Recorded Webinar: Advanced Integration Technology

For The Ambulatory Operating Room

Presented By: Steven Juett, P.E.

Designing and building technologically advanced ORs in the ambulatory surgery environment is a challenge.  With extreme capital and construction cost constraints, ASCs are often limited in their ability to employ the most state-of -the-art technology.  This is changing.  There is new technology on the market that enables full featured integrated ORs for a fraction of the cost of what a hospital would typically pay, including: audio-visual routing of surgical video, routing of c-arm and ultrasound images, live surgical streaming and connectivity to an ASC or hospital network.  This new technology is simple to use and easy to maintain, while keeping operating costs to a minimum.  It allows for remote learning and access to information everywhere.  Today’s new systems employ minimal cabling, advanced wireless technology, and eliminate the need for expensive equipment booms. Connectivity to labs, imaging centers, offices, pathology and conference rooms is now cost-effective and simple, promoting remote consultation.

This webinar features one of the most respected OR equipment planners in the country who specializes in OR technology and integration.

What you will learn:
1. How to get the complete integration features of a hospital OR at a fraction of the cost.
2. How to plan for an OR construction project in the Ambulatory Surgery Center.
3. How to create technologically advanced ORs on a budget.
4. What is OR integration and what value does it bring to the patient, surgical staff and center.
5. How to access offsite data and information, including patient records, PACS images from within the OR.

CLICK HERE  to register before viewing.

Steven Juett is a Registered Biomedical Engineer.  He is the Principal of Clinical Systems Planning for RTKL Associates, an architectural and engineering firm in Dallas, Texas.  The RTKL Healthcare Technologies group provides international consulting services for medical equipment, connectivity, clinical systems planning, procurement and transition planning.  The technology consulting spans a wide spectrum; structured cable systems, data center, medical equipment and commercial technology.   Steve received awards for his work on the Wireless Medical Telemetry Service by the American College of Clinical Engineers and a citation of honor from the FDA for working towards FCC law proposals to secure the RF spectrum for public health.  Mr. Juett has published several articles on medical equipment integration and communication systems in healthcare.

 CLICK HERE  to view the original webinar announcement.

 

Effective Healthcare Technology Integration

by Greg Thompson, Freelance Contributing Writer For 24×7

Evolving technology means new responsibilities, but clinical engineering’s proactive involvement can steer the change and empower the profession

Clinical engineering departments routinely fall under the IT umbrella these days, but it rarely ends up the other way around. The arrangement often comes down to two factors: money and manpower.  “Power in hospitals often rests with those who control the dollars,” says Ken Olbrish, enterprise imaging system administrator, information services (IS), Main Line Health System, suburban Philadelphia.  ”IT departments are getting more and more money. Clinical engineering departments are not.”

Today, given that nearly all medical devices are essentially networked computers at some level, workflow chart adjustments make sense on many levels beyond pure financial considerations. In 2001, Olbrish had so many overlapping duties within the clinical engineering department that it was not long before he moved to IT permanently to serve in a combination role.

Sporting the “enterprise imaging system administrator” title, Olbrish represents a flourishing breed within the biomedical world—the hybrid.  Now officially under the IS umbrella, Olbrish uses his extensive experience in imaging and IT to efficiently support today’s converged technologies.

The continued integration of clinical engineering into IT departments spells a change for the clinical/biomedical engineer—a change that has not been clearly defined.  The transition could mean taking on a new CE-IT hybrid role, having to report to a chief information officer (CIO) who may have little or no clinical knowledge, or having to rapidly come up to speed on IT knowledge.  Whatever the outcome, the driver of these changing roles and relationships comes back to the convergence of technology.

Some hospital IT departments have addressed the technology convergence by choosing to partner with clinical engineering and bringing the two groups together, thus integrating technology support service.  Others have chosen to hire their own clinical engineers, instead of merging with an existing clinical engineering service.  IT often makes this move to beef up clinical engineering expertise without taking on what some in IT perceive as the more mundane aspects of clinical engineering—such as preventive maintenance and repair services.

According to some in the industry, splitting these functions—picking up the clinical engineering-IT interface skill set without the service and repair component of traditional biomedical departments—leaves a fractured department that may ultimately weaken the clinical engineering role in the hospital. In addition, this policy still leaves the IT and clinical engineering departments separated when it comes to a problem with connected clinical equipment.

According to Stephen L. Grimes, FACCE, FHIMSS, FAIMBE, chief technology officer and director of clinical systems engineering, Linc Health, Holliston, Mass, this approach reflects how some organizations are dealing with the new realities of increasingly complex and integrated systems.  “What had been a clear line between medical and information technologies has blurred,” Grimes says.  “Clinical engineering and IT are being forced together to provide the most effective support for today’s converged technologies.”

Being “forced together” may sound like a negative, but many clinical engineers have taken the transition in stride, viewing their changing roles as something that has been a long time coming.  While IT may appear more powerful on the surface, Olbrish says he still sees a balance of power and responsibility. Others agree.

“I don’t think either clinical engineering or IT is necessarily more influential,” says Steve Merritt, an infrastructure engineer at Baystate Health, Springfield, Mass.  ”They both have their niches and specialties. We have a great working collaboration, mainly because we report to the same director.  There is a lot of give and take. It’s important that the industry as a whole start working together and stop complaining about each other.”

At Baystate Health, clinical engineering falls under IS and both report to one CIO.  One chief unites the disparate tribes, so to speak, and solves any territorial disputes.  As one of those “immigrants” from clinical engineering who eventually landed in IT, Merritt says the leadership arrangement works well and allows him to specialize in technology assessment and PACS issues. When it came time to replace the fetal surveillance system at the multihospital system, the CIO coordinated with clinical engineering to house equipment on standardized desktops and servers using the hospital network infrastructure—instead of building separate segregated networks.

Merritt is currently looking for a new nurse call system, but like so many systems these days, the task becomes more complicated with networking.  “We are not just buying a nurse-call system,” Merritt explains.  “Now you have to figure out how it is going to integrate with your alarm management systems, phone systems, and wireless systems.  We try to plot that out on a 5-year map, and clinical engineering has a vital role in that process.”

EMRs Driving Change

At most facilities, IT has grown exponentially in the last 2 decades and has become an essential element in not only finance—where it played its first major role—but in most other clinical and operational areas.  According to Grimes, IT is nothing less than the “dominant support service” in the industry.  “The most clear evidence of this is IT’s regular representation in the C-suite,” Grimes says.  ”While clinical engineering and IT may both be technically oriented, the two professions come from two very different cultures.  Some aspects of clinical engineering—like scheduled maintenance and repairs—are considered mundane or unattractive by IT, and so we’ve seen some IT services try to take on only those aspects of clinical engineering they more closely identify with—such as medical device integration into electronic medical records [EMRs].”

For better or worse, EMR-related projects are bringing new efficiencies, and occasional headaches, to clinical engineering and IT professionals across the country.  One such project for fetal heart monitoring went live at Olathe Health Systems in March 2011.

Clinical engineering and IT worked jointly to configure clinical applications and networking.  “We cut over from one fetal monitoring system to a new one, which integrated directly into the EMR,” says Dan DeMaria, manager, biomedical engineering, Olathe Health Systems, Olathe, Kansas.  “We literally flipped a switch and we were on the new Cerner system.  It was a year in the planning phase, and all of the key stakeholders were involved in the process that enhanced data management, waveform management, and alarm management.  As time goes on, we will bring in vital signs directly into the EMR as well. If it is data that we gather, it is getting into the EMR, and we want to automate that as much as possible.”

From his perch as head of a major independent service organization, Grimes must routinely seek out the rationale for incorporating new elements into the EMR.  Despite the federal government’s efforts to impel medical entities toward EMRs by 2015 through incentives and disincentives, Grimes cautions that the nursing staff must still first verify information (such as blood pressure readings) before sending to the EMR.

One of the reasons for getting medical devices and medical technology onto the network in the first place is to populate the medical record with accurate information, which improves care. Diagnostic devices include things such as vital signs monitors, physiologic monitors, laboratory equipment, medical imaging, cardiac, neurology, EEG, EKG, and fetal monitoring.  ”There are also therapeutic devices such as infusion pumps, and now there is a big drive to use intelligent infusion pumps,” Grimes says.  ”All of these elements clearly require the involvement of clinical engineering.  The push to deploy EMRs incorporating data from integrated medical devices represents a new major area of collaboration between clinical engineers and IT.”

Even the injectors in cath labs are now networked, monitored, and can flow into the medical record.  At first glance, it may all seem excessive, but Grimes points out that the patient benefits are real. “If we see that respiration or blood pressure on the patient is being depressed because of a drug that is being administered in an infusion pump, we have the ability to create closed-loop systems so that the monitor can actually slow down the amount of drug being delivered because it is networked,” he says.  “We will increasingly see those kinds of closed-loop systems.  This is a trend that will only accelerate in the coming years.

“We are building intelligence into the systems and removing some of the need to make those clinical decisions that are more straightforward,” Grimes adds.  “To the degree that you can remove some of the variability and potential for human error from the equation, that is a positive thing.  These are areas where IT and clinical engineering need to work together to make this all run smoothly.”

Integrating the Healthcare Enterprise (IHE)—an initiative by both health care professionals and industry members to improve the way computer systems in health care share information—has made things easier by encouraging the development of systems that can work well together, even if they are from disparate manufacturers.  It started with imaging systems 10 years ago and has now migrated into other medical devices.  “If you buy Alaris, Philips, or GE, and they are subscribing to the IHE adopted standards, you know they will work well together,” Grimes says. “And that is going to help with medical records as well.”

In the Driver’s Seat

As technology convergence continues to push the boundaries of the defined roles of clinical engineers and BMETs, it leads to evolved responsibilities, which could result in a new spectrum of clinical engineering titles and tasks.  According to Stephen L. Grimes, FACCE, FHIMSS, FAIMBE, chief technology officer and director of clinical systems engineering, Linc Health, Holliston, Mass, some of these roles will continue to focus on the traditional aspects of clinical engineering, such as technology management, service, and equipment planning.  Other jobs will offer specialized services to provide a bridge between medical and information technologies—such as clinical systems engineers, clinical system support specialists, or radio frequency spectrum managers. However, in the end, it is all still within the scope and best traditions of clinical engineering.

Yet, in response to the changes it faces, the industry has often been reactive and inconsistent in the approaches it takes with respect to new support options.  One of the approaches involves splitting elements of clinical engineering and separately placing those elements under existing IT and clinical engineering operations.  This splitting of services can dilute the effectiveness of a comprehensive clinical engineering scenario.  These new approaches have been changing the face of clinical engineering, while as a profession clinical engineering has generally been taking a more passive role.

“I think it would be useful to conclude that it would be to everyone’s benefit if we all became more proactive rather than reactive to these changes,” Grimes says.  ”A proactive approach is more likely to yield a paradigm that stands a better chance of evolving as the technology support needs change.”

As each organization copes with the reality of technology convergence, clinical engineering must decide the role it will advocate.  In these earlier stages, while the industry experiments with new support models, an awareness by clinical engineering departments of the challenges and options can empower them to step up and ask, “How can we drive this change so that it works to our benefit and growth, as well as to better patient care and our hospital’s success?”

“I believe there is no question these issues will end up having a major impact on the clinical engineering profession,” Grimes says.  ”If they are to survive professionally, the clinical engineering team will have to take a new bearing on the future of patient care and recalibrate their services to ensure they are making the greatest possible contribution.  If clinical engineering professionals insist on using paradigms designed for outdated technologies and approaches to patient care, the profession will soon fade and be replaced by others whose approaches the industry comes to see as more relevant.”

A New Way of Thinking

Paradigm shifts in any field may come gradually, while others can be traced back to an exact moment.  DeMaria remembers a day in the 1990s when everything changed.  The former Army medic was maintaining heart cath labs when DICOM appeared on the landscape.  Instead of generating images on 35-mm film, officials asked him to bring digital images onto a network and hard drive to display on computers.  “That was the day it occurred to me that this field was about to change,” DeMaria says, a 28-year clinical engineering veteran with 4 years at Olathe.  ”My personal journey began that day, and I started learning about computers and networking.  Of course, we all went kicking and screaming, because change is painful.”

Clinical engineering and IT departments at Olathe are officially combined, and both entities work together to take care of 5,000 pieces of equipment at a 300-bed institution, in addition to a 28-bed facility and 34 clinics.  Similar to Baystate Health, all report to a CIO, an arrangement that is now increasingly common.

DeMaria hired on 4 years ago to help facilitate the transition to one unified division under IT, and he admits that full integration took time and patience.  ”I was invited to weekly IT manager meetings with the CIO as one of the first steps,” DeMaria says.  “The initial challenge was erasing the clear dividing line between clinical engineering equipment and IT equipment.  Just because it looks and feels like a PC, it is not always a PC.  We now recognize that the skill sets and thought processes are different.”

After years of on-the-job learning, DeMaria applied to an online university 4 years ago to formally boost his own skill set and earn a degree in network security.  He expects to finish the degree this year.

The entire staff at Olathe has been to basic vendor networking courses, and 95% of the clinical engineers are actively engaged in IT course work at the community college level.  The by-product of better understanding is that the “us versus them” attitude is largely a thing of the past.

It is a good thing, because system-level integration, where devices are talking to other devices within the hospital network, has made cooperation more important than ever.  ”We are no longer seeing isolated LANS where radiology has its own little network,” DeMaria says.  “We need to work closely with the IT folks, which means the role of the clinical engineer must continue to change. If a switch goes out, we are not just losing the e-mail network; we are losing patient monitoring.”

Even in a combined department, assigning “ownership” to a particular problem is crucial in the case of a “hand-off.”  If IT works on a problem but later passes it on to clinical engineering, who is responsible for resolving the case?

“When clinical engineering finished their piece, they were reporting back to IT that the piece was done, but things got delayed because each side thought the other was moving forward with the issue,” DeMaria says.  “The process of handing off ownership had to be worked out and documented so that both sides clearly knew when ownership was transferred to the other group. Acknowledgement of that handoff had to be made.”

Not so long ago, DeMaria says that clinical engineering used to worry solely about patient care, and cost considerations were secondary.  Clinical engineering had a budget but did not always keep to it. “All that mattered was the patient,” DeMaria says.  “The opposite of the spectrum can be found on the IT side, where things are very rule driven, process driven, and business driven—with not so much emphasis on patients or clinicians.”

Recognizing that IT does some things really well has sped up the evolution of the clinical engineer’s role.  Change management is one example that has been cultivated within IT for years. For biomeds looking to alter the network and affect other devices, the IT commitment to communication has admittedly made everything smoother.

Meanwhile, the clinical engineering side is bringing a sense of urgency that IT administrators have lacked.  ”It’s OK to wait 5 minutes for e-mail,” DeMaria says.  “It is not OK to wait 5 minutes for vital signs and patient monitoring.”

Part of that customer service mentality can be seen when clinicians call up clinical engineering at Olathe.  Clinicians never hear the dreaded phrase, “That’s not my job.”  Instead, clinical engineers take on the roles of facilitators and helpers—whether the problem is IT-related or not.

“I want my clinicians to be clinicians,” DeMaria stresses.  “I don’t want them to have to determine whether they need to call the applications team or the network team or the IT team.  Clinical engineering makes the determination as to whether we are experiencing a network issue, an application issue, or a clinical engineering issue.  We route it to the right person, and we get it handled.  That gives clinicians one phone number to call.”

CLICK HERE  to view the original article
in 24×7 Magazine May 2011.

 

Free Webinar – Multiple IV Infusion Safety

Wednesday, May 30, 2012 @ 2:00 pm Eastern

Nine tips on how to safely administer multiple intravenous (IV) medications will be the focus of this free webinar.  Three study authors—two human factors engineers and a nurse—will be offering detailed advice on how to identify and mitigate the risks associated with the administration of multiple IV infusions based on their recent findings.

The recommendations are intended for all inpatient and outpatient care areas where multiple IV infusions are administered to patients.

Administering multiple IV infusions is a complex task and therefore prone to a variety of errors, the study authors found. Such infusions are often delivered with large volume pumps through a combination of primary and secondary “piggyback” infusions on multiple pumps and channels.  Potential errors include physical line set-up errors and mix-ups of infusion lines, bags, and pumps. For the patient, this could mean receiving an incorrect dose, at the wrong time, with harmful consequences.

The recommendations were developed by the Health Technology Safety Research Team at the University Health Network, under a grant from Health Quality Ontario and in collaboration with the Institute for Safe Medicine Practices Canada with support also from the Ontario Ministry of Health and Long-Term Care.

CLICK HERE  for the study details.

Speakers:
- Andrea Cassano-Piché, Human Factors Engineer
University Health Network
- Mark Fan, Human Factors Engineer
University Health Network
- Christine Koczmara, RN, Senior Analyst
Institute for Safe Medication Practices Canada.

CLICK HERE  to register.  This is a FREE webinar.

CLICK HERE  to view the announcement on the AAMI Website.

 

FCC Approves Spectrum Changes

for Sprint and Hospitals

The Commission issued new rules, trying to make spectrum use more efficient.

by Megan Geuss — May 26 2012, 10:45pm EDT

Late this week, the FCC approved some changes to the current allotment of the wireless spectrum, paving the way for Sprint to expand its current 3G network and launch an LTE service.  Possibly more importantly, the government agency also gave hospitals a slice of spectrum that will allow them to monitor patients without complex wiring.

A New Lease On 800MHz

For Sprint, the FCC changed the rules that govern how the 800MHz band of the spectrum is used.  Sprint holds rights to broadcast in those wavelengths, but hasn’t been able to efficiently build out more advanced networks due to rules that require certain spacing in between each channel Sprint uses in the 800MHz range.

Sprint obtained the rights to these wavelengths when it purchased Nextel in 2004, and the company originally used the spectrum to continue Nextel’s iDen network, which allowed for “push-to-talk”, walkie-talkie like service.  But that same year, the FCC started restricting how the telco could use each individual channel on its band, meaning Sprint could keep the iDEN system in place, but was severely restricted in adapting the band for new network technologies.  The FCC meant for these restrictions to prevent interference with licensees like firefighters and police stations that used the 700MHz spectrum for public safety purposes.  The regulator even tried to push Sprint out of the spectrum entirely, but eventually granted the company a temporary stay on that decision.

By 2010 Sprint began the process of shutting down iDEN and requested that the FCC rework its rules for the spectrum, a request the commission only just granted this week.  Sprint plans to build out its CDMA and LTE based networks on the 800MHz waves.

The changes mean that the commission will provide “licensees with the flexibility to add transmitters or modify operations within their licensed market and licensed spectrum as market conditions dictate,” and would have, “full discretion over channelization of available spectrum within the block.”

In exchange, Sprint will have to notify public safety licensees of their reorganizing, so that the licensees can monitor their channels for interference.  But, the FCC noted, “we do not anticipate that permitting EA-based 800 MHz SMR licensees to operate with wider channel bandwidths than currently permitted under Section 90.209 will result in an increase in harmful interference to public safety licensees.”

Hi-Tech Hospital

The FCC also approved a second set of spectrum-use rules, regulating the 2360-2400 MHz band for use in hospitals as a “Medical Body Area Network,” or MBAN.  The MBAN will allow doctors to hook their patients up to the physiological sensors like EEGs, heart monitors or neo-natal sensors and have those lightweight and often disposable sensors transmit information back to the monitoring equipment without wires.  Reducing the number of wires attached to patients will also lowers the risk of accidents and infections, and make patients more comfortable overall.

While MBAN isn’t the first wireless network for medical information (MedRadio and the Wireless Medical Telemetry Service have also been used to transmit patient data wirelessly) having this spectrum set aside for hospitals will further the advance of wireless technologies in medecine.  The band is only approved for short-distance transmissions at the moment, but long-distance in-home monitoring could be on the horizon as well. Last week the FCC attended a press conference with companies like Philips and GE Healthcare, whose leadership said they hoped to reduce hospital costs by making in-home monitoring available, so that more stable patients can get out of the hospital sooner and continue recovery at home (and surely the Philipses and GEs of the world hope to make a pretty penny off marketing devices using the new technology as well).

The rules governing the MBAN spectrum have much in common with the new rules governing Sprint’s spectrum—MBAN actually overlaps with the spectrum allotted to commercial test pilots, but the Aeronautical Mobile Telemetry licensees and MBAN proponents have agreed to “register and coordinate” the use of their networks to avoid interference.  The FCC noted that some amateur radio enthusiasts were concerned that MBAN frequencies could interfere with their existing licenses as well, but the public interest benefits seems to have largely outweighed those concerns.

CLICK HERE  to read the original news article.

10 Ways to Motivate Anyone

Understand the unique brain and personality types of your employees to keep them invested in work.

by Michael Lokner

I am often asked about how I keep employees inspired and productive.  It’s an essential question since companies today must accomplish more, with fewer people.  The most successful start-ups must be lean, nimble, and fierce.

In a nutshell, you should hire bright, energetic, innovative employees.  Then offer them the right incentives–the ones that will impact their personal brain and personality types–to keep them mentally and emotionally invested in doing their best.

It’s impossible to talk about motivation without mentioning Drive, a book by best-selling author Daniel Pink . (His TED lecture was turned into a fabulous video.)  Pink notes that people perform best when they are given autonomy, opportunity for mastery, and the belief that their task is meaningful.  He says money is not the best motivator, and that employees want to be “players, not pawns.”

Pink believes Google’s “20% time,” in which employees may spend one day a week on whatever they want is a shining example of how allowing intrinsically-based motivations (a sense of accomplishment or purpose) can flourish.  Personal endeavors from “20% time” resulted in Gmail, Google News, Orkut, and AdSense. Long before Google–back in 1948–3M instituted the “15% solution” or “dream time,” which yielded both Scotch Tape and Post-It Notes.

There’s no question that intrinsic motivation is essential. However, I do not agree with Pink that all extrinsic motivation (raises, bonuses, commissions, awards, titles, flex time, and other perks) is harmful.  A skillful entrepreneur keeps employees motivated with a combination of both.

That said, there is no cookie-cutter approach to motivating your people. What inspires one person may leave the next cold.  When you understand an employee’s thinking and behavioral preferences, you’ll be able to maximize his or her enthusiasm.  This will help you get your workforce aligned and moving in the same direction, and you’ll see incredible returns.

1. Analytical types want to know that a project is valuable, and that their work makes a difference to its success.  They need a leader who excels in a particular area, and whose expertise they believe benefits the group.  They prefer compensation that is commensurate with their contribution.  If they have done a tremendous amount of work on their own, don’t expect them to be happy if you reward the whole team.

2. People who are “structural” by nature want to know their work aids the company’s progress.  They prefer a leader who is organized, competent, and good with details.  They like to be rewarded in writing, in a timely manner, in a way specific to the task.  An encouraging email is appropriate to communicate with them.

3. Social people want to feel personally valued, and that what they are doing has an impact on a project.  They go the extra mile for a leader who expresses faith in their abilities.  They prefer to be rewarded in person with a gesture that is from the heart.  If your own preference is for written communication, send a handwritten note to a particularly social employee.

4. Innovative employees must buy into a cause.  To them, the big picture matters more than the individual who is leading the charge.  They prefer to be rewarded with something unconventional and imaginative, and would find a whimsical token of your esteem very meaningful.

5. Quiet staffers don’t need a lot of fanfare, but they appreciate private, one-on-one encouragement.

6. Expressive people feel more motivated when assignments are openly discussed and an open door is available.  They like public recognition, with pomp, and ceremony.

7. Peacekeepers hope everyone will move in the same direction. They’ll never demand a reward or recognition, so it’s up to you to offer it.

8. Hard-drivers are independent thinkers.  If they agree with you, they’ll be highly motivated.  They will let you know what they’d like as an extrinsic reward, and they tend to want whatever it is right away.

9. Those who are focused team members must have confidence in the leader and in the project, or their motivation may falter.  They want know up front what kind of reward they can expect.  Make sure you follow through on whatever is promised.

10.Flexible people go along with the team, as long as a project does not contradict their morals or beliefs.  They’re also happy with any kind of recognition.

Watch for the weakest link among your employees.  If you have a slacker who consistently does less than everyone else but seems to get away with it, this can dampen the motivation of everyone else.

CLICK HERE  to read the original post on Pat’s Blog.

Contributed by:
Patrick K. Lynch, CBET, CCE
Support Specialist
Global Medical Imaging, LLC
222 Rampart Street
Charlotte, North Carolina  28203
plynch@gmi3.com
www.GMI3.com/blog
www.gmi3.com

Patrick Lynch is a respected author of many articles for and about the field of Biomedical/Clinical Engineering and Healthcare Technology Management.  These articles have been published in many trade journals, magazines, and on internet websites everywhere.  He is a member, officer, advisor, and contributor to over ten different biomedical societies and healthcare technology management associations all across the country.  He is a member of our OCEA Advisory Committee and was an OCEA Spring Conference Presenter.

 

Portable (and Ultra-Low-Cost) Ventilators

Could Save Lives in Rural Areas and During Disasters

MIT students are developing a very-low-cost portable ventilator that could save hundreds of lives during emergencies and in rural areas, where hospitals often lack high-tech medical technologies.

In the aftermath of Hurricane Katrina, hospitals were overwhelmed and understaffed.  As hallways were flooded with patients, many of whom had life-threatening injuries and illnesses, the lack of proper supplies became apparent.  Especially alarming was the shortage of ventilators, many of which failed when the power went out.  Doctors and nurses were forced to give air by manually pumping machines for hours and days—sometimes resulting in the death of patients.  In an effort to alleviate these fatal situations, students at the Massachusetts Institute of Technology (MIT) are developing a small, portable ventilator that could be distributed cheaply to hospitals and rural areas.

CLICK HERE  to view the original article.

 

Why You Should Care

About the Middle Class Tax Relief and Job Creation Act of 2012

First off, you’ll want a copy for yourself.  Go ahead, I’ll wait.

http://www.gpo.gov/fdsys/pkg/BILLS-112hr3630enr/pdf/BILLS-112hr3630enr.pdf

The other day I was perusing “The Middle Class Tax Relief and Job Creation Act of 2012″ because of a requirement in one section dealing with amateur radio communications. (We use amateur radio in some of our hospital disaster plans.)

While flipping through the pages, the following quote in another section (6403) about the “incentive auction” of the broadcast TV spectrum caught my eye:

(iii) a channel 37 incumbent user, in order to relocate to other suitable spectrum, provided that all such users can be relocated and that the total relocation costs of such users do not exceed $300,000,000. For the purpose of this section, the spectrum made available through relocation of channel 37 incumbent users shall be deemed as spectrum reclaimed through a reverse auction under section 6403(a).

For those who don’t remember, TV channel 37 was designated as half of the radio spectrum available for the Wireless Medical Telemetry Service (WMTS).

For various reasons, I spend a LOT of my time reading federal regulations.  The act is undoubtedly one of the more obfuscated documents I’ve read, but here is what I can tell you:

The act consists of several sections, but Title VI, “Public Safety Communications And Electromagnetic Spectrum Auctions,” is what interests us.  Ostensibly, it’s written to reallocate radio spectrum for the establishment of a national first responder network. It also calls for “incentivizing” broadcast stations to free up spectrum, especially after the analog to digital television conversion a few years ago.  It seems most of that latter spectrum would go for developing broadband wireless, though that isn’t explicitly discussed.  And this is where the TV channel 37 section is located.  Yes, this means that at some point, half of the spectrum for WMTS telemetry is to be auctioned away, apparently so your iPhone will work better.  The act mentions nothing more about where, when, or how “other suitable spectrum” will be found.

According to the Federal Communications Commission (FCC) database, there are no licensed broadcast stations in the U.S., its territories, or possessions operating on TV channel 37 and there never has been.  Until the creation of the WMTS, this channel was reserved exclusively for radio astronomy users.  So, who exactly did members of Congress have in mind when they wrote this bill, which was later signed into law?  It would appear that hospitals are the “incumbent users” described here.  (Of course, one also wonders what will become of the radio astronomy sites.)

When will this happen? That isn’t clear.  The best I can make of it, the FCC was supposed to begin working on this as soon as the bill became law on Feb. 22, 2012 and must be finished with everyone moved by 2022.

What must be done seems much clearer to me.   First, we must speak through our industry groups, including AAMI, ECRI, ASHE, ACCE, directly to the U.S. Food and Drug Administration (FDA), FCC, and our elected representatives who created this bill.  We must demand the government, especially the FCC and the FDA, create an oversight group to provide input into this process.  It was done for the creation of the WMTS and it must be done again.

Rick Hampton
Wireless Manager
Partners Healthcare
rhampton@partners.org

CLICK HERE  to view the original post on the AAMI Blog

The Convergence of CE and IT Creates Opportunities

Are you ready to deal with new, increasingly complex, critical, and converged technologies?  By Jack Scharff

The times they are a changin’. These famous Bob Dylan lyrics are truer than ever today, especially in healthcare and the technologies supported by clinical engineers and biomeds.

Recently, the American College of Clinical Engineering (ACCE) presented a webinar on new IT-related job opportunities for clinical engineers. We spoke with the presenter of that webinar, Stephen L. Grimes, a past president and past board member of ACCE, to learn more about these new opportunities for CEs and biomeds.

TTJ: You recently presented a webinar that discussed new jobs and opportunities for clinical engineers and biomeds. What’s creating the demand for these new jobs?

Grimes: The main driving force for these new opportunities has to do with what’s been taking place in the industry over the past 10-15 years and is continuing to take place at an increasing pace: the convergence between medical and information technologies. As a consequence of this convergence, the CE and IT groups, who previously provided separate support for medical and information technologies, must now collaborate to provide effective integrated support as these technologies merge.

Another driver in creating these new IT-related opportunities for CEs and biomeds has been the industry’s push for electronic health records (EHRs) that achieve “meaningful use.”  Under the federal Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009, eligible healthcare professionals and hospitals can qualify for substantial Medicare and Medicaid incentive payments when they adopt EHRs certified as being capable of achieving meaningful use.  A key element in achieving an effective EHR is the integration of medical technologies.  By integrating medical technologies, the EHR reflects timely and more accurate medical data that can facilitate more rapid and effective diagnoses and treatments.  Demonstrating more rapid and effective diagnoses and treatments through these integrated EHRs is prima facie evidence of the EHR’s achieving meaningful use.

Due to these drivers that are aligning the services of CE and IT professionals, new roles are evolving. These are hybrid roles between the clinical engineering and IT communities and require hybrid qualifications and hybrid skill sets from both groups.

TTJ: Regarding these hybrid skill sets, is it easier for clinical engineers and biomeds to learn IT or is it easier for IT personnel to learn clinical engineering skills?

Grimes: I think the clinical engineers and biomeds are at an advantage in that they have a better understanding as to how the technology is used. They operate not just with the technology but they also understand what’s going on with respect to the patients, the clinicians who use the technology, and the environment in which the technology is used. This understanding is critical to effective support of these new, converged technologies that have IT elements in them. 

So it’s easier, I believe, for people coming from the clinical engineering or biomed background to acquire additional technical skills needed on the IT side to make them effective in these new hybrid roles.

I’m not implying that this is an easy process. There are significant obstacles, not the least of which are the individuals themselves. When considering this type of transition, many are not amenable to change. It is necessary to realize that we can’t continue to do things the same way as we have in the past. The convergence of the technologies requires us to adopt and adapt new paradigms.

TTJ: What qualifications and training do clinical engineers need to become more valuable in this changing environment?

Grimes: One is a basic understanding of the current kinds of technology. How are they being used and in what type of environment? By the way, that environment is changing. We will be moving away from the bricks-and-mortar hospitals to a healthcare environment that’s more community-based — more telemedicine, more in-home delivery.

Radical changes are taking place in terms of how clinicians will deliver care. These are all driven by technology, economics, and the changing needs of the population (more people are in need of chronic care rather than acute care).

We are also dealing with increasingly complex “systems of systems,” just like a pilot on an aircraft, who deals with multiple systems that control the flight environment. When the pilot pushes on the stick, he’s not in direct control of the ailerons or the rudder. There are multiple systems in between that read his intent and make the appropriate adjustments. The same things are occurring in healthcare. There are multiple increasingly complex systems. One consequence is that clinical engineers need to manage this increased complexity in a much different way.

Clinicians have become increasingly dependent on these complex systems. Because they are more complex, there are often more vulnerabilities and failure points than discrete devices.

TTJ: Are there additional certifications or courses that CEs should acquire or take?

Grimes: In addition to understanding basic computer networking, CEs should develop some project management skills and acquire a good understanding of risk management. It’s only through a thorough understanding of risk management that one can identify and focus available resources on any significant vulnerabilities and mitigate those.

Too often today, we spend too much time on providing services that may have been effective 10-20 years ago but are often of questionable value today because of changes in the nature of the technology we’re dealing with.  One good example is much of the testing and preventive maintenance still done today on many categories of clinical equipment. These services typically represent 40 to 50 percent of time expended by most biomed programs.  Instead, we should employ an effective risk management process and identify where the real risks are and apply our resources to address those risks.

Other areas to improve are developing process engineering and systems engineering skills and being more effective at data mining and analysis so we can take a look at the data we collect and determine if there is, in fact, any value to the testing we do. Are there other areas where we can more effectively employ our resources? If we accurately analyze the data, we can also determine which systems need replacement or which are the most reliable.

TTJ: What kinds of new jobs are being created?

Grimes: The new jobs are in three major areas that I focus on.

One is clinical systems engineering, which is a specialty in clinical engineering that looks at systems introduced into the healthcare environment and identifies which systems are most critical. This includes doing risk assessments and working with other stakeholders (clinicians, risk and materials management personnel, IT, manufacturers) to identify where the significant risks are and take steps to mitigate those risks.

This requires an understanding of working with complex “systems of systems.” This also requires that you be fairly astute at failure-mode effects analysis and root-cause analysis and work well with others to be sure the systems are effectively deployed, especially since many are deployed into environments where there are legacy systems and other equipment that must remain.

Another position is a clinical systems support specialist — someone who usually works in a service like the OR, neurology, or labor and delivery — the ones who have hands-on experience dealing with these systems and technologies in their area. A PACS [picture archiving computer systems] administrator is an example of a clinical systems support specialist in imaging. A PACS administrator makes sure that images are captured from the various modalities and stored appropriately for easy retrieval upon request by the clinicians.

The third area is as a radio frequency spectrum manager. This is an individual who manages the radio frequency (RF) spectrum and healthcare environment, knows what’s out there, and ensures there are no conflicts. As a result of a huge influx of RF devices in the healthcare environment (more Wi-Fi, technology and devices that emit radio frequency), conflicts often occur. The role of radio frequency spectrum managers is to ensure that they identify all legitimate radio frequencies in use and take steps to keep out all unwanted radio frequencies.

TTJ: What other changes are happening due to this convergence?

Grimes: We see a shift in the reporting structure. In the past 20-30 years most clinical engineers and biomeds reported to the facilities engineering department. Today, based on some informal surveys, about 30 percent now report to IT; that’s up from about 5 percent five years ago. There is a significant move to consolidate clinical engineering and IT, bringing the two groups together. This makes some people anxious because change is always somewhat scary, and the two groups come from different backgrounds and cultures. Whether CE and IT are consolidated or not, there is no question that they must collaborate. Technology convergence is the reality, and it necessarily follows that collaboration is a necessity. This creates new opportunities for clinical engineers and biomeds.

CLICK HERE  to go to The Trace Journal website and view the original interview posting.

Stephen L. Grimes, FACCE, FHIMSS, FAIMBE is Principal Clinical Engineer of ABM Health: a Boston-area-based healthcare technology consulting, management, and service organization meeting the needs of over 250 clients throughout the U.S. Grimes specializes in technology management, medical and information technology convergence and integration issues, and medical device security and risk management. He is also a recent past president of ACCE and winner of the ACCE-HIMSS Excellence in CE-IT Synergies Award given this year at HIMSS11 in Orlando.

CLICK HERE to go to the ABM Health website.

 

A Look at the Converging Clinical Engineering and IT

These Times Are A-Changin’.  By Dan DeMaria

In this edition of Tech World, Dan DeMaria, manager of clinical engineering at Olathe Medical Center in the suburbs of Kansas City, KS, discusses how his hospital system merged its clinical engineering (CE) and information technology (IT) depart- ments. He shares some of the obstacles and provides insight on how to avoid them.

” The times they are a-changin,” wrote singer-songwriter Bob Dylan more than 40 years ago.  For CE departments, those words are striking a chord today perhaps more so than ever before.

Historically, CE reported to plant operations, environmental services, or even supply chain. Today, this is no longer ideal.  In today’s clinical environ- ment, it makes sense to align CE with information services.  This allows us to more quickly and efficiently use the personnel, resources, and expertise available in these two departments.

As the lines continue to blur between IT infrastructures, clinical data reposito- ries such as patient archiving and com- munications systems (PACS), electronic medical records (EMR), and clinical systems such as patient monitoring, so too must the support structure blur.

Integrating CE and IT seems to be, at first glance, a fairly straightforward process.  Move the assets and reporting structure under the appropriate person, make a few bookkeeping changes, and then, presto–chango, integration.  Unfortunately, this may not be the best course of action.

I lead the CE department for a health system that encompasses two hospitals and 32 outpatient clinics.  We have suc- cessfully integrated the two depart- ments, though it didn’t happen overnight.

There are several key steps to a suc- cessful integration.  The first should be gaining support from the key execu- tives involved.  This can be accom- plished by showing how and why inte- gration is the right step for your organi- zation. Overcoming “How does every- one else do it in our community?” can be a difficult job.  Our response is, “We shouldn’t be like everyone else.  We should lead the way.” Follow this with examples of process improvement such as reduced response time when com- plex interdisciplinary systems are down.

A critical next step is defining man- agement structure.  At our facility, the CE manager reports directly to the chief information officer (CIO).  All of the IT managers, as well as the CE manager, meet weekly with the CIO to share information and report on projects and difficulties that may have arisen during the preceding week.

These informational meetings have had an unexpected result—a deeper understanding of the challenges faced by the different departments.  The CE manager gains an understanding of the problems faced by the network team.  The clinical applications management team gains insight into the challenges of the clinical equipment team.  This begins to erode the inherent “us vs. them” mentality that has crept into the CE/IT relationship in many facilities.  Managers of the respective departments begin to educate their own staff as to the difficulties faced by their peers.

Another step along the path to inte- gration is a unified help desk, which can be challenging.  The traditional IT help desk staff is not prepared for the sheer volume of different types of equipment. Additionally they may not have the clinical background to speak comfortably with clinicians about equipment of which they have no knowledge.

Our solution has been to have those help desk calls that are clearly CE in nature be routed directly to the CE department.  Those that could be CE or IT are also routed to CE for triage and assignment as appropriate.  At no time is the clinician told, “You’ll need to call . .”

One last step toward integration is a hybrid CE/IT role, which could actual- ly be broken down into two different positions or combined based on facility size and needs.  The first hybrid would be a mid-level manager who possesses formal CE and IT training. He or she would function as a project manager, be the liaison between the different departments under the CIO, and would also understand the unique business model and challenges of the respective departments.

The second hybrid role would be a frontline support technician, who would also possess both IT and CE skills and specialize in network and computer-based equipment.  Job descriptions for both of these roles are being refined by the CE-IT Community—the joint collaboration among members of AAMI, the American College of Clinical Engineering (ACCE), and the Healthcare Information Management and Systems Society (HIMSS).

Let’s face it: The CE departments of the past are history.  Or, as Dylan wrote:

The line it is drawn the curse it is cast The slow one now will later be fast

As the present now will later be the past The order is rapidly fadin’

And the first one now will later be last For the times they are a-changin’

 

CLICK HERE  to view this article on the HIMSS website.

 

HTM and BE/CE Appreciation Week In Ohio

A Proclamation:

———————————————————————————————-

The 2012 Healthcare Technology Management and
Biomedical/Clinical Engineering Appreciation Week in Ohio

Whereas, as medical technology advances, healthcare facilities must keep pace by providing quality, well-trained professionals capable of understanding the complexity of medical equipment operation and applications; and

Whereas, the complexity of medical technology today and in the future makes it essential that those individuals responsible for the care, safety, and accuracy of this equipment are recognized as an invaluable resource to the healthcare industry; and

Whereas, biomedical equipment technicians, clinical engineers, and other healthcare technology management professionals uniquely serve patients, the medical community, and new technology development to improve the quality of today’s healthcare; and

Whereas, these professionals research, recommend, install, inspect, and repair medical devices and other complicated medical systems, as well as advise and train others concerning the safe and effective use of medical devices, thereby controlling healthcare costs and improving patient safety; and

Whereas, OCEA, the Ohio Clinical Engineering Association is an alliance of biomedical equipment technicians, clinical engineers, and other healthcare technology management professional members united by a common goal to increase the understanding and beneficial use and management of instrumentation and technology in healthcare, and

Whereas, OCEA, the Ohio Clinical Engineering Association seeks to advance the interests of Ohio’s biomedical equipment technicians, clinical engineers, and other healthcare technology management professionals; so now and

Therefore, OCEA, the Ohio Clinical Engineering Association hereby proclaims the week of May 2Oth thru May 26th 2012, as Healthcare Technology Management and Biomedical/Clinical Engineering Appreciation Week in Ohio.

Declared and Designated By the Executive Committee Of
OCEA, the Ohio Clinical Engineering Association.

CLICK HERE  to view/download the official document.