By Phyllis Hanlon
As the medical equipment maintenance profession moves away from the mechanics of technology and places more emphasis on the management of technology, today’s biomedical technician needs a broad range of skills that goes far beyond fixing broken ventilators or performing preventive maintenance procedures on an anesthesia machine. Whether the broad array of academic institutions and training programs are responding effectively is an open question.
Advances in technology, the HITECH Act, the Affordable Care Act (ACA), Meaningful Use, and mandated electronic medical records (EMRs) are all reshaping the practice parameters for biomedical technicians. Steve Yelton, BMET in the Center for Innovative Technologies at Cincinnati State Technical and Community College, notes that years ago when he graduated from a 2-year academic program, he was trained to work in a hospital setting or in manufacturing doing repairs. That level of education today would only enable an individual to become an entry-level technician.
To advance in the field today, he says, requires a more holistic approach to education, involving networking, technology management, business expertise, and critical thinking. “Students should study project management in addition to anatomy and physiology and biomedical instrumentation,” he says. “If you look at the changing job titles, you’ll realize we need to come more in line with what’s happening in the field.”
Students also need to learn “soft skills,” such as customer service. Yelton says, “Looking at the big picture, you need to fix the ‘broken customer’ and then fix the broken equipment. And all programs should have cooperative education or an internship component.”
Joey Jones is a professor at Kentucky Community and Technical College System and a 19-year veteran of the industry. He says that as the ACA is rolled out, significant increases in patient care are to be expected. An increase in patients means an increase in the strain on medical equipment, so basic biomedical skills will still be important. “We will have to be more wise in how we maintain medical devices,” he says. “Many hospitals now do interval-based scheduled maintenance. They will have to assess how they are maintaining equipment and re-evaluate the process. There will be more stress on the technology, so hospitals will have to look at ordering and adjust their stock.”
While managing and maintaining technology are key aspects of the biomedical engineer’s responsibilities, technicians should also educate themselves in the area of risk management. This comprises two key areas, Jones points out: product recalls and incident investigations. “Techs need to know the standards, such as Health Level Seven International” (HL7), Jones says.
Additionally, technicians should know and understand the accreditation process of the hospitals in which they work. “They should know the codes, standards, and regulations,” Jones says. “Clinical engineering is integrated now; they don’t just stay in the shop all day. Biomedicine is tied into every aspect of healthcare.”
According to Barbara Christe, PhD, program director, Healthcare Engineering Technology Management, associate professor, Engineering Technology Department, at Indiana University Purdue, in the past, technicians dealt mainly with the “guts of a device.” Now, the industry is witnessing a big push for interoperability. “Technicians have to have computer abilities and networking skills, and know about communication between devices. The EMR mandate and financial incentives as part of the ACA are linking two diverse groups: IT and BMETs,” she says. Techs need to have network knowledge, device integration, and security expertise, as well as good customer service and communication skills. “They have to write policy, prepare training reports, do presentations,” she says. “There is a real desire to be critical thinkers. When they are called into the OR, there could be 25 different issues. Larger problem-solving requires critical thinking.”
A cultural shift is taking place that requires techs to convince hospital administrators of the importance of advanced biomedical education. And monetary factors could help support the technician’s arguments. In this economy, hospitals are seeking ways to operate on shoestring budgets. If a facility can hire one person with the skills of two or three employees, the facility saves money while getting the job done, Christe notes.
Technicians who can be involved in life cycle planning are more valuable to their employers. “Technicians now should be involved in utilization, statistical analysis, and quality assurance. They also need financial planning skills, which many associate degree programs don’t offer,” she adds. To become better rounded and advance professionally, a technician might have to pursue a 4-year degree, which emphasizes leadership, management, and people skills, rather than technical expertise.
University of Massachusetts Boston recently created a graduate certificate program in healthcare informatics, which Noushin Ashrafi, professor of information management systems, developed after a 2-year exploration of 150 programs nationwide. The coursework covers all aspects of interoperability, data mining, privacy/security, and standardization of data flow between systems.
She explains that any biomedical technician should understand the process of analyzing and organizing data. “And if you use technology, you have to know about interoperability. Not all software recognizes and talks to each other,” Ashrafi adds. “There’s a demand, and supply for this information is limited since it’s a new field. You have to keep up with the new technology.”
Moreover, Ashrafi points out that interoperability will not only affect the bottom line, but will also impact health outcomes. With all patient data pulled together in one electronic record, physicians will be able to make better treatment decisions. “Health information can increase efficiency and effectiveness with lower costs as a result,” she says.
The military has been ahead of the curve on educating biomedical engineers. On January 10, 1943, the surgeon general authorized a 3-month training course at the medical depot in St Louis; this program became the first US Army Biomedical Equipment Training School. At that time, coursework concentrated on the mechanics of electronic medical devices.
In 1963, technological advances in biomedical equipment prompted the school to relocate to Fitzsimons Army Medical Center in Denver and to change its name to the United States Army Medical Equipment and Optical School (USAMEOS). In addition to instruction in basic repair, maintenance, and troubleshooting, the curriculum included computer science, networking, patient safety, risk assessment, and technology management.
Valdez Bravo survived this intense training when he enlisted in the Army in 1995. He points out that what amounts to a 2-year course in a civilian setting was accomplished in the span of 38 weeks in the Army. “With long hours and no breaks, we learned anatomy and physiology, basic soldering, AC/DC theory, transistor theory, basic logic circuits, and computer language and troubleshooting,” he says. “When I got out, I had all the basics.”
The hands-on training Bravo received in the military far surpassed what he would have received in a civilian program, he asserts. “The Army had the money to buy and fix equipment. This helped with critical thinking and logical troubleshooting. Some schools can’t afford to buy that much equipment. Military BMET programs versus private make a big difference in troubleshooting,” he says.
In addition to academics and practical application, Bravo notes that mentorship and leadership in the Army helped instill a strong work ethic. He says, “I felt the instructors were good role models. They taught us not only to take care of the doctors and nurses, but also the equipment, as if your family would be using it. They taught quality of work, no shortcuts.”
After discharge, Bravo landed a job at a VA hospital in Portland, Oregon, and throughout his career has attended many VA-sponsored seminars, but cites the need for further education as interoperability becomes standard system-wide. “I’ve had lots of training opportunities and have gone to local association meetings,” he notes. “Now, biomed techs have to work with project managers and IT so they can be a conduit between different departments.”
Motivated to enhance his education and advance his career, Bravo applied for and was accepted into a 1-year intensive graduate healthcare administrator training program at Fort Sam Houston in Texas, a Baylor-accredited program run by the Army. “At the end of the year, I’ll go back to Portland, where I’ll do a residency,” he says.
Tobey Clark, lecturer at the University of Vermont and the director of Instrumentation and Technical Services at the college, wholeheartedly endorses the quality of military training for biomedical technicians. In fact, half of the 35 BMETs who work for him have military training. “The military has done a good job of training techs. They are both the educator and the customer,” he points out. “Colleges are isolated from the healthcare system. The military is an integrated system. They know the healthcare needs for the hospital.”
In a hospital setting, a biomed technician has the perfect opportunity for advanced education when new equipment is purchased. Typically written into capital equipment contracts is a specified amount of vendor-sponsored training. In addition to device-specific instruction, some vendors offer a range of educational programs that can enhance a biomed’s professional knowledge.
Bud DeGraff, general manager of Diagnostic & Clinical Services, GE Healthcare, offers one example. He says that the GE Healthcare Life Care Solutions (LCS) business, which includes patient monitoring, monitoring networks, anesthesia, maternal/infant care, and diagnostic cardiology products, has made service manuals and more than 140 biomed courses available to technicians for many years. “GE does this because in the LCS business, the in-house biomed, for many products, is the first-call engineer to handle break-fix of the product, and provides a beneficial service to the LCS products in their hospitals,” he says.
Additionally, around 2007, GE Healthcare introduced a series of courses directly related to network infrastructure and protocol training. “These courses have been updated regularly as network technology needs have shifted in the biomed hospital environment,” DeGraff says. “These network courses are tailored to the specific needs of the hospital network environment, not specific to GE equipment but inclusive of the hospital network environment.”
LCS biomed courses in primary modalities are typically offered at the GE Sites, like the GE Healthcare Institute in Waukesha, Wisconsin, but can also be accessed remotely. “While many of our courses are instructor-led and offered at GE sites, there are many courses, like our prerequisites, that are offered online or at a customer site,” DeGraff reports, adding that in most cases, courses are paid for by the employing hospital. Siemens and Philips are among other OEMs that offer technical training on devices as well.
Discussions at a staff retreat for the Association for the Advancement of Medical Instrumentation (AAMI) faculty in 2010 focused on industry training programs for quality systems. These talks led to the creation of AAMI University, a curriculum that aims to serve as the go-to training center for medical device and healthcare technology management (HTM) professionals. “With the growing curriculum for both segments of AAMI’s membership, it was essential to create a central location for individuals to plan and track AAMI training and professional development activities,” says Deborah Reuter, AAMI’s senior vice president of education.
AAMI’s Technology Management Council, a 24-member AAMI committee that represents the interests of biomedical equipment technicians, clinical engineers, and other HTM professionals, serves as a resource when it comes to educational needs for biomed technicians. Reuter notes that AAMI recently held its third Future Forum to identify education and training gaps that exist in the HTM field as a whole, and develop a plan for filling those gaps. The Forum also identified training gaps in achieving the future vision for the HTM field and determined what credentials should be required as “proof” of readiness for entering and moving up the career ladder as an HTM professional, she adds.
“AAMI is implementing a learning management system that will serve as a central location to access curriculum and manage transcripts. Students can map out their training plan and track progress, and employers will have access to training records for their employees. The university will offer a blended learning environment by offering both face-to-face courses and eLearning to allow easy access to training,” Reuter says. “Individuals will be able to take one course or a certificate program consisting of a combination of courses and webinars in a specific area of study.” Other educational resources, such as publications, webinars, and websites, will also be available to students.
AAMI is planning to launch expanded certificate programs, which will consist of a mix of face-to-face courses, webinars, and eLearning programs, in 2015. “A certificate for quality system engineers will be the first one offered and will be part of the AAMI University launch. A certificate for quality system managers will launch by early 2015. Among other certificates being planned is one for HTM professionals on risk management of integrated systems and networks in healthcare environment,” Reuter reports. “While there is no degree associated with AAMI University at this point in time, it is an opportunity staff is considering for the future.”
Fees are based on the programs attended. AAMI University is open to all parties interested in learning and professional development.
Personal and Professional Development
Martin Smith, MSETM, manager in biomedical engineering at St Francis Health System in Tulsa, Oklahoma, preaches self-development as a way to grow in the field. He emphasizes that increased knowledge helps a person both personally and professionally.
At the very least, Smith recommends that biomed techs read trade journals and magazines and attend AAMI and hospital-sponsored workshops to keep abreast of best practices and trends. He also suggests taking advantage of the independent online opportunities for self-development and personal and professional growth. “You can take any number of online classes. Some offer certificates, and some require you to simply watch a video,” he notes. “If you are looking to set yourself apart, look into MOOC (massive open online courses).”
For instance, one technician at St Francis Health System is taking a cardiac arrhythmia course through the hospital. “This is the same class the clinical staff takes. To work on the equipment, you have to understand the human element as well as the electronic element,” Smith reports. “Taking a course like this enhances his knowledge, making him a better biomed technician. It helps him understand what he should be looking for.”
“If you want to grow in the field, you have to dedicate time. At some point, we all have to grow. Establish a baseline, and grow from that. As the job changes, so do the educational requirements,” Smith says. “Biomedicine is an integral part of the hospital. As we continue this evolution and equipment becomes linked in such a larger chain in patient events, our knowledge has to grow. We have to acquire more skills.”
Phyllis Hanlon is a contributor to 24×7. For more information, contact editorial director John Bethune at firstname.lastname@example.org.