The start of a new decade: Health care reform still a promise looming, economy improving but still struggling, terrorist attacks continue in our homeland, clinical technology continues to evolve, and the ability to integrate data from this technology into an electronic medical record (EMR) continues to expand. As we enter this new decade, it is good to look back over our past to remember our accomplishments as well as to look to the future to prepare for what will be.
Professionally, we have been biomedical equipment technicians (BMETs) and/or clinical engineers (CEs) since the 1970s. Are we at a point in time looking forward where we need to evolve our profession to be prepared for the future?
The Merriam-Webster’s Collegiate Dictionary defines evolution as:
- A process of change in a certain direction: unfolding;
- A process of continuous change from a lower, simpler, or worse to a higher, more complex, or better state: growth;
- A process of gradual and relatively peaceful social, political, and economic advance;
- The historical development of a biological group; and
- A process in which the whole universe is a progression of interrelated phenomena.
|L-R: Clinical engineers Willy Endres, Angela Baltz, and BMET Roman Fomin set up a simulation of devices to be integrated into the EMR. Photo courtesy of Ben Dalusong, CBET.|
Change never comes easy, and there are those purists who would cringe at the thought of change. Our world, as well as our profession, is evolving. I can remember back to not that many years ago when we could replace a discrete component to repair a device. Now, when you open a device—if you can open it—the racks of circuit boards are distilled down to one multilayer package where there are no discrete components. The requirements for planned maintenance and support of microprocessor-based devices has dramatically changed how we support our clinical technology and conduct our business.
Now, enter the world of device connectivity, a place where our discrete clinical devices can exchange data with EMRs in the IT world. It will require us to expose our soft underbelly protected by our closed clinical networks and distinct devices to the harsh reality of the hospital network and its connection to the outside world. Can highly trained, motivated, and competent BMETs and CEs be successful in this new world? Absolutely! Is this something that can be added to their already overflowing plates? Maybe!
I attended a medical device and connectivity conference in Boston last September. At the conference, Stephen L. Grimes, FACCE, FHIMSS, FAIMBE, vice president of enterprise resource planning at Technology in Medicine Inc, Holliston, Mass, provided a couple of different job descriptions that are worth considering. He was kind enough to allow me to share them as part of this article.
Clinical Systems Engineer
Coordinates an organizationwide program to ensure the effective deployment, integration, and support of interconnected medical systems. Responsibilities include:
- Maintaining current inventory of networked and integrated medical systems (including catalog of services, features, interconnections);
- Coordinating the security management process including risk (such as criticality and probability) and vulnerability analysis, and related documentation associated with interconnected/integrated medical systems;
- Coordinating with stakeholders a process to prioritize, develop, and implement a plan to manage/mitigate identified risks associated with interconnected/integrated medical systems by applying appropriate administrative, physical, and technical safeguards;
- Maintaining the integrity of FDA approval for interconnected/integrated medical systems;
- Working with stakeholders to ensure effective deployment, integration, and support of new medical systems into legacy systems and nonmedical elements of the organization’s information infrastructure;
- Working to ensure systems are deployed into an optimum (secure and supportive) environment;
- Continually reviewing system components to determine which are obsolete or otherwise no longer adequately supportable, and then:
- Planning for and implementing component upgrades/replacement in a timely manner;
- Identifying and managing appropriate software upgrades, security patches, and antivirus installs for interconnected/integrated medical systems according to industry best practices;
- Conducting root cause analysis and failure mode effects analysis on incidents involving integrated medical systems and reporting findings to appropriate stakeholders for follow-up action;
- Monitoring and adopting industry “best practices” to ensure integrity, availability, and confidentiality of data maintained and transmitted across interconnected and integrated medical systems;
- Educating stakeholders on security and other implications associated with the proliferation of interconnected and integrated medical technologies; and
- Supervising clinical engineering and other staff as necessary in clinical systems integration and infrastructure support (such as hybrid reporting structure and project supervision).
Clinical Systems Support Specialist
Responsible for providing engineering support of specialized medical devices and systems (such as cardiology, neurology, surgical, monitoring). This support may include installation, integration, clinical training, operation, diagnostics, technical service, and vendor management in these specialized areas. Responsibilities include:
- Maintaining inventory of all devices, systems, and components in their assigned areas;
- Coordinating deployment of new medical technologies in assigned areas, including planning, needs analysis, evaluations, installation, integration, and training;
- Managing other special projects associated with technologies considered for or currently used in assigned area(s);
- Monitoring operational effectiveness of medical devices and systems in assigned area(s);
- Ensuring devices/systems are effectively maintained by judicious application of scheduled and corrective maintenance, upgrades, and overhauls as appropriate;
- Acquiring, deploying, and utilizing appropriate hardware/software tools to monitor and manage device and system performance;
- Developing or acquiring, and deploying administrative, technical, and physical safeguards to maintain integrity and availability of clinical information maintained or stored by medical devices and systems;
- Developing and providing operational and service training to clinicians and support personnel on devices and systems in assigned area(s);
- Providing consultation to clinical staff on capabilities and limitations of available technologies;
- Representing technology perspective for assigned area(s) as needed at meetings with other stakeholders;
- Monitoring medical device hazard/recall reports for their assigned area(s) and ensuring appropriate follow-up, such as through communication, corrective action, etc;
- Monitoring regulatory developments affecting devices and systems in assigned area(s) and identifying/coordinating implementation of appropriate compliance measures;
- Maintaining technical library and database with information critical to the support of devices and systems in assigned area(s);
- Participating in the development and maintenance of a capital equipment plan (for existing and new operations) for assigned areas. Basic plan elements should include needs analysis/assessment, total cost of ownership analysis, and comparative evaluations of technologies; and
- .Consistent with the needs of clinical engineering and other team members, may perform other duties as requested or assigned.
I am sure, based on your experience and organization, that there may be items that could be added or deleted from these two comprehensive job descriptions. These new positions, in concert with our existing positions, will provide a sound and crucial evolutionary foundation necessary for us to continue to be successful. I know these are in my plans as I start my budget preparation.
Interdisciplinary teams are working in our facility to identify technology and data that will be integrated into our EMR. The “what” tends to be much easier to identify than the “how.” The payoff to this work in terms of improved patient safety and clinical outcomes cannot be overstated. It is also mentioned in many of the health reform bills that have been developed by Congress.
How you and your organization evolve depends on you. You can choose to be part of the solution, or leave it to others in the organization to assume the responsibility. Being a contributing member of an interdisciplinary team with IT, nursing, and support services holds much greater promise than looking through the window from the outside.
Dennis Minsent, MSBE, CCE, CBET, is director, clinical technology services, Oregon Health & Science University, Portland, Ore. For more information, contact .