The need for collaboration between HTM and IT departments is becoming more pressing by the day. Here’s why.
By Chris Hayhurst
Dave Harrington, PhD, admits that he has a chip on his shoulder. A medical devices consultant in Medway, Mass., Harrington describes himself as “mostly retired” after a long career in healthcare technology management. He loved what he did, he says, but one aspect of his job always rubbed him the wrong way: “The biomeds, in my experience, were always cleaning up after the IT people. They’d screw something up, and we’d take the hit.”
The problem continues to this day, complains Harrington, who spent 20 years at Tufts Medical Center in Boston leading the facility’s clinical engineering department. “I’m old and crotchety and somewhat set in my ways, but I’m very insistent that patients always come first. And it doesn’t look to me like IT understands that. They’re focused on the data and all of these new technologies, but they don’t seem to be thinking about patient care.”
The fact that the two departments seem to have different priorities has real implications for healthcare systems, Harrington adds. “A lot of this technology is just getting between clinicians and their patients—it’s not making their jobs easier or helping them with treatment. And the spending for this stuff is out of control; if we’re not on the same page, we’ll never rein in costs.”
So what does Harrington, in his current role as observer, believe should be done about this state of affairs? “The way I see it, we have to come together; IT needs to be a part of biomed.” Placing the two departments under the same roof certainly won’t solve everything, Harrington says, “but it will help on the communications side of things, so when there’s a problem it can be addressed right away—and before it has an impact on the quality of patient care.”
Communication Is Key
Harrington’s not the only one in healthcare who thinks it’s time HTM and IT learned to get along. In a recent post to her blog “Health IT Connect,” Sue Schade, MBA, principal at Starbridge Advisors and a leading voice in the world of health IT, noted there’s been “a lot of history between the people who support the medical devices that touch patients and those who support the information systems used by clinicians.”
That history, added Schade, who has served as chief information officer at several different healthcare organizations over the course of the last two decades, “has not always been positive.”
Schade, the first CIO to serve on the AAMI board of directors, finished that post with a strongly worded recommendation: “To my CIO and IT colleagues,” she wrote, “let’s be sure to meet HTM more than halfway and be true collaborators. There is clearly a mutual benefit to our working together to serve our patients.”
Schade says she was inspired to write the post after attending the AAMI annual conference in June. During the meeting, she attended a panel discussion about HTM and IT collaboration. “I asked the panelists, ‘What do you want IT leaders to understand?’ and the biggest thing I heard was about this need for better communication.” (An AAMI blog post soon after the conference made the same observation: Under the headline, “HTM-IT Communication Breakdown Named Top Issue at Conference Forum,” the writer noted that one lively discussion revealed “a burgeoning tension between HTM and IT departments and both departments’ unwillingness—or inability—to communicate despite continued convergence between the fields.”)
The problem, Schade says, is something she’s seen in her own work as well: Few organizations have considered the relationship between their HTM and IT departments, much less taken steps to improve their integration. “And in my opinion, that needs to change,” she says. “When you look at the devices that are on the network now and you look at all of the security risks we face, or if you think about our electronic health records and all the medical devices that are capturing patient data, there’s no question there needs to be more working together.”
Nurses and physicians, Schade notes, don’t care if you’re in IT or HTM. “All they want to know is that their tools are going to work, and they expect you to do your job and make sure that they do.”
The question, of course, is how this collaboration might be facilitated: Should biomeds be absorbed by their organizations’ IT departments? Should information technology fall under HTM? And what happens if organizations decide to pare down? Will biomeds (or IT folks) find their jobs to be at risk?
“When I was a hospital CIO,” recalls David Reitzel, national leader of healthcare IT for the Chicago-based accounting and advisory firm Grant Thornton, “I never considered replacing anyone. Instead it was always, how are people going to work together to make sure that we’re enabling patient safety and addressing our requirements from a clinical-care standpoint?”
It’s important to realize that biomed and IT each have their own strengths, and their individual offerings can help any organization, Reitzel says. “The IT people don’t want to be biomedical people, and the biomedical people aren’t experts in IT.” The perfect scenario involves bringing the two groups to the same table to make collaboration more natural and their work more productive, he adds. “Everything tends to work a lot more seamlessly that way.”
A Matter of Keeping Up
Finding ways to help HTM professionals better integrate their work with that of their IT colleagues has been a long-time priority for Stephen Grimes, FACCE, FHIMSS, FAIMBE. “Something I think we’ve all seen over the last 15 or 20 years is this growing convergence between medical and information technology so that almost all medical devices are now specialized computers,” says Grimes, who is managing partner and principal consultant at Swampscott, Mass.-based Strategic Healthcare Technology Associates.
Years ago, he points out, BMETs spent their days doing basic electrical and mechanical work—checking devices for electrical safety, for example, or replacing components on circuit boards. Since then, however, these devices have evolved and become more and more complex, “and overall the HTM profession just isn’t keeping up with the pace of technology evolution.”
Biomeds, Grimes says, “are at risk now of finding themselves increasingly marginalized or even obsolete” if they don’t adapt their skills to the needs of these new technologies. And failing to adapt could impact healthcare quality, too: “Conceivably, if we don’t do something, we’ll hamper the effectiveness of these technologies, many of which hold the promise of improved patient safety and patient care,” he says.
IT professionals are facing similar issues as their jobs evolve, as well, Grimes maintains. “It used to be that IT departments had programmers in them and they provided technical service on all the IT equipment. “But now we’re using medical devices that are more like thin clients that don’t need the same kind of technical support, and most of our data is moving to the cloud.”
Meanwhile, Grimes says, the discord between IT and HTM is palpable. “Generally speaking, the IT people think HTM is full of cowboys who don’t play by the rules and operate in a different world. And the HTM community thinks that IT people are too hung up on their rules and not responsive enough to the needs of the users.” Neither preconception is fair, he adds. “They’re misunderstandings based on ignorance on both sides.”
The path toward a profitable partnership—and to better service and better healthcare—will involve breaking down those misunderstandings through education and the development of a “common language,” Grimes says. HTM, he adds, could stand to put better processes in place for things like change management, configuration management, risk management, and other jobs.
“IT, by and large, has already worked those things out, and I think we would benefit if we did the same.” (Grimes points to two standards for quality management that were primarily developed for information technology professionals, ISO 20000 and ITIL: “We need to become more effective at taking standards like those and adopting and adapting them to meet our needs.”)
Toward that end, Grimes and other members of the biomed and IT community, including leaders from AAMI, the Healthcare Information and Management Systems Society (HIMSS), and the American College of Clinical Engineering (ACCE), recently committed to a reinvigoration of their “CE-IT” committee to, among other things, “develop guides and standards that define CE/HTM and IT roles [and] responsibilities in a manner that ensures seamless collaboration and support of increasingly integrated, hybrid systems.”
Leaders of the three organizations are slated to meet in late August in an effort to redouble their efforts on the development of a so-called “Healthcare Technology Management Community” (HTMC) that is open to all professionals in the CE-IT arena. “We all firmly believe that it’s extremely important that we address these concerns right away,” Grimes says. “These groups can’t keep operating in silos and continue to do their jobs effectively.”
Years ago, Grimes recalls, when he was the director of clinical engineering at a major academic medical center, his team suddenly lost the ability to store digital diagnostic ultrasound images on their servers. “These were pre-op ultrasounds being done on pediatric patients,” Grimes says. “So it was an important part of their planning for surgery.”
They started poking around, looking for a solution, but every path they took culminated in a dead end. “We engaged the manufacturer; we engaged IT; we racked our brains and tried everything we could think of.” They restored the operating system, Grimes says, “and then we looked at the hard drives thinking maybe we’d find something there.” When that proved fruitless, they swapped out the motherboard. “Again,” he recalls, “that did nothing.”
The search for a culprit continued, Grimes says, until eventually an employee over in IT stumbled across an anomaly in the system log. “One of their staff had changed the IP address on the server, thinking they’d changed it on a server with a similar name.” Fortunately, it was an easy fix, “but with the time we spent and the delays in surgery, it wound up costing us hundreds of thousands of dollars,” he says.
The lesson learned, Grimes recalls, was one that’s stuck with him ever since: “If our departments had been better about communicating with each other and had put in place an effective change-management process, something like that would have never happened.”
From that point on, Grimes says, it was clear to him that in hospitals everywhere, HTM and IT departments were facing similar problems. “We’d often looked at these cases in isolation, thinking ‘Oh, this is just a one-off, we can deal with it and move on.’ But the more I looked around, the more it became obvious that this was industry-wide,” he says. “The lack of effective integration was really holding us back.”
Today, Grimes says, he can point to just a few organizations that have taken steps to ensure IT and HTM walk hand in hand. The Mayo Clinic is one, he notes; Cedars-Sinai in Los Angeles is another. (Read the 24×7 Magazine story about how Jennifer Jackson, MBA, CCE, director of clinical engineering and device Integration in the Cedars-Sinai Enterprise Information Services department, has promoted “CE-IT synergies” here.) “There are examples of programs that are more effective than others, but they tend to be the exception rather than the rule.”
That comes as no surprise to Dave Harrington, of course. (He’s heard Grimes’ imaging story before, he says, and cringes at the thought of the confusion he endured). But he does see a future where things might get better. “Some day we’ll get there; we have to, I think. It’s just a matter of people realizing how much not collaborating costs,” Harrington says. “That’s when we’ll start to see a real change.”
Chris Hayhurst is a contributing writer for 24×7 Magazine. For more information, contact chief editor Keri Forsythe-Stephens at [email protected].