The convergence of medical systems and IT is a hot topic, often centering on roles, responsibilities, or even reporting structure. The need today is for comprehensive support programs for these hybrid systems and cooperation between clinical engineering and IT. Systems like obstetrical information systems, hemodynamic monitoring, smart pumps, ICU monitoring and charting, EKG management, and others fall into both the clinical engineering and IT worlds. HIPAA and regulatory/accreditation bodies have put forth new requirements that raise the questions of who is responsible for these converged systems and how they get supported.
Until recently, all clinical systems were either stand-alone or communicated by some kind of proprietary protocol. CEs had complete control of these systems, supporting them with the clinical department, independent from IT. Clinical systems today are designed to be part of the hospital network, communicating with a host of other systems. New tools, knowledge, and processes compatible with IT are required to support these clinical/ device systems. The clinical systems must meet all the IT requirements, such as patching, security audits, and virus protection (not inclusive); and also meet the specific needs of the clinical department that provides patient care. These systems often require manual intervention, workstation by workstation, working around patient use.
Troubleshooting clinical equipment on the network adds a new layer of complexity. Now, CEs and BMETs need to understand not only the medical device, but also the network and IT’s processes. For example, a recent problem was reported where a medical device was not sending information to an electronic charting system. The source of the problem was not the device or the network, but a server software process that had terminated. Biomeds today need to obtain knowledge in all areas to be able to determine the problem and restart the process. Tools needed in this example were network analyzers, a laptop, remote software, training, and a good understanding of the data flow and system architecture of the monitoring and charting system.
What Tools Can Help?
Some tools used are off the shelf: network analyzers, protocol analyzers, cable and connector testers, virus scanners, remote access software, and ghosting software, to name a few. Off-the-shelf tools imply an understanding of how these are to be properly used. A tool that is not off the shelf but has become invaluable is a clinical information-management database. The system can be developed in-house to enable a department to inventory and track clinical information systems (CIS) and networked devices. This includes any devices connected to the network such as image modalities, specialized medical devices, independent workstations, etc. The system provides clinical engineering and IT with information needed to support and track the systems and their components. The system includes inventory, software version tracking, patch status, device status, IP addresses, system diagrams, and HIPAA conformance. For facilities coping with multiple locations and clinical systems, this tool can enable a department to quickly determine problems, resolve them remotely, or dispatch a technician with the proper tools to resolve the issue.
|Troubleshooting clinical equipment on the network adds a new layer of complexity. Some tools used include remote software and network analyzers.|
Below is a list of some of the other tools used to support systems:
- Network analyzers/protocol analyzers;
- Cable and connector impedance/continuity testers;
- Spectrum analyzer (not telemetry) but 802.11 and other telecom;
- Laptop or workstation software for testing network adapters;
- Patch-management, tracking, and virus-reporting software;
- Various software tools on laptops to analyze problem workstations;
- Remote access software for remote diagnosis/evaluation/ review;
- Ghosting software for system backups/disaster recovery;
- Project-management software;
- Clinical information-management software that provides remote monitoring and support, maintains CIS inventory (shared with IT), provides CIS management, monitors device network activity, creates system network diagrams, captures critical system monitoring information, maintains key OEM/developer contacts, develops problem-escalation processes, tracks HIPAA and other requirements, and has the capability to receive alerts/problems from the system before users notice.
Knowledge and Training
Chances are that many clinical engineering departments already have individuals who are well versed in the IT world, but for those who are not, there are avenues for CEs and BMETs to pursue to expand their knowledge. At Cincinnati State Technical and Community College, the biomedical engineering technology program has been renamed the biomedical instrumentation and information technology program. IT courses were added and other courses were reshuffled to allow the students to obtain a solid background in the IT world as well as in their primary role as a BMET. For the established BMET, colleges are just one of many sources for training. There are online courses available from national and local BMET and clinical engineering associations, plus specialized certification programs. Some OEMs now offer IT training that include such topics as network systems—basics to advanced or certification; operating systems covering Windows, Unix, and Linux; database; applications (PACS, hemodynamic, etc); wireless; interfacing (HL7 and DICOM); and hardware (servers, workstations, switches, displays, and UPS).
CE and IT personnel will need to cooperate for the overall benefit of the health care organization. IT is generally represented by the chief information officer (CIO) at the highest level of administration, and as such is closely plugged into the business and management strategies of the organization. Clinical engineering’s strength is its close alignment and support with the clinical users, its support flexibility, and its multidisciplinary background. To work together, IT and clinical engineering must cooperate, be mutually respectful, and be able to trust each other. Some successful practices to employ are:
- Regularly scheduled meetings between clinical engineering and IT management;
- Clinical engineering participation in any of IT’s change management processes;
- Adoption of project management processes compatible with IT’s;
- Dual participation in the capital acquisition process, review potential purchases together;
- Symbiotic relationships—understanding that CEs are good on the front end with clinical users and applications, and IT is good on the back end—system integration and project management;
- Work together, develop trust—communication is essential; and
- The administration and CIO should lend support and encourage cooperation.
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CIS and medical devices require new tools for their successful support. The support of these systems also requires cooperating with IT, and some shared tools and knowledge. The convergence of medical devices and information systems pushes traditional medical systems into the IT world and their requirements, necessitating the adoption of IT tools, the development of new management software, working closely with IT, and the knowledge to use these tools.
Greg Herr, BSEE, MBA, CCE, is director, imaging support and technology management, Masterplan Inc, Health Alliance of Greater Cincinnati Hospital. Also contributing to this article were Mark Prell, manager, clinical information systems; and Greg Scott, both of Masterplan Inc, Health Alliance, Cincinnati. For more information, contact .