In Julie Kirst’s “Up Front” column in the March 2009 issue, I stated that “the majority of 24×7 readers would only be impacted peripherally” by the American Recovery and Reinvestment Act and that the act “really deals with health care IT.” I still believe that this is true; however, what this does point out is that in tough economic times the decreasing pool of health care dollars are still flowing toward IT. The question then becomes, does this recession signal a major shift in support (or at least support dollars) away from more traditional clinical engineering support to IT support in health care (if this hasn’t already been happening for some time)? And, if so, what happens to clinical engineering, and—perhaps more importantly—what happens to the functions previously performed by clinical engineers (CEs)?
I would argue that, despite tough financial times, clinical engineering will not disappear in the near future. Certainly there is tremendous value in a position that understands both technology and clinical workflow. There is clearly a need in having staff who can understand the desired clinical workflows of its staff and translate them into technical requirements for a medical device vendor, and in turn translate technical information from the vendor back into simple language that addresses the clinical workflow needs of the departments. However, I would also argue that the merging of clinical engineering functions into health care IT departments will continue, if for no other reason than IT departments generally have much larger allocations of money within a hospital, which means they can better afford to pay for IT and CE staff. And given decreases in revenue, CEs may be challenged to take on IT or other additional functionality in their new roles as hospitals look for ways to reduce staff or keep staff at a minimum, even if new clinical demands arise.
One of the most important items to address during this transition is what happens to all of the clinical (ie, non support) functions that CEs provide for various departments. CEs typically perform a lot of additional functions beyond simple troubleshooting and support for the clinical departments. It is very easy for management to look at simply moving medical device maintenance from a clinical engineering department to a merged clinical engineering-IT department, but it may not be apparent for management to look at the other functions performed by CEs and make sure that these functions are not lost in the transition—particularly if CEs are asked to take on additional IT support functions as a result of the merger.
|When CEs are shifted into IT departments, proactive involvement from all parties is needed to ensure a smooth transition.|
To ensure that the needs of the clinical departments are supported in cases of clinical engineering-IT mergers or in cases where CEs are shifted into IT roles or departments, all parties involved in the transitions should be involved to ensure a smooth transition that causes minimal or no impact to the clinical departments. This should be done proactively rather than after the movement of staff, and it should ideally start as far in advance of the actual transition date as possible.
So what really needs to be done? Ultimately, the clinical department is the customer, regardless of whether an individual supports them from clinical engineering, IT, or some other department. As a result, the best place to start is to have the clinical departments define specifically the job tasks that the individual in transition performs for them on a regular basis. These may be support-related tasks, or in some instances they may involve training, documentation, maintenance, or other tasks. Regardless, it is vital to get a clear understanding of what functions the individual performs for the clinical department and the department’s expectations for maintaining those functions moving forward.
Once the functions are defined, representatives from the clinical engineering, IT, and clinical departments as well as the transitioning staff should meet to determine who will assume responsibility of those functions. In many cases the functions may move with the CE who is transitioning into a new position. Nevertheless, this is a critical step for a number of reasons.
- First, it helps to reassure the clinical department that despite the transition their support will not change or at least will not change without their input into the decision.
- Second, it presents IT with a better picture of the type of functions that the CE performs and makes IT aware of the functionality that they may need to support by assuming responsibility for the CE.
- Third, it ensures that tasks necessary for departmental operations are not overlooked in the transition.
- Fourth, it gives the CE the opportunity to provide input into the transition process and make recommendations that best meet the needs of the customers who the CE supports, thereby giving the CE some level of comfort with the transition.
It is just as critical to ensure that the transitioning CE is not forced to walk away from certain functions immediately. This individual has built a level of trust with the clinical department and has developed expertise in certain clinical functions over the years of support. It does not benefit an organization to sever this relationship just because the CE is moving into a new position or department, as experience and knowledge are lost in such cases and the comfort level the clinical department has with the individuals who provide its support may be damaged. Even if the CE is given the opportunity to train someone else on a specific clinical function that he/she may perform, it is always a good idea to have that CE act as a mentor or resource for the newly trained staff for some period of time until the newly trained individual is up to speed. The IT or other department receiving the CE should ensure that he/she will still have some transition time to continue to assist in performing some clinical functions beyond support, even if the plan is to ultimately transition those responsibilities back to the clinical department.
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As more CEs move into new roles or departments, health care organizations should embrace this transition as a chance to revisit the support needs of their clinical customers and not simply view it as a means to consolidate staff or reduce costs. If the transitions ultimately lead to unhappy clinicians and staff who feel that their support needs have been cut or diminished, then the cost savings and other advantages afforded by the transitions may be diminished or lost. In the best transitions the clinical departments will not notice any difference in their support, and through proper planning and discussion this goal can be realized despite any changes in support structure that take place.
Ken Olbrish, MSBE, is an enterprise imaging system administrator in the Information Services Department for the Main Line Health System, suburban Philadelphia, and is a member of 24×7’s editorial advisory board. For more information, contact .