Three experts identify the key issues facing healthcare technology management, and how the profession can address them
Ask ten different biomeds what’s most challenging about their job, and chances are you’ll end up with ten different answers. Among the possibilities: time management, working efficiently as part of a team, or the stress that often comes with handling extremely expensive equipment that patients might depend on for their very survival. They’re likely to bring up many other issues as well, from concerns that pivot on the personalities of department leaders, to questions about salary or working difficult hours.
The bottom line: Healthcare technology management (HTM) is anything but easy. If you’re going to last in this challenging field, you’d better come equipped with an exceptionally thick skin and be ready to act quickly under extremely high pressure.
Which made us wonder: Considering the sheer variety of issues faced by individual biomeds, what are the biggest challenges facing HTM as a whole? And even more important, what can the profession do to address these concerns, whether it’s today, in the coming months, or 3 years down the road?
We asked three industry veterans for their expert opinions, and then boiled down their thoughts to arrive at a “top 10.” Here’s that list, in no particular order of importance:
1) Bridging the gap between the services HTM provides and those that are actually needed.
“We need to get out of the rut of doing things the same old way they’ve always been done,” says Stephen Grimes, managing partner and principal consultant with Massachusetts-based Strategic Healthcare Technology Associates. Hospital technologies, Grimes notes, are becoming more sophisticated and integrated by the day, and yet little has changed in terms of how HTM departments go about their business. “They still spend about half their time testing equipment, and a lot of that testing is basically unnecessary.” For example, Grimes says, “virtually everything” is monitored for leakage current, “but you almost never find problems with leakage current anymore, so why spend so much time doing it? It’s just not an issue and our response today generally remains way disproportionate to risk.”
Scheduled preventive maintenance is also often of little benefit, he notes. “You used to be able to detect [impending] breakdowns before they happened because equipment would develop problems over time.” With newer technologies, that’s very unlikely, as “they’re far more apt to fail spontaneously than wear out” in any detectable way.
So what needs to change? Grimes and others, including leaders at the Association for the Advancement of Medical Instrumentation (AAMI), are intrigued by an approach known as reliability-centered maintenance, in which failures are analyzed to determine exactly which maintenance activities are most needed and most beneficial. Do that, Grimes says, “and we can focus our attention on the technology challenges that are really important.”
2) Getting HTM more involved in equipment acquisition and other processes once reserved for the C-suite.
Several years ago, notes Patrick Bernat, AAMI’s director of Healthcare Technology Management, The Joint Commission put forth an “element of performance,” or EP (EC.02.04.01 EP 1), that requires hospitals to seek input from frontline technicians when they choose and purchase medical equipment. “But how many people even know that EP exists?” he asks, calling it a “validation of what the field brings to the table” in terms of technological expertise. “Hospitals should be aware of it, and HTM departments should be aware of it.”
Toward that end, Bernat says, AAMI is redoubling its efforts to not only get the word out about this EP, but to also promote the value the profession can provide the industry. The hope: Whenever healthcare executives make decisions about technology, they’ll look to their HTM departments for professional guidance. “It won’t happen overnight,” he acknowledges, “but we’re determined to get there.”
3) Bringing new talent to the field.
According to the most recent 24×7 salary survey, well over half of HTM professionals are now age 50 or older. This graying of the workforce is pushing the field toward a “crisis point,” Grimes says, as there are “excellent people” coming into the field, but not nearly enough to meet demand or to replace the many thought leaders who are reaching retirement. The reason, he ventures, likely has to do with the same lack of awareness that has kept HTM from fully participating in the acquisitions process—if HTM professionals appear to be undervalued, why would a person choose this field as a career?
One solution, he says, would be to focus on education, including the development of more HTM-focused master’s degree programs (and clinical engineering in particular). Along similar lines, AAMI has been promoting the field to high school students using social media, a YouTube video, and a national essay contest. The group also plans to produce a recruiting brochure it will distribute to students at career-related events.
4) Increasing training in information technology and “systems thinking.”
As medical devices are increasingly connected into systems, many BMETs and clinical engineers are moving into “bridge roles” that require them to have skills in both HTM and IT. “You’re no longer dealing with just equipment itself,” Grimes notes. “Now you need to understand how everything in the environment interacts.”
Part of that entails thinking about closed-loop systems, where outputs from diagnostic devices like heart rate monitors affect inputs on therapeutic devices like infusion pumps. It also requires considering vulnerability and risk and focusing on concerns like cybersecurity. When everything is connected, Grimes says, there is a “much greater risk that if something fails, there will be dire consequences.”
To address this challenge, AAMI is creating a task force on HTM/IT bridge roles that will identify the skills professionals need in these roles and ultimately develop resources for education and training.
5) Facilitating collaboration between HTM and other departments to minimize health technology hazards.
Among ECRI Institute’s “Top 10 Health Technology Hazards for 2016” were safety risks related to inadequate cleaning of equipment, missed alarms, misuse of operating room technologies, and inappropriate operation of intensive care ventilators. Many of these hazards can be attributed to healthcare facilities using new technologies that for HTM professionals and others present unfamiliar challenges. “There is a lot of change going on in this environment right now,” notes David Jamison, ECRI’s executive director of Engineering Evaluation and Safety. “The good news is, if these professionals collaborate across departments, they can manage this change and minimize the risks.”
Jamison points to what the group calls the number one hazard for the year: the risk of flexible endoscopes spreading deadly pathogens when they’re not cleaned adequately prior to disinfection. “Everyone,” he says, “should be part of the solution,” including clinicians, HTM, reprocessing staff, and others. “And the key to success is usually good communication. These problems can’t be solved by one group independently. You need to have a focused and cross-organizational effort.”
6) Improving support with consolidated service desks (CSDs).
When clinicians have a problem with a particular device, they shouldn’t have to worry about whom to bring in for help. But often that is exactly what happens—and often they wind up calling the wrong person.
“The problem is typically around hand-offs,” Grimes says. “A physician will call Clinical Engineering or HTM and then nothing will happen, and it’s because it turns out the issue was computer-related—it should have gone to IT.”
A well-run consolidated service desk acts like a funnel for all support requests so that jobs are assigned to the appropriate departments. An increasing number of facilities now use CSDs, Grimes says, “but not nearly enough.”
7) Finding ways to turn data into actionable information.
The problem is not that we don’t have enough data; it’s that hospitals are struggling to use that data efficiently and effectively. “We need to find ways to not only ensure that we’re collecting data and storing data,” Grimes says, “but that we’re also then processing that data into actionable information and delivering the right information to the right people at the right time.” Alarms and alerts data are prime examples of the scope of this challenge, he adds. “Clinicians are being inundated with all this unprocessed data, and it’s just too much to handle, so then they often don’t respond to it appropriately.”
So how do we extract the “actionable information” from the “data noise”? The best solutions will most likely come from equipment manufacturers that build such capabilities into their products, and from the growing number of enterprise data warehousing, analytics, and integrating companies now offering their services to the healthcare market.
8) Clarifying questions about standards and regulations.
“I think there’s a great deal of confusion around regulations and standards that impact HTM,” says AAMI’s Bernat. For example, during a 2015 roundtable at the North Central Biomedical Association conference in Minnesota, attendees told him they were “simply baffled” about a number of issues.
Those included questions like the relationship between the Centers for Medicare and Medicaid Services and The Joint Commission, which organization’s rules supersede the other’s when their standards or regulations conflict with one another, and how the National Fire Protection Association’s NFPA 99 (the Health Care Facilities Code) fits into the picture. The sense of bewilderment is “understandable,” he says, “because standards and regulations can be complex, they change over time, and they don’t always agree with one another.”
Bernat points to another example: the ongoing ripple effects of the CMS ruling regarding equipment maintenance. Initially, he explains, “CMS chose to severely restrict HTM departments’ ability to select equipment maintenance strategies, but 2 years later walked back on that” and instead opened the door to so-called “alternate equipment maintenance,” or AEM. Although CMS now gives HTM departments greater flexibility in selecting appropriate maintenance strategies, “there’s uncertainty about what is acceptable within an AEM plan, and what the best AEM strategies are.” AAMI hopes to shed light on this and other points of confusion in 2016 by launching a new educational campaign focused on the issue.
9) Taking action on issues related to safety.
Back to that ECRI report on health technology hazards. Jamison, who earlier pointed out that collaboration is key to reducing risk, also thinks individuals should “take action on their own” in certain situations. For instance, he says, the group’s number 10 hazard for 2016 involves medical device malfunctions due to the misuse of USB ports. “The problem here is you have a doctor in the OR plugging something into the back of an anesthesia machine because he needs to charge it up, or someone’s plugging their cell phone into a ventilator in the ICU,” which causes it to stop working. “These kinds of things have actually happened.”
Biomeds, Jamison says, are in a unique position to make a difference in such situations. “But you have to take action. Block the ports with locks; try to create a new policy for your facility that says all USB ports should be covered and protected.” HTM professionals can also take action when it comes to managing device recalls and manufacturer-recommended changes. “If there’s a recall, especially in a situation that is potentially dangerous, it’s up to HTM to be all over it. You know, get in there—make sure that equipment isn’t used anymore until the work has been done.” He compares it to a car owner getting a notice in the mail from the manufacturer that the brakes have been found to be defective. “You don’t just put that aside and keep driving. You take your car in and find out what’s going on.”
10) Working with manufacturers to optimize supportability.
The supportability of medical devices has always been high on the list of concerns for HTM professionals, and it remains so today. Among the biggest issues: nonexistent or inadequate service manuals, error codes and logs that are impossible to interpret, and manufacturer-led training courses that are prohibitively expensive, if they’re offered at all. The manufacturers, of course, see things from a different angle: If they free up facilities to support their devices as they see fit, they risk liability and potential loss of intellectual property.
Last November, AAMI took a step toward resolving these issues by hosting a forum on the topic at its headquarters in Virginia. The event included representatives from the HTM community, manufacturers, regulatory bodies, and service companies, and was convened with the hope that the various stakeholders might use the occasion to find common ground. By the end of the meeting, the group had created a list of prospective actions it agreed might improve the situation. But it also concluded there was more work to be done.
Chris Hayhurst is a contributing writer for 24×7. For more information, contact chief editor Jenny Lower at [email protected].
Photo credit: © Michal Bednarek | Dreamstime.com
As a member of the over 50 crowd, I have to remark that there is nothing new here, save that us old folks are not being replaced as we exit. Well, almost nothing, but more on that later. We’ve known that the need and nature of electrical safety testing has changed for decades. Ditto PM programs. Ditto participation in capital acquisition processes. Ditto the value of data. Ditto ditto ditto.
Einstein is reputed to have defined insanity as doing the same thing the same way over and over and expecting different results. Having served on a number od standards committees mostly populated with manufacturer representatives over the more recent years, and having dealt with manufacturers to get things done at the pointy end of the stick throughout my career, I’m perplexed by so many sticking to a “Why can’t we all just get along?” strategy.
My experience has been and remains that it is far too often like pulling teeth to get manufacturers to provide information we request. You have to love the closing lines of this article “By the end of the meeting, the group had created a list of prospective actions it agreed might improve the situation. But it also concluded there was more work to be done.” This could be appended to a s report from just about every one of the joint efforts I’ve been connected with over my almost 37 years in the field.
I’ve said it before and will say it again: The nature of providers’ relationship with manufacturers is supposed to be adversarial as well as collegial. That we should work together on standards efforts and in meetings focused on shared objectives doesn’t mean we do not have conflicting objectives. We do. That’s how and why the system is supposed to work. And that begs the question whether or not there is ANYTHING that provider-based practitioners will step up and defend as fundamental, that they will tell manufacturers is not acceptable to not address to the provider community’s satisfaction. I would hope that would be safety-related, but right now anything would do.
I opened this message with the teaser that there might be something new in this list; that would be the investigation of reliability centered maintenance as an approach to a rather stagnant perspective on the field’s bread and butter work. If it’s new to this community, it’s hardly new to the world. It’s a good sign that some in the field are looking outside the proverbial box, and it’s good to be looking for things that have worked elsewhere. I would only caution to approach RCM (or anything else) not as the Next Great Thing but rather as another potential tool for practitioners’ tool boxes. Its investigation in the current context a practical research opportunity that hopefully will be picked up by the young folks. Ditto any other new ideas, new or old, that may be out there.
“Ripple in still water
When there is no pebble tossed
Nor wind to blow”
– The Grateful Dead
I would like to add test equipment calibrations, it is quite expensive and when I have asked vendors how often have they have had their equipment go out of cal I have been told never, yet I still have to send them in annually!
In my 30 plus years I have seen this career go from an office type to a shop that is in the facilities dept. We need to get that respect for this profession where it needs to be and end complacency and reposition ourselves for success. This is the BEST JOB no one knows about. Let’s get the word out encourage the young people don’t discourage.