This article will appear with 24×7’s June 2016 anniversary coverage.
“It’s tough to make predictions, especially about the future.” —Yogi Berra
Nearly five decades ago, when ECRI Institute published its first Health Devices evaluation of manually operated resuscitators, it rocked the healthcare community with the news that half the devices on the market didn’t work. At that time, patients were diagnosed and treated mainly in two places: physician offices and hospitals. The hospital was usually a single institution in one building. Nurses and physicians were the main users of medical equipment.
Medical equipment needed a lot of preventive maintenance. Electrical safety was a major concern, and so BMETs spent much of their time troubleshooting with a voltmeter and oscilloscope and replacing components on electrical circuit boards (some devices still had vacuum tubes). Manufacturers, a few in-house departments, and independent service organizations (ISOs) provided maintenance and repair services. Computers were not in general use.
Today, patients are seen and treated in more places. The hospital may have a free-standing dialysis or imaging center, an urgent care center, and even a long-term care center. Hospitals rarely stand alone any more—they are usually part of a group or network.
These days, there are many other specialized clinicians in hospitals who use medical equipment. The educational level of these device users ranges from high school to graduate school, so we need to offer training consistent with their educational background.
We also need to understand how the individual pieces of equipment function and how people work with them. Many modern devices have onboard computers, and more and more of them are connected to a hospital network. Since patient information is now flowing to and from networked devices, security issues are very important.
Software enables device functionality to be upgraded, changed, and configured to accommodate a range of patients. The HTM department needs to manage software updates and make sure the devices work well with other networked devices. In addition to software-based “fixes,” repairs today mostly involve swapping out major components and circuit boards. Unlike their predecessors, “stand-alone” devices are reliable and need little PM. Likewise, electrical safety is no longer a major issue.
These days, the HTM department manages hazards and recalls, contributes to purchasing decisions, reviews operator errors, and meets with users to help them improve their performance. In addition to customer service, the main skills for BMETs today relate to computer technology—installing software updates and networking medical equipment with patient information systems. A significant number of hospitals have outsourced their HTM departments to major equipment manufacturers or ISOs.
In the future, there will be even more places where patients are diagnosed and treated. Hospitals will be used only when very specialized care or equipment is required. Most care will be delivered closer to home or in the home itself. Organizations beyond the “traditional” healthcare industry will be more involved in healthcare.
Many clinicians will treat patients remotely so telecommunications and “the cloud” will play a significant role in healthcare delivery. Thankfully, the devices themselves will be very reliable and won’t need PM. Their condition will be monitored 24/7, and the device will either repair itself or let us know that it’s not working properly. More devices will operate as closed loops integrating monitoring, feedback, and delivery technology. There will also be new equipment specialties and job titles such as spectrum manager and network interface engineer. The main skills for BMETs and clinical engineers will include systems-level thinking and troubleshooting, networking, and data management. Customer service will continue to be a valuable skill. There will be even more equipment to be managed.
We will have plenty to do.
Jonathan A. Gaev, MSE, CCE, PMP, is business line manager, BiomedicalBenchmark, ECRI Institute.
Photo: Yogi Berra, © Jerry Coli | Dreamstime.com