What’s the current state of healthcare technology management (HTM)? In this expert panel discussion, four influential figures in HTM—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 Gordon Hosoda, chief of HTM at VA Portland Health Care in Oregon—attempt to answer just that. Below, they share their reflections on the key lessons gleaned from 2023 and provide insights into their expectations for 2024 and beyond.
24×7: In your expert opinion, what have been the top issues in the HTM industry in 2023?
Gordon Hosoda: In short, recruitment and retention. Cultural shifts among Gen Z and others appear to have led to a reduced interest in biomedical engineering. This may be due to the perception that the “repair and recurring preventative maintenance” is less glamourous and more repetitive than other fields. Still, the value and importance of a role is not determined by how “shiny” or eye-catching it is.
Clarice Holden: Succession planning remains an issue—within my healthcare network, we have experienced persistent vacancies for our chief biomedical engineer positions (typically greater than one year). Despite our efforts to create special salary rates, which can be challenging within a federal government hospital system, we still face a shortage of applicants for key leadership positions.
During the past year, several healthcare systems within my network have elevated biomedical engineering to a service line within the hospital. Prior to the move, biomedical engineering had limited access to a facilities C-suite leadership. In hospitals where biomedical engineering is under facilities management service, the biomed team has reduced access to executive leaders, and significantly less autonomy in matters like HR prioritization.
Binseng Wang: The following issues received a lot of attention during this year:
a. Right to Repair: The HTM community hoped to convince multiple states or the federal government to require OEMs to release “service material.” This would enable medical equipment owners and service providers to promptly repair devices, ensuring patient safety and reducing premature replacements that contribute to excessive environmental pollution. A small but significant achievement occurred when Colorado passed a law specifically for powered wheelchairs.
b. Remanufacturing guidance: The FDA was expected to issue a practical way for servicers to perform maintenance without significantly changing device specifications or intended use, preventing inadvertent shifts into remanufacturing. Despite feedback and discussions with the FDA, the agency has not issued its final guidance yet.
c. Cybersecurity: The HTM community was hoping the federal government would coordinate the actions of several agencies to provide a comprehensive and effective plan to protect patients from cyberattacks that either make equipment fail or limit its use. Despite much discussion, nothing concrete has emerged.
Matt Baretich: HTM programs have had trouble recruiting and retaining experienced BMETs and clinical engineers. Yes, the HTM community should continue its efforts to attract people to the profession. But we need to look long-range at how to get essential work done with fewer people.
24×7: How is artificial intelligence (AI) impacting the HTM field? And how do you expect it to change it even more in the future?
Hosoda: Recent articles I’ve come across discuss the use of AI for earlier disease diagnosis, which results in earlier treatment and presumably better long-term patient outcomes. Although medical care is typically more reactive than proactive, I believe AI could help prevent the development of age-related disease and mitigate the effects of it. Even so, there appears to be more money in reactive medical care, rather than preventative care—so that may drive the market more.
I believe we’re at the forefront of AI’s expansion into medicine, although I do have general AI-related concerns, perhaps influenced by watching too many “Terminator” movies.
Wang: So far, we’ve seen little direct impact of AI in HTM. Most of what we have seen is in patient care, such as improvements in medical image analyses and laboratory tests, prognostics from patient vital signs monitoring, medical diagnoses, etc. Some companies have been trying to advance maintenance from the classical scheduled and corrective maintenance to condition-based and predictive maintenance by monitoring equipment conditions and error messages. This would help predict how soon an intervention is necessary, instead of having a fixed schedule or waiting for equipment to break down.
While AI is a promising new technology, I’m afraid concrete, actionable results are still a few years away. Nonetheless, once it becomes viable, it can significantly reduce equipment downtime, particularly when a patient is being diagnosed or in surgery, and reduce time spent troubleshooting.
Baretich: So far, the impact of AI on HTM has been quite limited. In the short term, we’ll likely see AI used to help us get good information into our CMMS databases and, perhaps more importantly, get actionable management information out of the data we collect.
Holden: AI has become another layer of technological advancement available in certain healthcare delivery systems. Upgrades that fine tune disease detection and treatment, along with the software support of devices, has become even more crucial in the management of medical devices throughout their lifecycle.
In the future, I expect AI to assist in device triage and repair, with advanced diagnostics making devices capable of some level of self-repair. Biomeds will still need to be onsite for more involved repairs; however, AI may help determine the issue. As an aside, I would appreciate it if AI could assist in wrangling time-and-leave requests, as well as timecards.
24×7: How can the HTM industry attract and retain top talent amid ongoing staffing challenges and an aging biomed field?
Baretich: One of my concerns is that many of the HTM employment surveys are not as statistically representative as they could be. I’d like to see a scientifically valid study of the state of HTM employment.
Holden: Pay is always a great way to attract and retain talent. But what I think Gen Z is most after is a mission. Being part of a healthcare system (like my employer, the Department of Veterans Affairs) means being part of a distinct, well-defined mission. Working for an organization with a clear-cut mission and meaning in the day-to-day work will absolutely help.
Talking to more university students and programs about clinical engineering will help, as well. Teaching a lecture or guest speaking at a college helps to spread the word.
Hosoda: That’s the $100,000 question. Like I said earlier, I believe cultural shifts in the younger generation are making this an uphill battle. Technology advancements have made strong networking skills a must, alongside the traditional troubleshooting and repair abilities, although component-level repairs are now rare, with most focusing on board swaps.
Then there’s the challenge of retention. Older generations, like myself, have different motivations for staying in the field compared to younger generations. Commitment to personal growth often outweighs dedication to a cause or organization. And higher pay only goes so far, with job satisfaction differing between generations.
Attracting and keeping top talent may require flexibility, but there are limits. Remote work options are attractive, but being onsite is essential in biomedical engineering, especially in a hospital environment.
Wang: We are facing two primary challenges that are unlikely to be resolved soon. First, the retiring Baby Boomer generation is being followed by a much smaller population. Second, the incoming generation of employees are often attracted to different work models, such as online and remote work. In my opinion, this combination makes it nearly impossible to find sufficient talent to fully replace aging HTM professionals.
That’s why we should take several approaches, such as:
- Work smarter instead of harder—i.e., reduce busywork and focus on truly meaningful work that impacts patient safety and timely care.
- Migrate from the classical scheduled and corrective maintenance to condition-based and predictive maintenance.
- Motivate older workers to stay in the workforce by providing them with more flexible working hours and opportunities to mentor younger people.
- Welcome more foreign HTM professionals seeking opportunities in the U.S.
24×7: The U.S. FDA recently finalized its guidance on medical device cybersecurity. In your opinion, what else should be done to bolster cybersecurity in the medical device sector?
Wang: Well, the most recent guidance on cybersecurity is for premarket submissions. While useful, the main challenge we face today is what to do with the 2.4 million to 5.5 million pieces of “legacy” equipment that still works well but some OEMs claim cannot be patched against cyberattacks.
It would cost between $30 billion to $70 billion to replace them, a sum that is well over the $24 billion typically invested each year by all American community (i.e., non-governmental) healthcare delivery organizations. Furthermore, the FDA has agreed with some OEMs to restrict access of non-OEM servicers to the software embedded into medical devices, known as “privileged access,” in its post-market cybersecurity management guidance document. While that could help secure those devices, it also severely limits the non-OEM servicers’ ability to maintain them. This could result in unsafe and out-of-specification devices, potentially causing care delays or care diversions and posing additional risks to patients’ lives.
Holden: Educating clinical and support staff about clear, basic tenets of cybersecurity will help. Often, it’s a staff oversight or assumption that can put patient information or devices at risk. Training and “secret shoppers” for cybersecurity incidents—such as an organization sending emails that should be reported as phishing and seeing how many staff members actually report the message—help staff recognize and feel empowered about keeping devices and information safe.
Hosoda: Overall, I think that medical device cybersecurity hasn’t kept up with emerging threats. Even so, medical equipment connected to the hospital network can still serve as an entry point to access patient records or financial files, as demonstrated by the recent increase in ransomware attacks that have been seen in the news.
The VA is in the process of connecting to the Department of Defense network. Despite the slowdown in the Cerner EHR rollout, there’s ongoing awareness of the need to prevent medical devices on the VA network from becoming potential entry points for cyberattacks on DOD systems.
Creating and maintaining the highest degree of network security is critical. The VA is already involved in these efforts, where devices connecting to the VA network must have active FIPS 140-2 (or higher) certificates. Equipment undergoes a detailed national vetting process before it can be allowed to connect to the VA network. Further controls are in place locally by using a MAC address list.
24×7: What’s exciting you most about the HTM field right now?
Baretich: I love seeing all the podcasts, TikToks, YouTube videos, and other new media with real-life HTM content. I like the expanded availability of educational webinars, many of which are free. These [resources] provide tremendous opportunities to learn from each other.
Wang: I’m most excited about the discussion on the Right to Repair (RtR) for medical devices. While we are still slow in getting traction, RtR for consumer products has become law in several states, such as New York and California. It’s very frustrating to see that we are 30 years behind the European Union in requiring OEMs to provide service information to purchasers and owners of medical devices. (For reference, see the EU’s 1993 Medical Device Directive whose service information release requirement was reiterated in the 2017 Medical Device Regulation.)
Hosoda: What’s exciting me most are the advancements in medical equipment technology, and how they impact the quality of patient care and outcomes—particularly in medical imaging, where AI is being increasingly used.
Holden: Personally, I’m very excited about data development for the biomedical engineering teams I work with. We have several separate sites for standards, organizational resources, and ongoing projects. Formatting that information in a more accessible way will lead to greater efficiency. It’s a “back-to-basics” concept; however, it will be helpful at this time to build a firm foundation for further growth.
24×7: Looking ahead, what do you think will be the biggest issues in the HTM field in 2024?
Hosoda: I think the biggest issues will continue to be cybersecurity and staff recruitment and retention.
Wang: With the COVID-19 pandemic behind us, it’s an opportune time for the CE/HTM community to finally slow down and strategically plan how to advance our profession and, thus, improve patient safety and care. Most of the top issues discussed before are likely to hang around for another year because they were not totally resolved in 2023, such as the Right to Repair, the FDA’s final remanufacturing guidance, and cybersecurity.
One topic that I believe will gain attention next year is “medical equipment aging,” which explores whether equipment undergoes deterioration over time, like human beings and other living organisms, demanding increased maintenance and timely replacement. I’m raising this issue not because it affects me directly—yes, I am getting older and starting to feel the aging effects myself —but because it’s significant to the CE/HTM community.
One of our main responsibilities is to properly plan maintenance and replacement in a safe and efficient manner, benefiting both patients and healthcare delivery organizations (HDOs). This can help them preserve their care provision capabilities and wisely manage their capital resources, as well as reduce waste and protect the environment.
Baretich: It’s time for us to be more proactive in dealing with regulators. We’ve been in reactive mode for too long, struggling to adapt to the latest requirements that come our way. Instead, we need to be “at the table” when the requirements are under development.
Holden: In 2024, the biggest challenge will be advocating for the field to students. The more students who know about careers in the HTM field, the more applicants to the growing number of positions within the healthcare industry. Also, the training/formation of new or mid-career leaders will be very important to fill the vacuum of experience that will be left after career HTMers retire.