Where’s the Border?

larkinMany people believe there is an immutable border between biomedical engineering and facilities engineering. Incorrect. Both camps segregate these units within healthcare organizations and that hurts hospitals, it puts patients at risk and — if you need to be hit in the wallet to see the logic of this — the segregation stifles career opportunities for people working in the healthcare technology industry.

Jim Welch, now an executive at Welch Allyn Protocol, once observed that the building is the largest item on any hospital technology inventory. It’s impossible to separate a sensitive EEG from the quality of power feeding it, an anesthesia machine from the gas coming out of the wall outlet, or a dialysis system from the water flowing through the facility’s plumbing. Yet, we mentally do this every day and hold grand finger-pointing sessions when the combined results at the point-of-care are less than what the clinician desires.

The facility is sophisticated technology. Current building management systems apply computers, servo motors and sensor arrays that are as complicated as anything seen in a CT suite, and it’s spread all over the campus, yet the people who maintain these systems seldom get excursions to exotic factory schools.

The facility is dangerous. More sentinel events are triggered by power interruptions, med-gas mistakes and HVAC-spread nosocomial infection than by leaky patient monitors, yet many organizations still measure success by the safety sticker.

Everyone wants to be the Chief Technology Officer. Nurses, lab directors, respiratory therapists and radiology administrators all say they should be the person holding the CTO’s scepter. Materials managers say the same thing. IT directors think the title is rightfully theirs because, heck, it’s easy to convince hospital executives that computers are the most important thing in the world. Clinical engineers remain sitting in the corner, grumbling about not being asked. Facilities managers, currently preoccupied with electric rates and fuel oil prices, aren’t interested in such “little stuff.” Staff physicians in large academic medical centers are simply seizing the crown.

Most of the people vying for this highly-political post are ill-equipped for the task. They define “healthcare technology” to fit their own narrow interests and are unable to comprehend the entire healthcare theater of operations. The fatal flaw in most healthcare technology proposals, no matter who brings them to the table, is that they restrict the program’s scope to gadgets inside the interior walls, and lifecycle to the time equipment is on the floor. Effective technology management must include plumbing, medgas, wiring, ventilation — even the electromagnetic space. The lifecycle must begin with the architectural drawings and end with demolition.

Out in the trenches, it’s individual technicians who are forced to cross the artificial border between facilities and biomed. They do it under their own initiative and often without support. Biomedical and imaging contractors need to realize healthcare service requires more than specialized knowledge of a single cath-lab system. Plumbers, electricians, HVAC techs and carpenters need advanced training so they can enhance their skills to meet the new responsibilities of their trades.

Call it NAFTA for healthcare. We need to open the border between facilities and biomed.

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Correction
In “Ultrasound Vendor to Pay $3.2 Billion for Anticompetitive Service Practices” on page 6 of the April 2001 issue, there should be no connection made between the fictitious story and the graphically altered ultrasound system on fire that appeared with it. Neither the maker of the ultrasound system, Medison America Inc., nor its products are in any way connected to this story that was intended as an April Fool’s joke. 24×7 apologizes for any misperceptions.