One Step Away from Direct Patient Care

One of the biggest challenges for many healthcare technology management departments is also one of the newest, namely, the integration of medical devices with information technology (IT) systems as the equipment clinicians use to treat patients become increasingly interconnected.

Below, Gordon Hosoda, chief of the HTM department at the VA Portland Health Care System in Portland, Ore, sits down with 24×7 to discuss how the Portland VA team meets the new challenges posed by IT network integration while continuing to manage an enormous inventory of medical equipment and systems.    

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Brittany Ruby, an OR Biomed technician, happily working on an ESU.

24×7 Magazine: Can you please tell us a little bit about your team and the workload you handle?

Gordon Hosoda: The Portland VA Healthcare Technology Management (HTM) department is responsible for over $100 million of medical equipment that covers about 11,000 equipment and equipment systems. The section currently has 16 team members, including one chief HTM, one staff HTM engineer, one systems planner, an operations supervisor, and 12 biomedical equipment support specialists (BESS). These 12 are further broken down into one lead imaging BESS, two imaging BESS, two information systems (IT) BESS, and seven main medical BESS. We are mostly a younger shop with experience levels ranging from two to 32 years. We cover the full spectrum of medical equipment from high volume to high cost. BESS’s group in three major areas of responsibility: medical equipment, radiology equipment, and Biomed IT.  

24×7: How has your department evolved over the past few years, and how do you see it evolving even more in the future? 

Hosoda: One of the biggest evolutions in our department has been the integration of information technology into medical equipment to create networked medical systems.  There has been a steep learning curve to understanding how to best build a hospital network infrastructure that securely supports our growing number of networked medical servers. In the VA, we use a Medical Device Isolation Architecture (MDIA) based on ACLs to secure medical servers on protected VLANs. These integrations are doubly challenging due to extremely stringent cybersecurity standards of the VA and Department of Defense.

The advancement of networked medical equipment systems requires enhanced IT skillsets above and beyond the skillset typically needed for the general repair and maintenance of medical equipment.  Knowledge of networking, network infrastructure, network communication protocols, standards, and ports is now just as critical as understanding the operation, repair, and maintenance procedures of the equipment.

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Arthur House, Lead Imaging/Radiology Biomed Technician, with the Portland VA’s newly installed PET/CT.

One unique role the Portland VA has established to help oversee the integration process is the System Planner.  In addition to leading our facility’s medical equipment lifecycle planning process, the System Planner is also responsible for integrating our networked medical systems onto the VA network backbone. This includes working with the clinical services, vendors, Office of Information Technology (OIT), and Information Security Officers (ISO) to consider risk mitigation and cybersecurity.

The Portland VA also strives to provide our patients with new, state of the art equipment and equipment systems such as a PET-CT, Hybrid OR, MRIs, CTs, etc.  Each of these modalities also requires integration onto the VA OIT backbone to connect properly to the Picture Archive Communication System (PACS) system and Electronic Medical Record (EMR) system.  As OIT continues to integrate into medical equipment systems, OIT background or knowledge, enhanced software troubleshooting skills, increased network diagnostic and troubleshooting capabilities will be just as necessary as the more traditional skills of understanding medical equipment operation, troubleshooting, and repairs.

24×7: What would your HTM team say are probably the biggest challenges they face day to day? Can you think of an example of how they overcome or work around challenges?  

Hosoda: We believe that the biggest day-to-day challenges the section faces are troubleshooting and finding the key cause of network problems that impact the operation of networked medical equipment, and then finding the right person with the right level of access within OIT who can remedy the situation.  The increase in networked medical equipment systems has increased the number of potential failure points, any of which could result in operational failure.  This, in turn, impacts direct patient care.

24×7: Can you please discuss a time when your team “saved the day” for another department or another anecdote about the important work your team does every day?  

Here are a few examples:

  • Regular occurrence: When Imaging calls for service on high-dollar equipment systems (I.e. MRIs, CTs, etc.), even though there is a service contract on it, the contractual response time is 1-hour call back time and 4-hour onsite time. The Imaging team goes up immediately and performs first call response, contacting the vendor’s tech line. A majority of the time, they can get the system operational even prior to the contract field service engineer calling. This results in minimum system downtime, which equates to minimal or no patient case cancellations or postponement.
  • The lab pathologists were having a tumor board (reviewing and analyzing patient’s tumors as a team) that failed to operate. The BESS assigned to the lab was called up, and given his expertise, he was immediately able to troubleshoot and bring the video viewing system back into operation so that the tumor board could continue. 
  • A recent patient monitoring upgrade resulted in the clinicians being unable to view real-time patient waveforms from any computer in the medical center. This caused huge patient care impact for clinicians. The BESS overseeing patient monitors worked with the OEM and OIT to determine the cause of the issue. Ultimately, he got approval for a DLL push and helped OIT implement it. This resulted in the restoration of remote real-time waveform viewing.  
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Biomed Technician Jahaziel (Ozzy) Eguia configures a Philips patient monitor.

24×7: Is there anything else you would like to share about your team and what sets them apart from others with 24×7 Magazine’s readers? 

Hosoda: The VA Portland HTM team are available on a 24×7 basis, takes ownership of the perspective that they are one step away from direct patient care.  They regularly work side by side with clinicians to troubleshoot, repair, and ensure that medical equipment is ready for clinical use.

The VA Portland HTM team also established an Interagency Agreement to help support two clinics from the Indian Health Services, another government agency.  This has been a ground-breaking agreement and has helped radically improve their equipment operations and equipment uptime.

To see your CE/HTM/Biomed department featured in an upcoming A Day in the Life article, contact [email protected] Please include ‘Day in the Life’ in the subject line.