Binseng Wang
A well-known clinical engineering (CE) pioneer, Ode Keil, recently wrote an essay in the Journal of Clinical Engineering wondering whether CE is on life support.1 In the 1960s, he wrote, the thinking was that a “graduate-degreed clinical engineer” was needed in healthcare organizations to help clinicians and administrators manage the rapid introduction of technologies and to address issues including equipment selection, user education and training, and software integration. Today, Keil believes CE is in danger of extinction because of the combination of three factors: advances in information technology (IT), cost control (“money”), and poor communication skills.
Hope for the Future
[sidebar float=”left”] This article marks the debut of “CE Perspectives,” a bimonthly column dedicated to the discussion of current issues and concerns for clinical engineering professionals. This column replaces “CCE Prep” by Arif Subhan, who will serve as contributing editor for CE Perspectives. [/sidebar]
While I agree with some of the concerns he expressed, I am definitely not as pessimistic about our future. First, I would like to make a distinction between a CE professional and a “graduate-degreed clinical engineer.” Even though Keil did not say a 4-year engineering degree is a minimum requirement, I think it is worthwhile to clarify my viewpoint so the readers can understand the rest of this article. I believe everyone who manages and maintains medical equipment deserves to be called a CE professional, regardless of the degree he or she earned. (Would anyone like to argue with me that the recently deceased Joel Nobel, founder of ECRI Institute, should not be considered a CE professional and pioneer simply because he was a medical doctor and never earned an engineering degree?)
Within the various categories of CE professionals, those with earned degrees (and certifications) deserve respect for their investment in education and the expertise they have acquired. However, they should not be considered the sole CE professionals in the field. Biomedical technicians, imaging specialists, and equipment distribution staff are all needed, and deserve to be considered CE professionals as well.
It is true that IT and, more appropriately, the rapid evolution of electronics, material sciences, and software, have resulted in profound changes to medical equipment and, thus, the CE profession. However, the enhanced reliability of solid-state-based equipment and the fact that roughly 25% of CE departments are now under the supervision of IT do not mean that CE professionals are no longer needed for anything beyond the basic tasks of repairs and asset management. The challenges of equipment selection, user training, risk and safety management, software integration, human-factors engineering, and similar issues have actually increased since the 1960s. Just as medical equipment is nothing but a tool for clinicians to deliver health services, IT has likewise become another pervasive—and often invisible—tool for most professionals to perform their jobs.
Financial Realities
Cost control has undeniably affected the way many healthcare executives perceive CE. The illusion of perfect safety at any cost has caught up with the reality that Americans spend more per capita than the citizens of any other industrialized nation and yet don’t have the best outcomes.2 CE cannot escape from this reality and must find ways to be more efficient by eliminating waste (such as performing unjustified scheduled safety and performance inspections, blindly following manufacturers’ recommendations, and requiring only “genuine” parts). Good examples of the efficiency that can be achieved by sharing expensive resources (including CE professionals with advanced degrees and specialized skills) include the outsourcing of CE services, the formation of large health systems, and collecting and analyzing large amounts of maintenance data.
Poor communication skills is indeed one of the serious handicaps that many engineering, not just CE, professionals have. This should not be surprising, as it is widely known that the high-school nerds attend science and engineering schools, while the gregarious ones go to business, health sciences, or social studies. However, this kind of skill can be learned (as can another important one: finance). Much harder is the reverse, as engineering expertise requires years of mathematics and physics foundation, as well as systematic, critical thinking. (By the way, I think the reason Keil wrote that, “The least important part of being a clinical engineer is the technical knowledge and understanding of technology,” was only to emphasize his point that CE professionals “are irrelevant if no one is listening.”)
Concerns for the Future
On the other hand, I do share some of Keil’s concerns for the future of CE for other reasons. First and foremost, CE professionals are notorious for not willing to learn3 from and collaborate with one another, even when their livelihoods are threatened and their professional expertise is questioned. This was evident in the struggle with the edicts issued by the Centers for Medicare & Medicaid Services in the last 3 years. Our lack of cohesiveness and political savvy allowed companies to impose their wishes through political maneuvers.4
Another symptom of weak professionalism is the fact that licensure has not become a reality after more than half century of existence as a professional field.5,6 In the meantime, several other healthcare professions that started in the same era (such as respiratory therapy and physical therapy) have attained it. The lack of licensure also translates into the lack of CE undergraduate programs and the very small number of graduate programs. Without a clear professional career path, few college students are willing to venture into the field, even though new biomedical engineering graduates have had a tough time finding jobs in the industry for the last 5 years, while many healthcare and service organizations have had many unfilled vacancies.
I do agree with Keil that the future depends on us. I hope we will not become our own worst enemies. If we are not willing to fight together for our place under the sun, we should stop complaining that we are stuck in the basement next to the morgue!
References
1. Keil OR. Is clinical engineering on life support? J Clin Eng. 2014;39(4):161.
2. Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall – How the performance of the US health care system compares internationally, 2014 update. The Commonwealth Fund, New York NY. available at: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf. Accessed October 30, 2014.
3. Lynch PK. Observations and Insights: Why can’t we learn? Biomed Instrum Technol. 2014;48(5):398-399.
4. HTM community welcomes new maintenance guidance. AAMI News. February 2014;49:1, 8-9
5. Wang B. Are you licensed? 24×7. June 2003. Available at: https://24x7mag.com/2007/01/article-18300/. Accessed December 7, 2014.
6. Wang B. How can we attain licensure? 24×7. July 2003. Available at: https://24x7mag.com/2007/01/article-18313/. Accessed December 7, 2014.
Excellent article.
Mr Wang always provides thoughtful, lucid insights into our field and where it needs to go.
I don’t have much time for articles on the job, but he is always worth to reading.
Wang I agree with your arguments for professional licensing. Brazil, discovered in 1500 created the CONFEA/CREA system (Federal/Regional Council for Engineering and Agronomy) in 1933. It took 433 years to create a system to supervise the performance of each professional and companies here in Brazil. Each engineering company must have a registered engineer.
Today CONFEA/CREA system has eighty years and Biomedical Engineering became subject to supervision since 2008, just as Technologists in Biomedical Systems (Healthcare Technologists) and Biomedical Equipment Technicians are
Also monitored by the Council. So Biomedical Engineering is officially monitored just for six years. As any other engineer, they must be registered with the board and each service provided or contract, must be reported to the Board through a document called ART (Technical Responsibility Annotation).
Here, we must be licensed but I have similar concerns as described in your article. We have to work closer too.
By the other hand, Biomedical Engineering is so new once the first group was graduated in 2005 at UNIVAP University. In spite of the fact there are, at least, 5 universities that graduates biomedical engineering, there are not enough professionals yet and, healthcare system needs the support of others engineers, technologists and technicians.
To end my comments, the Issue No. 29 – Year IX – December 2014 of CONFEA/CREA magazine that is celebrating 80 years of the Council, it can be seen that one of 2013 achievements was the creation of a Public Hearing to discuss as the text says, the invasion of foreign engineers and foreign engineering companies in Brazil. We are moving forward I believe, but we still have a lot of work to do.
Great article Binseng! I still have the tie you bought me when I worked in your Quality Department with Doug Snyder at Mediq PRN’s Sante Fe Springs, CA Service Center.
Lately, I have been referring to myself as a Healthcare Clinical Technology Professional, perhaps Healthcare Clinical Engineering Professional is better.
I like that in Canada that they are utilizing “Technologist” in their CE departments since I think it adds an air of respect that Technician is sorely missing in my humble opinion.