We live in a fast-paced world. And those who have to stay on top of the latest technological developments know exactly how fast it can be—just ask any biomedical/clinical engineer.
This is particularly the case with computer technology. In the mid 1960s, Gordon Moore, a founder of Intel Corp, predicted that the number of transistors that could be integrated into a single silicon chip would double about every 18 to 24 months (see online chart). Consequently dubbed “Moore’s Law,” the trend has held for more than 40 years and is expected to do so for at least the next decade.
While this means that there will be an increase in the functionality and usefulness of computer technology, it also means that the people who need to maintain it can expect to see this continuing technology explosion affect the way they do their work.
Of course, that’s the biomed’s role. They are expected to maintain equipment and keep up with any technological advances that come down the pike, but how to do this when they are affected by factors such as Moore’s Law is the question. Clinical/biomedical engineering departments across the country cope with the technology sprint in unique ways—including more aggressive purchasing, taking a wait-and-see approach, and committing to the strong education of biomedical technicians.
Replace As You Go
Robyn W. Frick, CCE, clinical engineering manager of Eastern Maine Medical Center (EMMC), Bangor, Me, says that the accelerating rate of change with technology has radically altered the way that equipment is now procured at the 411-bed medical center.
“It used to be that the equipment would have to be falling apart before we’d replace it,” he says. “Now, it’s all about throughput efficiency and more of a production-line mentality.”
Much of this is fueled by regional competition for patients from other medical centers, which has led EMMC to adopt digital mammography, for instance.
A key factor in keeping up with changes for the EMMC clinical engineering department is a good multidisciplinary communication system. “We have an open, transparent [communication and acquisition] system that is promoted by the administration,” Frick says. To keep this communication productive and open, Frick adds, it has to be constant and up-front. Without it—and the involvement of the clinical engineering department—there could be unintended consequences. For instance, a simple $1,000 equipment upgrade could cost the hospital $50,000 if it is not compatible with the computer system. So, it is crucial that the clinical engineering department be involved with any decision about equipment, no matter how seemingly insignificant.
This means that Frick and his staff need to not only communicate, but also stay up to date about the computer software that is used throughout EMMC. Frick observes that health IT goes to a new iteration every 6 months. To cope with this problem, the biomeds are encouraged to interact with the entire staff throughout the hospital. And this has produced important fruit. For example, the department is the official liaison between IT and the pulmonary staff. In addition, clinical engineering has created several other three- and four-way lines of communication with other departments to help keep equipment up-to-date and cope with other issues. This is important because the advances and processes can take a life of their own and careen out of control. “When things start moving too fast, you almost have to call a time out,” Frick says. With the drive to keep up-to-date, the hospital is cognizant that it must maintain good risk-assessment protocols and does so regularly.
While communication and a good acquisition system are crucial, so is having a strong educational program in place for the biomeds. “Our technicians are always willing to go to school,” Frick says. “It’s an excellent confidence builder.” He notes that the department has had an IT training program in place for the last 2 years.
But it isn’t just the high tech that is of interest to Frick. He calls himself a champion of low technology. Through his efforts, he started a department of common equipment that is in charge of simpler items.
Escalating technology, budget concerns, and impatience on the part of clinical staff can make the ongoing acquisition process a complicated and never-ending tug-of-war, but EMMC is clearly in the driver’s seat, which is particularly important for a biomed department. “What happens if you’re not helping, if you’re standing back, is that somebody will step in to fill the void—and that usually means it becomes vendor driven—and that’s one thing you don’t want to happen,” Frick says.
While vendors can be important partners in helping to make the acquisition and transition of new equipment smoother, they can—at times—offer their own challenges.
The Vendor Shuffle
Like every modern clinical/biomedical engineering department, the clinical engineering team at Rockdale Medical Center, Conyers, Ga, works hard to keep up with technological developments. “We try our best to stay on top of these new advances by attending training, but sometimes the vendors do not allow us into training or the training is not very in-depth, so we just do our best,” says Charles R. Alloway, director of clinical engineering. “And when that isn’t enough, we have to call in the vendor.”
Most of the changes the department is experiencing are primarily computer-based, and this means that many of the end users have a tough time interfacing with the computers. “The end users are relying on us to help them when they get into trouble. We rely a lot on the manuals, and when that isn’t enough, we call on tech support or have the salesperson come back in for more in-service,” Alloway says.
There are a number of criteria that the hospital uses when purchasing equipment. “When we do purchase new equipment, we look for the best equipment for the buck,” he says. “We do look at whether it is state of the art, the ease of use, and whether or not the end users will like it. If we need new equipment, we look at what is on the market, the technology level, and cost. We have never taken the wait-and-see approach.”
Alloway works hard to make sure the staff is using the same iteration of each piece of equipment. This maintains a level of consistency for giving care and eliminates confusion for the clinical staff who might be caring for several patients in several areas of the hospital throughout a shift.
While Moore’s Law might mean that Alloway and his staff have to constantly keep up, he says this is not the biggest challenge. Instead, it is vendor training. “We can sometimes get vendor training, but it is not the same as their service people get,” he says. This might present some frustrations, but his staff does pay close attention when the vendor service representatives come to Rockdale to repair equipment. “We have very good vendor service people, and they will assist us or let us watch as they service [equipment]. They are very good at answering questions,” Alloway says.
Regularly scheduled in-services are as crucial to keeping things running as keeping the equipment up to date. Because of the complexity of some of this equipment—particularly from the computer-interface perspective—it may take several in-services before a sufficient level of competence is reached.
But Alloway does not rely on the vendors to keep Rockdale running smoothly. The hospital has what he describes as a liberal training policy that allows the technicians to get any additional education that they need. “If it is good for the facility and good for you, you can get the training,” he says. “We really push training.”
Perhaps the biggest issue facing many hospitals in the push to keep up is economic, and that can mean taking the long view on technology.
Wait and See
Publicly funded Wishard Hospital, Indianapolis, is experiencing a budget crisis, and, because of this, the staff have to be very careful about the way they purchase equipment. “We have to make sure it’s a smart spend,” says Daniel T. Dudley, CBET, director of medical engineering.
When evaluating a new technology, Dudley looks at both the technological and clinical benefit of the equipment. These two elements go hand-in-hand.
Lately, the department has had to take a wait-and-see approach to purchasing. While this might be frustrating to an early adopter, Dudley is more philosophical, saying that it gives him the opportunity to watch the kinks get hammered out of a new technology before a big capital investment is made. For instance, he is currently paying close attention to the development of RFID technology, which, he says, has both its pluses and minuses.
While they might not be buying, Dudley does have strong relationships with vendors—who, like him, take the long view—and that allows him to keep himself and the clinical staff up-to-date through in-services. Vendors bring in their latest and greatest and demonstrate their equipment, enabling the staff to stay abreast of advances while Dudley builds relationships for the day when—in the not-too-distant future—Wishard builds its new facility.
Dudley says that he and his team keep up on the latest medical technology developments through trade and other publications and through continuing training. Using a common-sense approach, he says, “If you want to stay up on the technology, you have to go to it,” he says. Among the ways they go to the technology is by attending industry and association meetings.
Every technician has the availability to take additional training, but Dudley recommends targeting those biomeds who are most interested in learning, and not just choosing biomeds in the department based on seniority or another basis.
While Dudley exercises prudence in his recommendations of what equipment to purchase, he makes sure that, in the meantime, the medical engineering department hones its skills by repairing older equipment that may have broken down and keeping things running as smoothly as possible until the day when they can purchase improved technology.
No matter the individual issues facing a department, there is a constant that will continue: Technology will change.
Read other department tips in past issues of 24×7.
The rapid pace of technological development might make it tough to plan ahead, but keeping up through teamwork, communication, and education can make it easier when the time comes to purchase the newest piece of equipment. Being a key part of the mix can also help. Frick and his team are heavily involved in IT and help with numerous projects.
It might be impossible to predict where technology is going, but one thing is certain: It will be expensive. Frick has a simple solution regarding new equipment: “Start building a budget—you’re going to need it.”
C.A. Wolski is a contributing writer for 24×7. For more information, contact .