Five of the industry’s top talents look back, ahead 

How do you sum up a year? In this expert roundtable, five of the biggest movers and shakers in healthcare technology management (HTM)—Samantha Jacques, PhD, FACHE, AAMIF, vice president of McLaren Clinical Engineering Services at McLaren Health Care in Grand Blanc, Mich.; Binseng Wang, ScD, CCE, fAIMBE, fACCE, vice president of program management at Sodexo HTM; Clarice M. L. Holden, BSE, VISN 17 chief biomedical engineer at VA Heart of Texas Health Care Network in Arlington; Matthew F. Baretich, PE, PhD, president of Baretich Engineering; and Ken Olbrish, group product manager at Arthrex in Santa Barbara, Calif.—attempt to do just that. Below, they reflect on key lessons learned from 2022 and reveal what they expect in 2023 and beyond. 

24×7 Magazine: In your expert opinions, what have been the top issues in the industry in 2022? 

Clarice Holden: 2022 has been a “return to normal” for many—but the impacts of the global pandemic still linger, causing twinges of pain when experienced for the umpteenth time. Masks are very much still utilized in the direct healthcare environment, telework has become expected, and any symptoms of illness are treated cautiously. (Sick leave is embraced as an initial solution, rather than a last resort, for ever-busy HTM professionals.)

This year’s top issues have been data loss—not appropriately storing information to be retrievable or experiencing a catastrophic event without adequate back-up solutions (burdening patients, providers, and medical infrastructures in order to re-collect the information); interfacility coordination—sharing of information and experiences between hospital systems to avoid repeat mistakes; and overall facilitation of large-scale medical device implementation projects (forming the right team, motivating that team, and accomplishing the work in a timely manner).

Binseng Wang: To me, 2022’s top HTM issues have been challenges in recruiting and retaining talent; financial constraints on healthcare organizations caused by rising costs and diminishing revenues; lack of cooperation from certain, albeit not all, manufacturers on service materials (i.e., documentation, software access, proprietary parts, and test tools; and, finally, cybersecurity.

Samantha Jacques: Certainly, cybersecurity (vulnerability notifications, patch availability, turnaround time for patches, lack of support from medical device manufacturers on mitigations for risks); parts availability; availability of labor for in-house teams, third parties, and OEMs; and capital availability for replacement of obsolete technologies. The latter is directly tied to hospital bottom lines.

Ken Olbrish: There have been a few issues that have affected the HTM field this year. First, we are still seeing the fallout of COVID-19. In many cases, this has continued to place significant financial constraints and staffing burdens on facilities. Second, there continues to be deficiencies in the number of HTM professionals in the field. As facilities find that they cannot adequately staff their HTM departments, existing HTM staff members are being asked to do more.

Third, the cybersecurity burden continues to grow as the number of cybersecurity threats to medical facilities rises. HTM professionals, along with their IT counterparts, are being tasked more than ever in ensuring that medical devices remain secure from growing cybersecurity threats.

24×7: What emerging healthcare technologies are you most excited about and why?

Matt Baretich: As our population ages, what can technology do to keep people out of the hospital and in their homes? There are many nontechnical aspects to that broad challenge, but I think technology can be used to monitor the wellbeing of the elderly—especially, the frail elderly—so they’re safe in a comfortable environment.

Jacques: Anything that’s pushing care out of the hospital—home health, telehealth, remote monitoring, wearables, etc. Greater care closer to home is a must with all the small/independent hospitals closing their doors or going bankrupt and even large systems cutting service lines in a bid to cut losses. I’m also excited to see the cyber regulations coming out of Europe that will drive most multinational manufacturers to enhance their security stances.

Wang: The most exciting, but perhaps still a bit far away, is the gene-editing technology that was recognized by the 2020 Nobel Prize in Chemistry. It will introduce profound changes to medicine and, therefore, to HTM. Less distant are predictive maintenance tools being developed for performing maintenance well before the failure has caused the equipment to stop working properly. It’s already in use for aircraft engines but not yet fully operational for medical equipment. Hopefully, it will become widely used in the next three to five years.

Holden: I’m most excited about large imaging modality mobile units. MRIs and CTs are not always easily accessible for rural healthcare systems in my region. As technology gets smaller, more options become available for health systems to expand capabilities and bring services to where the patients are.

24×7: The HTM field has been affected by numerous staffing challenges in recent years. What are some ways you believe the industry could do better to attract and retain top talent?

Olbrish: Salary and benefits are no longer the only determinant for applicants looking for new positions. More and more, the culture of the work environment is also a driving factor in an employment decision, as is work-life balance. In terms of talent retention, educational opportunities are critical, as well as opportunities for employee growth within the organization. Education can no longer just be classroom- or online-focused, but it needs to occur on the job in the employee’s day-to-day environment. And employees need to see that there is a path for future growth within the organization.

Jacques: In my view, recruitment and retention are tied directly to culture. Organizations with great culture aren’t hurting as much for staff. Great culture looks like a clear vision/mission, transparent communication, empathy for staff, flexibility, growth and development plans, and more. Personally, my department has not had to deal with many turnover issues because we strive to build a great culture.

Baretich: Recruiting and retaining HTM professionals will continue to be a challenge. I think we’re going to have to face the fact that doubling down on the usual practices is not going to be enough. We’ll need fundamental changes in how we define our work and how we get it done. We should be asking questions like: ‘What would make it possible to keep medical technology safe and effective with, say, half the HTM workforce we have now?’ ‘What would have to change in the areas of regulation, equipment design, education and training, productivity tools, and lots more?’

Holden: Salary is often what current professionals think is foremost in the mind of prospective employees—but money is only table stakes. What keeps a new employee long enough to become a seasoned employee is the balance of work and life, as well as the opportunity to find meaning in their job. HTM managers need to make sure they treat their employees like people with objectives and intentions—and help employees find meaning and purpose in their work. That connection makes an incredible difference.

After establishing trust with an employee, having a hybrid environment that offers the flexibility of telework alongside the connection of in-hospital work will increase employees’ job satisfaction. Having some leeway with projects—for instance, offering employees eight hours a week/20% of their time to pursue an HTM interest otherwise outside of their normal duties—can also help to increase creativity and job satisfaction.

The field of HTM needs to break free from being a best-kept secret. To get the word out, current professionals could volunteer to attend career fairs at high schools, colleges, and associate schools. Networking is very important to interfacing with prospective employees, and employers can network virtually (i.e., LinkedIn) or in-person. Volunteering with AAMI, [the American College of Clinical Engineering], or [the Healthcare Information and Management Systems Society] is another good way to meet prospective HTM professionals.  

Wang: This challenge appears to be the result of a combination of the retirement of more experienced workers and the lack of newcomers to the profession. I think the more experienced workers could be convinced to continue to contribute by allowing them more flexible working conditions (part time, remote, and/or support roles). It will be difficult to compete with more fashionable technological areas (e.g., artificial intelligence, virtual reality, etc.) to attract younger talent.

We need to consider offering opportunities for people who are interesting in changing careers (e.g., from facilities or environment services, automotive repairs, etc.). Another possibility is to ask the government to allow more foreign workers with appropriate skills and training to come to the U.S.—much like what large IT companies have been doing for years.

24×7: From a cybersecurity perspective, what are some steps HTM professionals can take to promote device security and patient safety? 

Olbrish: HTM professionals should be champions of cybersecurity in their facilities and not just rely on IT to handle anything related to cybersecurity. This means that HTM professionals should be engaged in looking at device cybersecurity as part of the device selection process, should ensure that vendors are following up on cybersecurity commitments they made to the organization, and should be looking for opportunities to strengthen existing cybersecurity practices already in place. At the same time, HTM professionals have a unique perspective on cybersecurity that their IT counterparts may lack since they often have more clinical experience. 

As a result, HTM professionals should leverage this experience to ensure that cybersecurity practices are practical in a clinical setting. If practices cannot be easily implemented and followed in a clinical setting, then clinical staff will look for ways to bypass security measures when they become too burdensome, and this introduces risks. HTM professionals should be able to assess cybersecurity measures to ensure they won’t negatively impact the clinical staff and should work with their IT counterparts to implement practices that are both secure and practical.

Wang: First and foremost, HTM professionals need to be trained in cybersecurity in addition to IT fundamentals. Next, we need to encourage more interaction and cooperation between IT and HTM professionals. Each side has many things to bring to the table and neither can do it solo. We need to collaborate to not only do our own jobs better and more efficiently, but ultimately to ensure patient safety. 

This is a “team sport” that is only winnable if everyone not only does his/her part but also helps to “watch their partners’ backs.” The recent ransomware attacks on healthcare organizations show this challenge is not likely to subside anytime soon; rather, it is likely to escalate because we have a tradition of creating silos within healthcare and among medical device manufacturers.

Unfortunately, it seems that some—although not all—manufacturers are using this challenge as an opportunity to push for earlier replacement of equipment and/or lock out both in-house and third-party servicing organizations.

Jacques: There are two key steps. The first is having clear, transparent conversations prior to purchasing devices, including terms and conditions in purchase agreements that mandate minimum cyber requirements. (See the Health Sector Coordinating Council’s standard contract language.) The second is building great relationships with IT and security teams to define roles and responsibilities across departments and put plans in place for incident responses.

Holden: [HTM professionals] should practice what they preach in terms of medical device cybersecurity. This includes not plugging in devices to workstations to charge, downloading files safely, locking their workstation, and always maintaining custody of their identity badges (even in hybrid environments). We should support the rules by following them and by communicating expectations clearly with clinicians. Explaining the costs of having infected medical devices or corrupted records (not just in employee time, but in patient impact) helps to drive home the importance to otherwise occupied clinical staff.

24×7: What do you think will be the biggest issues in the HTM field in 2023? 

Jacques: 

1. Hospital bottom lines: This will drive which hospitals stay open, which ones close, and which ones cut service lines. This will affect capital for lifecycle replacements, as well as money for initiatives like cybersecurity/IOT systems/solutions. This will also affect staffing; some hospitals will use their financial status to drive reductions in headcount, especially in non-clinical departments like HTM and IT.
2. Cybersecurity: This one isn’t going away any time soon. With the passage of the FDA bill, which removed all the cyber requirements, we’ll be fighting this for a while.
3. Right to repair: This issue will continue to rear its head here and there as state bills are hashed out.

Wang: It does not seem that the challenges we have seen in 2022 are likely to be resolved soon, so they will continue to need attention in 2023. One topic that was not on my prior list is the FDA guidance on remanufacturing because the FDA did not release its final version in 2022 as originally planned. However, it has stated that it is on the “A” list for 2023.

Depending on how the FDA wants servicing organizations to ensure that they have not made significant changes to the safety, effectiveness, and indication for use, this could have severe consequences not only for the third parties but also for the entire HTM field (because the in-house team often depend on third parties) and, ultimately the healthcare organizations in both financial burden and patient care delays—if not denials.

Olbrish: Many of the challenges faced in 2022 will continue in 2023. HTM staffing continues to be an issue as is time management in trying to do more with less staff. And cybersecurity is only growing in importance. Finally, reduced budgets will continue to be a challenge.

Holden: I think recruitment will remain a significant challenge. Also managing data—there are more and more ways to display, study, and analyze all kinds of data generated in the healthcare environment. Being able to manage that and get meaningful use from data will be a challenge. We operate in sometimes data-rich, information-poor environments. We need to support a significant shift to information-rich settings.

24×7: What advice do you have for someone mulling a career in HTM? 

Wang: It’s definitely a rewarding and secure career. Nothing beats the satisfaction of having contributed to the wellbeing and recovery of patients. I don’t believe another technical career provides such an immediate sense of connection to another human being. It’s also a very secure career because healthcare is a human need that is unlikely to disappear anytime soon—unless the genetic splicing technology mentioned above becomes a clinical reality very soon.

Baretich: Go for it. Talk to HTM professionals at your local healthcare facility and ask them for a tour. Take advantage of internship and volunteer opportunities. Consider both clinical engineering and biomedical equipment technology.

Holden: Do your research. Look for someone to shadow; consider if you want to work with patients (clinical track), or for patients (aka: in HTM). Do your discernment before you enroll—that way, you’ll hit the ground running once you are in school. Consider the work environment you want (being in the office vs. telework/remote vs. hybrid). Consider who you want to work for: an independent service organization, a hospital, or a group of hospitals. Be willing to work your way up a career path. Talk to someone who has the job you want or works for the company you want, discover their journey, and use the knowledge to guide your own.

Olbrish: The HTM profession is very rewarding due to its overall impact. The work an HTM professional performs daily ultimately helps all patients in a facility. There are very few professions where your work can benefit so many people. Add to this the fact that there is always a need for healthcare, so there is always a need for HTM professionals. And HTM professionals get to learn about and work with a variety of new technologies on a continual basis. All these factors make the HTM profession very attractive.