The IT/Biomed Interface
For years, webiomedical equipment technicians (BMETs) and clinical engineers (CEs)were the masters of our environment. We managed and controlled our clinical monitoring networks and the like. The networks were proprietary and did not talk to or interface with anything in the outside world. It was a very controlled and safe place! Early in our careers, many of us may have been challenged with the task of identifying the dividing line between our and the facility engineers responsibilities. While there may have been some early struggles, we found a clear, physical dividing line between our worldsa wall!
The general agreement has typically been that we are responsible for everything up to the wall, and the facilities department was responsible for everything beyond that wall. That included electrical, plumbing, wiring, drains, ceiling lights, utility columns, heating, ventilating, air conditioning, piped gases, air, and vacuum. These were all services we needed, but they were controlled and managed by facilities. That clear dividing line has served both us and facilities very well through the years.
A New Age With New Rules
Now, we are in the information age. Everything is expected to interface with, and provide data to, a wide variety of devices and systems. Clinicians wantand needto be able to directly access data, whether they are on the nursing unit, in their office, at home, on the golf course, across the country, or across the ocean. These requirements have created a completely different environment for us to work in and deal with. It has also created a new partner for us work with. With this new partner, we need to redefine our roles and the division between our world, the chief information officer (CIO), and the information technology (IT) specialists.
Now, we are in the information age. Everything is expected to interface with, and provide data to, a wide variety of devices and systems.
Our clinical systems are evolving to use fewer and fewer proprietary systems, moving oftentimes to a more open Windows®-based operating system and a general networking environment. Now, rather than us having our own system and network to manage, devices are placed on the hospital networkwhich is an environment that we neither manage nor control. This network interface can be either a hard-wired connection to a network jack, or it can be interfaced using radio frequency (RF) to a wireless access point in the area. The device may be communicating with a data server on the unit that is somewhere in the building, or it may transfer information to a building in another part of town or across the country.
The complex mazes of wires, routers, switches, relays, and the like send our data to its storage location. Our data is also competing with all the other data, email, Internet traffic, picture archiving and communication system, lab reports, admission information, billing, and supply requisitions on the network to get to its final destination. This is a much different scenario than we, as biomeds, have typically dealt with in the past.
So, is there a clear dividing line? That is not a question that can be answered as easily as the one between the biomed and facilities world. What I can say is that it is vital for both the IT and biomed departments to have an unmistakeable understanding of how our responsibilities impact each other. Only when we both have that understanding can we work to establish those clear boundaries, if in fact they still exist. Let us take a closer look at these two disciplines and begin to formulate that understanding.
Appreciating Our Differences
I have had the opportunity to visit hospitals across the United States. The perspectives presented here are not from a specific organization, but are generalities drawn from my observations of many different organizations and from discussions with colleagues around the country. It is safe to say that every organization has its own way of doing things, and that there are many ways to structure a department or conduct business.
Let us start by looking at how we support equipment and systems. Through my discussions with IT departments, I have found that these departments typically staff one technician for every 225 to 250 desktop computers. Biomeds typically staff one technician for every 900 to 1,100 pieces of equipment. As you can see, the typical models for developing staffing are very different.
There are also some very dramatic differences in how both disciplines support an equipment system. As an example, we can compare a central monitoring system and a clinical information system. If a nurse has a problem, the nurse contacts the biomedoftentimes directlyand the biomed responds to the call. The biomed is trained to take care of everything, including the connection to the patient and bedside device, the network, the server, the central display, alarms, and the printing systems.
If a nurse has a problem with the clinical information system, he or she typically calls the IT help desk, which provides a basic level of support. Should the problem be more complex, the IT help desk will triage the call within the IT support structure. The call could go to a clinical applications specialist, a network engineer, a wireless engineer, a desktop specialist, or the infrastructure specialist. The call may then be triaged to another specialist in that group if the first individual does not find that the problem is present within their area. This can continueand can occasionally go through several different individualsuntil the problem is identified and resolved.
The IT systems are incredibly complex, and the infrastructure can be spread out over the entire organization. If you talk with IT staff members, they will sometimes admit that it can be a challenge internally to know exactly who to call to resolve a specific problem. Fortunately, tools are continually being developed to streamline the troubleshooting and resolution of problems.
One other difference between our worlds that is worth noting is that we, as biomeds, are very comfortable working in the patient-care environment with the hospital staff at the patients bedside. If you ask an IT specialist about this, he or she will often admit that the closer the problem is to the patient, the less comfortable he or she is in dealing with it. Given that the IT world is much larger outside of health care than it is within it, this is just not something that is taught as part of an IT curriculum.
As you can see, there are a number of differences between our specialties. Over the next several months, we will search for that clear dividing line between our worlds. We will discuss how we impact each other, look at issues that are common to both of us, identify new technologies that will require us to work with one another, and demonstrate why we all need to collaboratively work together. 24×7
Dennis Minsent, MSBE, CCE, CBET, is the director of clinical technology services at Oregon Health & Science University, Portland.