Extinction? Maybe.

Mr. Dennis Librandi certainly asks the right question: “Will in-house departments continue to exist?” [Soapbox, May 2000.] I would expand his question to ask: “Will any kind of centralized medical technology management and engineering operation exist in ten years?”

There is a trend towards transferring responsibility for in-house biomedical operations to other hospital departments, such as materials management, information systems and plant services. More and more frequently, we see the function outsourced, although the outsource option depends on making clinical engineering and biomedical equipment functions profitable, and this remains to be observed since it appears, for commercial third-parties, that the profits come from selling the customer medical equipment.

Do these trends serve the best interests of the patient?

I believe a strong, centralized clinical engineering operation serves the best interests of the patient. Patient safety is enhanced by the presence of knowledgeable professionals who not only understand equipment systems, but understand the facility, medical procedures and the capabilities of the patient care staff. Scheduled and unscheduled maintenance is controlled, documented and proceeds when the cost to the facility is least and disruption to clinical activities minimized. With consistent technical support, there are fewer problems. Staff education can be provided when an equipment issue arises, rather than in a disconnected classroom. Hospital operations are improved, and as a result, clinical staff morale rises.

System acquisition and decommissioning are enhanced by the presence of unbiased, technically sound advice. Physicians’ confidence in hospital equipment and technical operations are enhanced by the consistent clinical engineering presence. Equipment modification and appropriate clinical research is facilitated, even in community hospitals.

These benefits are detailed in two North American documents: ANSI/AAMI EQ56, Recommended Practice for a Medical Equipment Program; and Clinical Engineering Standards of Practice for Canada. They can be applied to an organization performing clinical engineering functions no matter who is responsible for the work — in-house, multi-hospital system or third-party.

I take issue with Mr. Librandi in two areas. First, there is no intrinsic difference between the requirements for large university hospitals and smaller community hospitals, nor should there be a distinction between in-house vs. other methods of providing service. Thus, Mr. Librandi’s characterizations, such as “comfy in-house department” and “rapid change isn’t supported by the academic DNA” are broad generalizations that are unnecessarily divisive and only mask the universal issues that created the spectre of extinction facing all clinical engineers and biomedical equipment technicians.

The goals of the clinical engineering department are reached though collaboration with other healthcare disciplines, and this requires mutual trust that can only develop over time. The title “Chief Technology Officer” does not automatically instill caregiver confidence. Respect cannot be created by administrative fiat.

Clinical engineers and biomedical equipment technicians are partially responsible for the current crisis. We failed to demonstrate the full breadth and importance of our professions to healthcare practice. We allowed organizations to concentrate on one aspect of technology duties, such as repair or equipment safety, endorsing a cheaper “Clinical Engineering Lite” that puts full-service programs at a financial disadvantage. We failed to promote minimum professional requirements for people leading clinical engineering efforts in hospitals, allowing people without adequate preparation or experience to adopt the title, “Director of Clinical Engineering”. As a consequence, healthcare institutions are naive consumers, vulnerable to low-ball prices. These bare-bones programs damage the trust our professions achieved through years of hard work. It will take more years to repair our reputation with clinicians.

Mr. Librandi demands action. I agree, and propose that we begin to carefully explain the contributions our professions make to healthcare. This advocacy must come from our professional organizations. Individual case studies that demonstrate the value of full-service clinical engineering are plentiful, but we need to broadcast them to medical instrumentation professionals, healthcare professionals and the general public.

We need to make it clear that the demise of our professions is a tragedy for patients. That eliminating full-service clinical engineering programs is a mistake for healthcare institutions that profess to offer the safest environment for patients’ recovery. The ACCE has an advocacy agenda stressing these things.

Mr. Librandi, thank you for your enthusiasm and years of commitment. Don’t despair! Let’s work together for the good of the patient.

Tom O’Dea, Ph.D., PE, CCE, SASHE, is chairperson of the Advocacy Committee of the American College of Clinical Engineering. He may be reached at odeat@msn.com.