TechNation - February 2016

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VOL. 7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

FEBRUARY 2016

ALTERNATIVE EQUIPMENT MANAGEMENT What Works Best?

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Versus Technology 5 Tips to Convince Leadership to Invest in RTLS

20

Biomed Adventures It Starts with a Good Movie

40

The Roundtable Digital Radiography

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TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

40

THE ROUNDTABLE – Digital Radiography TechNation reached out to the medical imaging industry to gain insights into digital radiography, including the advantages of using this format and how facilities with a limited budget can best afford this technology.

Next month’s Roundtable article: CMMS

48

ALTERNATIVE EQUIPMENT MANAGEMENT: WHAT WORKS BEST? Today, health care facilities have adopted their own approach to workable alternative maintenance programs. The programs must meet strict requirements that include procedures to regularly evaluate the approach and a determination about how malfunctioning equipment is identified. We look at options and ask HTM leaders to share their thoughts.

Next month’s Feature article: Get Smart: Avenues for career advancement

TechNation (Vol. 7, Issue #2) February 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

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

FEBRUARY 2016

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9

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Warren Kaufman Jayme McKelvey Andrew Parker

ART DEPARTMENT

Jonathan Riley Jessica Laurain Kara Pelley

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

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

WEB DEPARTMENT

Betsy Popinga Taylor Martin

ACCOUNTING

Kim Callahan

CIRCULATION

Lisa Cover Laura Mullen

EDITORIAL BOARD

Eddie Acosta, Clinical Systems Engineer at Kaiser Permanente Manny Roman, CRES, Founding Member of I.C.E. Karen Waninger, MBA, CBET Robert Preston, CBET, A+, 2014 Salim Kai, MSPSL, CBET, Clinical Safety Engineer University of Michigan Health System James R. Fedele, Director, Biomedical Engineering Izabella Gieras, MS, MBA, CCE, Director of Clinical Technology, Huntington Memorial Hospital Inhel Rekik, Biomedical Engineer, MS, Clinical Engineer

P.12 SPOTLIGHT

p.12 Professional of the Month: Dean Skillicorn p.14 Company Showcase: 5 Tips to Convince Leadership to Invest in RTLS p.18 Department of the Month: Phoebe Putney Memorial Hospital Biomedical Engineering Department p. 20 Biomed Adventures: It starts with a good movie

P.24 INDUSTRY UPDATES

p.24 News and Notes: Updates from the HTM Industry p.28 ECRI Institute Update p. 30 AAMI Update

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

Tools of the Trade Webinar Wednesday Biomed 101 Shop Talk

P.56 EXPERT ADVICE

p.56 Career Center p.58 Ultrasound Tech Expert Sponsored by Conquest Imaging p.60 The Future p.62 Karen Waninger p.64 David Scott p.66 Patrick Lynch p.68 Roman Review

P.70 BREAKROOM

p.70 Did You Know? p.72 The Vault p.74 What’s On Your Bench? p.78 Index Like us on Facebook, www.facebook.com/TechNationMag

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PROFESSIONAL OF THE MONTH: Dean Skillicorn, CBET

By K. Richard Douglas

A

fter 30 years as an HTM professional, Dean Skillicorn has done it all. The Project Service Manager/ Operations Manager at Philips Healthcare in Los Angeles saw duty as a BMET and field service representative before entering management.

Like so many in the field, Skillicorn received his training in the military, but his original intention was to train for a different area within electronics.

“I enlisted in the U.S. Air Force in October of 1984. I went in guaranteed electronics, hoping to get into avionics on F-16s. Instead, I was selected for a ‘small’ field called Medical Equipment Maintenance,” he recalls. “My training instructor told me I had just been selected for the best electronics position in the military. I definitely agree with that position 30 years later.”

Skillicorn’s Air Force training consisted of 40 weeks in the USAF Medical Equipment Maintenance Course at Sheppard Air Force Base in Witchita Falls, Texas. He graduated in August of 1985 and headed off to Korea to do a short tour at Osan Air Base. That assignment lasted until September of 1986, at which time he ended up at the USAF Medical Center Keesler at Keesler Air Force Base in Biloxi, Mississippi.

When that assignment was up, he received an honorable discharge and went home to Oregon.

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CAREER PATH From his days in the Air Force all the way to his current position with Philips, Skillicorn has garnered extensive experience in many places.

“I have been a Field Service Representative for Physio-Control in Los Angeles, a BMET in the USAF, and a BMET at St. Charles Medical Center in Bend, Oregon,” he says. “My management positions have been at Glendale Memorial Hospital in Glendale, California; Kaiser Permanente in Southern California; Trinity Health in South Bend, Indiana; Sodexo Clinical Technology Management in Biloxi, Mississippi; Morse Medical in Seattle, Washington; and Philips Healthcare North America in Escondido, California at Palomar-Pomerado Health.”

In his current position, working at the Los Angeles County Department of Health Services, he manages a $7 million contract consisting “mainly of Philips and multivendor imaging and ultrasound equipment as the operations manager.” As a manager, Skillicorn relies on the technicians who engage in the actual maintenance activities for their knowledge and background. His job is to support them so that they can provide “the best customer service to our customers and create the best possible patient care experience for patients.”

Like so many in the HTM field, he approaches the task of maintaining medical equipment with the assumption in mind; what if that device was being used on me or a member of my family? The patient safety aspect cannot be overstated for Skillicorn.

“I think that comes from working in the USAF and the fact I have a special needs child,” he says.

He positions this concern for patient

FEBRUARY 2016

safety, against the competitive market environment that exists today, and says that it is the biggest challenge in health care.

INVOLVEMENT The rigors of work are just part of Skillicorn’s involvement in his profession.

He volunteers his time also.

“Certification is the biggest one. I served on the ICC/USCC/US BMET Board of Advisors for four years until it transitioned to the AAMI Credentialing Institute this spring,” he says. “I am still very much involved in certification. I was a part of the Subject Matter Experts which developed the newly released Certified Healthcare Technology Management Certification for ACI the last two years and released in June.

I am still actively involved with CBET, CLES, and CRES as needed.”

He helped form the Medical Equipment and Technology Association (META), which started in 2005. He remains on the board of representatives for that organization. He has also been involved with the California Medical Instrumentation Association (CMIA) in the past.

Skillicorn says that he takes an immense level of pride in the HTM field.

He says that it takes special people to face the daily challenges in supporting health care in the manner that members of the profession do every day.

“I love what I do in this profession. I have been very fortunate to have the relationships with the people I have met over 30 years. I love doing the behind-thescenes things to support the profession,” he says. “Involvement with AAMI, META, the CMIA, etcetera. Mentoring the people I mentored. For me, it’s all about the lifelong relationships I have developed. I have a huge love of this profession. It’s

FAVORITE MOVIES:

“A River Runs Through It” and “Slapshot”

FAVORITE BOOK:

Dean Skillicorn manages a $7 million contract containing mostly imaging equipment.

Any western by Louis L’amour. I have almost every book he wrote.

Anything by Tom Clancy, Ted Bell, or Michael Connelly. On the professional side, “Outliers” by Malcolm Gladwell. I encourage anyone who wants to be successful to read that book. It changed my perspective on management and the way I look at things today.

FAVORITE FOOD: what I will leave behind when I retire and a future legacy for the profession.”

FAMILY Away from work, Skillicorn enjoys fly fishing and hockey. He is a big Los Angeles Kings fan. He puts family ahead of everything else though. His family includes his wife Kelly and their six children. They enjoy camping as a family, traveling and bar bequing.

“I have been married for 25 years to my wife, Kelly Renee Shoemaker-Skillicorn.

She is my partner, best friend, and staunch supporter and advocate,” he says. “We live in Alta Loma, California. We have six kids: Brian is 21 and a freshman at Indiana Institute of Technology where he majors in Business Administration and plays collegiate hockey. Our son Daniel, 19, is a senior at Alta Loma High School and plays tennis. We have twin daughters that are 18, Kaitlyn and Jessica. Kaitlyn is also a

senior at Alta Loma High School and is a musician. Her sister Jessica is a special needs child and has her daddy wrapped around her little finger. Our son Jason is 16, and wants to be a forensic scientist.

The ‘baby’ Adam is 10, and plays soccer and ice hockey.”

Working for a major player in health care, he still gives credit for his work and longevity in the field to those around him.

Those extra hours away from work also require some understanding and support.

“My position is that I cannot be successful as a manager and employee without good people above and below me supporting what I do,” Skillicorn explains. “They are the reason I am successful, and that especially is true of my family who have sacrificed a lot of time with me by allowing me to participate in what I do in this profession.

My wife has been my biggest supporter and biggest fan. I don’t think I would be successful without her support.”

Anything I can barbecue!!!!

HIDDEN TALENT:

Nature photography. “I love taking pictures of the great outdoors!

FAVORITE PART OF BEING A BIOMED:

“Mentoring people, helping develop things in the profession, working with the people I work with on a daily basis.”

WHAT’S ON MY BENCH • I do crossword puzzles every morning … it stimulates my thinking processes.

• My copy of “Outliers” which I have read at least 15 times.

• My cellphone … can’t live without one today!

• Photos of my family and friends.

• My studies to finish my degree in Business Administration. Life is about learning and selfimprovement.

SPOTLIGHT

5 Tips to Convince Leadership to

INVEST IN RTLS W hen an IV pump or other piece of mobile equipment is recalled or due for preventive maintenance, the hardest part of your job is finding it.

How much time do you spend searching the whole hospital looking for those secret hiding places where nurses stash equipment?

You’ve heard about real-time locating systems and know that RTLS would make your job easier – you just need to convince leadership to make the investment.

The key is proving its worth it not only for your own workflow efficiency, but also hospital-wide. Here are 5 tips you can use to put your hospital on the right path.

1

PUT PATIENT SAFETY AT THE FOREFRONT

When equipment is recalled, it can take days to find it in your hospital. During that time, patient safety may be at risk.

The same can be said for equipment that is overdue for preventive maintenance. If you can’t find it to maintain it, you

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never know if it will end up in use with a patient. The right RTLS not only helps you track assets, it also proactively alerts you if recalled or out-ofmaintenance equipment enters patient care areas.

2

MAKE IT ABOUT SUPPORTING NURSES & PATIENT CARE

If equipment hoarding is an issue in your hospital, think about its root cause. Nurses can’t afford the time it takes to hunt for IV pumps or other critical equipment; their job is to give the highest quality of care to patients. So they stash units away where they can be found when they need them.

What if this equipment was always available to nurses? The right RTLS offers the ability to manage par levels of equipment, sending proactive alerts when units are over- or under-stocked with IV pumps, wheelchairs, or other equipment. This enables distribution to efficiently manage the mobile equipment fleet and eliminate the root cause of hoarding altogether.

And, this means patient care isn’t delayed due to equipment availability.

3

EXPLAIN THE ROI OF ASSET UTILIZATION

Your mobile equipment fleet represents a significant investment of capital expenditure. Hospitals

FEBRUARY 2016

THE RIGHT RTLS IS AN OPERATIONAL INTELLIGENCE PLATFORM FOR THE ENTIRE HOSPITAL

The biggest key to selling your leadership on an RTLS investment is helping them understand its value beyond the biomed team. The right RTLS can be leveraged for multiple purposes throughout the entire hospital, including:

• Par-Level Asset Management (beyond asset tracking) • Patient & Staff Locating • Automated Nurse Call Cancellation • Nurse Rounding Alerts & Reports • Personal Panic Buttons for Staff Safety

• Patient Flow Automation in EDs, ORs, Clinics and Hospital-wide • Hospital Capacity Management • Contact Tracing • Hand Hygiene Monitoring • EMR Automation • Data Collection for Process Improvement Initiatives

For more about these applications and their benefits, an educational booklet is available at versustech.com/operations.

typically purchase 20% more assets than they actually need, just to ensure they can be found. Meanwhile, much of this valuable investment sits idle — or worse, gets forever lost in a maze of hallways and hiding places. The right RTLS offers inventory management tools to “right-size” your fleet and historical analytics to better inform purchasing decisions.

By way of example, PeaceHealth in Oregon immediately saved $600,000 through cost avoidance once they implemented par-level asset management. When they

were able to understand how many IV pumps they already had and how they were being used (or not used), they knew the order they were about to place was unnecessary.

Further, by using the par-level workflow tools to better manage the flow of pumps in real time, the hospital was able to actually reduce their fleet by 26 percent and eliminate their rental program, saving a staggering $2.7 million dollars on IV pumps alone. For more on PeaceHealth’s success, download their case study at versustech.com/assets.

RTLS helps bridge the gap between distribution, biomed and nursing teams. Beyond just locating assets, the right RTLS can help your hospital manage asset fleets in real time to ensure that IV pumps and other critical equipment are always available to nurses when they need it, eliminating the root cause of hoarding.

Full-featured real-time locating systems not only allow you to keep track of mobile equipment inventory, they also help your hospital adequately stock each unit with essential assets. Real-time alerts provide proactive notification about patient safety issues, or when valuable equipment is seen walking out the door.

4

UNDERSTAND YOUR EXISTING INFRASTRUCTURE

The investment to bring RTLS into your hospital may be less than leadership realizes.

In fact, you might already have an existing RTLS installed as part of your nurse call system. If your nurses wear locating badges that automate nurse presence when they walk into patient rooms, you already have infrastructure that can be leveraged for asset tracking. What’s more, you can utilize your Wi-Fi network for zone-level locating. The right RTLS can leverage what you already have in place and build upon it to meet your facility’s goals.

5

DEMONSTRATE HOW RTLS CAN BE LEVERAGED HOSPITAL-WIDE

Hospitals across the U.S. are using RTLS to achieve operational efficiency well beyond asset tracking. The right RTLS allows hospitals to take a building-block approach, starting with Wi-Fi asset tracking and adding precision locating where necessary.

Hospitals can add on applications as they need them to create a complete operational intelligence platform that aids with not only asset workflow, but also staff workflow and patient flow in the ED, OR and hospital-wide (see

sidebar), increasing capacity and improving the patient experience.

Your hospital’s RTLS infrastructure is an important investment that can have a wide-ranging, positive impact on operations. To get RTLS approved for the biomed team, bring your leadership the whole picture. Help them understand how the right RTLS allows you to start with asset tracking, then easily and economically grow into more advanced applications.

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DEPARTMENT PROFILE Phoebe Putney Memorial Hospital Biomedical Engineering Department

By John Wallace, Editor

P

hoebe Putney Memorial Hospital in Albany, Georgia, sits in a quiet neighborhood near downtown. However, the hospital is abuzz with activity and the Biomedical Engineering Department provides the work behind the scenes that keeps everything The hospital is a part of the Phoebe Putney Health System. It is a not-forprofit integrated health care delivery system that serves more than half of million residents in Southwest Georgia.

The Phoebe family of facilities is comprised of more than 4,500 physicians, employees and volunteers caring for patients in 35 counties.

The flagship facility, Phoebe Putney Memorial Hospital, is the region’s largest tertiary care provider. With hospitals in five communities, Phoebe offers a full spectrum of care for residents in the surrounding area, ranging from outpatient specialty services to some of the most advanced surgical, cardiac and cancer treatments.

The Phoebe Putney Health System includes four more hospitals, including Phoebe Putney Memorial Hospital North Campus, Phoebe Sumter Medical Center, Phoebe Worth Medical Center and Southwest Georgia Regional Medical Center. Phoebe also operates Phoebe Physician Group, a self-governing

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not-for-profit entity that includes clinic practices and hospital-based physicians throughout Phoebe Putney Health System.

Phoebe Physician Group offers a wide range of medical specialties.

Other facilities and care centers located throughout Southwest Georgia include Phoebe Convenient Care Centers, Phoebe Family Care Center and other outpatient facilities that provide cuttingedge diagnostics and services throughout the region.

The system also serves the community with a variety of specialty centers including cancer care, digestive health/ gastroenterology, heart & vascular care, orthopaedics and sports medicine, as well as a women and children’s center.

As a true not-for-profit community hospital, Phoebe is operated by a volunteer board drawn from the community it serves. Phoebe is constantly reinvesting in the health of Southwest Georgia through programs in prevention, education and research that go beyond the bounds of traditional medicine.

Bruce Verneau, CBET, is the director of the Biomedical Engineering Department at Phoebe Putney Memorial Hospital. He said his team works well together as it maintains more than 12,000 pieces of medical equipment within the health system’s six hospitals and more than 30 clinics.

His team is made up of talented individuals with a variety of experience.

They are able to learn from each other and provide support for a wide range of projects. The team members who keep the system’s vital medical equipment up and running are Jason Misner, CBET, Supervisor; Tony McMillon, Imagaing Engineer III; Ralph Bischoff, BMET II; Ben Fletcher, BMET II; Jeff Covey, BMET

FEBRUARY 2016

II; Wilson Tolbert, BMET I; and Mark Peavey, BMET I. Some of the most recent projects the department has completed include converting all pulse oximetry from Masimo to Nellcor technology. They updated, replaced and supplemented all monitors in the Phoebe Health System.

The department also recently replaced all the defibrillators in the main hospital.

Each member of the department is cross-trained to be able to work on any device within the system.

“While we do have people trained on specialized equipment like anesthesia, ventilators, dialysis, and imaging, we do not have anyone dedicated to a modality,” Verneau said. “All of our technicians can go pretty much anywhere in the system to respond to a service call.

Like most in-house departments, we are general practitioners with some specialty training thrown in.”

Patient safety is the number one goal for the Phoebe Putney Biomedical Engineering Department. The department also prides itself in its ability to help the hospital achieve cost savings.

“One of our sayings is ‘If we are not improving outcomes or decreasing cost, we are not doing our job,’ ” Verneau said.

“We take possession of unwanted equipment and see if we can utilize it

Members of the Biomedical Engineering Department at Phoebe Putney Memorial Hospital include (from left to right) Ben Fletcher, Mark Peavey, Jason Misner, Anthony McMillon, Wilson Tolbert, Carl Mellena, Bruce Verneau and Jeff Covey.

“Some training is negotiated with the purchase of new equipment.

We also have taken advantage of the educational offerings of organizations like HTMA-GA, MD Expo, GBIS, AAMI and NCBA.” somewhere else within the system. If not, we offer it for sale to a list of equipment companies we have done business with in the past. That way we are not warehousing equipment that will never be used.”

One cost-saving tool is the department’s expert insights when it comes to equipment purchases. He said third-party equipment suppliers provide economical options for the health system.

“We are an active part of the capital acquisition process. In fact, Biomedical Engineering is the first department to receive all capital requests when they are first submitted,” Verneau said. “We utilize proven third-party service organizations when possible.”

The team concept carries over to interaction with other departments within the health system, including IT. “We work very closely with our IT system analyst, who is responsible for the connectivity of patient care equipment to

the Phoebe network. With our system-wide transition to Meditech EMR, we are having to upgrade some of our equipment,” Verneau said. “One of the biggest projects is upgrading all of our Alaris infusion pumps. That responsibility falls to our department.”

He explained that the department is an Aramark crew but that few people in the hospital realize that they are not hospital employees. He said everybody treats them like they are hospital employees and makes them feel welcome. After all, they are all on the same team working toward the same goal of positive patient outcomes.

The department members believe in training and remain up to date on the latest trends via a variety of educational offerings.

“A lot of our training is provided by Aramark’s Technology and Innovation Center in Charlotte,” Verneau said. “Some training is negotiated with the purchase of

new equipment. We also have taken advantage of the educational offerings of organizations like HTMA-GA, MD Expo, GBIS, AAMI and NCBA.” Overall, the Biomedical Engineering Department is made up of talented and knowledgeable biomeds who make a valuable contribution to health care in Southwest Georgia.

“We work hard to let others know that we are the resource when it comes to patient care equipment,” Verneau said.

“Whether it is pre-purchase evaluations of equipment or manufacturers, proper operation and care (of a device), or help with disposal of unneeded equipment – we are the folks to call.”

SHARE INFORMATION about a department you would like to see featured in TechNation by emailing Editor@MDPublishing.com

SPOTLIGHT

BIOMED ADVENTURES It Starts with a Good Movie K. Richard Douglas

I

n previous Biomed Adventures, we have featured HTM professionals who had a sideline, hobby, talent or adventure worthy of sharing. Usually, there has been a single subject, beyond their work as a biomed, that caught our attention. In the case of Eric Pabon, there are several.

Pabon is a biomedical equipment technician with Biomed Technologies in Mount Arlington, New Jersey. He lives in Pennsylvania. Away from work, he is an artist, a film maker, a prop/model builder and a collector of comics, toys, and film props. That’s enough to keep anybody busy in their off hours.

Comic books were the inspiration for Pabon’s first attempts at taking pencil to paper.

“I’ve been drawing since I could hold a pencil, but the real power of art entered my world through the comics medium. I grew up reading anything I could get my hands on, and the emotions that a simple illustration could convey were astounding to me,” he remembers.

“I very honestly view comics as one of the most versatile art forms in our culture.

There’s a punk-rock aspect to it that speaks to me on some level, where you can use this simple, childish method to illuminate the biggest and most important ideas you can,” he adds. “I write and illustrate, and would love to commit time in the near future to self-publishing some graphic novels.”

Pabon says that movies also played a big role in his life when he was growing up. Films like “Ghostbusters,” “Star Wars” and “Raiders of the Lost Ark” were favorites and he developed a fanatical love for these movies.

“Here’s some context for you; the ‘Star Wars Force Awakens’ trailer made me cry – just a little,” he admits.

He says that this period was also something of a golden age for the horror film genre.

“There was no greater thrill than

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browsing the selection of gore-laden VHS tapes at the local video store,” he says.

It was this love of movies during his formative years that led to one of his hobbies as an adult. The chance to be in the director’s chair was a big bucket list item.

“I’ve always been fascinated by the film making process, and had always wanted to make my own. So one day, I just decided to do it. I wrote a short horror script titled ‘CUT’ as a kind of ode to my favorite childhood slasher films,” Pabon says.

“The script was well received by a friend who works in television, and after a long and amazing shoot – I had the opportunity to cross ‘film director’ off my list. Sometimes you are just confronted with the realization that if you don’t chase whimsy, don’t flex creative muscles, don’t pursue silly passions – you’ll wake up one day with a profound sense of regret,” Pabon reasons.

The love of movies was the catalyst for one of his other hobbies; prop/model building.

“I like to think that my younger self would be really ecstatic to walk into my office and see the hoverboard from ‘Back To The Future Part II’ or a replica of Raphael’s head from the ‘Teenage Mutant Ninja Turtles’ movie,” he says.

“I’ve learned many different artistic methods over the years, and prop building has now become sort of meditative and relaxing for me,” he says.

“I usually either build from scratch, or start with a commercially available piece and customize it.”

FEBRUARY 2016

Eric Pabon’s love of comics and film fuels his hobbies.

ENTERING THE FIELD EARLY Not only did Pabon’s hobbies find their roots at an early age, but his decision to become a biomed did also. Because of his dad, he started working on equipment and was inspired to remain in the field.

“When I was born, he was maintaining the Record and Playback Subsystem (RPS) at a NASA shuttle launch and landing site, and his career grew toward clinical instrumentation. By the time I was about 18, I was being trained on Roche and Olympus lines of chemistry analyzers,” Pabon says.

“I spent many years working with him, learning an awful lot, and performing service and preventive maintenance for many accounts in central and south Florida,” he adds.

Family is still the dominant benefactor

Eric Pabon has many movie collectibles, including some he made.

Eric Pabon realized a dream when he was the director of a short film.

of Pabon’s time, ahead of any hobby.

“I married the girl of my dreams – a woman whose love and support know no bounds. We have two incredible children.

It’s just an amazing life,” Pabon says.

“There is no greater feeling in the world than pulling into the driveway and knowing what’s waiting for you inside – a beautiful tornado of noise, excitement and love.”

Not necessarily a hobby, but a lifestyle choice, Pabon is also into weight training and healthy eating. He enjoys the science of both. He used a personal trainer when he lived in Orlando and learned about using high-intensity training to build muscle.

“Working out in the field used to mean quite a bit of fast-food,” he says. “Training or not – you can’t outrun your mouth. I had put on more than a few pounds as I entered my thirties. In the past year, I’ve been able to reduce my body fat quite a bit by adopting a mostly vegan diet, and am back to a weight that I haven’t seen since my teens.”

ON THE JOB For the past five years, Pabon has worked for Biomed Technologies. His territory includes New Jersey, New York, Pennsylvania and Delaware.

“You try to bring your strengths to the table at any company, and luckily I’ve been able to do that here,” he says.

“One day I’ll be performing an electrical safety inspection at a surgery center in Manhattan, the next I’m designing promotional artwork for a trade show. I’m always looking to expand my knowledge base and take on new responsibilities, and they’ve responded to that drive,” he says. “I currently am responsible for a state-wide region, and look forward to growth in my career.”

It may have been a parent’s influence that pointed Pabon not only in the direction of the HTM profession, but also toward his love of things related to science fiction.

“My dad’s influence looms large in my career, and out of that grew a respect for not only the craft, but a love of the sciences in general,” he says. “I think one of the things that attracted me to the world of medical device repair is the detective-like nature of troubleshooting, and the satisfaction that comes with solving problems with scientific and technical literacy (and maybe a screwdriver or two).”

Props to this biomed for managing a busy life full of interests.

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NEWS & NOTES Updates from the HTM Industry

MEDISURG OFFERS BIOMED TRAINING

MD EXPO INTRODUCES REVERSE EXPO! MD Publishing adds Reverse Expo to kick off the 2016 spring MD Expo!

The next MD Expo, being held April 21-23, in Dallas, will feature a reverse expo. This networking and business generation event will be the first ever at an MD Expo!

“We are proud to announce a new twist … where added value and ROI is the name of the game,” according to the MD Expo website.

The Reverse Expo will be held Thursday, April 21, 2016, from 1-4 p.m. at the Fairmont Hotel Dallas.

The reverse expo will allow medical equipment sales and service vendors a unique opportunity to meet with 20 supply chain, procurement and healthcare technology directors from America’s

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most prestigious hospitals, imaging centers and health systems. They will meet with real decision makers, have one-on-one interaction and network with high-level executives.

MD Publishing will provide a unique and optimal environment to start the relationship at the Reverse Expo. Then, throughout MD Expo’s exhibit hall, networking events, classes and entertainment, build and establish a real rapport and bond with decision makers.

It’s the perfect recipe for maximizing your time and return on investment!

The Reverse Expo is limited to first 40 vendor attendees!

For additional information, visit www. mdexposhow.com/dallas/reverse-expo/.

FEBRUARY 2016 DECEMBER 2015

MEDiSURG in Indianapolis, In., was established in 2002 to assist customers by providing a comprehensive approach to service in the phacoemulsification and vitrectomy niche. In 2015, MEDiSURG announced the creation of its StarPath Training division. StarPath Training is a unique provider of biomedical equipment service technician training for the Alcon Vision Systems.

“The opportunity for increased savings, uptime and freedom for organizations that have trained, in-house staff to diagnose and maintain phaco procedure equipment is undeniable,” MEDiSURG President John Weymouth said. “So, we created a dedicated division that trains biomed techs to maintain and service Alcon Centurion, Constellation, Infiniti and Accurus Vision Systems.”

The StarPath Training staff is made up of former expert field technicians – so they know these products inside and out.

With individual classes or on-site courses for multiple employees, StarPath creates training that fits individual needs.

“The market is looking for options and StarPath promises self-sufficiency – for both management and biomed techs,” Weymouth added.

To learn more, visit www.starpathtraining.com.

MAINSPRING PARTNERS WITH PARTSSOURCE Mainspring Healthcare Solutions has announced a new partnership with PartsSource that will transform how HTM departments manage parts inventory. Over the last decade, the two companies have been innovators in their respective markets; PartsSource with its highly automated parts procurement solution and Mainspring with its integrated equipment lifecycle management platform. The new partnership will deliver benefits to clients, including significantly reduced parts costs, improved staff productivity and detailed visibility into parts consumption, spending and quality.

The PartsSource ePartsFinder application and online marketplace automates the complex workflow of medical equipment parts procurement. The company facilitates more than 300,000 transactions annually by connecting thousands of suppliers and OEMs to over 3,300 hospitals worldwide.

The solution makes it easy to find the best options for replacement parts, whether it’s new from the OEM, aftermarket or refurbished. It also manages the procurement process by seamlessly coordinating information between the hospital’s purchasing system, the vendor and Asset Enterprise,

Mainspring’s CMMS. “The Mainspring partnership with PartsSource is going to take our software automation to a new level, by incorporating the power of ePartsFinder directly into Asset Enterprise. Users will be able to view the PartsSource catalog and place purchase requests from within a work order. Their purchase request status will then be automatically updated in the system, saving HTM departments a great deal of time and money,” said Mainspring CEO Hank Goddard.

Asset Enterprise will also have the ability to automatically order parts based on upcoming scheduled work and par levels.

This level of automation reduces unplanned downtime, improves compliance for preventative maintenance, while reducing parts and shipping costs.

The automated closed-loop process for parts procurement will give managers complete visibility into parts usage, inventory levels and costs. Asset Enterprise can interface with ERP software to allow for purchasing information to be shared seamlessly between the operational and financial databases.

The basic integration between Asset Enterprise and ePartsFinder is free to Mainspring clients.

NEW UNI-SIM LITE PATIENT SIMULATOR FROM RIGEL Rigel Medical has introduced a compact and versatile simulator capable of verifying the performance and accuracy of essential patient vital signs monitors.

The new multifunction UNI-SiM Lite handheld and battery-powered simulator ensures that essential medical equipment continues to provide accurate data for the correct diagnosis, treatment and monitoring of patients.

The entry-level patient simulator carries out the most common simulations and checks, performing NIBP, SpO2, ECG waveforms, temperature, respiration and invasive blood pressure tests simultaneously.

Among the UNI-SiM Lite’s many special features are user definable systolic and diastolic pressures for NIBP simulations to allow specific NIBP settings for different types of monitors.

In addition, it is compatible with the Rigel PULS-R SpO2 universal simulation finger, which ensures accurate representation for each type of SpO2 probe, reducing the need for separate accessories.

Fully synchronized simulation signals in the UNI-SiM Lite provide the closest and most accurate representation of a real patient, with the incorporation of a wide range of adult and paediatric custom physiological settings.

The unit’s fast start up function, single push-button activation and long battery life means that biomedical engineers and technicians can complete spot checks and verify performance of essential medical equipment quickly and efficiently.

The new UNI-SiM Lite forms part of a comprehensive range of specialist biomedical test equipment available from Rigel Medical.

For full details, visit www.seaward-groupusa.com/unisim-lite.

INDUSTRY UPDATES

BILL COLLIER EARNS IBS LIFETIME ACHIEVEMENT AWARD the very beginning of the organization. These are the people who have mentored us over the years so that we could provide better health care to the patients we serve,” VanDeWalker said.

“Unfortunately, when we came up with the award Bill Collier – who had built BC Group up from the ground floor – had sold the company and retired before we could recognize him for all of his efforts in helping Indiana Biomedical Society members.”

“We decided that we needed to correct that and felt this would be a good year to bring him back and thank him for

The Indiana Biomedical Society recognizes Bill Collier, entrepreneur and small business coach with Collier Business Advisors, as the winner of its 2016 Lifetime Achievement Award. This special award was presented on the organization’s 25th anniversary. Kelly R. VanDeWalker said the recognition is long overdue for a man who has dedicated himself to supporting IBS and the healthcare technology field.

“This is the Indiana Biomedical Society’s 25th year and we have vendors and salespeople who are retiring who have been with us from

what he has done for the health care field and the Indiana Biomedical Society,” he added.

Collier is a long-time entrepreneur turned business coach, consultant, professional speaker, and author. Before becoming an entrepreneur, his career included time in the U.S. Air Force, McDonnell-Douglas Aircraft (Boeing) and General Electric Company.

In 1988, he and his wife founded BC Group International Inc. with a small personal investment and a loan guaranteed by the SBA. Over the 15-plus years that they owned the company, it grew

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Bill Collier from a local/regional distributor of biomedical testing equipment into a respected force in the industry with customers all over the world.

INTERMED RECEIVES SAFETY AWARD InterMed Biomedical recently received a SHARP award. The On-site Consultation’s Safety and Health Achievement Recognition Program (SHARP) recognizes small employers who operate an exemplary safety and health management program.

OSHA encourages employers to operate exemplary safety and health management systems. To reward such employers, OSHA allows those who meet a few basic eligibility requirements to become exempt from OSHA inspections for a period of not less than one year, with eligibility for renewal if qualified.

InterMed received a 36-month exemption, which is the most any company has ever received, according to Keith Brown, a safety and health consultant. InterMed can renew after the 36-month period but must meet eligibility requirements.

There are four steps to SHARP: 1. Request a full-service comprehensive visit from USF SafetyFlorida and correct all hazards (serious and other-than-serious) identified by the consultant.

2. Implement and maintain a safety and health management system.

3. Score at least two on all 50 basic attributes of the Safety and Health Program Assessment Worksheet (OSHA Form 33).

4. Agree to notify USF SafetyFlorida prior to making any changes in working conditions or work processes that might introduce new hazards into the workplace.

For more information about InterMed, visit www.InterMed1.com.

REPORT: BIOMEDICAL ENGINEER AMONG TOP HEALTH CARE JOBS The demand for health care professionals continues to grow, and for those thinking about a career in the health care industry, CareerCast has identified 10 of the best jobs in a new report.

“The health care industry is thriving, in part due to the Affordable Care Act,” says Kyle Kensing, Online Content Editor, CareerCast. “More insured consumers means more access to care. More people are visiting their general practitioner, resulting in increased hiring at doctor’s offices of support staff like medical records technicians and medical technologists, two of the best health care jobs.”

Health care will always be a cornerstone of the job landscape, as many of the services health care professionals provide are necessities. As of November 2015, the U.S. Bureau of Labor Statistics reports approximately 18.9 million are employed in health care professions. That’s an increase of nearly 4 million from a decade ago, and the industry is projected to grow, as a whole, by another five million by 2022.

CareerCast names audiologist, biomedical engineer, dental hygienist, optometrist, physical therapist, medical records technician, chiropractor, pharmacist and medical technologist among the best jobs in health care.

With a growth outlook of 27 percent through 2022, the demand for biomedical engineers is very high.

TRISONICS GROWTH TAKES SHAPE On November 16, 2015, Trisonics started an exciting new chapter in the company’s history. With employees, members of the local Chamber of Commerce and elected officials in attendance, a ribbon was cut signaling the opening of the company’s new 24,000-square-foot facility.

This new office will offer many new benefits not only for the company, but for its customers as well. The expansive warehouse space will allow for the addition of more inventory as well as housing stations for extensive in-house repair capabilities. The larger office also allows for Trisonics to continue to expand its personnel to meet the increasing demands of the industry.

The office includes a state-of-the-art training room. The 36-seat training facility boasts a static-free floor, 65-inch interactive smart board and can accommodate up to 200 participants remotely.

“For years we have been asked to provide training,” offers Stuart Latimer, President. “But we just did not have the space or the resources to do so. Now, not only can we offer the most experienced and knowledgeable engineers in the business teaching the courses, but a comfortable, high-tech facility to house it.”

A full schedule of the training classes, as well as the registration form, can be found on theTrisonics website at www.trisonics.com.

INDUSTRY UPDATES

ECRI UPDATE

What Technology Hazards are Lurking in Your Hospital? Part 2

E

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

To help hospitals prioritize technology safety efforts that warrant their attention and to reduce risks to patients, ECRI Institute publishes an annual list of top 10 health technology hazards. The 2016 Top 10 Health Technology Hazards list includes both high-profi le and unexpected issues, as well as ones that are emerging, such as hazards related to electronic health records.

How are the topics selected? ECRI Institute engineers, scientists, clinicians, and other patient safety analysts nominate topics for consideration based on their own expertise and insight gained through investigating incidents, testing medical devices, observing operations and assessing hospital practices, reviewing the literature, and speaking with clinicians, clinical engineers, technology managers, purchasing staff, health system administrators, and device suppliers.

Hazards one through five were covered in the January issue of TechNation (1TechNation.com/ecri-update-hazards/).

Read on to learn about the rest of the hazards on our list.

6. Errors Arise When HIT Configurations and Facility Workflow Do Not Support Each Other Poor alignment between the configuration of a health IT (HIT) system and a facility’s workflow increases the opportunity for medical errors, putting patients at risk. Problems can arise if the HIT system is not configured to support the processes and workflow used in a particular care area, or if the workflows and standard operating procedures are not adjusted to accommodate the capabilities of HIT systems.

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This can lead to issues such as: • Missed information or the inability to find needed information within the HIT system • The mistaken application of default values – for dosing, time, or orders – instead of the desired values • Input errors • The use of workarounds Any of the above problems can result in patient harm due to delayed, incorrect, or undelivered therapies. Facilities should consider configuration issues during the HIT system selection phase and should modify and validate workflows to confi rm that they align with the system’s capabilities.

7. Unsafe Injection Practices Expose Patients to Infectious Agents Unsafe injection practices are an ongoing patient safety concern, both in hospitals and in outpatient settings. Far too often, incidents occur leading to the transmission of bloodborne viruses, the spread of bacterial infections, and potential exposures that require notifying large numbers of patients about the threat to their health.

Some practices that put patients at risk are: • Reusing a needle or syringe that had been used to administer medication • Sharing an insulin pen among patients (even if a new needle is used) • Using a single-dose medication vial for multiple patients • Failing to use aseptic technique when preparing, handling, and injecting medications Cross-contamination resulting from unsafe injection practices has led to: • Disease transmission causing patient illness or death • Damage to the health care facility’s reputation, its financial health or its accreditation status • Criminal prosecution resulting in penalties and, in some cases, imprisonment for the responsible health care professionals Solutions involve action by frontline health care workers, by the leadership of hospitals, outpatient clinics, and skilled nursing facilities, and by patients.

Uncontrolled access to medical device USB ports could also lead to a security breach, putting the patient’s data and the health care facility’s systems at risk.

8. Gamma Camera Mechanical Failures Can Lead to Serious Injury or Death Gamma cameras incorporate heavy, moving components that can cause significant harm if they rotate into or fall onto a patient or staff member. ECRI Institute and FDA have received multiple reports of mechanical failures involving gamma cameras that had caused serious – and in one case fatal – injuries.

• Such failures can occur when gamma camera systems are not maintained properly.

• A notable concern is the fact that safety-related recalls are not always addressed in a timely manner, which can allow a hazardous situation to develop.

With more than 40 gamma camera safety recalls having been fi led with FDA in a recent two-year period, incidents could occur at any health care facility that lacks an effective process for handling gamma camera recalls.

Facilities should advise staff not to leave patients unattended in the gamma camera scan room. They should also maintain, service and inspect gamma cameras in accordance with the manufacturer’s guidance, and verify that all current recalls and safety notices have been acted on.

9. Failure to Appropriately Operate Intensive Care Ventilators Can Result in Preventable Ventilator-Induced Lung Injuries Inappropriate patient ventilation can cause ventilator-induced lung injury (VILI), particularly in intensive care patients, and may lead to patient death. Lung-protective strategies (e.g., using lower tidal volumes) have been developed, and advanced ventilator modes and features are available to aid clinicians in providing safer and more effective ventilation.

Too often, however: • These existing techniques and tools are not used to their full advantage.

• Best practices and device capabilities are not assessed and adopted, when warranted.

Factors that contribute to the inadequate implementation of safer and more effective ventilation strategies include: • A lack of continuing education on the best practices for patient ventilation • Insufficient understanding of complex ventilator functionality • Inconsistent terminology among ventilator manufacturers, leading to potential confusion among clinical practitioners Facilities can alleviate these issues by confirming that all staff involved with mechanical ventilation have a sound understanding of the devices and their use.

10. Misuse of USB Ports Can Cause Medical Devices to Malfunction Plugging unauthorized devices or accessories into USB ports on medical devices can cause the medical devices to malfunction. Direct effects on medical device operation – for example, causing a physiologic monitor to reboot – have been observed in clinical practice.

Possible problems include instances in which: • The device shuts down, and the patient does not receive therapy.

• The device settings are changed or performance is compromised.

• A patient monitor ceases to monitor the patient or fails to alarm for problems that require attention.

Uncontrolled access to medical device USB ports could also lead to a security breach, putting the patient’s data and the health care facility’s systems at risk.

Facilities need to develop and implement a policy on the appropriate use of USB ports on medical devices.

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

INDUSTRY UPDATES

AAMI UPDATE

AAMI Foundation Releases Compendium to Help Hospitals with Alarm Management

T

he AAMI Foundation has synthesized the knowledge, experience, and advice of leading practitioners into a toolkit designed to help health care organizations meet The Joint Commission’s National Patient Safety Goal on clinical alarms.

As of last month, The Joint Commission now expects hospitals to have established and implemented policies and procedures for managing clinical alarms, as surveyors will be documenting noncompliance to the second phase of the goal.

“Noncompliance will be a direct finding, and the organization will have to submit a plan for corrective actions.

Noncompliance also will be posted on Quality Check,” said Ronald Wyatt, M.D., medical director of health care improvement for The Joint Commission. The Quality Check website provides detailed information about an organization’s performance and accreditation.

To assist in developing the necessary policies and procedures, the AAMI Foundation’s complimentary Clinical Alarm Management Compendium provides specific tips and outlines practices already being used by leading institutions. Among them are the following 10 ideas for safe alarm management: • Issuing a call to action, championed by executive leadership, which recognizes the challenges, risks, and opportunities of alarm management, and committing to solving them.

• Bringing together a multidisciplinary team to spearhead action and build consensus.

• Gathering data and intelligence to

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identify challenges and opportunities.

• Prioritizing the patient safety vulnerabilities and risks to target with alarm management improvements.

• Setting and sharing goals, objectives, and activities to address these vulnerabilities and risks.

• Developing and piloting potential solutions.

• Evaluating the effectiveness of improvements and making adjustments as needed.

• Developing policies and procedures.

• Educating staff to build and maintain competencies.

• Scaling up and sustaining by creating ownership at the unit level and with continuous improvement.

In addition to outlining ways to implement these ideas, the compendium provides a set of default alarm parameters that could be used to benchmark alarm system settings. These parameters were developed from information reported in a survey conducted by the AAMI Foundation, and they represent responses from 17 of the 25 hospitals and health care system members of the National Coalition for Alarm Management Safety.

“No single institution has the ‘right’ answer that can be turned into an off-the-shelf solution. However, there is a lot we can learn from the practitioners who have been leading the way in

FEBRUARY 2016

meeting the complex challenges of alarm management for years. Their insights and best practices can be used to launch and guide an alarm management initiative, or strengthen one that’s already in progress,” said Marilyn Neder Flack, senior vice president of patient safety initiatives at AAMI and executive director of the AAMI Foundation.

AAMI BOARD ESTABLISHES NEW FOUNDATION FUND FOR RESEARCH, INITIATIVES With an eye on making further inroads toward patient safety, the AAMI Foundation now has a special fund that will support research and initiatives to develop lasting and creative solutions to some of today’s toughest healthcare technology challenges.

At its fall meeting, the AAMI Board of Directors voted to transfer – as a onetime, unrestricted gift in 2016 – $3 million from AAMI’s reserve to a new strategic priorities fund for the Foundation. In addition, the Board of Directors approved the transfer of another $495,000 to the Foundation to support five specific projects.

Marilyn Neder Flack, senior vice president of patient safety initiatives at AAMI and executive director of the AAMI Foundation, expressed her gratitude to the Board, saying the transfer gives new muscle to the work of those looking to make healthcare technology safer.

“The AAMI Foundation has been a leader in bringing together all stakeholders to solve long-standing issues associated with the safe and effective use of healthcare technology,” she said.

“Now, in addition to continuing that work, we will be able to lead the national

patient safety research effort in healthcare technology. I am extremely grateful to the Board for this visionary, generous, and impactful move.”

The five initiatives in line for the initial financial support of $495,000 are: • A research project looking at “validated” medical device alarms sounds that will be incorporated into international standards and will have an impact on how all devices with alarm sounds are developed.

• The development of a cloud-based server to hold physiological waveform data and alarm signals. Such a server could revolutionize how alarm algorithms are developed, tested, and validated.

• The development of a toolkit to help hospitals ensure efficient and appropriate labeling of infusion lines with drug names and dates for changeouts.

• A project aimed at evaluating the feasibility of the Foundation launching two new initiatives: one focused on working with hospitals for safe adoption of electronic health records, and one that would involve working with hospitals to improve clinical education about complex technology.

• A project to evaluate the current and future state of infusion therapy in the home setting.

A research review committee will be established this year to assess the merits of proposals received by the Foundation in response to specific requests.

AAMI Board Chair Michael Scholla, global director, regulatory and standards, at DuPont, said his proudest accomplishment for AAMI in 2015 was the establishment of the $3 million

strategic priorities fund for the Foundation.

“This is a significant sum – and also shows how far the Foundation has come in the past few years,” he said.

AAMI KICKS OFF ‘RELIABILITYCENTERED MAINTENANCE’ PROJECT FOR HTM FIELD AAMI has begun exploring whether an approach known as reliability-centered maintenance (RCM) is a feasible strategy that could be adopted on a wide scale throughout the field of healthcare technology management (HTM). After longtime clinical engineer Malcolm Ridgway approached AAMI with the idea, AAMI enlisted the guidance of HTM consultant Ken Maddock to help explore the possibilities.

“In the 1950s, the civil aviation industry pioneered a means of maintaining aircraft based upon analyzing the exact nature of the failures that actually occur, then focusing their maintenance activities on areas where they would be truly beneficial,” Ridgway said. “They called this method reliability-centered maintenance. Other high-reliability industries quickly followed suit, and during the latter part of the last century, military aviation, the entire aerospace industry, the nuclear submarine industry, and the nuclear power industry, among others, all adopted the RCM approach. HTM is the only high-reliability industry that has not yet adopted these very effective and highly efficient practices.”

For this to become a reality in the HTM world, Ridgway said that a scientifically solid, but simple-tounderstand and credible, RCM-based method must be developed for

determining which specific types of medical devices can truly be made safer through periodic scheduled maintenance.

He added that time spent “performing inefficient and ineffective maintenance” should instead be spent on activities that truly improve patient safety.

Maddock stressed that the approach must be “clear, specific, and achievable” and must meet regulatory guidelines.

With some exceptions, the Centers for Medicare & Medicaid Services (CMS) allow a hospital to “adjust its maintenance, inspection, and testing frequency and activities for facility and medical equipment from what is recommended by the manufacturer, based on a risk-based assessment by qualified personnel.”

CMS further notes that “hospitals electing to adjust facility or medical equipment maintenance must develop policies and procedures and maintain documentation supporting their alternate equipment management (AEM) program” and that “they must adhere strictly to the AEM activities and/or frequencies they establish.” As a result, a scientifically sound RCM approach could presumably fit within the allowances on equipment maintenance offered by CMS. Maddock has proposed establishing a task force “to review materials in terms of their practicality and ability to be implemented across different business units.” The task force would also “help the plan to gain momentum and credibility.”

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

INDUSTRY UPDATES

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FEBRUARY 2016

sales@radcal.com www.radcal.com

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Webinar

Wednesday

WEBINAR WEDNESDAY RTLS Webinar Caps Off Great Year Staff Reports

T

he 2015 TechNation Webinar Wednesday series closed the year with the informative “RTLS – An Overview” sponsored by Renovo Solutions and Sonitor Technologies.

The webinar was popular with 135 attendees to put the total number of attendees for the year at 4,205.

The hour-long webinar reviewed current applications of RTLS within a health care facility. It provided a look at available technologies, the potential ROI, as well as the role of HTM professionals and others in the strategic implementation of an RTLS solution.

Alan Tangen, Director of Technical Sales for Sonitor Technologies, kicked off the webinar and discussed specific clinical/business problems RTLS can address. He pointed out that it is important to designate a person or department responsible for the implementation and management of a RTLS system.

Tangen also explained that an RTLS system can help with asset management, nurse call integration, patient/staff localization, operational workflow management and contact tracking/ hygiene compliance.

Alan Moretti, Vice President of Advanced and Emerging Technologies for Renovo Solutions, joined Tangen and said that HTM professionals are critical stakeholders when it comes to RTLS. Moretti outlined how RTLS can be used for collaborative integration with CMMS and real-time utilization tracking. He said that RTLS can help with periodic medical device PM performance, recall management, risk management and determining a medical

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device’s total cost of ownership.

Sanford Health Process Improvement Coordinator Liz Wheeler added to the webinar by sharing her first-hand experiences using RTLS. The RTLS webinar added to a long list of pertinent topics covered by experts via the Webinar Wednesday series in 2015.

Attendees praised the series in their post-webinar surveys.

“I love the webinars. They are often geared toward topics and issues we are currently facing,” Kevin B. wrote in his survey.

“The TechNation webinar series provides the easiest way I have found to stay abreast of developing trends and technologies in health care,” Shannon D. added.

“TechNation webinars are always informative and relevant with regards to today’s technology,” Eric C. wrote. “I have attended several and always leave knowing more about something or learning about something I didn’t know.”

Robert Z. said the webinars help him on the job.

“Without TechNation’s webinars I would have been caught without an answer on at least a dozen occasions,” he writes. “I would strongly urge you to make use of this asset or get used to the phrase ‘Would you like fries with that order, sir?’ ”

FEBRUARY 2016

“The TechNation webinar series provides the easiest way I have found to stay abreast of developing trends and technologies in health care.”

- Shannon D.

FOR ADDITIONAL INFORMATION about the TechNation Webinar Wednesday series, including recorded presentations and a calendar with upcoming presentations, visit www.1TechNation. com/webinars.

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35

BIOMED 101

Connected Medical Devices Create Cybersecurity Risks

By Neil Oliver

S

ecurity experts have billed 2015 as the “year of the health care hack” with increasing numbers of medical systems being attacked by cybercriminals targeting valuable personal data. While cybersecurity is commonly associated with software attacks, the health care sector is finding that the hardware it’s employing to improve patient care is creating backdoors for the criminal element.

The 2014 report “Will healthcare be the next retail?” by Bitsight found that health care and pharmaceutical companies have the worst cybersecurity record among the Standard & Poor’s 500 and are at risk of high-scale breaches.

Cybercriminals tend to fall into three core groups; those who are in it to make money by either selling data or blackmailing companies for its return, people in it for the fame, or those who are in it for political reasons. Whatever the motivations, the cost of cybercrime is growing.

LEAVING THE BACK DOOR OPEN Medical equipment has taken an evolutionary leap in recent years to take advantage of digital age developments. Devices are no longer chained to hospital beds; they can move around a facility, follow a patient home, or even be implanted in a person. Developing equipment to include computer chips, software, wireless technology, and Internet connectivity creates a portal for those wishing to cause trouble.

With the rise of the Internet of Things (IoT), medical devices are “connected,” and not just to the Internet. They are often connected right into a health care provider’s network, establishing a pathway to

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NIEL OLIVER

Technical Marketing Manager at professional battery manufacturer, Accutronics

data that seems otherwise protected.

Medical devices are a stepping stone to access health care networks, and a recent report by TrapX revealed three stand-out cases where hospitals were hit by data breaches after medical equipment was infected with malware backdoors, with the malware subsequently moving laterally to infect other areas of the network. TrapX found ransomware, as well as programs like Zeus, Citadel and Conficker on devices that the hospitals had no idea was present.

At the end of 2014, the U.S. Department of Homeland Security launched an investigation into numerous cases of suspected cybersecurity flaws in medical devices

FEBRUARY 2016

and hospital equipment that officials feared could be exploited by hackers.

Equipment under review included infusion pumps and implantable heart devices, the kinds of devices that leave patients at risk of harm if compromised.

The 2015 hacker conference DerbyCon flagged the severity of the situation. It was revealed that there had been 68,000 attempts at hacking critical medical devices, such as MRI scanners, over a six-month period.

Fortunately, these were fake devices or “honeypots” set up to lure in malicious hackers. This shows the importance of addressing cybersecurity flaws, particularly in devices that leave patients at risk of harm if compromised.

TIME TO IMPROVE In the fight to close the backdoor, every measure must be taken to secure the hardware. The U.S. Food and Drug Administration (FDA) has pushed for improved cybersecurity when it issued guidelines aimed at helping medical device manufacturers manage cybersecurity risks as well as “maintain medical device functionality and safety.”

Research by the FDA has also shown that “as patients move to the use of home health care services for

recuperation or long-term care, the medical devices necessary for their care have followed them. In 2004, the National Association for Home Care & Hospice reported that more than 7 million people in the United States receive home health care annually.”

To support these goals and ensure cybersecurity, even the battery technology used in medical equipment needs to be taken into consideration.

POWERING SECURITY A lack of hardware-based encryption is causing widespread concern about medical equipment and about the reliability of batteries used in such equipment. Portable medical devices have to be designed to operate without mains electricity/AC power, and so the use of reliable and safe backup-power management systems is a necessity.

Devices such as acute ventilators, portable anesthesia workstations and digital radiography panels all need continuous and safe power to protect patient health.

Battery counterfeiting is a problem faced by the medical industry on a scale never before witnessed in the sector. Accutronics has worked hard to tackle this problem, developing the CMX series of smart batteries and chargers. The new range incorporates some innovative features, including

SHA-1 hardware encryption.

SHA-1 (secure hash algorithm) is a cryptographic hash function designed by the U.S. National Security Agency (NSA). The algorithm is flashed onto the smart battery’s fuel gauge before being sealed in during production. At the same time a software update is made on the host medical device. Upon insertion, the battery is challenged to complete a calculation within 100ms, if it matches with the one performed by the host device, it’s genuine, otherwise it’s fake and can be rejected.

It’s time to lock the gate and shut cybercriminals out of medical devices by building cybersecurity and encryption into the equipment. Doing this means thinking of every part of the machine, even something as seemingly insignificant as the battery.

Building encryption into the hardware itself will provide the first line of defense against those who would use medical devices to cause trouble, reducing the threat to life and reducing the potentially massive costs of leaving the backdoor unguarded.

NEIL OLIVER is the technical marketing manager at professional battery manufacturer Accutronics. He has worked in the battery industry for 24 years, providing him with extensive experience and technical knowledge.

THE BENCH 410002 INTERNATIONAL MEDICAL TechNation AD 09102015.indd 9/10/15 1 4:08 PM

SHOP TALK

Conversations from the TechNation ListServ Q: A:

What do you love about being a biomed?

The opportunity to continually learn, the anticipation of what this day may bring and the ability to practice and perfect my problem solving talents The smiling faces and thank yous don’t hurt either.

A:

Good question. I have been asking this to myself lately a lot.

Why did I get into this field? I went into this field because it sounded interesting when I looked at the Owens Community College career choices. At that point in my life I had changed majors several times, as I was undecided on what to do. When I was young I would build go-carts with old lawn mower engines and do electrical repairs around the house. I always enjoyed building models and flying Cox airplanes. Once I started to drive, I learned that cars needed a lot of maintenance back in the ‘70s. I changed many brake pads, water pumps, alternators, batteries and even replaced an engine, taking it completely out of my 1977 Cutlass. I still do my brakes, change my oil, replace electrical window mechanisms and perform minor engine repairs. I found out that many in this field are handy men or women around the house. This field has provided for my family for over 30 years, with many opportunities for growth if you wanted it. Most in this field have the opportunity to be your own boss, as performing PMs and repairs in most cases, you need little to no supervision.

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Mastering the art of prioritizing all the service calls is a daily task for anyone in this field, so each of us becomes self employed in a way. I have found that just about everyone in this field are just good people. I remind those who I have worked with, how important our job is in maintaining the medical equipment and keeping up with regulatory compliance. In the 30 years I have been in this field, there has been a lot of change. The amount of equipment in a hospital has at least quadrupled. Technical training is very important to keep up with all the technology that comes into our hospitals. Everything is at a much faster and busier pace these days for all of us in the medical field. We might not always be recognized like we want to, but we have to remember that the equipment our field supports helps caregivers perform diagnostic procedures, monitoring, and surgeries, which often prolong and save the lives of those we serve. Do I like my job?

Yes. Do I recommend it to others? Yes. Do I get frustrated sometimes? Yes. Do I feel overwhelmed? Yes. Am I proud of the work we do? Yes.

A:

I always remind myself that we are responsible for the reliability and risk of medical devices that either diagnose or treat patients and all of us will have loved ones go through this. If we look at each patient we remember how important biomedical work is. I also love the high-tech, constantly changing health care environment. It stays interesting. Fixing problems is very gratifying. Figuring out how to

FEBRUARY 2016

assess and make things better is what biomeds do and what energizes me.

Q:

I am having problems with excessive chassis leakage current on one of our hospital’s treadmills. It is a True Fitness model 700 [TTZ700LC] from 2007 (with a brushed DC motor). During its PM last month, the leakage current maxed out my safety analyzer (> 1999uA). I have gone under the hood and blown out all the dust from inside/outside the motor and around/under the brushes.

This did not appear to help any. The brushes appear to be OK. I called True Fitness and they said this is not a medical grade treadmill but rather just a commercial one. They had no recommendations about what to do and do not even have a specification of maximum leakage current for the treadmill and, if nothing else, recommended plugging it in to an isolation transformer. So I called the motor manufacturer, McMillan, and they said their specifications of upper leakage current is 2000uA – but I don’t know if that is where the problem is.

So the long and short of it is, I am not sure where all the leakage current is coming from or how to reduce it.

Perhaps there is an issue with the transformer on the motor control board. Any advice would be appreciated. The treadmill works OK otherwise, and the ground resistance is OK. Last year, the chassis leakage current was 20.6 uA.

A:

Is the leakage there at idle or only when the treadmill is running? If it is there at idle I would unplug the motor and see if there is a significant drop in leakage. With the motor unplugged check resistance from each brush holder to the chassis of the motor. With brushed motors the leakage is often caused by excessive carbon dust buildup. Unfortunately, at that point, just blowing them out may not be enough because the dust clings to the outside of the brush holder causing a current path from the brush to the chassis.

A:

One time, years ago, on a Friday afternoon, here at my hospital, I was told to check in four new treadmills for our brand-new cardiac rehab area. Each treadmill came in at 1.2 mA, or 1,200 microamps. I refused to allow their use. Several people got annoyed. But my director backed me up. After some research the next Monday, and no they were not being used, we finally found that in order to stay in code and to safely run these treadmills, each one had to have a second, independent ground wire run from the chassis to a permanent ground.

The electricians were not happy with me either, but they got it done that Monday and the treadmills passed and were operational. The company was notified and they came out a week later and changed the power supplies in all four of them. I retested them and they were within our limits. So I’d suggest running a second ground wire.

A:

I’d go with the isolation transformer except if your past reading is correct, a problem would be indicated.

My guess is the old reading was wrong. Disconnect the motor and take another reading.

A:

Could be the motor – carbon tracked from the brush dust. In the really old days we would take it out and take it apart and flush it out with blue shower or you could take it to a motor shop and have them do it. Or you can put a fixed redundant ground on the mill. Leakage current always takes the path of least resistance, so when you do your leakage test it should come out at zero.

A:

I had read about possibly running a second dedicated ground wire (or an isolation transformer). Turns out, the brush clips were not seating properly, even after many attempts and experimenting. Once they were seated properly, the leakage current was acceptable.

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

THE BENCH

ROUNDTABLE Digital Radiography

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NOVEMBER2016 FEBRUARY 2014

D

igital radiography is a form of X-ray imaging, where digital X-ray sensors are used instead of traditional photographic film.

TechNation reached out to the medical imaging industry to gain insights into digital radiography, including the advantages of using this format and how facilities with a limited budget can best afford this technology.

Industry experts participating in the TechNation roundtable on digital radiography are InterMed Vice President Dave Bauerle; RSTI President/COO Dale D. Cover Jr.; Technical Prospects Director of Engineering Kenneth Hable; and AMX Solutions Strategic Account Manager Mike Helms.

Q:

WHAT ARE SOME ADVANTAGES DIGITAL RADIOGRAPHY OFFERS COMPARED TO FILM-BASED RADIOGRAPHY? Bauerle: The advantages that digital radiography offers over film based are less retakes, more accuracy, lower dose in most cases, no repeats and much less expensive processing and storage, instant access to images via the computer and huge cost savings and transport of the images electronically rather then snail mail.

Cover: There are numerous differences between film (analog) and digital imaging.

Most of them prove digital to be superior.

Film, being a physical object, can only be in one place at a time. For consultation with another physician you would either have to copy the film, which reduces resolution, and send it out or bring the doctor in. Digital images, because they are virtual, can be sent nearly instantly anywhere on the planet where there is an Internet connection. Additionally, because it is digital, there is no loss of resolution because the files are identical. One of the best arguments for digital is the ability to apply software enhancements and tools to the raw image. Most systems have several

Radiography) and DR (Digital Radiography) which is split into two categories; Direct and Indirect. The most obvious benefits apply uniformly and are no need for darkroom space and processing chemicals (environmentally friendly), lower overall cost of ownership versus film, more flexible image storage (on/off-site PACS) versus film archive/library, image retention and reproducibility, and image distribution (ease of transfer; CD/DVD, flash drive, file transfer or email). Additionally, depending on the qualifiers mentioned above, you may also see these advantages with the Direct DR option: improved workflow – case management (no more carrying and changing cassettes); and improved workflow – patient management (immediate image review).

DAVE BAUERLE

InterMed Vice President

preset algorithms to achieve specific image outcomes even if the technique isn’t quite perfect. Once the initial processing is complete, the image is presented on a monitor. If the reading physician wishes, areas of interest can be enhanced by further manipulation of the numbers through brightness and contrast adjustment. Among the tools available with digital imaging are magnify, area measurements and quantification, computer-aided diagnosis (CAD), inversions and side-by-side comparison.

Film, sadly, is static. If the resultant image doesn’t demonstrate the anatomy adequately, the only corrective action is to retake the image using another technique.

This is one of the ways digital imaging reduces dose. The primary characteristic where film excels is resolution. The pixels in a digital image are larger than the very fine granules in film. This limits digital’s ability to resolve very small objects such as micro-calcifications. However, the slight loss in resolution is far outweighed by the other benefits of digital imaging.

Hable: This can be a loaded question if addressed without a qualifier; that being, what type of digital radiography are we discussing? The three primary considerations are CR (Computer

Helms: The first and most significant advantage is self-explanatory – no film.

Second, and really important, is dose to patient. Third, is the time necessary to get film developed and the obvious cost associated with film and screens developer/ processor space and chemicals. Space and storage of film is expensive – digital storage not so much. Technicians are able to see images, check for position, content and patient coverage of diagnosis success without having to wait for film to develop.

Images are available instantly on the monitor and, once processed, can be sent to the radiologist for interpretation.

Q:

IS IT AFFORDABLE TO UPGRADE TO A DIGITAL RADIOGRAPHY SYSTEM? HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE DIGITAL RADIOGRAPHY NEEDS OF TODAY? Bauerle: Affordability is on a case-by-case basis however in most cases saving time saves money. Saving space by not having to store film and buy chemicals and pay for the X-ray film itself provides, in many cases, cost savings.

Cover: The easy answer is: It depends.

There are several ways to upgrade to digital. The most extreme upgrade would be to replace the entire room with a system that was designed from the ground up to be

THE ROUNDTABLE

digital. This is a radical step and, to be honest, not very affordable given a limited budget. Then, there are the upgrades that mount and interface physically into the existing system. These would be less expensive than a new room, but still a bit pricey. The price is compounded by the fact that the image receptor has only one room it can service, if you have a department to convert you would need to buy multiple systems. CR plates and DR panels, that mimic film base cassettes in terms of shape and form, give a facility the opportunity to convert one room or the entire department.

The portability of these cassette-style detectors allow them to be used on systems such as an AMX portable to produce digital images. There is one caveat to the DR though; if the panel requires interfacing to the system for exposure window signals then you are back to the one panel, one system scenario. The latest version of the DR cassettes incorporate what is referred to as automatic exposure detection (AED) which eliminates the need for interfacing to the X-ray system so the panel may be used with every system independently. Speaking of upgrades, the new DR panels with AED will, in my opinion, do to CR what CR did to film. Look into this technology when it is time to replace your current CR system.

Hable: It is difficult to say that it is “affordable” but it has become essential to have some digital capabilities within the MI department. Smaller institutions and those with limited budgets can ease into digital radiography through a transitional pathway; where they can continue to maintain their existing exam equipment by replacing film with CR and/or Indirect DR options. Once this transition has occurred, or when new capital equipment purchases are available, making the jump to Direct DR is the logical progression. Lastly,

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can be scary; time and savings of personnel and, possibly, fewer people; traditional financing; non-traditional financing. There are leasing and other alternative options in the market now that even larger institutions are leveraging.

Q:

WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF WIRELESS DETECTORS? Bauerle: Today’s modern wireless detectors offer almost all of the advantages of fixed or tethered with very little downside of the possible security issues involving theft and/ or a possible greater propensity to drop the cassette.

DALE D. COVER JR.

RSTI President/COO

additional costs such as film archive scanning will need to be considered along with justifying the overall expense in terms of realistic workloads, exam throughput and system serviceability requirements.

Without these you will most likely not realize a decent return on investment.

Helms: Well, the answer is yes and maybe – not no! While it seems that the cost of going digital looks large at the purchase point, analyzing the overall workflow of the process, you find that the actual cost to own and use very quickly shows workflow savings, processing savings, film delivery to the radiologist and other time and physical cost savings are significant, not to mention the value to our customer’s patients in improved overall service and quality. Finding a way to stretch tight budgets is always a challenge. There are several ways to look at this: up-front costs

NOVEMBER2016 FEBRUARY 2014

Cover: The main advantage of wireless panels is the fact that they are the same size and shape as a large format film cassette.

Being the same size eliminates the need to adapt the bucky (film holder) to fit.

Portability is another advantage. There are two basic functional types of wireless detectors: those that require interfacing to the X-ray system (pre-AED) and those that don’t (with AED). Pre-AED wireless DR panels still required something to inform the digital imaging system when the exposure begins telling the panel to start accumulating the X-ray signal. It is also needed to inform the imaging system when the exposure ended to initiate a read cycle of the panel. With this type of system, if you wanted to work with one panel and one reader, every system that needed to be converted would need to have an interface to the image computer. With AED you just shoot and read with no interface, similar to CR. Some disadvantages would be battery life and charge cycle issues, image storage capacity when you are out of range of the reading computer or a WiFi access point, drop survivability and being lost or left

behind when used with portables.

lighter, faster, and more durable, due to changes in reimbursements this is a major factor when choosing the right systems and/ or equipment.

Hable: Advantages include ease of use (such as) – no cable, lighter weight (depending on model/manufacturer), greater mobility within exam space, and interchangeability (depending on model/ manufacturer and other available systems).

Disadvantages are cost (initial purchase), maintenance costs (battery replacement), battery life/charge level effects availability, and transmission range.

Helms: Advantages include: wireless detectors offer freedom; no cable to deal with; versatility with respect to where the panel can be used; and patient comfort.

Disadvantages include: if the detector is dropped this is costly and the industry has developed insurance for this inevitability. It is not a matter of “if” but “when” a detector will get dropped. It might not be damaged, however, it needs to be planned for. As for the safety of data, these platforms are stable and very safe to use.

Q:

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REPUTABLE THIRD-PARTY DIGITAL RADIOGRAPHY SERVICE PROVIDER? Bauerle: The most important thing, since this is a very large investment, is trust and experience once you have made this large investment. Having the ability to fix this important technology rapidly is also of great importance in a provider as well as offering options for drop coverage that would be affordable.

Cover: I would look for the same things that I expect from any service company: trained engineers, enough staffing to meet their customer load, direct access to support

KENNETH HABLE

Technical Prospects Director of Engineering

services either from the OEM or other reputable sources, a track record of success and customers that are happy to recommend them. Plus, and this is important, a very strong background in IT and computers to include PACS/DICOM. Hable: Their market presence (time in the industry). Depth of knowledge on the specific product line. Reputation and overall quality. Support capabilities.

Cover: There are several notable new and emerging technologies. First, as I mentioned before, the introduction of AED will have revolutionary effects on the radiographic image capture world. With AED, DR is now as adaptable as CR in that without any other modification DR can be used with any system. Another technology that will be gaining will be imaging techniques such as tomo-synthesis where the X-ray tube sweeps across the patient and makes a series of exposures during the pass and the imaging computer compiles a 3D image from the “views” acquired. Currently tomo-synthesis is used in mammography but it would have application in many imaging scenarios. Dual-energy imaging is becoming more popular as well. Thanks to advances in image processing, two images can be taken of the same anatomy at different energies. For example, from a chest X-ray, there would be three possible images produced by subtractive software: just the bones or just the soft tissues and internal organs and both together.

Q:

Hable: Improvements in digital image acquisition speeds and panel construction are enabling advanced acquisition capabilities such as dual-energy radiography and digital tomosynthesis.

These advanced methods are used to overcome the superimposition limitations of conventional projection radiography while advances in image processing software will increase post-processing and 3D rendering capabilities.

Bauerle: DR technology is going toward

Helms: Digital panels have been around for awhile, the newest and most popular

Helms: Stability – are they going to be there for you when you need them? Efficient and timely installation and applications training.

Response time – do they call back quickly?

WHAT ARE SOME OF THE NEWER TECHNOLOGIES AVAILABLE?

THE ROUNDTABLE

Bauerle: Sometimes the least expensive, even though it’s a wireless panel, is not necessarily the best choice. Image quality has many different components and the necessity for certain levels of image quality, such as pediatrics or mammography, have a much higher image quality need then say chiropractic or general radiography.

Orthopedics require higher quality as well so it’s important to not just look at price.

technology available today is the AED (Automatic Exposure Detection). Excess dose is a real hot subject that has been virtually eliminated now by panels that react and acquire at blistering speeds. Less than a 5-millisecond response time is very common. We are now seeing dynamic panels with very fast reaction and reconstruction time so that positioning and techniques can be verified. Even during flouro studies, these panels can be utilized.

Panels are now storing and maintaining up to 100 images. The weight of the detectors is coming down and cost is coming down with the competition in the marketplace and strong competition among OEMs.

Q:

HOW CAN HTM DEPARTMENTS MAKE SURE THEY RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS FOR THEIR DIGITAL RADIOGRAPHY? Bauerle: Partnering up with the right company who can align you with the resources and training is a must.

Cover: HTM departments always have the most negotiating power during the bid and purchase process. If documentation, training and special tools are not included in the purchase agreement then it may be very expensive later if you can get it at all.

CR and DR systems are ancillary to the X-ray system and do not generate radiation so there is no regulatory requirement to provide documentation, much less training.

Hable: Communication with the departments involved in the evaluation and purchasing of the system is key and is often overlooked as the focus is usually placed on the acquisition of the system and not its maintenance. It is possible to build into the initial purchase support staff training and

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1TECHNATION.

MIKE HELMS

AMX Solutions Strategic Account Manager

education when making a significant system purchase from a major OEM. If going with a smaller third-party provider, be upfront and request the necessary literature and discuss any additional support tools and training that may/will be necessary to maintain the product.

Helms: HTMs should be diligent to be involved with the purchase process.

However, the serviceability of these products is currently very limited in scope.

They should be available for the applications and installation process. Be interested and involved as the companies that sell this product are open to help and share the information. Ask!

Q:

WHAT ELSE DO TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND SERVICING DIGITAL RADIOGRAPHY?

NOVEMBER JANUARY 2016 2014

Cover: With so many variations of X-ray systems and almost countless digital imaging possibilities, it is important to understand how these systems interrelate.

Budgets are often the driving force for one decision over another but as a service professional with the proper education and experience you may be able to provide insight that can save money in the long run by spending a few more dollars now on a digital imaging system that will be applicable to future systems or scalable enough to handle the entire enterprise.

Hable: Digital radiography detectors (CR and DR detector systems) now make up the majority of the imaging receptor market, especially CR and Indirect DR formats.

Knowledge of the different digital-based system characteristics, advantages, disadvantages and operational details will prove most significant in establishing the confidence to make informed decisions regarding purchase and support.

Helms: Be involved in the purchase process and learn all you can about the product.

Service for now is going to be “black box.”

There really is nothing to amount to in servicing the detectors. Have QC testing available. If the detector fails, it will most likely go back to the factory for repairs due to the design. This will not change for the product. It is a sealed item that has needs

THE ROUNDTABLE

FEBRUARY 2016

1TECHNATION.COM

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FEBRUARY 2016 1TECHNATION.COM

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FEBRUARY 2016

ALTERNATIVE EQUIPMENT MANAGEMENT Wh a t Wo r k s B e s t ?

By K. Richard Douglas

I

n 2012, there was an intense focus in the HTM community about evidence-based PM versus a manufacturer’s recommended maintenance schedules. The issue moved front and center when CMS declared that a manufacturer’s schedule had to be followed in late 2011. This threw the proverbial fly in the ointment for many who had developed well-reasoned alternative methodologies.

The evidence-based approach, much like its counterpart in medicine, was scientific in application, and a realistic option to the more standardized approach. The community waited on clarification after many questions arose as a result of the CMS directive. It took two years to receive a clarification.

The decision was made to give the HTM community a little more rope, but it was incumbent on each HTM department not to hang itself.

With that clarification came the separation of equipment classifications into those eligible for alternate PM schedules and those that must adhere to its manufacturer’s recommendations. It also required that alternate methods be constantly monitored to evaluate their reliability, their methodologies and a process for discarding non-functional equipment. The rules further require that an alternate equipment maintenance (AEM) program, and its processes, must be in writing and qualified personnel must administer the program.

Today, health care facilities have adopted their own approach to workable AEM programs. The programs must meet strict requirements that include procedures to regularly evaluate the approach and a determination about how malfunctioning equipment is identified. A health care

organization must keep an updated inventory of all medical equipment.

The approach used to determine maintenance schedules, and how it relates to patient safety, is the nexus of any discussion about AEM programs.

The importance of getting an AEM program right is as crucial as determining a hospital’s continued eligibility to receive Medicare and Medicaid reimbursements.

Creating metrics by which devices can be rated for reliability and developing concise maintenance reports are components as well.

“The latest CMS and The Joint Commission requirements call for health care organizations to identify high-risk medical equipment. The Joint Commission uses the term ‘high-risk’ whereas CMS uses the term ‘critical,’ but the definitions are identical,” says Matthew Baretich, P.E., Ph.D., president of Baretich Engineering Inc. in Fort Collins, Colorado. Baretich presented on this topic at the 2015 CABMET Symposium.

“These definitions are somewhat expanded versions of the ‘life-support equipment’ terminology that the Joint Commission has been using for several years. Health care organizations should have a policy that includes a list of equipment it considers to be high-risk medical equipment. These should be flagged in the CMMS inventory,” Baretich says.

ALTERNATIVE EQUIPMENT MAINTENANCE

“

Utilizing tools to define risk can help an organization develop an alternate equipment maintenance program that is cost effective, promotes uptime, and focuses on streamlining practices.”

When a TJC surveyor drops in to review your program, it must meet muster. In order to be compliant, the program needs to be based on accepted standards of practice.

During his 2014 presentation at the AAMI annual conference, George Mills, from The Joint Commission, alerted the HTM community to the additional scrutiny that these requirements would place on them.

Presently, is there any one standard of practice that is better or worse than others as far as TJC is concerned?

“It really depends on the device and suggested frequencies that are being evaluated,” Mills says.

“Each has a specific advantage and disadvantage. For example, interval based maintenance is easy to schedule, but may not be the best for alternative strategies.”

MEASURING RISK “From my experience with dealing with different regulatory agencies as of late, the two keywords during any inspection are ‘risk’ and ‘mitigation,’ ” says Anthony J. Coronado, biomedical engineering manager and account manager for Renovo Solutions LLC working at Methodist Hospital of Southern California.

“In 2014, Alternate Equipment

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Maintenance Program’s written guidance was established by The Joint Commission and CMS to help health care facilities constructively develop a Medical Equipment Management Program. If you review the TJC’s Elements of Performance (EC.02.04.01 EPs 6 and 7, and EC.02.05.01, EPs 6 and 7) details and the CMS State Operations Manual, proper risk assessment is the primary focus,” he continues.

“Utilizing tools to define risk can help an organization develop an alternate equipment maintenance program that is cost effective, promotes uptime, and focuses on streamlining practices,” Coronado says. “The goal is not only to meet the requirements from these regulatory agencies, but to provide best practice for the future.”

Malcolm Ridgway, Ph.D, CCE, FAIMBE, the retired former chief clinical engineer of Aramark Clinical Technologies, points out that one of the major misunderstandings is that overall equipment failure rates are a reasonable indicator of the effectiveness of PM programs. He says that this is not the case.

“It is particularly important to remember that the only failures that can be prevented by performing

FEBRUARY 2016

ANTHONLY J. CORONADO

Biomedical Engineering Manager, Renovo Solutions LLC

PMs are: Those that result from inadequate restoration of the device’s non-durable parts (MR 1 type failures, as well as instances of serious physical deterioration), and those that result from a failure to detect and repair some kind of hidden deterioration that is affecting the performance or safety of the device.”

Ridgway says that in order to make that work properly, everyone would have to change over to a new way of documenting maintenance findings.

He points out that this would be no small challenge.

“All of the regulatory ‘instructions’ about performing some kind of ‘risk assessment’ seem to have many people puzzled and I get the impression that many are just going along with performing PMs on all of their equipment according to the manufacturer’s recommendations,” Ridgway says.

“What a tragic step backwards!

This takes us back to the Stone Age and leaves us far worse off than we were before TJC introduced the Fennigkoh Smith process back in 1989. It is going to be a major challenge just getting copies of all of those manufacturer recommendations.”

Maintaining all equipment, as the manufacturer recommends, flies in the face of the realities of current day hospital budgets and HTM resources as well.

There are various alternate approaches to handling PM. Some acceptable methodologies might include metered maintenance, corrective maintenance, reliabilitycentered maintenance or predictive maintenance.

If equipment doesn’t have enough documented maintenance history, if it is a medical laser or imaging or radiologic equipment, it cannot be included in an AEM program.

The old adage about knowledge being power has great application at the core of this discussion. The accumulated evidence and/or data, from a multitude of HTM sources, could be shared, condensed and formatted in a way to provide a roadmap to a reliable and workable alternate maintenance strategy based on evidence.

An amalgamation of data has been the approach used in medicine to provide guidance in treatment decision making. This model has been trusted and relied upon to determine the course of treatment in medicine for many years. With this in mind, an alternate maintenance approach that would satisfy regulators, could be derived in the same way.

CONSIDERING RCM Standardization is not here yet, but it could be a reality in the near future, as useful and relevant methodologies are being reviewed and some of the best minds in the field are offering ideas from an impressive brain trust.

The aforementioned approaches are all potential candidates for an AEM program. AAMI and ANSI’s EQ56 also outlines the criteria for an AEM program. It covers the creation of alternative maintenance procedures, maintenance strategies and documenting findings and repairs, along with a lot of other useful information. It is a standard that Mills has recommended.

One methodology that has emerged

as a potential viable choice for some type of standardization is reliabilitycentered maintenance (RCM), which is used in a number of industries and has a proven track record. Malcolm Ridgway brought the approach, and its history, to the attention of AAMI. Ridgway has proposed that RCM should be considered as a standard for AEM programs because if its success in other industries.

In November, AAMI kicked off a project to explore RCM, to determine if it is a “feasible strategy that could be adopted on a wide scale throughout the field of healthcare technology management (HTM).”

The project is under the guidance of HTM consultant Ken Maddock.

“What we need to ask is why more organizations aren’t taking advantage of the flexibility offered by the AEM program. It is important for organizations to fully embrace the AEM program and take advantage of it to develop a program that is not only safe but efficient,” Maddock says.

He says that the hope is to promote a methodology that not only fits within current regulatory guidelines, but supports the universal goal of cutting health care costs while maintaining an appropriate level of quality.

“Ultimately the hope is that we can achieve a goal which would be a real turning point for our industry; the universal adoption of an effective best practice. I believe that the lack of a consistent approach to maintenance practices within our industry leads some outside of the industry to believe that we need stricter guidance on how best to support medical technology,” Maddock adds.

“While the classic definition of reliability-centered maintenance (RCM) varies depending on the source, it is fundamentally a structured process for identifying the best maintenance practices for a given technology or group of technologies,” says Larry Fennigkoh, Ph.D., P.E., professor of biomedical engineering at the Milwaukee School of Engineering.

Fennigkoh says that in this context, the “best” practice is one that

KEN MADDOCK

HTM Consultant

“

I believe that the lack of a consistent approach to maintenance practices within our industry leads some outside of the industry to believe that we need stricter guidance on how best to support medical technology.”

ALTERNATIVE EQUIPMENT MAINTENANCE

LARRY FENNIGKOH, PH.D., P.E.

Professor of Biomedical Engineering at the Milwaukee School of Engineering

“

HTM has been doing this and in essence a (very loose) form of RCM for decades. What we haven’t done – as Malcolm and others are so painfully aware of – is brought or developed any structure and standardization to our maintenance practices.”

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maximizes equipment availability (or uptime), reliability, and safety while it minimizes costs.

“As RCM may be applied to a group of technologies, what is ‘best’ may be a combination of maintenance practices, i.e., conventional and periodic ‘preventive maintenance’ may be needed for some, interval or real-time monitoring for others, and simply run-to-failure for others,” Fennigkoh says.

“In this regard, HTM has been doing this and in essence a (very loose) form of RCM for decades.

What we haven’t done – as Malcolm and others are so painfully aware of – is brought or developed any structure and standardization to our maintenance practices,” he adds Fennigkoh points out that “one of the reasons RCM works so well in other maintenance-intensive industries has been due, in part, to their ultimate and effective use, and proper analysis of equipment failure modes, mechanisms, and frequencies.”

It is only with such data, he says, that an organization or industry then determines optimum PM intervals — if any — [and] optimum inspection procedures (if any).

“The continuing lack of standardized maintenance procedures, recording, and data validation techniques – combined with no meaningful, centralized, and substantial database – remain some of HTM’s greatest obstacles and challenges in bringing a true RCM approach to medical devices,” Fennigkoh adds.

TWEAKING WHAT WORKS When Joshua Virnoche, MBA, CBET, came on board as a clinical engineering manager with JPS Health Network in Fort Worth, Texas, the situation was that all equipment with a risk score higher than seven was serviced at least annually.

“All equipment less than seven was run until fail; this accounted for a significant portion of our overall equipment. Risk score greater than seven accounted for roughly 6,000

FEBRUARY 2016

items, while risk score less than 7 accounted for about 17,000 items,” he says.

Virnoche says that the hospital’s AEM program was set up using a risk assessment that put a risk number on each piece of equipment based on the ECRI formula E+A+[(P+F+U)/3], where equipment function is E, clinical application is A, preventive maintenance requirement is P, likelihood of failure is F, and environmental classification is U. “The current process has been revised to be in line with regulatory requirements. We still use the same risk score calculation, but have revised the layers,” Virnoche explains.

“Anything that is risk score 15+ is considered ‘high risk’ equipment, and is maintained by manufacturer’s specs. If we don’t have the service manual or the test equipment to maintain this equipment in house it is maintained by the manufacturer. All imaging, lasers, and equipment subject to federal or state law, or Medicare Conditions of participation, is maintained at this level as well,” he says.

“Additionally, all new devices with insufficient maintenance history is maintained at this level.

Risk scores less than 15 now receive a performance, functional, and electrical safety check on, at minimum, an annual basis. If this equipment fails any of these tests it’s repaired, and then a manufacturer’s recommended PM is performed.”

Virnoche says that a year into the new maintenance plan has revealed some benefits, as well as some drawbacks.

“Overall, expanding scheduled maintenance to all of our equipment has been a daunting and on-going task. We’ve seen great results in the functionality and reliability of the equipment, with less overall failures of the equipment, since we catch problems before equipment fails, in most cases,” he says. “Less downtime has definitely increased our positive feedback from our customers, and our working relationships have improved all around.”

“ MALCOM RIDGWAY, PH.D., CCE, FAIMBE

Retired Former Chief Clinical Engineer of Aramark Clinical Technologies

On the other side, there has been a significant investment in time to ensure that the department has the right manuals, strategies, test equipment and manpower to cover the added work load, Virnoche says.

The original AEM program took six biomed techs and two imaging techs, along with a significant investment in service contracts and time-andmaterials and labor-hour contracts (T&M labor).

“Today, we’re budgeted for four imaging technicians and 20 biomed technicians,” he says. “We rely much less on contract and T&M labor, which has offset the cost of the new employees. The FY2015 budget offset was initially net neutral, offsetting $1 dollar of contract cost for $1 dollar of in-house labor, but by the end of the year we had saved an additional $300,000+ in contract labor over expectation.”

Virnoche says he expects additional savings in FY2016 over FY2015.

“I’d like to reiterate, that while we have saved budget dollars, our quality of work has significantly increased since we began this journey,” he says.

LOOKING FORWARD In the meantime, Maddock and

I do agree that using an RCM based approach is the best way out. It also provides a very solid case for reducing the amount of PMs that we would have to do very substantially.”

AAMI are working behind the scenes on assessing how RCM might fit into the equation.

“Organizations are being solicited that would be willing to adopt RCM practices and record the data so we can verify the effectiveness of this methodology,” Maddock says.

“At the recent Supportability Summit, there was very good cooperation between manufacturer representatives and HTM professionals, so we hope to engage manufacturers on how they might get involved in this effort,” he says.

“The plan does include a shared database that would start small, but over time could expand to become a national database,” he adds.

“Any database would be used as supporting documentation rather than part of a live support system, so recovery would be more appropriate than full redundancy.”

He says that the current draft plan is to write a series of articles and/ or white papers that would explain how to use the process and how it fits within current regulatory guidelines.

Working within the regulatory framework, the task of running an effective alternate equipment maintenance program is an important step in allocating human resources,

maintaining safe equipment and watching the budget. The day may come when the implementation and management of such a plan includes some degree of standardization and readily accessible online resources.

“I do agree that using an RCM based approach is the best way out,” Ridgway says. “It also provides a very solid case for reducing the amount of PMs that we would have to do very substantially.”

There are four parties at the table of any AEM discussion. There are the patients, the regulators, the HTM community and the manufacturers.

All three of the other parties are interested in the well-being and safety of the patients. The regulators have the final say. The manufacturers have their recommended schedules and the HTM community has limited resources. Finding a path that is practical for the HTM community is a work in progress.

This year should see the development of an AAMI RCM task force, as well as the possibility of a database. Those things are still preliminary at this point, but would certainly move the ball forward.

To access the HTM community wiki database website, visit www.

HTMCommunitydB.org

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CAREER CENTake Charge of Your Career by Focusing on Your Goals

By Cindy Stephens

M

ost of us are thinking about our future especially this time of the year when the new year presents an opportunity for change.

We consider changes to make our personal and professional lives more fulfilling and successful.

CINDY STEPHENS Stephens International Recruiting, Inc.

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Some of us are on track to accomplish our New Year’s resolutions! Then a few of us (like me) start to make the positive changes at the start of a new year, but quickly fall back to the old habits. Often our New Year’s resolutions are too difficult to achieve due to a lack of a planning and follow through. My reasons?

I was too busy, overwhelmed, and I didn’t have a clear plan! It seems many people feel the same way – too busy and overwhelmed to even start thinking about their well-intended resolutions.

Whether it is professional or personal, it is not always easy to make changes or work on resolutions. However, the good news is that it is never too late to start improving yourself and now is a great time to make resolutions for change. We just have to make the choice of either continuing with the “old” habits or working toward a new improved self or routine!

Interestingly, the most successful people are those who made a choice to be successful, established goals, and set out to accomplish them. Ultimately, it is up to each of us to take charge of our professional and personal growth.

However, achieving success in anything requires having a plan – setting goals and actions to carry them out.

The key to achieving success is to motivate yourself to turn your goals into realities. Setting goals is a very powerful technique to make a positive difference in achieving success. Therefore, if you want your life to change, you must set your goals into a plan, and take the steps to be successful.

It sounds easy enough, but studies show a majority of the people don’t take the time to identify their goals and make a

FEBRUARY 2016

plan for reaching them. Goals give you a destination. Knowing where you are going will help you get there! Here are some easy steps to put your resolutions and goals into action!

Start out with small steps, and keep it simple so you can achieve your goals!

Maybe you want to be more productive at work or add to your professional skills to work towards a promotion. You may just want to simplify your life, manage your time better, or find the time to do the things that are more important in your life.

• Determine your objective — What do you want to achieve? What is it you want to do in your life and career?

Once you have a vision and know what you really want to accomplish with your life, you will be able to define your goal and develop a focused plan to set you in the right direction.

• Define specific, but realistic, goals.

Categorize your goals for your personal, financial, career, spiritual and other major areas. However, don’t have too many goals which can sabotage your success and become overwhelming.

• Begin with well-defined goal statements that form the basis for your plan. One way to remember how to create a clear and accurate goal statement is to think of the “SMART” acronym used by many experts in goal setting workshops stands for: Specific, Measurable, Achievable, Relevant (or Realistic), and Timely. Each goal statement should have clear steps to provide direction and focus to achieve the goal. Have a plan of action, that allows you to track your progress toward the goal in a time frame that is realistic.

• Narrow down the list to concentrate on a few goals at a time. As soon as you achieve those goals, you can move down your list. You want your goals to be worth working toward.

• Once you have a defined your specific goals, you need some direction to follow to achieve each goal. Create an action plan that gets results. If you don’t know where you are going, how can you expect to get there? Write down in detail how you will achieve it and by what date. This plan is your roadmap to success. The more specific and measurable the plan, the better, but the key is to have a written plan to keep you on track and moving forward.

• Goal setting is an ongoing process that is accomplished over time. Review your goals daily to become more productive, to remain focused and determine your priorities. As each set of goals is reached, you will be compelled to set new goals, but consider rewarding yourself for your achievement!

• Maintain a log of your progress along the way to help keep you on track. Even small steps will get you a little bit closer to your goal.

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• Do not become frustrated if you do not achieve your goals overnight. Keep in mind some resolutions fail and consider the potential roadblocks that may prevent you from achieving them. Facing these roadblocks up front will prepare you to overcome them.

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• Stay motivated even in the face of obstacles or setbacks.

Remain flexible and willing to adjust your plan when necessary. Sometimes you may need to take a detour along the way, but don’t get discouraged and let this throw you completely off course. Stay committed and keep going!

Whatever the reasons are for change, I hope these steps will give you more focus and direction to assist you in accomplishing your New Year’s resolutions! Take charge of your career by focusing on your goals and achieving success.

Contact apmsales@philips.com or call 866-507-4793 to find out how we deliver on the promise.

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By Matt Tomory

any of the questions our technical support, service and sales teams at Conquest Imaging receive revolve around various aspects of software. With today’s modern technology, software effects almost all aspects of an ultrasound system including scan conversion, networking, diagnostics and overall system operation. Software can be responsible for almost any type of malfunction. There are times I miss working on the old Acuson 128 which had no hard drive; only EPROMs were used and software issues consisted of self-inicted bent pins during software upgrades or board replacements.

OPERATING SYSTEM SOFTWARE One of the issues service engineers face is the availability of the operating system software. Some OEMs will supply it with the system such as GE but you may need to request it from others. It is best to ensure system purchases include OS software so you are prepared in the event of a software issue. If you do not have your software, I highly recommend you determine the revision of your system and request the software and installation instructions from the manufacturer. Our technical support team is also available 24x7 to assist you.

MATT TOMORY VP of Marketing & Sales, Conquest Imaging

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SOFTWARE UPDATES VERSUS UPGRADES As an independent service and support organization, we consistently get asked about the availability of updates and upgrades when competing against the OEM. The perception is if you have a contract with an OEM, you automatically receive software upgrades. This used to be the case many years ago (back when I was bending pins on EPROMS) but rarely, if ever, seen today. A software upgrade contains new features, capabilities or enhances existing ones. A software update is implemented when there are performance or regulatory issues involved with an

FEBRUARY 2016

existing revision. Regardless of contract coverage, if there is a performance or regulatory issue, the OEM is obligated to install or provide it to you regardless of your parts or service provider. Upgrades on the other hand are products you must pay for regardless of coverage although there may be a discount involved if you are under warranty of service agreement. Both updates and upgrades are the intellectual property of the OEM and only the OEM can (should) change the software revision of your system for regulatory and legal reasons.

BACKUPS When discussing software, I would be remiss if I did not mention one of my favorite subjects and that is backups. Back with the EPROM based operating systems, backups were handwritten or printed out on a thermal printer and contained very little information. Today, they are electronic (CD, DVD, USB drive) and contain system options, presets, network data and other user defined information so backups are critical to maintain your systems and mitigate downtime.

Software is a complex issue and does raise many questions, some of which I hope I answered here. You are welcome to reach out to me with any additional questions or comments at mtomory@ conquestimaging.com.

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THE FUTURE

Recruiting Younger BMETs

I

By Roger A. Bowles, MS, EdD, CBET

n the past few months, we have had the great fortune of having several large employers visit our program and interview our students. Many of those interviews resulted in job offers. Indeed, lately the job market is looking very promising for BMETs. All of the employers have concerns about the number of students coming into the program as they see their hiring needs increasing. In fact, most of them see a huge hole coming in about 5-10 years because of the number of people in the field retiring. Students really like hearing this, of course, because it means opportunities for them are increasing.

Roger A. Bowles MS, EdD, CBET, Texas State Technical College

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When I first became a BMET, the average age was reported to be about 33.

That number has steadily increased. In fact, most of the surveys I have read place the average age to be about 50. One employees recently told us that almost half of his employers will be retiring in the next five years. That is an alarming number. We are getting old, folks! And to top it off, many of students coming into our program are older. The average age of our incoming students is between 28-30 and increasing steadily.

We are having a harder time recruiting younger people out of high school. One reason is people are still unfamiliar with our career field and what a BMET does.

Our lab assistant has been on a recruiting mission for the last year. She is a graduate of our program and wants to spread the word about us and about BMETs. And … she is doing a terrific job. She has probably visited 40 high schools in the past six months or so and many of the teachers and counselors are asking her to come back. I’m anxious to see how it pays off next fall.

One of the things I’m doing is researching the attitudes and career “wants” of people in that age group (16-19). They want a career where they can do meaningful work and where they make a difference more than anything.

Healthcare Technology Management would seem to be a perfect fit! Many

FEBRUARY 2016

“One employer recently told us that almost half of his employees will be retiring in the next five years. That is an alarming number.” mention flexible work arrangements. I’m not so sure every employer can provide that but the work itself makes a huge difference in health care. While money isn’t their primary concern, they do want opportunity for advancement and training. Check and check.

I always ask the younger students how they heard about the program. Almost all of them know someone who works as a BMET or Field Service Technician.

Very few of them hear about it through advertisement (ours or otherwise) or teachers/counselors. This is troubling.

This a group of students who have unlimited access to technology and yet they don’t really use it to view recruiting videos (or so they tell me), especially since the school is making a more

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concentrated effort to reach them through technology.

Personally, I applaud the latest career videos on BMETs. But I wonder if a different approach is necessary. Many of the videos show people in the laboratory/classroom setting or talking about the career field and its benefits. This is wonderful and it would definitely attract me toward the career field if I were not already in it.

Perhaps a different type of career video would be more effective. I wonder if it would be possible to strap a GoPro (maybe a chest mount?) to several outstanding BMETs for a day (several types of employers and environments, of course) and record “a day in the life.” The highlights could be edited into several short career videos that could be uploaded to YouTube and other places. Without advertising any particular institution or employer, maybe this would be effective. I’m just thinking out loud. If you have other ideas, I would love to hear them. We have to find ways to reach this generation.

O

N

D

DESIGNER: KK

EXPERT ADVICE

KAREN WANINGER What Did You Expect?

By Karen Waninger, MBA, CBET

I

heard one of my teachers in college express a theory that really didn’t make sense to me at the time. It was just a statement made in casual conversation with another teacher as they were walking through the hallway. He said, “Some students will only perform up to the level you expect of them.” The other teacher simply shook his head and responded, “That’s right” with a deep sigh. That comment stuck with me, and I have been reminded of it frequently.

KAREN WANINGER, MBA, CBET

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It is my observation that the same concept holds true for the workforce in general. Setting the right performance expectations can determine the success or failure of each member of the team. If you do not present enough challenges to keep the top employees interested, either they will go elsewhere to find excitement, or they will choose to stop excelling. At the same time, if you expect too much from someone who is a solid performer, he or she may become discouraged before experiencing the feelings of success that keep them motivated.

Throughout my years in the Healthcare Technology Management profession, I have had the pleasure of working with some really great people who were determined to drive positive change in the environment around them.

I have also found myself wondering why some people still have jobs when the results of their actions are consistently below the performance level of others. I believe it’s appropriate to give an individual the benefit of the doubt until there have been specific, documented attempts to assure the employee knows what is expected. If unacceptable performance is allowed to continue without any efforts toward correction, it’s a clear indication that all fault rests with the supervisor or with the general culture of the organization. With that

FEBRUARY 2016

said, however, it is crucial to remember that the managers and Human Resources employees must be in compliance with organizational policies and be respectful of the individual rights of each employee. Translation – remember that unless you are one of the individuals involved in performance management activities, there may be efforts in progress that no one else in the department is aware of.

It’s never pleasant for either party to go through the feedback process when employees fail to meet the minimum expectations of their role. When that situation happens for me, my first thought is that I have failed to be effective as a manager. I may not have established or communicated clear performance objectives, or I may have expected some results that were not actually attainable. Either way, it’s critical that we discuss the situation, identify where changes should be made and clarify who is responsible for taking which actions. Then, it’s important to check back after a few weeks to further clarify any misunderstandings or address other barriers, whether real or perceived.

The busier people get, the harder it is to make the time for these important steps in the overall evaluation of an employee’s contributions to the team. If there is a need to implement remedial

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action, it can be a lengthy cycle of improvement and regression before performance is sustained at an acceptable level, or not.

Another common failure when it comes to performance evaluations is to set expectations too low. It is always rewarding to work with individuals and teams who are focused on improving upon their own past results. As a manager, how should evaluations be handled when every employee is a top performer? Often, these individuals are referred to as “Type A” personalities or “Overachievers” because they are competitive, sometimes impatient, and diligent workers. They usually expect more from themselves than they expect of other people. While it is exciting to work with an “A Team”, they bring their own set of challenges, especially when it comes time to conduct the formal performance evaluations.

A typical system-wide measurement scale includes a range that is something like this: 1) Does Not Meet Expectations, 2) Inconsistently Meets Expectations, 3) Meets Expectations, 4) Exceeds Most Expectations and 5) Significantly Exceeds Expectations. How do you determine appropriate scoring when actions that would be viewed as “exceeding expectations” on other teams are now only perceived as “meeting expectations” because the bar has been raised for everyone on the team? The manager charged with completing the assessment may as well accept that whatever the score, and the explanations to support it, those high performing and perfectionist-like employees will always want their scores to be higher. If they are disappointed with an evaluation score, it is not necessarily assumed that the manager’s evaluation is unfair toward them. It is more likely that they have already pushed themselves beyond “normal” performance levels, yet somehow failed to reach the mark they were personally striving for.

Unlike the professors I remember who were disappointed with a student who elected to exert only the minimum required effort, we are fortunate to be part of a profession where there are so many individuals who want to be the best in their field.

It can be a great problem to have as a manager, to try to find ways to keep challenging and rewarding an entire team of professionals who expect to excel in everything they do. The key there, as with everything else related to being a manager, is to make sure your own expectations are aligned with those of your employees, your customers, and your organization. If all are working toward a shared objective, then everyone benefits.

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By David Scott

any techs that I have met or know are outstanding at technical skills and learn new technical skills easily. Most of them like to go to manufacturer training or some other kind of technical training class so they can improve their proficiency on different types of equipment. However, I have noticed the biggest thing that many BMETs struggle with is communication and customer interaction. Most techs are awesome at repairing equipment. Sometimes the customer doesn’t know that it has even been repaired until they go to use it. That is where the problem lies – communication.

DAVID SCOTT CBET, Study Group Organizer, CABMET

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When I was a younger tech I worked with senior techs and I was always amazed at how well most of them could talk to customers and tell them what was going on with their medical equipment repair status in a way the customer could understand. It didn’t seem that difficult to me, until I tried it myself.

How can you improve this nontechnical skill? One of the ways that I have tried to become better at this is to challenge myself. I am involved in our local biomed association. I can tell you first hand it is very intimidating as a young tech to get up in front of a large group of techs. I still remember the first meeting when I had to speak about something. I was shaking and couldn’t remember what I was saying! I was worried about what all these techs, that I had so much respect for, would think of me. It was a challenge I made to myself because I knew it would help me with talking to people including other technicians, nurses and doctors. It helped me build my confidence in myself enough to talk to almost anyone.

You might have seen the CABMET study group that I run for the biomed association. I can tell you that it doesn’t come natural for me. To me that is another way of challenging myself. I have been doing that study group for going on 12 years and it is still very difficult for me to cover the electronics presentation. I

FEBRUARY 2016

normally have another person, who instructs electronics at a local community college, do it for the group. However when he is not able to do it or I’m doing it for the MD Expo I have to step up and do it myself. It is still intimidating to me to be in front of a room full of techs, I am sure most of them know more about a certain type or brand of equipment than I do. Usually I try to learn from them when they are willing to share. I can get through it thanks to my experience with former presentations and from talking with customers.

This brings me to another point and the idea behind this article – how to get continuing education points. Many community colleges offer speech classes.

These classes are great for teaching you what you need to know to make a speech.

Recertification points for taking a speech class fall under the category of Academic/Vocational course at a university or college. For these classes, the attendee is able to get one point per academic hour. Most of these courses are three or more credit hours. There are other employee development courses that offer customer relations and these can help also.

Remember to always challenge yourself. That is how you improve. And remember to keep your recertification journal up to date.

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65

PATRICK LYNCH

Image Quality – Do Biomeds Know What It Means, or Care About It?

By Patrick Lynch

I

’ve been doing some work lately that has caused me to begin to question the wisdom of traditional Biomeds moving into imaging service. You see, when we were trained to repair the general biomed equipment (monitors, infusion pumps, incubators, etc.), we had simulators which created known and precise inputs. We then could measure the outputs, which had to be just as exact and precise (within specified tolerances). It is fairly simple for us to adjust the medical equipment to make the output match the input. You use a simulator to inject an 80 BPM ECG and make sure that the monitor reads 80 BPM. Simple. Easy. Foolproof.

PATRICK K. LYNCH, CBET, CCE

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Let’s now examine ultrasound. The image is fuzzy. It is not well defined. It is not often clear what the doctor is looking for. It is not obvious what is normal and what is not normal.

One of the most difficult things for a biomed to do when servicing an ultrasound is return the unit to an image that the sonographer finds acceptable. It seems that almost every sonographer has different preferences and thoughts about what is the “correct” setup and image.

So, if the sonographers can’t agree among themselves, how can we be expected to apply a uniform standard? I see only one way to do it. Use a phantom and have some pre-printed photos of how the screen should look when the particular phantom is used in such-andsuch mode, with certain settings.

Those of us who are old will remember when we had to manually adjust the color on our color television set. We had a color and tint control. By adjusting these, we could vary the intensity and shading of the images. I was a TV repairman back in those days.

In order to help us adjust the color accurately, and avoid the varied perceptions of each of our customers, we had a preprinted COLOR BAR CHART. One of our items of test equipment was a COLOR BAR GENERATOR. It created a matching color pattern on the TV screen. We then held the preprinted

FEBRUARY 2016

color chart up to the front of the TV, and adjusted the color and tint controls until the screen colors matched the color chart. Simple.

Why shouldn’t we do the same thing for ultrasound? Using a known phantom, with preset machine settings, print what the image on the screen should look like. When making a service call, using the phantom and the standard settings, if the screen matches the preprinted screenshot, then that is a pretty good indication that the entire image chain, from the transducer to the front end, to the signal processor, to the display, are all working properly.

I am sure that some people out there will fine holes in this straightforward plan. Please – let me know where I am missing the boat. It seems so simple to me.

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Making our customers heroes™

THE ROMAN REVIEW Communication

By Manny Roman

I

have been contracted by a national association of medical service and equipment providers to be their Association Business Operations Manager. I am lovingly called the ABOM.

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

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Since the members are all over the U.S. and I am in Las Vegas, most of our communication is by email.

Many of you may know that I don’t consider email a good communication method. It may be the worst possible way to attempt to get anyone to truly understand the message and its intent. It is the intent that is missing from emails that makes them easy to misunderstand.

When I conduct my Successful Customer Relations presentation, I always begin with a discussion on communication. I talk about how we use a filtration system to encode an idea into verbal and nonverbal communication. I talk about the need to minimize the noise factors that interfere with effective communication. I also cover the need for feedback to ensure understanding of the message and idea being communicated. I even cover body language and nonverbal cues. I cover the mechanics and the “should dos” well.

However, the mechanics don’t take intent into consideration. Intent encompasses your objective for the message and expectations of the response.

The intent of the message should dictate the communication method best suited to ensure good communication.

First, let me state that good communication involves proper informing. Informing is telling the what, the why, what can be expected as a result, and gaining acceptance of understanding. Without acceptance, there is no communication.

Also important is that research indicates that the words only carry 7 percent of a message. The voice tones and inflections carry 38 percent and the nonverbal cues (body language) carry the remaining 55 percent. Now, let’s discuss the methods of communication.

FEBRUARY 2016

The first is face-to-face. In this method we have immediate response and can observe the nonverbal cues from the body language (the entire message). We should use this method when the subject is both urgent and important. A written record of the conversation should be kept for follow up purposes.

Telephone is the next best method to ensure that the message is communicated. You miss the body language however you can hear the voice inflections that carry much of the message. The telephone allows for a full feedback driven discussion and allows for communication of urgent and important issues. Contemporaneous notes will provide a written record.

Texting is an addition to the communications arsenal. It is immediate and can be used for important and urgent communication. We may have a written record of the conversation. We now begin to lose the nonverbal cues.

Email seems to be the preferred method of communication now. We send an email, it disappears onto the cloud, and we expect a reply sometime in the near future. This method may be used for important but not for urgent messages unless we are sure that we will get a prompt reply. Any written communication is subject to the Ladder of Inference effect so we must be careful with our wording. (If you don’t know what that effect is, Google it or see my discussion in a previous TechNation article).

Then there is “social media” – Facebook, Twitter, etc. Although the users consider these methods important and urgent, especially Twitter, how important is it for me to know, right now or at all, that you just ate a ham sandwich without mustard? The purpose

TRIM 3.25”

of these seem to be to keep anyone who may have interest aware of your daily activities, concerns and moods.

I will not discuss snail mail, newsletters and webinars here so I have space to discuss the next topic – email usage. You see, email has become so prevalent that it has superseded all other forms of communication. It is abused and overused and quite often ignored. Our expectations are that we can “intrude” on anyone about anything if we send an email. We don’t even have to provide all the information within the email, nor do we have to use proper spelling, grammar and courtesy (Ruth is fond of pointing out my errors after I hit the send button).

I get many emails that do not even have a nice greeting and close, just one giant paragraph that was obviously not given much preparation time. Leaving me to decipher the what, the why and the expectation. I have come to the conclusion that email is not a form of communication at all. There is no communication without acceptance of understanding. If you leave me to make the interpretation, I guarantee that I will interpret it wrong.

Also, email does not seem to adhere to any etiquette. Do you even reply, and by when? What should I do if the content is important and you do not reply in a “reasonable” time? What is a reasonable amount of time before I escalate to a phone call, or a face-to-face? How do I know that you really understood my intent? I propose that email be used for non-important yet possibly urgent topics. If the message is important and urgent call me, leave me a message and I will get back to you in a reasonable amount of time after I peruse my hundreds of emails.

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Car covers the length of three football fields before driver regains full attention Source: David Strayer of University of Utah; AAA Foundation for Traffic Safety Graphic: Helen Lee McComas, Tribune News Service

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71

THE VAULT

D

o you consider yourself a history buff? Are you widely regarded among coworkers as an equipment aficionado? Here is your chance to prove it! Check out “The Vault” photo.

Tell us what this medical device is and earn bragging rights. Each person who submits a correct answer will be entered to win a $25 Amazon gift card. To submit your answer, visit 1TechNation.com/vault-february-2016. Good luck!

LAST MONTH’S PHOTO

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

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FEBRUARY 2016

A Grass Model 78 Electoencelphograph, circa 1970. The photo was taken at the antiquated equipment display by CABMET at the 2015 AAMI Conference and Expo.

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

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WHAT’S ON YOUR BENCH?

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echNation wants to know what’s on your bench! We are looking to highlight the workbenches of HTM professionals around the country. Send a highresolution photo along with your name, title and where you work and you could be featured in the What’s On Your Bench? page and win a FREE lunch for your department. To submit your photos email them to info@medwrench.com.

Various hard copy service manuals. I’m old school in that I occasionally go back and break out books to repair some devices.

Our organizational protocol used when employees are sick before they can report back to work. Very important because you don’t want to get patients or other employees sick.

My plastic box contains PM stickers and safety inspection stickers A manual blood pressure unit that I calibrated. It is back at its home happily working.

A compression device I repaired. It is used in blood flow circulation in surgery patients.

Grathell Poage Biomedical Technician III Elmhurst Memorial Healthcare, Elmhur st Illinois

SPOTLIGHT ON: See what’s on Professional of the Month Dean Skillicorn’s bench, pg.12

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FEBRUARY 2016

Certificates from classes. The one in the middle is my apprenticeship program and the one on the far left is employee of the year at KMA. A pair of safety glasses, a set of lockout tag outs and my ID badge.

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ALPHABETICAL INDEX AAMI- Association for the Advancement of Medical Instrumentation ………………… 71

GMI ………………………………………… 2

Quantum Biomedical ……………………… 61

Gopher Medical …………………………… 39

Radcal Corporation ………………………… 33

ICE/Imaging Community Exchange ……… 76

RTI Electronics …………………………… 76

Injector Support and Service, LLC ………… 61

RSTI ………………………………………… 6

ATS Laboratories, Inc.……………………… 77

IMES/International Medical Equipment & Service ……………………… 37

Southeastern Biomedical ………………… 46

Bayer Healthcare- MSV …………………… 4

InterMed Group …………………………… 77

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

BC Group International, Inc. ……………

BC

J2S Medical………………………………… 33

Stephens International Recruiting Inc. …… 77

BioMedical Equipment Service Co. ……… 69

KMA Remarketing Corp. …………………… 63

Summit Imaging, Inc ……………………… 67

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

Maull Biomedical Training LLC …………… 46

Technical Prospects ………………… 45, 69

Ozark Biomedical ………………………… 54

Tri-Imaging Solutions ……………………… 65

Pacific Medical LLC ……………………… 8

Trisonics …………………………………… 39

PartsSource

……………………………… 26

USOC Bio-Medical Services ……………… 55

Pheonix Data Systems, Inc ………………… 54

Versus Technology, Inc. ……………… 14-16

Pronk Technologies ……………………… 5

Zetta Medical Technologies …… 23, 47, 59

AllParts Medical …………………………… 57 Alpha Source ……………………………… 17 Ampronix …………………………………… 22

Conquest Imaging ………………………… 11 ECRI Institute ……………………………… 73 Elite Biomedical Solutions ………………… 3 Engineering Services ……………………… 82 Fluke Biomedical ………………………… 35

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

BC

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

39

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

33

BEDS / STRETCHERS KMA Remarketing Corp.

Ph: 814-371-5242 www.kmabiomedical.com

63

BATTERIES Alpha Source Ph: 800-654-9845 www.alphasource.com

17

PartsSource Ph: 877-497-6412 www.partssource.com/shop

26

1TECHNATION.COM

FEBRUARY 2016

22

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

69

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

39

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

77

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

6

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

46

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

7

Quantum Biomedical Ph: 866-439-2895 www.quantumbiomedical.com

61

ic rv Se

ts

e

e

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

Pa r

Pa g Ad

e ic rv Se

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78

ts

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ANESTHESIA

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SERVICE INDEX

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

45, 69

71

61

CT / COMPUTED TOMOGRAPHY AllParts Medical Ph: 866-507-4793 www.allpartsmedical.com IMES/International Medical Equipment & Service Ph: 704-739-3597 www.IMESimaging.com

33

Quantum Biomedical Ph: 866-439-2895 www.quantumbiomedical.com

61

57

37

Injector Support and Service Ph: 888-667-1062 www.injectorsupport.com

61

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

6

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

76

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

45, 69

Ozark Biomedical Ph: 800-457-7576 www.ozarkbiomedical.com

54

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

6

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

22

PaciďŹ c Medical Ph: 800-449-5328 www.pacificmedicalsupply.com

8

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

55

MRI AllParts Medical Ph: 866-507-4793 www.allpartsmedical.com

57

Bayer Healthcare- MSV Ph: 1-844-MVS-5100 www.mvs.bayer.com

4

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

37

PartsSource Ph: 877-497-6412 www.partssource.com/shop

26

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

23, 47, 59

NUCLEAR MEDICINE

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

65

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

2

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

23, 47, 59

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

77

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

6

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

33

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

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

MAMMOGRAPHY

CONTRAST MEDIA INJECTORS Injector Support and Service Ph: 888-667-1062 www.injectorsupport.com

Company Info

LABORATORY

CONFERENCE AAMI Ph: 703-525-4890 www.aami.org

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Company Info

Pa ge Pa rts

SERVICE INDEX

3

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

76

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

33

INDEX

PATIENT MONITORS 69

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

IBC

Phoenix Data Systems Ph: 800-541-2467 www.goaims.com

54

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

IBC

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

3

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

39

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

3

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

33

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

39

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

8

33

PartsSource Ph: 877-497-6412 www.partssource.com/shop

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

8

Quantum Biomedical Ph: 866-439-2895 www.quantumbiomedical.com

8

61

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

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

61

46

Quantum Biomedical Ph: 866-439-2895 www.quantumbiomedical.com

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

46

7

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

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

55

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

7

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

55

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

23, 47, 59

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

45, 69

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

77

RTLS Versus Technology Ph: 1-877-9VERSUS www.versustech.com

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1416

FEBRUARY 2016

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

BC

Fluke Biomedical Ph: 800-850-4608 www.flukebiomedical.com/

35

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

5

Radcal Corporation Ph: 800-423-7169 www.radcal.com

33

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

76

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Pa ge Pa rts

Company Info SOFTWARE

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

PET

80

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Company Info

Pa ge Pa rts

SERVICE INDEX

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

46

TRAINING

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

11

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

2

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

33

ATS Laboratories, Inc atslaboratories@yahoo.com www.atslaboratoriesphantoms.com

77

Fluke Biomedical Ph: 800-850-4608 www.ukebiomedical.com/

35

Summit Imaging Ph: 866-586-3744 www.mysummitimaging.com

67

Maull Biomedical Training Ph: 440-724-7511 maullbiomedicaltraining.com

46

Trisonics Ph: 877-876-6427 www.trisonics.com/

39

PartsSource Ph: 877-497-6412 www.partssource.com/shop

26

X-RAY

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

6

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

22

Bayer Healthcare- MSV Ph: 1-844-MVS-5100 www.mvs.bayer.com

4

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

82

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

77

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

45, 69

TUBES / BULBS AllParts Medical Ph: 866-507-4793 www.allpartsmedical.com

57

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

37

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

33

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

65

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

6

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

76

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

45, 69

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

65

ULTRASOUND AllParts Medical Ph: 866-507-4793 www.allpartsmedical.com

57

Alpha Source Ph: 800-654-9845 www.alphasource.com

17

ATS Laboratories, Inc atslaboratories@yahoo.com www.atslaboratoriesphantoms.com

77

Bayer Healthcare- MSV Ph: 1-844-MVS-5100 www.mvs.bayer.com

4

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Company Info

Ad

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Company Info

INDEX

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