Recently, the convergence of medical devices and information technology, and the changes it portends, has been a hot topic. But, in a practical sense, how do IT—also known as Information Services, or IS; or Information Services and Technology, or IS&T—and clinical engineering (used here to encompass all the names medical technology support may go by: biomed, BMET, imaging, radiological engineering, lab service specialist, or an ISO) work together for the benefit of patient care? Understanding how IT works and differs from clinical engineering is necessary in order to effectively work with IT and be effective in the institution. Every organization will vary, but below are seven points our hospitals have focused on with IT, and both of our departments have benefited.
- IT organization (structure, leadership, internal communication);
- Defining IT and clinical engineering roles, or who does what;
- Policies and procedures;
- IT terminology;
- The three C’s: Communicate! Collaborate! Cooperate!; and
- IT relationships.
Through understanding how IT is structured, the internal organizations can assist in navigating a complex organization. IT is not one homogenous service, at least in the large and medium groups. It is made up of many technical specialties. Unlike clinical engineering, IT has a leader represented at the senior executive level: the chief information officer (CIO). The CIO reports to a very senior leadership executive of the institution. Responsible for the overall IT leadership and direction, a primary responsibility is to match IT to the business needs of the organization.
Technical groups in IT might be structured as follows: networks, servers, workstations, databases, software applications, and systems interfaces, to name a few. Additionally, project management, change management, specialized purchasing, and IT security are usually part of the IT program. These latter groups are the glue that helps keep all of IT on the same page. Security and compliance to regulatory requirements drive a lot of IT processes and are often the point of contention among clinical users, clinical engineering, and IT.
Defining the Roles
First, it is necessary to define responsibility for what systems and to what level IT and clinical engineering support. At our facilities, a list of clinical engineering-supported applications was shared with the IT help desk. If the IT help desk is contacted for a clinical engineering application, the help desk is able to redirect the request to the proper clinical engineering resource without delay, and vice versa.
Another important area is the analysis of clinical engineering systems compliance with security requirements, HIPAA, and other policies to identify deficiencies and develop mitigation plans for compliance. Tools were developed to analyze and track the requirements and status. Most clinical engineering systems are actually owned and operated by the clinical users. Clinical engineering may not have budget authority to upgrade or replace a system. The tools developed helped get visibility of the deficiencies or issues to upper management and often resulted in budget approval to bring the systems into compliance.
Policies and Procedures
Clinical engineering should know IT policies and procedures in order to work effectively together. If there are issues with an IT policy/procedure related to a clinical system, such as patching operating systems via an automatic push affecting the operation of medical devices, then this needs to be brought to the attention of IT management. We have found the best process is to directly address the issue with IT leadership and be able to explain the problem. Vendor management (service and setup), remote access, security processes, disaster recovery, and, of course, HIPAA are often where clinical engineering and IT procedures require differentiation.
By processes, this means how does IT manage its technology and applications? For example, how might it go about planning and implementing updates or changes to its systems? Examples are project management, change management, security assessments, critical system reviews, etc. Clinical engineering processes are usually less formal than IT, but this is changing due to the complexity and impact to the organization. For example, we send a representative to the weekly change management meeting and various project management reviews. This process has been invaluable to the overall clinical engineering operation, allowing the rest of our staff to know and plan for potential changes/effects. The reverse is also true because clinical engineering reports changes that IT needs to know about to identify any potential conflicts to these proposed changes.
Well, it is true. IT has acronyms for everything. Keeping up with IT technology terms and acronyms is challenging. Just like communicating with clinical users, clinical engineering needs to get familiar and understand the lingo and be the translator to the clinical groups, our natural forte.
The Three C’s: Communicate! Collaborate! Cooperate!
Undoubtedly a two-way street. It is important that an atmosphere of trust and sharing gets adopted versus the alternative. One factor that was of great value to our two services was periodic scheduled meetings between clinical engineering and CIO/IT leadership. These high-level meetings provide IT leadership with direct knowledge concerning our challenges and issues. In turn, clinical engineering saw IT’s side. Both services were able to understand how to help each other for the benefit of the hospitals. Knowing that clinical engineering leadership was regularly meeting with upper IT management set the tone for both departments’ technical managers to collaborate and work more cooperatively.
Working with IT is no different from working with other departments such as facilities engineering, materials management, nursing, etc. Clinical engineering is a support department, and as such, many of the other support departments and direct patient care departments are our customers also. IT is no different. Of course, the reverse is also true. How well IT and clinical
engineering work together is usually directly attributed to the relationships the leadership in IT and clinical engineering have with each other. Setting a favorable tone at the leadership level promotes cooperation throughout the two organizations.
Today, some clinical engineering departments are now part of IT. Whether this is good or bad depends on each instance. What is important is cooperative collaboration. Sitting down with IT provides both parties with information that may prevent future problems. Working for IT can be a bonus if the IT department understands clinical engineering and wants to support them. Can it be a problem? Of course, but that is true for any reporting structure; it is dependent on the leadership. In general, clinical engineering thrives when it has good access to senior executives with a good reputation by the clinical users.
Whether we like it or not, clinical engineering and IT are increasingly playing in the same sandbox. Clinical engineering’s role has always been central to the clinical user, assisting in the adoption of technology at the point of care, where IT comes from the financial and business side. The convergence of medical technology and IT is changing how clinical engineering functions in the health care environment. Clinical engineering needs to embrace these changes and help develop new tools and controls to meet IT, regulatory, and clinical requirements.
Read about IT terminology in the February 2008 Networking column.
Many of the clinical systems clinical engineering deals with do not have all the safeguards and management tools IT requires for their systems. Clinical engineering can be of primary help in identifying deficiencies, tracking them, and developing mitigation plans to resolve the issues. As the clinical systems evolve and expand, a primary role for the CE and BMET is to be the technical expert in the clinical arena. Communication and relationships with the CIO or designee is critical regardless of to whom a CE or BMET reports. Of course, there will be disputes, but if they are handled and resolved professionally and successfully, then the institution benefits and the two technical services can enhance each other’s capabilities.
Greg Herr, BSEE, MBA, CCE, is director, imaging support/technical assessment for Masterplan Inc at the Health Alliance and The Christ Hospital in Cincinnati. For more information, contact .