient lift repairs and parts, I have heard that Hill-Rom has better prices. Your thoughts and experience?

A:

We got rid of our Arjos a long time ago and went with the EZ-Way lifts (Mobile). They have great tech support and are easy to work on. I can’t say on the Hill-Roms.

A:

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compile a list and distribute the list back out to each of you, and to Chris (who had the idea for a study group). We can then start the process of collecting and distributing information about the test.

ROUNDTABLE Rigid Endoscopes

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NOVEMBER AUGUST 2014 2015

E

ndoscopes are an important medical tool. There are a variety of different endoscopes, including rigid and flexible varieties, tailored for specific procedures and uses within the health care arena. The proper cleaning and disinfection of these devices has been a big topic in the news recently regarding patient safety concerns. The importance of these devices regarding treatment and diagnosis procedures remain and that is one reason experts are working to outline specific cleaning procedures for all types of scopes. TechNation reached out to manufacturers and technicians to find out the latest about rigid endoscopes.

The panel of industry experts for the roundtable discussion includes Kelly Klink, Product Manager, Rigid Endoscopy and Fiber Optic Repair Divisions, Mobile Instrument Service and Repair Inc.; Marci Morgan, Lead Scope Technician, Scopeplus + Labs Inc.; Darryl Rock, Business Unit Vice President, Surgical Endoscopy and Systems Integration, Olympus Corporation of the Americas; and George Wright, President and CEO, Integrated Endoscopy.

Q:

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN RIGID ENDOSCOPES AND IN THE RIGID ENDOSCOPE MARKET IN THE PAST YEAR?

Wright: One significant technology advance in the rigid endoscope market is the introduction of the first single-use arthroscope, providing a new option for facilities that may help them better manage costs and eliminate cumbersome, time-consuming reprocessing requirements. The development of high-quality, single-use surgical instruments is increasing rapidly in ORs and ambulatory surgery centers, especially in the field of orthopedic surgery. Several factors are driving increased demand for single-use devices, including ease-of-use, lower cost, instrument accuracy, and the elimination of infection risk.

Klink: Manufacturers are answering the call for smaller endoscopes which significantly reduce patient trauma, blood loss and recovery time. While the make-up of the optic system is relatively the same, (glass rods, spacers, etc.) they are becoming smaller by design.

Morgan: In my opinion there have not been many changes in a long time. Most scope manufacturers continue to use the same rod lens systems for over 10 years.

Each manufacture has about three different lens systems they use based on scope diameter and length. One example is a rod lens that is used in 4 mm cystoscopes made by one of the biggest and most popular companies. I have used this same diameter and length lens for these scopes for more than 15 years.

There are also a few major manufactures that share the same lens system. Yes, you can take one system out of one manufacturer’s scope and put it in the other. Once you have a bright, clear and focused image there are not many things to improve on. Why reinvent the wheel.

Glues have changed to autoclavable types that will take the 272° temperatures.

Eyepiece material and colors also have been tweaked a little. Yes HD and 3D scopes are out there, but with the cost I don’t see many of them.

Q:

KELLY KINK

Product Manager, Rigid Endoscopy and Fiber Optic Repair Divisions, Mobile Instrument Service and Repair Inc.

Rock: The rigid endoscope market has seen only a few significant changes over the past 25 years. More recently, 4K Ultra High Definition (UHD) rigid endoscopes are advancing imaging technology along with 4K Imaging Platforms. The new glass lens telescopes used in the new 4K system offer four times the resolution and color reproduction than HD telescopes.

Olympus will introduce the 4K UHD in the coming months for both 5 mm/10 mm telescopes to be followed by 4 mm arthroscopes and sinuscopes.

HOW WILL THOSE CHANGES IMPACT RIGID ENDOSCOPE MAINTENANCE? Klink: Smaller naturally means more delicate, which creates a challenge in handling the scope for everyone from the sterile processing technician to the surgical technician and physician. Having the correct storage, transport and cleaning resources on hand is vital.

Education on proper care and handling for everyone who touches them from the end user (physician) to the sterile processing staff is an absolute must to help reduce damage.

Morgan: Scope repairs years ago were somewhat easier in that the scopes were not autoclavable. The glues were not as strong so opening the scope took less time

THE ROUNDTABLE

and heat. Internally, there are very few changes. The lens systems haven’t changed. External things like gold plating and colored rings have always been replaced. The new glues are more expensive and take time to cure, but you adjust repair procedures to this change.

Mechanically each manufacturer’s scope is made different. Each has its own special way to disassemble. Most repair facilities have their own set of procedures, tools and fixtures for this.

ownership of equipment such as endoscopes, and not just the cost to acquire new technologies. This allows physicians to consider technologies that will help them achieve long-term goals.

Facilities with limited budgets are looking for device manufacturers to provide technologies that can be maximized across multiple specialties. Universal platforms are a great solution.

Rock: The all-in-one design of the ENDOEYE videoscope helps to reduce the number of points along the imaging chain where the image can degrade over time. 4K Technology will provide significant improvements in clarity and visualization resulting from the increase in resolution.

Wright: Single-use rigid endoscopes eliminate two key issues associated with reusable endoscopes — reprocessing and maintenance/repairs. Reusable endoscopes must be cleaned and sterilized or high-level disinfected after every use, and extensive documentation, handling, storage, and inventory requirements must be followed. In addition, reusable endoscopes get damaged during use, handling and reprocessing. As a result, they are sent out for repair an average of six times a year, and lifetime repair costs can amount to more than twice the purchase price.

Q:

WHAT TECHNOLOGIES ARE WORTHY OF THE INITIAL INVESTMENT? HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE RIGID ENDOSCOPE NEEDS OF TODAY? Klink: The high-definition video equipment on the market today can give even the most basic type of endoscope an incredible image. So while the endoscope plays a major part, the HD image displayed on screen is much more a function of the video equipment. A good way to upgrade is to sell older equipment and apply the proceeds to the purchase price of newer, more advanced models.

Working with a reputable leasing

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1TECHNATION.COM

MARCI MORGAN

Lead Scope Technician, Scopeplus + Labs Inc.

company can also help make upgrades more affordable. Finally, taking a hard look at repair costs and providers can also free up funds. For example, repair-exchange programs are incredibly convenient, but if you do not need the rapid replacement, you are overpaying for repairs. Those savings can be applied to expanding or upgrading inventory.

Morgan: Scopes have not changed much over the years. Most urological and orthopedic procedures have used the same scope and instrumentation for years. There are some new very expensive scopes out there. Scopes with flexible distal ends and robotics are there but again I don’t see many. Some surgical procedures are now preformed with smaller diameter scopes and sheaths.

They basically take the same lens design and grind it to a smaller diameter. This allows a procedure to use a 3 mm scope rather than a 4 mm. Reduced stress on the patient with a smaller diameter sheath is a plus. On the downside, the scope is repaired more often because of the smaller size. It breaks quicker.

Rock: Facilities are beginning to expand their scopes to look at the overall cost of

AUGUST 2015

Wright: Maintaining an adequate inventory of endoscopes to meet surgical demands requires a significant investment for facilities. Single-use arthroscopes provide an option that eliminates the need to invest in large inventories of more expensive reusable scopes. This is particularly useful in ambulatory surgery settings, where closely managing costs is crucial for profitability.

Q:

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING RIGID ENDOSCOPES? Klink: Too often, purchases are not thought through. Taking time to carefully assess your real needs is key. Look at your inventory and what gets used. Review your caseload and build a forecast of your needs so you can optimize your inventory and approach to repairs and maintenance. And most of all, get custom education from your repair supplier.

OEMs and third parties have textbook classes. Demand a program that is tailored to your facility so you can make the class more relevant to staff. If rigid scopes are maintained and cared for correctly, they will last many years and the supporting equipment (video cameras, processors, monitors, etc.) is where the investment should be focused.

Morgan: Occasionally we see repairs come in from manufacturers you have never heard of. It can be a problem if no replacement parts are available. If the eyepiece is broken and there isn’t a replacement around, we have to make a drawing and send it to the machine shop.

This could add 2-3 hours to the repair.

Make sure the scope is readily used in the

industry and serviced by local, qualified repair facilities. If it has to always go back to the manufacture, they are now in control. We can take a 10-year-old scope, rebuild it with new tubing, light fibers and lenses. It’s now a perfect scope ready for surgery. The manufacture tells you it’s not serviced anymore. They sell you a brand new scope with the same components inside that was just deemed not repairable or serviced anymore.

Rock: Many vendors provide rigid endoscopes, but not all scopes are created equal. High-quality instruments typically provide more value with better visualization and long-term quality than low-cost, low-quality products. Service also is something that can’t be taken lightly. Many facilities invest in high-end technology, but then trust third-party entities to repair that technology instead of taking it back to the OEM. Service by the OEM is critical because only the OEM can provide original parts that are designed to be used with each specific rigid or flexible endoscope. Using the OEM for service will ensure the longevity of the equipment and maximize the investment.

Wright: When purchasers look at making an investment in rigid endoscopes and are considering either reusable or single-use scopes, it is important that they consider the total cost of ownership. A Millennium Research Group study found that the greatest costs associated with rigid endoscopes are attributable not to purchase price, but to scope backup/ inventory requirements, repair, refurbishment, sterilization and OR downtime — contributing an additional 650 percent above the purchase cost over the life of the device.

Q:

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR WHEN DECIDING WHETHER TO GO WITH AN ORIGINAL EQUIPMENT MANUFACTURER OR A REPUTABLE THIRD-PARTY RIGID ENDOSCOPE PROVIDER? Klink: Quality – Does the provider return

assembled by another source that puts their name on it. I have heard company reps say they can’t buy the same lens we use. Why have I repaired scopes for 25 years and always get perfect images? Is the doctor seeing a different picture with my repair? I have meet with many German lens designers and manufactures over the years. They make lenses and sell them all over the world. We order them with a specific diameter, length and focal distance. Most manufacturers don’t even fix your scope, they give you another scope that someone broke or dropped that has been refurbished. Why not get the same scope you own, refurbished and sent back to you?

DARRYL ROCK

Business Unit Vice President, Surgical Endoscopy and Systems Integration, Olympus Corporation of the Americas

the scope to its exact original specifications and designs or simply do the minimum needed to make it work again? Parts – Are new parts used when a replacement is needed or are parts salvaged from other scopes? Reliability – What specific experience do they have with the equipment you use? Relationship – Will they provide you with the education and tools you need to keep your repair budget in check? Are they a hands-off type of company (call me when it’s broke) or are they hands-on, and work with you and - your staff to resolve issues and reduce repairs? There are some providers that propose bundled offers. It’s important to look it over closely, understand the real cost for the components you need and make sure it fits your vision. Most times facilities are purchasing equipment they may never utilize to get a discount on a large purchase. But in the end, they may find that some of those items never get taken out of the box.

Morgan: Chevrolet does not make tires.

They buy them from tire manufactures.

Most scope manufactures buy tubing, light fibers, glues and lenses from many different sources and have them

Rock: The term “Original Equipment Manufacturer” says it all. The original manufacturer has the parts, as well as the product history and intelligence to produce and maintain the highest quality product. Many OEMs, including Olympus, do not provide proprietary parts to third-party vendors, so once a third-party vendor has worked on a scope it is no longer validated by Olympus. This also will play a vital role in how the endoscope is reprocessed under CDS standards. OEMs are FDA “regulated” and held to specific standards which are set and routinely monitored. Most third-party vendors are instead FDA “registered,” which does not hold them to the same standards.

Olympus takes pride in the quality of its devices and utilizes patented processes to maintain the highest quality standards in manufacturing and repair that, in our experience, third-party vendors cannot duplicate.

Wright: We believe the answer is not whether an OEM or third-party manufacturer is the issue but, more importantly, the technology behind the rigid endoscope. Things like high-quality lenses, elimination of outmoded fiberoptic technology, the use of state-of-the-art LED illumination, and the elimination of potential cross contamination from accumulated bioburden are much more important issues.

When looked at in this context, the new technology found in the single-use arthroscope is perhaps the best answer.

THE ROUNDTABLE

Morgan: If they are buying a new scope get one from a reputable company. Make sure the company has been making these for a long time. Don’t buy the first of the line. I know of a company that specializes in ENT. They came out with a urological line of scopes. I got three calls asking if I knew where they could get it repaired.

Hmm …

Q:

IS IT POSSIBLE TO KEEP UP WITH THE LATEST RIGID ENDOSCOPE ADVANCES AND IMPROVEMENTS WITHOUT BUYING BRAND NEW? WHAT ARE SOME OF THE NEWER TECHNOLOGIES AVAILABLE? Klink: There are many times that model upgrades put on the market really have no functional or internal changes from the prior model produced. Similar to the automotive marketplace, a new scope might boast a new look on the outside, but under the hood, it’s largely the same components. Video arthroscopes have been a mainstay for a long time. Until a few years ago, they were largely unchanged in their basic design. What is new on many models is a magnetic drive focus assembly. It gives the orthopedic surgeon a smooth rotation and takes minimal effort to fine tune an image.

Morgan: As stated earlier there are HD and 3D scopes in the market. I don’t see many of them. The most common scopes are 2.7 or 4 mm diameter for ENT, orthopedics and urology. That hasn’t changed in 20 years. The lens systems are still the same. Most of the advances have come in video and recording devices.

Rock: New technologies enable facilities to offer patients the newest advancements in health care. Customer upgrade programs help facilities afford the newest technologies. For example, Olympus’ 3D imaging is a cost-effective upgrade for facilities who own the latest Olympus 2D imaging system. The modular design of the EXERA III Universal Platform (compatible with all current rigid endoscopes) provides an economical upgrade path from 2D to 3D imaging since a facility can add the necessary items to their system after purchasing the base 2D system.

Wright: Over time, endoscopes get damaged and degraded in optical quality due to frequent use, handling and reprocessing. In fact, most surgeons performing endoscopic surgery rarely get to use a brand new endoscope. Single-use

44

1TECHNATION.COM

GEORGE WRIGHT

President and CEO, Integrated Endoscopy

endoscopes leverage technology used to mass-produce small, high-definition glass lenses for cellphone cameras, as well as patented, inexpensive, and durable LED technology to produce a low-cost, single-use endoscope with high-definition optics. As a result, single-use arthroscopes provide a first time experience for every surgeon, every time.

Q:

Rock: The initial attraction of a low-priced product can be tempting, but there is more to consider than acquisition price. Added benefits, such as on-site training, education, and support necessary to learn and maintain the equipment can be costly afterthoughts.

Olympus provides a variety of educational resources for customers included with their purchase.

Additionally, service plans help health care providers protect their investments by extending the useful life of their endoscopes, and maximizing procedural uptime and clinical performance. Full service agreements offer a fixed annual repair rate, eliminating the guesswork for repair budgets. Literature and training tools also are provided by OEMs to support customers’ needs for education and training of proper use, care and handling of these products.

HOW CAN PURCHASERS ENSURE THEY ARE MAKING A WISE INVESTMENT IN A RIGID ENDOSCOPE? HOW CAN THEY ENSURE THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS?

Wright: Purchasers should research all options and consider the most recent technology advances in order to make decisions based on their specific needs and budgets. Speak with the manufacturer to ensure that all literature and training tools are obtained, and keep them on file for future use.

Klink: Look at need first. Understand what physicians want and need for their caseload. Then, involve people who are behind the scenes including people responsible for reprocessing and maintenance. A team approach works best. We’d suggest including language in the purchase agreement that stipulates the type and frequency of education sessions and access to documentation for staff. We think quarterly assessments of staff and processes and facilities are key to long-term repair management. If you cannot get this from your OEM, ask others in the market to step in.

Q:

AUGUST 2015

WHAT ELSE WOULD YOU LIKE TO ADD OR DO YOU THINK IS IMPORTANT FOR BIOMEDS TO KNOW ABOUT RIGID ENDOSCOPES? Klink: Rigid endoscopes are workhorses.

If repaired, reprocessed correctly and handled with care, they can last many years. OEMs discontinue models from time to time and inform facilities that they no longer support/service them. That shouldn’t make your facility have a knee-jerk reaction and fear that you need

to purchase new equipment. We routinely see well-maintained older rigid endoscopes arriving for repair that are 10 plus years old. If the inventory of rigid scopes is adequate and the needs of the surgeons are being satisfied, the investment should be more focused on the supporting equipment that enhances the rigid endoscope and the surgical view it provides to the surgical team.

what’s inside. They actually handle items better now that they have learned more about lenses and light fibers.

Rock: Olympus understands downtime due to equipment repairs can result in lost revenue for health care facilities so we recently put into place the Olympus Uptime Guarantee. This agreement guarantees next-day equipment replacements for Olympus full service agreement customers at no charge. These are the types of programs and support that OEM vendors provide to customers to ensure their total cost of ownership is in line with budget needs.

Morgan: If they have the opportunity to go and see a local repair facility, then go.

Find out if they really do it. Everyone uses other facilities in some way. Most of us are friends and help each other. Make sure they specialize in something. Either Wright: Endoscopic surgery has rapidly they do scopes, cameras or related evolved into the gold standard for instrumentation. I have had biomed efficient, lower-risk surgical procedures. technicians, doctors, OR and SPD staff at PROOF APPROVED CHANGES NEEDED However, recent infection outbreaks have my repair facility many times. They all increased awareness about patient safety have left with a better knowledge and CLIENT SIGN–OFF: issues connected with inadequately understanding how things are made and

PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS

reprocessed scopes. In addition, a recent study in the American Journal of Infection Control showed that repetitive use and reprocessing causes alterations to the surface of endoscopes, with the incidence of endoscope contamination directly proportional to the number of times it was used and reprocessed. The results suggest the necessity of limiting the duration of time reusable scopes may be used. Some have called single-use instruments the “way of the future” because they have the potential to minimize the risk of infection transmission, improve operating room efficiency, and help hospital and ASC control costs.

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There are several strategies for parts acquisition. None is perfect.

VS

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COMPARISON SHOPPING A LOOK AT PURCHASING OPTIONS

By K. Richard Douglas

VS

BY K RICHARD DOUGLAS

D

ecisions, decisions; every day is fraught with them.

There are often multiple considerations involved in making a decision and most of the ones related to health care today are overshadowed by budget concerns. It’s never a cut and dry choice.

Like everything in the information age, there is a boatload of data available to go into the decision-making process. That fact has not skipped over the question of parts, the procurement process and who makes decisions. With multiple options comes lots of questions in order to make an informed decision.

Who is involved and responsible for parts purchases? Is it biomed? Is it a parts procurement division or person?

How are facilities using CMMS software to manage and keep inventory? How can this help with parts purchasing options?

There are also concerns about how you compare the quality of parts and judging quality versus price. Do you let the biomeds do repairs and have somebody else buy parts and take care of acquisition? What are the pros and cons of having a dedicated parts procurement specialist versus having an HTM professional handle this task?

“Repair parts for medical equipment can be costly. But equipment downtime and the additional labor from installing bad parts can be even more costly,”

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says Patrick Lynch, CCE, CBET, fACCE, CHTS-PW, CPHIMS, Biomedical Support Specialist with Global Medical Imaging (GMI).

“There are several strategies for parts acquisition. None is perfect. None of them meets all of the goals of lowest price; highest quality; speedy delivery; tech support and liberal return policy,” Lynch adds.

Lynch’s observation explains the conundrum that many HTM professionals face; achieving several objectives that might be impossible to deliver on. Some may even be mutually exclusive.

In some HTM departments, within larger institutions, a specialist handles the many considerations of procuring parts.

“At ProHealth Care, I’m the Biomed Procurement Specialist who sources parts for availability, quality, price, issues the purchase orders, tracks delivery, handles returns of exchanges and/or incorrect parts, and enters all this detail into work orders for all our techs,” says Mickie Wong, RN. “We also have a Biomed Department Assistant, Rosa Dunton, who provides similar service for no charge/warranty/ service contract parts.”

Within departments that can have a person dedicated to this function, it alleviates the question about how much time the HTM professional has to spend reviewing all the considerations involved.

“At ProHealth Care, Rob Bundick, our Biomed Manager, stresses the importance of our technicians ‘turning a wrench,’ understanding that the tech’s time is best spent focused on corrective and preventive maintenance versus time spent on the phone/ computer performing clerical functions involved in obtaining parts/service that can be performed by myself and/or our office support staff,” she says.

PATRICK LYNCH, CCE, CBET, FACCE, CHTS-PW, CPHIMS

Biomedical Support Specialsts, Global Medical

One of the considerations that a procurement specialist or an HTM professional is faced with is whether or not buying parts from the OEM is the way to go. There are clearly arguments on both sides of this approach. Cost is generally at the top of the list.

BUYING FROM THE OEM “In my mind there are two strategies; buying all of the parts from the OEM, or a mixed approach, buying from the OEM and selected third parties, as there are some parts only available from the OEM,” says Ken Maddock, BSEET, who co-taught a course titled “Device Supportability: The Dos and Don’ts of Using Replacement Parts” at the 2015 AAMI Conference and Expo.

“The pros of buying from the OEM is

“

Buying parts from the OEM is the path of least resistance, and typically, is the most efficient when you consider the amount of work your organization has to do to purchase parts, especially if you consider technician time.

- Ken Maddock

DAVE FRANCOEUR

Regional Vice President at Compass HealthCare Technology Solutions

that theoretically you should be getting the best quality parts that are almost guaranteed to work with your device.

Although this is theoretical, it is a very high probability,” Maddock says.

“Buying parts from the OEM is the path of least resistance, and typically, is the most efficient when you consider the amount of work your organization has to do to purchase parts, especially if you consider technician time,” he adds.

“You also promote a strong relationship with the OEM by using only their parts.”

Maddock says that on the flip side is that you “typically pay a higher cost than other options and you can generate complacency on the part of the OEM if they think you aren’t open to other options.”

He also points out that there are times when the OEM may have a part on back order that is available immediately from an alternate vendor.

According to Wong, some of the pros of using OEM parts include: the OEM provides updated info on the latest rev

level, there is tech phone support to confirm which part/rev level is needed, a comfort in knowing/avoiding [the] fear factor that you will receive the same replacement part and the OEM typically has a larger inventory when parts are needed quickly.

Like Maddock, Wong cites higher costs as a con, along with “resistance to provide support if an ISO’s part is used.”

When the downside is price, the HTM professional is faced with one of those conundrums mentioned.

“This is the hardest component of our role in my opinion. The role of a HTM professional is to ensure the medical equipment for which they are responsible for is available and working properly so it is ready for use,” says Dave Francoeur, regional vice president at Compass HealthCare Technology Solutions.

“There is a constant balance between cost and quality, and while an organization you collect a paycheck from may feel one way about that, the organization that you are providing the

services for may feel another,” he adds.

Francoeur says that there are very complicated algorithms that “take into consideration price, usage, failure rates, life cycle cost and life expectancies.”

“Then you need to layer on factors associated with what makes best sense for your organization. Balancing price, customer satisfaction, and as always; risk. My personal perspective is that over time, it usually equals out ‘pay me now or pay me later.’ When one attempts to cut corners, assuming all things being equal, eventually you will make up the difference in cost in some manner. Frequency of failures, customer satisfaction, down time/lost revenue, risk/adverse outcome,” Francoeur says.

The price/quality equation seems to be central to any debate about using OEM sourced parts. It begs the question; how do you balance price versus quality?

“There is no absolute answer to this question. It depends on your organization’s philosophy on where it prefers to live on the risk curve,”

COMPARISON SHOPPING

“

[Using an ISO offers] greater negotiating power for lower prices, warranties, and/or keeping exchange parts.

- Mickie Wong

KEN MADDOCK, BSEET

Maddock says. “Some organizations are willing to take little risk where quality is concerned, but more and more are willing to live with more risk if it potentially involves significant costsavings. For the HTM leader, in my opinion, you have to use typical risk assessment strategies. You evaluate the possibility of a negative impact along with the potential outcome. If the possibility of a negative impact is low and the potential cost-savings great, it is an easy decision.”

But Maddock points out that most decisions aren’t easy. He suggests that it is better to err on the side of the negative impact because of the potential impact on patient outcomes and patient safety.

“If the potential savings aren’t significant, I believe you select the choice with the lowest potential for a negative impact. Again, you have to understand your organization’s philosophy on risk and use that to assist you with the tough decisions.

Sometimes you just have to make a tough choice and be willing to live with the outcome,” he says.

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From a parts procurement specialist vantage point, the price/quality issue has clearly delineated borders.

“Price is not an issue when our uptime on a hard down situation — with no backup equipment — will always take priority. However, when we’ve worked with ISOs long enough, we gain a trust in their refurbishing capabilities for quality,” Wong explains.

“For those situations, when we can only obtain a used or refurbished part from an unknown vendor, then higher price is desirable over questionable quality.”

USING AN ISO “Obviously cost is always the major factor in attempting to secure parts for devices needing preventative or correct maintenance. The balance needs to come from finding the appropriate partner(s)

that can provide the right price, right quality, and in the appropriate time frame,” Francoeur says.

“These three criteria are paramount to the success of any good progressive organization that wants to make a positive difference,” he adds. The value of partnering with an independent service organization are the scales of economies. As an ISO, it allows for acquiring large quantities of products, driving maximization of value, as well as the leverage of driving change.”

Wong adds that there are typically lower costs with an ISO and they bring an increased availability of parts for older equipment. This provides the additional benefit of not having to upgrade or replace obsolete equipment when parts are still available on the secondary market.

She says that another positive for using an ISO is “greater negotiating power for lower prices, warranties, and/ or keeping exchange parts.”

MICKIE WONG, RN

Biomedical Procument Specialist ProHealth Care

Maddock says hospitals have an additional option when a procurement specialist, or another person in the HTM department isn’t assigned to this task.

“Many organizations use their supply chain department to purchase parts for the HTM team. The advantage of this is that you are utilizing existing personnel trained for the purpose and it should be more efficient if managed properly with an appropriate mechanism for acquiring parts on an emergency basis,” he says.

“There are also some organizations that will reach an agreement for a third-party to purchase all HTM parts if they feel there is a financial advantage and have done all of the background checking to verify proper controls and the viability of the third-party organization,” he adds. “I am not aware of any organization that allows the HTM department to acquire medical equipment other than items below the capital limit that are used for spares.”

“I truly believe in the old adage

– What got you here today, may not be what gets you there tomorrow,” says Francoeur. “We should continually challenge ourselves to make sure what has worked in the past is still the best solution today. Within the ISO world, having dedicated resources and maximizing on that benefit absolutely nets the best results, and we are provided with data continually we can use to challenge and prove that point.”

Francoeur says that changes will be made whenever an opportunity for improvement is found. He says that resources dedicated to procurement will intentionally and randomly vet certain services and purchases to validate that the price, quality and delivery that they are receiving, are the best they can be.

“The biggest factor for both OEMs or ISOs is knowing the vendor and asking: is [the] part new, refurbished, or used/as-is; who is the OEM of that part — since it’s often-times not the manufacturer themselves — do they refurbish themselves, [and] if so, what is their experience, where are parts manufactured – oversees, etcetera, and the age of our equipment,” Wong says.

HTM DOES IT ALL When the decision falls to an HTM professional, as it so often does, then let the HTM pro own it lock, stock and barrel.

“Let the BMET find the part and choose the vendor – this works very well, as the BMET is responsible for the complete repair and will choose the best overall parts vendor,” Lynch says.

On the flip side, Lynch says that there can be a problem, with an increased workload. A BMET is an expensive person to have chasing down parts. He says that there is always the possibility

“

I truly believe in the old adage – What got you here today, may not be what gets you there tomorrow.

– Dave Francoeur

also that they may be aware of only the older, established vendors and not in touch with newer, more innovative providers.

“Probably the best overall scenario to meet the complex needs of the hospital is to allow the hospital HTM administration to select preferred vendors, negotiating deals, discounts, training, etcetera, and then let the individual BMET place orders and manage the transactional events,” Lynch says.

Whichever strategy is employed, a balance between quality parts, availability and a budgetary focus must be found. Thin budgets paired with patient safety makes for challenging times and more complex decisions.

COMPARISON SHOPPING

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55

CAREER CENTER

Surviving The Resume Screening Process

T

By Cindy Stephens

he competition for jobs is very tough in today’s economy and the hiring process can be discouraging as well as challenging for applicants and hiring officials. To complicate the hiring process, websites and online applicants can get lost in the piles of resumes submitted for job opportunities. Human Resources professionals and hiring managers have to delve through the resumes quickly and often the best candidate may lose out on the opportunity because of very simple mistakes.

Cindy Stephens Stephens International Recruiting, Inc.

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We often receive calls from candidates who do not understand why they were not considered for a job they expressed interest in or submitted a resume for. As a recruiter, and I am certain many HR professionals will agree, we see and hear all sorts of things when it comes to candidates applying for positions. In this tight job market, applicants are disregarded right away because of the simple mistakes they make in the job search process For example, today we received an email from a candidate who was very interested in a great opportunity we had advertised on our website. When we attempted to contact this senior level technician, his cellphone was “not set up to receive calls.” Another example is when we attempted to leave a voicemail message for another terrific candidate, he did not have his voicemail set up. Both of these are good examples of ruling out a candidate quickly! So if you are looking for a job, it would be smart to accept incoming calls or at least have your voicemail set up so hiring authorities, recruiters and HR professionals are able to reach you.

It is a good idea to ensure your voicemail message reflects professionalism

AUGUST 2015

on both cell and home phones. Replace any funny voicemail messages with a message that reflects you as a professional.

Be sure to respond to messages as soon as possible. We have dealt with unemployed candidates who took a week to reply to email and voicemail messages. If you are serious about getting a job your response should not take longer than a day to respond.

Writing and submitting a resume is just the beginning of the job search, and it is the “first impression” that hiring officials have of the applicant. It is very important that the resume conveys that the candidate is qualified and competent.

Ensure your resume is up-to-date and error free. Honestly assess your background and be prepared with explanations for any weak points. Be sure to present your background in a thorough and accurate manner, highlighting a few specific accomplishments in your prior positions. Review your career achievements and relate your major strengths and accomplishments as they relate to the job you are applying for.

Know how your experiences, training, education and skills can be applied and valuable in the position being offered.

We are seeing more and more resumes that do not include complete contact details (street address, city, state, telephone and email). Sometimes the resume templates found on the Internet are not the best to use when it ignores this important detail. This simple mistake makes candidates appear unprofessional. You might also want to change your email address if it is “unprofessional.”

If the resume is well written and the qualifications are a match, the next “first impression” will be a telephone interview.

To ensure the telephone interview goes

TRIM 2.25”

are trying to see how you can contribute to the company. Sell yourself but do not brag, and don’t talk so much that you talk yourself out of the job. You must present a professional and upbeat attitude to the prospective employer.

Communication skills are extremely important. Your ability to formulate and respond to questions can mean the difference in making it to the next step of the interview process. Listening skills also demonstrate the manner in which you follow instructions. Never interrupt the interviewer, even though you may have a response ready. Clarifying the question exhibits good listening and communication skills.

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If youJLdo not make a positive impression early, you will not make it to a face-to-face interview.

If you’re reading Once you make it to a face-to-face this, then print interview, you must continue to be ads still work. So prepared and professional. It is up to would yours. you to convey reliability, enthusiasm, honesty, integrity, confidence, and communication skills during your interview.

Competition is at an all-time high and you must standout to survive the resume 800.906.3373 screening process to get to an interview. mdpublishing.com Do not overlook the simple things, and remember that preparation is the key to ensure that you don’t lose out on an opportunity because of simple mistakes.

STOP

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well, find a quiet room and do not allow interruptions. Remain 100 percent focused on the interview. If you are asked to do a Skype interview, be sure to practice the setup and the call with a family member or friend ahead of time. For a Skype interview, we highly recommend a very professional appearance.

When speaking with clients, one of the main reasons they do not consider an applicant after an interview is because the candidate was unable to “sell” their skills and qualifications to the hiring authority.

Preparation is a big part of the interview process. Research the company and learn as much as possible about the company as well as the position requirements to ensure the position and the company are a good fit for you. If necessary, prepare a few specific questions for clarification during the interview. Go to the company’s website and get to know their products and services as well as their goals and mission statement. Be prepared to tell the hiring authority why their company is attractive to you. The interviewer will be impressed that you took the time to research their company, and that knowledge will indicate that you are a serious and informed candidate.

Be enthusiastic about the job itself, your career, and the prospective company. Employers look for people who love what they do, and those who get excited about the job.

When you speak with potential employers, always remain positive and never bad mouth former employers, companies or peers. Biomed is a very small industry and the person you speak negatively about might be a part of the hiring decision.

Express confidence and competency that you can do the job. The interviewers

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MATT TOMORY VP Sales and Marketing, Conquest Imaging

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The electrical safety testing procedures for console based systems is fairly uniform but portables are more make/model specific. For example, on the GE Vivid series, GE states since the transformer is completely encased in plastic and very low DC voltages are used, no enclosure leakage testing is needed unless the system is integrated into a cart and then the cart is tested to NFPA 99 standards. The GE Logiq series states you should use “accessible metal surfaces” and test to IEC 60601-1 Medical Equipment Safety Standards.

On the other hand, Biosound systems and the Philips CX-50 transformer have integrated ground lugs and leakage is tested as you would a console based system. As with all PM and safety procedures, please consult the manufacturer’s service manual and follow their guidelines to ensure conformance.

Repairing these systems has been a challenge due to the high level of integration of components and sub-

AUGUST 2015

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Heat is a common issue with these systems as well. Ensure all cooling grates have clearance and are cleaned thoroughly and that the system is used on a hard surface to ensure adequate airflow beneath the system.

One of the most common problems we see are malfunctions and damage caused by mishandling; ensure all operators are aware of how fragile the displays, hinges, hard drives and user interfaces are to mitigate mishandling issues.

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59

THE FUTURE Reminder to Move

By Roger A. Bowles

B

y the title of this column, it might seem that a career change or residence change is on tap. Not so. However, with the weather being like it has been over the past two months here in Texas, the thought had crossed my mind. First, the record setting rains and storms in May. I don’t think I have ever spent so much time in the closet with a handheld weather radio and I’m starting to think a tornado shelter might be a wise investment.

Then, just when the weather starts to break a bit, Tropical Storm Bill rushes up and dumps another 6 to 8 inches of rain. But all in all, I think we have been luckier than some. The roof is still intact and most of the trees are still standing.

Roger A. Bowles MS, EdD, CBET, Department Chair BMET at Texas State Tecnhical College, Waco

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I missed the AAMI conference this year for the first time in probably over 10 years.

Budgets are getting tighter and changes are coming fast and furiously. Besides the weather in Denver, I’m sure it was a fantastic conference and I hope to attend another one in the near future. Thankfully, MD Expo is coming to Dallas next year. It will be held April 21-23 at the Fairmont Hotel.

No, the title for this column didn’t come from the weather or the changes occurring in our program. The title came from the incessant buzzing and beeping from the device strapped to my wrist. In the interest of my health, and at the insistence of my wife, I bought a Garmin VivoFit 2. It is an ingenious little thing that counts my steps, watches my sleep patterns, and probably a few other things that I haven’t figured out yet. From what I have read, I’m supposed to be taking at least 10,000 steps per day – something that undoubtedly was not a problem back when I worked as a BMET in a hospital. These days, apparently that is not as easy as I thought with meetings and staring at a computer screen for hours on end. The neat thing about this device is that when it senses that I have been inactive for a while, it beeps and vibrates prompting me to get up and move. I’m not sure I’m losing any weight, but I am taking a lot more steps! Not being a gym rat, I

AUGUST 2015

“ I’m a firm believer that when it comes to careers, we are either growing or dying. I need to be learning something new every year and preferably more often than that.” guess I need some prompting to take better care of my health.

It would be nice if someone would invent one of these things for our careers.

If it sensed no growth or movement for a while, it would light up, start flashing and buzzing and tell us that we are inactive and need to do something before we become obsolete. I’ve been at Texas State Technical College for a long time and away from the day-to-day life of a biomed.

Sometimes it is a struggle to keep up with all of the changes. It takes effort and I’ll be the first to admit that I don’t always apply

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as much effort as needed. I was reminded of that recently when talking with some former (and very successful) graduates about ultrasound. True, the equipment we use is typically older because it is donated, but sometimes older is too old and needs to be replaced as the technology is truly obsolete. We are working on that now and I’m soon to get updated with training courtesy of our friends at GMI. I’m a firm believer that when it comes to careers, we are either growing or dying. I need to be learning something new every year and preferably more often than that.

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BEYOND CERTIFICATION What is a CHTM?

By David Scott

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HTM is a Certified Healthcare Technology Manager. It is one of the newest certifications from the AAMI Credentialing Institute. In the last Beyond Certification article I touched on it a little. It covers two areas: the management of healthcare technology operations; and, the management of personnel. The manager functions include participation in the leadership of the business enterprise.

The manager is also expected to have the skills and understanding needed to perform strategic, business, and change management as well as employee relations.

David Scott CABMET Study Group Organizer, Children’s Hospital Colorado

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Like the CBET, CRES and CLES there are minimum requirements to take the test. There are five different paths to meet these requirements. They are: Path 1 – A current certification as a clinical engineer (CCE), CBET, CRES, CLES with at least three years of work experience as a supervisor or manager in the last five years.

Path 2 – Successful completion of the Department of Defense’s biomedical equipment maintenance technician (DOD BMET) training program with at least three years of work experience, military or civilian, as an HTM supervisor or manager in the last five years.

Path 3 – An associate degree in biomedical technology, related health care discipline, information technology or business with at least three years of work experience as an HTM supervisor or manager in the last five years.

Path 4 – A bachelor’s degree or higher in biomedical technology, engineering, related health care discipline, information technology or business with at least two years as a manager within the last five years.

Path 5 – Work experience with or without a degree not related to

biomedical technology, related health care discipline, information technology, or business management. Seven years of work experience in the HTM field with three years of management experience in the last five years.

In each of these paths if you don’t have the title of supervisor or manager, you would have to confirm that you perform management duties either through self or third-party attestation.

The CHTM test questions will be based in five categories. They are: financial management (19 percent of test), risk management (12 percent of test), operations management (46 percent of test), education and training (11 percent of test), and human resources (12 percent of test). The questions will ask about recall, application and analysis of each category.

The CHTM test schedule is different from the other tests (CBET, CRES, CLES). It is available four times a year instead of only three .

If you work in a leadership role I think you should at least look into the certification. The CHTM Handbook can be found on the AAMI website at http:// goo.gl/o1pzgD. Until next time, keep your journal up to date.

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KAREN WANINGER What Does That Mean?

By Karen Waninger

I

have always believed that it’s important to keep learning. I have also come to realize the value of lessons learned through life experiences. After completing any step along the formal education path, there is always the challenge of being able to retain and effectively apply what was learned. That same concept holds true with the lasting impact from life experiences. Just as each student retains different pieces of information from a lecture or reading assignment, each significant event in life may leave a different impression on every individual who shared in the experience. Have you ever thought about why people remember things differently?

KAREN WANINGER, MBA, CBET MBA, CBET

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Has there been a time that you remember vivid details of an event, yet another person who was with you the whole time cannot even remember that he or she was there? If it’s a spouse or significant other, we may write it off as them intentionally having selective memory (just like selective hearing) and not think much about it, right? There are other times, though, where it doesn’t seem possible that someone could completely forget what someone else perceived as a memorable event.

Do you know what factors are involved in determining whether something will be retained or forgotten? According to one publication on the Study of Intelligence from the Central Intelligence Agency, “the contents of memory form a continuous input into the analytical process, and anything that influences what information is remembered or retrieved from memory also influences the outcome of analysis.” I understand that to state that if you have a positive experience when a memory happens, it will be a positive experience when you retrieve the memory, or vice versa. You remember based on what has meaning to you.

I started doing some random, informal research into the factors required to create “meaning” within any situation. Terms that surfaced frequently include: substantive, of value, important, make a

AUGUST 2015

difference, have influence, and affect. My findings can be summarized with a simple statement. People must care about something for it to have meaning to them, and they will only remember things they care about.

Now translate that to the requirements for achieving success within the HTM profession. If you are part of the HTM profession, regardless of your specific role, you had to learn at least a few things to get to this point. It is reasonable to expect that you will have to continue to learn if you want to be effective in this profession in the future, and it will probably be helpful if you retain at least a portion of what you learn along the way. My recommendation is to direct your energy toward an end goal that will have lasting meaning for you, and not be distracted by aspects of the journey that may be less rewarding. Focus on the aspects of the role that you care the most about, and remember what is required to ultimately be successful in that role.

Let me explain what I mean by using a correlating example. I have remembered some specific details from my past experiences that I am not sure I actually cared about, like the formulas that are still bouncing around in my head from my college classes. I don’t think I had any feelings toward the formulas, but in retrospect I realize that I cared about passing the classes so I could graduate and

find a meaningful job. Learning those formulas was a necessary task to make that possible, so I cared about them in an indirect manner.

Within the HTM profession, there are some tasks that we may not enjoy. Most of us dislike the requirements for documenting our activities, and many of us are uncomfortable when we have to communicate directly with the users of the equipment when they are displeased about an equipment related situation. In the course of delivering service, there are times of frustration when parts are not delivered on time, or when an intermittent failure eludes our best troubleshooting efforts.

For those in management roles, perhaps the challenge of dealing with budget constraints or regulatory requirements is overshadowing the joy that comes from

seeing the professional growth of your team members. We all have days like those, where there are more frustrations than rewards, but we keep working toward that end goal of being successful, of overcoming whatever the challenges are that we face along the way. We are in this profession because we care, directly or indirectly, about doing things of value and making a positive difference for our customers and the patients we serve. That is what it means to be an HTM professional.

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By Patrick Lynch

I

attend lots of conferences. Most are local. Many are state. Some are national. I have noticed a very disturbing pattern that I believe is contributing to our profession not being recognized for the value we have to contribute. I am referring to the ability to talk to other people.

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

While at the annual AAMI conference in Denver, I was in many meetings.

These were in large rooms, many with poor acoustics. The use of microphones was a requirement. Some of these meetings had 50 or more participants in them. These participants were, in most cases, the leaders of the professions or their local organizations. I became totally frustrated and embarrassed at the inability of half of these HTM professionals to introduce themselves in a manner that was understandable, of adequate volume to be heard by all, and was succinct to the topics of interest to the rest of the group.

Let me offer a few tips to make us more professional in all of our meetings, both in and out of the hospital.

BODY LANGUAGE When addressing a group, especially a large group, it is customary to stand up, look at your audience, make eye contact, and scan the room as you make your talk.

MUTTERERS So many of these individuals seemed to have no idea that they were in a room with other people. They seemed to be carrying on a conversation with

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themselves instead of an esteemed group of colleagues.

VOLUME Although many started speaking in a normal volume, as they became lost in their thoughts, their volume drifted down into a whisper and their chins sometimes touched their chests. They seemed to lose awareness of the audience.

MICROPHONE MANAGEMENT Speaking into a microphone is an art. It takes practice. The most difficult is admittedly a hand-held that is passed from person to person. As you turn your head, become animated, and move about, the microphone moves closer and farther from your mouth, resulting in some very frustrating volume changes for your audience. Holding it the correct distance from your mouth and maintaining this distance can be very challenging.

I have developed a foolproof technique. 1) Grasp the microphone just below the windscreen (the metal mesh ball at the top). 2) Place all four fingers around the microphone. 3) While holding the microphone with your fingers, stick your thumb up, like you are making the “thumbs-up� sign. 4) Touch

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your thumb to your chin while speaking into the microphone. This maintains a perfect distance, allowing you to turn your head and move about without varying the distance between your mouth and the microphone.

•

CONTENT It is tempting to launch into a self-aggrandizing tirade when you have the microphone and the attention of a roomful of people. But trust me, you are doing more harm than good when you go off touting your accomplishments or travels if they do not directly relate to the subject at hand. Rehearse, think ahead, and keep it short and sweet.

Here are a few key items to remember as you prepare to attend a meeting: • Stand Up. In all but a very small meeting with people you know very well, it is a sign of respect to stand up when making your initial introduction or presenting an important point.

• Look at your audience. Sales 101.

Engage. All meetings between people

•

•

•

are sales opportunities. You are working together to achieve a common goal, but if you have an idea, your goal is to have it embraced and accepted by the others. Professionalism is key. Look various members of the audience directly in the eye. It makes your points seem more believable and you seem more trustworthy.

Speak Up! Yes, in HTM, we largely come from the realm of engineers and techies. But that is no excuse to not be able to speak up and ennunciate.

Practice controlling the volume of your voice, matching your volume to the size of the room and the ambient noise present. And remember, too loud is as bad as too soft.

Hold the microphone stable. Use the thumb on chin technique to keep consistent volume and look like a pro.

Think ahead. Consider your audience, what they are interested in, and what you could say that would be meaningful to them.

Keep it topical. Listen to the instructions from the moderator, and pay attention to the kinds of things that the people before you told the group.

Learn from them, and make your talk better than theirs by adding things they omitted and omitting things they should have left out.

Practice. Nothing replaces practice.

Every point here can be vastly improved with practice. Get in front of the bathroom mirror and practice all of the items in this list.

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It’s Lonely at the Top

By Manny Roman

I

recently received John Maxwell’s “A Minute With Maxwell” titled “Lonely.” He spoke about his new book for a while and then talked about it being lonely at the top. He states that if you are lonely at the top, you are not a leader, you are a hiker. Leaders always have people around them. I agree with him so I decided to explore the lonely at the top thing further.

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

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Quite often you hear that leaders are like eagles. They don’t flock and you find them one at a time. The comparison to an eagle does not mean that leaders are rare and lonely, it means that leaders have a clear and great vision and courage to act on that vision. Eagles have powerful vision and pinpoint accuracy, to the detriment of the targeted mouse or fish, of course.

The comparison also means that leaders do not surround themselves with those who lack vision and positive attitude. They want to lead those who are willing to support, commit and contribute to the mission. Average people want to take the easy route. They do not want to be led, they want to be pushed and prodded so they can resist.

Great leaders are surrounded by people who admire and respect them.

These people feel empowered and motivated. They look for the challenge and the feeling of accomplishment that comes with success. The leader does not leave these people behind. Leaders empower others.

So what is this about loneliness at the top? If you are lonely at the top, research indicates that it is due to your feeling of power. You are lonely at the top because you selfishly do not share the power. You question the intentions of others whenever they attempt to establish relationships with you. You distrust their motives and hesitate to repay favors.

Trust is crucial to good relationships.

AUGUST 2015

Trust is established by the back and forth exchange of small vulnerabilities between and among individuals. One provides a favor to the other. The other reciprocates the favor. Each discloses a small embarrassment to the other. Over time, trust is established and with it a great relationship. When we trust, we believe that a person will act in our own best interest even when we are not there to monitor the action. Violate a trust and there goes the relationship.

So power reduces trust. Power changes our beliefs about the generosity of others. Interestingly, this distrust is apparent towards those perceived to be less powerful. Why are they doing this favor for us? What do they have to gain?

According to research, when the favor is done by a peer we don’t have the same perception and distrust.

Under the influence of power, we reciprocate those favors we think were done for our benefit not for the ulterior motives of the individual providing the favor. If there appears to be no benefit to the favor-giver, then we are comfortable giving back. However, if the favor-giver can benefit from providing the favor, we are reluctant to reciprocate.

When we can attribute selfishness to the kindness of others, our power will tend to distrust the actions and therefore impede the relationship. Without good relationships, we will exist in a world of distrust. We will take the kindness yet not reciprocate. Others will distance

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themselves and we will be lonely at the top, powerful, yet lonely at the top.

Now all this does not mean that the powerful are walking around looking for someone to distrust. Research indicates that at the moment when someone attempts to establish closeness through generous acts and unsolicited favors that power gets in the way.

I have written about how “we judge others as we judge ourselves” before. Essentially we attribute our own feelings and motivations onto others. It is very difficult for us to look at other people with unbiased eyes, and the bias is determined by how we perceive ourselves. If you achieved your power motivated by selfishness and through questionable actions, you will definitely be distrustful of the intentions of others.

The powerful are generally unaware of the tendencies to distrust others and thus contribute greatly to the lack of good relationships. To know this, is to take a step toward rectifying the situation. This, of course, assumes that you wish to rectify the situation. If you believe that all is fine, then no evidence to the contrary will ever change your mind.

You believe that in the end everyone is in it mostly for themselves. You are already powerful, relationships are overrated, business is business and love is bull poop. It is not lonely at the top; your dog adores you and that is all you need.

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“The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it.”- Michelangelo

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