Changes in Clinical Engineering and Health Care

Richard J. LeeThose of us who have been in the clinical engineering profession for 20 years or more have seen the tremendous changes in clinical engineering and health care. The progress that has been made in medicine has changed clinical engineering and the way we maintain clinical equipment.

Let’s look back at a few examples of how we serviced and calibrated equipment for preventive maintenance. In the past it might have required more than 2 hours to calibrate and perform PM on a patient monitor. Due to the manner in which some were designed, it was possible to cause damage while trying to perform some of the adjustments and access some of the components. An electrocardiogram machine with a hot stylus would need to be changed after the stylus burned out. Oftentimes this was done on the fly on the patient floor, as the unit needed to be up and running immediately for the next patient. Defibrillators required service to the battery-charger board when capacitor failure occurred, and they were repaired immediately as an absolute need in the patient area. Electronic components did not have the reliability that circuit boards have today. State-of-the-art electronics and mechanical designs of clinical equipment today require little or no calibration and maintenance, which makes the equipment more reliable.

Today, medical technology helps reduce the cost of many procedures as well as improving care. As a result, some hospitals are closing intensive care units and admitting patients to intermediate care units, which utilize high-tech monitoring systems that require much less care and less-invasive procedures.

In the operating room, open-heart surgery used to be complicated and difficult for the patient. After open-heart bypass, the patient might have stayed in the ICU for 2 to 3 days and remained in the hospital for as long as 3 weeks. Today the patient is out of the ICU in just hours and discharged in just 3 to 4 days. These advancements reflect the improvements in surgical skill, anesthesia, nursing, and pharmaceutical care.

Some cardiac patients no longer require open-heart surgery but rather cardiac angioplasty, a minimally invasive procedure performed in a cardiac catheterization lab with radiology imaging. The patient is awake during the procedure, monitored for 24 hours after the procedure, and discharged.

I recently had an MRI and was diagnosed with a ruptured disc of my lumbar spine. The accuracy of this exam allowed my surgeon to make a small incision in the exact location of the rupture, which minimized the invasiveness of the procedure. This allowed me to walk just 7 hours after surgery and to be discharged in 12 hours. Without MRI, the precise location would not be possible and would have led to a more invasive procedure and substantially increased recovery time.

Advances in communications and information technology (IT) have allowed hospitals to redesign their campuses in a way to expand and remove some services, such as outpatient surgery, minor procedures, endoscopies, and imaging services, such as diagnostic radiology, MRI, CT, mammography, and nuclear medicine, to off-site satellite facilities.

Electronic communication technology is rapidly growing to where it can take patient information anywhere. We hear terms such as DICOM, PACS, DR, and CR. In the beginning, these abbreviations just meant something to do with electronic communication and Web-based programs to us. We become familiar with these terms, and as we learn more, we become fascinated with this technology and what it means for the future of health care.

In the past, we managed discrete instruments and repaired to the component level. Tomorrow we will deal with clinical systems and self-diagnosing equipment. Due to the increasing reliance on information systems, our clinical engineers need to be involved in this technology. It is extremely important to our customers that we have the knowledge, expertise, and support that they have become accustomed to. Some of us have been involved with patient-monitoring purchases by partnering with information systems support people and working with them to make the appropriate choices for the monitoring systems and networks that will work for our institutions to meet their needs.

Clinical engineering and IT personnel need to work together to combine and share our knowledge and respect one another’s professions. We are both technology support services for the hospitals, and if we work together we can be a combined strong resource for the hospital staff.

Richard J. Lee, CBE is account manager at Technology in Medicine in Holliston, Mass.