With another year behind us, 24×7 reached out to influential figures in HTM—Binseng Wang, ScD, CCE, fAIMBE, fACCE, vice president of program management at Sodexo HTM; Matthew F. Baretich, PE, PhD, president of Baretich Engineering; and Gordon Hosoda, chief of HTM at VA Portland Health Care in Oregon—to get their expert opinions on the big issues affecting HTM right now and what might be in store for the year ahead.

24×7: In your opinion, what have been the top issues in the HTM industry in 2024?

Binseng Wang: 

A) Less financial support for HTM:  HDOs are struggling to recover from the COVID pandemic and protect themselves from labor shortage and cyberattacks, so they are even less willing to fund HTM appropriately than before the pandemic.

B) Qualified labor shortage:  HTM continues to lose experienced workers due to retirement and other life events, and the industry has had challenges to bring in young talents due to more fashionable professions available to them and strict limitations on immigration.

C) Right to Repair (RtR):  it has gained more momentum and support from not only in-house HTM teams but also from those who work for the government (VHA and DoD), as recalcitrant OEMs are becoming even more restrictive in allowing access to service materials—especially software keys.  The RtR Panel held at the recent MD Expo-New England was a clear demonstration of interest of the majority of event participants.

Gordon Hosoda: 

A) Recruitment and retainment. Google states that by 2025, Gen Z will comprise 30% of the workforce.  Due to this, HTM will need to deal with the Gen Z culture, attitudes, and perspectives they have about work, job advancement, job changes, etc. As the older (late Baby Boomer) generation retires, there will be a large loss of institutional knowledge and experience. I believe that Baby Boomers, in general, did not change jobs often and maintained a degree of commitment to locations rather than careers.  The Gen Z  group may have a different perspective, and this will be challenging to keep the Healthcare Technology Management Program “stable” since it has a long-range focus of managing medical equipment over its lifespan of up to 8-10 years.

B) Cost of non-contract components and parts of high-dollar, high-technology medical equipment (mostly imaging, surgical robots, etc.) that forces facilities into service contracts.  For high cost/high tech items, the cost of a part or component on a time and material (PO basis) can sometimes cost as much as an annual service contract.

C) Increasing cybersecurity risks (although the military and financial institutions are higher-value targets at this time.)

Matt Baretich: 

Once again, a top issue has been BMET recruitment and retention. I have no doubt that that’s a real problem. However, I’m not sure the expected mass retirement of senior BMETs is as serious as we fear. The employment surveys I have read are not scientifically representative of the entire HTM community. I suspect that survey respondents tend to be older than the BMET population as a whole, which skews the data and any conclusions we draw.

RELATED: HTM Expert Roundtable 2023

24×7: How can HTM teams improve collaboration with clinical staff to maximize the effectiveness and safety of medical devices?

Wang:  A) Be engaged in the equipment planning and acquisition phase of their respective HDOs, particularly advocating for hands-on testing of competing brands and models by the clinical users (to weed out devices with poor usability/human-factors engineering) and inclusion of maintenance training and service materials in the purchase orders. 

B) Abandon the traditional, obsolete HTM “productivity” measure of hours documented in work orders as a percentage of paid hours to allow more “unproductive” time for HTM staff to round routinely with clinical staff and help them understand better how to use equipment safely and correctly.

C) At the risk of being accused of being a “sexist,” I believe we should employ more female HTM professionals because they tend to have better social skills than their male counterparts and, thus, can relate more easily with the clinical staff.  Providing social skills training to all, especially male, HTM staff can also help.

Gordon: The foundation of collaboration is communication.  It is critical for HTM teams to build bridges of communication in two key ways: (1) Be able to understand and use some of the same clinical lingo as clinicians, and (2) to have the skillset to explain technical operations, functions, situations, and remedies in a manner that clinical staff can understand. Speaking to clinicians using words, phrases, and acronyms that are commonly used amongst the HTM community will carry little meaning to clinical staff.  They will likely not understand, and may not ask for clarification.  This situation does not build bridges of collaboration.

To be able to build bridges of collaboration, one would need to see things from their perspective, aka to “walk in their shoes.”  Once communication is established, concessions in communication regarding words, concepts, etc. will have to come from the side of HTM more than the clinician side. 

Key engagement (aka collaboration) from the target audience will come when they realize WIIFM (What’s In It For Me). That is true for a lot of communication. The listener/recipient will be more attentive and focused if they understand that the ramifications of the situation will have a direct impact on their operations, efficiency, effectiveness, etc.  Communication will need to be slanted towards the clinicians to clearly show WIIFM. This should obtain the buy-in necessary to meet the goal of maximizing the effectiveness and safety of medical devices.

Baretich: I have always been a big fan of assigning each clinical area to a primary BMETs These technicians can do rounding on a regular basis – more often for critical areas like the OR and less often for less equipment-intensive areas like outpatient clinics. They can even schedule their rounds to coincide with clinical activities like safety huddles. This encourages clinicians to think of them as “their” technicians, a member of their team. And it allows the frontline technicians to be more proactive and effective in supporting the clinical areas.

24×7: What strategies can HTM professionals adopt to manage aging medical equipment efficiently while balancing budget constraints?

Wang: Either analyze their own service data or adopt the aging model proposed by my colleagues and I (Wang et al, J Clin Eng, 2024) to predict the aging behavior of medical equipment and, thus, plan better both maintenance and replacement of existing equipment.  A very large portion of modern medical equipment do not exhibit aging (aka wear and tear), so there is no reason to perform “preventive” maintenance (although safety and performance inspections are still necessary).  Furthermore, many of them can be deployed more than twice the number of years than the “estimated useful lives” (EULs) suggested by AHA and other organizations.  So maintenance and replacement for this group of equipment (showing “no impact of aging” – NIA) should be different than those that exhibit wear and tear (i.e., “clear impact of aging” – CIA).  

By extending the lives of medical equipment, HTM professionals can brag to their C-suite leaders that the return on investment (ROI) for HTM is in the order of 20-30% in CapEx.  Such ROI is much better than most kinds of financial investments (Wang, 24×7).

Gordon: Care and consistency in performing preventive maintenance as an effort to prolong the usable life. Ensure, via reminders, training, and chargebacks (if possible – for damage caused by misuse/abuse, lack of proper understanding of proper usage), that equipment is used properly, effectively and handled correctly. Find sources of spare parts, particularly before the OEM stops supporting the equipment.

Baretich: These days, much of my work is in Canada (Lower Mainland Biomedical Engineering in Vancouver, BC). Canadian hospitals tend to keep their medical equipment running longer than U.S. hospitals. That can be cost-effective as long as there is a strong program of PM (planned maintenance) in place. Binseng Wang has an excellent 3-article series, recently published in the Journal of Clinical Engineering, that investigates what factors increase the longevity of medical equipment.

24×7: How do you see the evolving regulatory landscape impacting the daily operations of HTM teams in 2024, particularly in areas like compliance and data security?

Wang: The recently released remanufacturing guidance by FDA is overbearing and almost impossible to implement, as some OEMs are still refusing to provide technical specifications and service material.  Overly eager HTM companies and professionals are likely to venture into remanufacturing unknowing due to the lack of information and the need to provide clinicians with desperately needed equipment, as we have witnessed during the pandemic.

There are currently 2.5 to 5.5 million pieces of equipment that are classified as “legacy devices” in terms of cybersecurity.  Not only will it be impossible to protect those pieces of equipment from data theft and loss, but they can also be conduits for cyberattacks.  HDOs don’t have the capital necessary to replace them all at once and FDA is not requiring the OEMs to provide solutions even if only for a few years.  It is also doubtful that OEMs have the production capacity to replace all the legacy equipment promptly, considering the problem is worldwide and not limited to the USA.

Gordon: My opinion is that overall, regulatory aspects have been evolving slowly. The focus on completion vs compliance has been ongoing over the years.  My personal opinion is that compliance is more important than completion (ie. completion of a PM).  However, compliance is more challenging to track and monitor, but I think is the correct focus for the equipment.

Data security (aka cyber security) is becoming an increasing focus, but due to the fact that there are higher value “targets” (i.e. financial institutions, cellphone personal records, etc.), it appears that networked medical equipment systems and EHRs have been less affected…for the time being.

However, I work for the Veterans Health Administration, and the long-term goal is to integrate the patient records of the VA with those from the DOD (Dept of Defense).  The aim is to have the soldiers’ medical records flow seamlessly from the DOD to the VA.  Due to this, we are keenly focused and aware of the need for data security.   Networked medical equipment on the VA backbone and the VA EHR must be kept secure so that hackers cannot utilize the VA as an entrance point into the DOD network.

Baretich: I’m expecting to see CMS (Centers for Medicare and Medicaid Services) issue revised guidance regarding AEM (Alternative Equipment Maintenance) programs. I have no idea what the revisions will look like or if CMS will seek input from the HTM community. When that happens, the Joint Commission and the other accrediting organizations will quickly follow suit and the HTM community will need to react quickly.

24×7: What technological developments are currently the most exciting or transformative in the HTM industry?

Wang: It is not here yet, but some OEMs and other companies are working aggressively on AI/ML algorithms to detect failures that are in the process of occurring so predictive maintenance can be performed before the failure actually happens and put patients and possibly clinicians in jeopardy.  Unfortunately, most of these advances are proprietary and not likely to be shared with the HTM community (unless, of course, you pay a hefty price for it).

On the other hand, some HTM colleagues may get too enthusiastic about AI/ML and try to use it to plan maintenance.  AI/ML needs to be trained with vast amounts of data before it can make accurate recommendations.  Furthermore, it is unclear whether AI/ML can make correct interpretations of regulations and standards that often mystify even the bureaucrats.  So HTM professionals need to analyze AI/ML recommendations very critically to avoid making serious mistakes that can put patients and clinicians in jeopardy.

Gordon: Virtual reality used in conjunction with surgeries, where CT or MR scans are overlaid with VR allowing 3D imaging of areas of interest, tumors, etc.  See https://www.medivis.com/

Baretich: I will let others answer this regarding medical equipment developments. What I find fascinating is the proliferation of communication by HTM professionals through YouTube videos, blog posts, newsletters, artwork (some but not all AI generated), and books. It’s an exciting outpouring of creativity that makes good use of both old and new media.

Wang: A) Recruitment challenges will continue to be the number one challenge.  Fewer and fewer young people are willing to pursue this career, as they are enticed by social media and fancy ideas like artificial intelligence, virtual reality, etc.  Academic biomedical engineering programs are also becoming more and more focused on biological and genetic research instead of the traditional engineering disciplines such as electronics, mechanics, and chemistry.  Studies have shown that more than one half of HTM professionals are over 50 years old (AAMI News, Mar 2021), so it will be difficult to replace them without younger talents.

B) RtR will continue to be a serious challenge, as FDA continues to refuse to adopt requirements that have existed in the EU since 1993 (>30 years!).  Due to the polarization of politics, it is unclear whether it will be possible to pass legislation to support RtR not only to lessen the cost burden for healthcare but also decrease toxic waste and slow down climate change.

C) Cybersecurity and the large number of legacy devices will continue to challenge the HDOs and the HTM community.  Unfortunately, no comprehensive solution is in sight, again mostly due to lack of cooperation among political groups.

Gordon: I think the challenge will be to keep HTM support at the hospital on relatively calm waters in the midst of churn caused by expected job changes of the new incoming workforce and retirement of current staff.  Medical Equipment management runs from the conception of need stage, through procurement, installation, usable lifespan, and replacement.  Since this cycle can run between 8-10 years, having consistent staff and leadership will help the equipment lifecycle process operate smoothly.  However, it is expected that new people entering the workforce may not be in that particular position for any length of time, so the resulting manpower churn will likely create challenges in managing the equipment lifecycle seamlessly.

Baretich: I think we’ll see more applications of AI in HTM. We already see manufacturers implementing sophisticated AI algorithms to predict maintenance needs rather than relying on fixed schedules that may not be as cost-effective. Soon we should see AI methods used to analyze the vast amount of data we collect in our CMMS databases. This will give us another incentive to standardize how we collect certain data.