Last year, we published our inaugural biomed viewpoints, which was mainly focused around the industry name change from “biomed” to “healthcare technology management (HTM).” We also talked about some challenges facing the biomed, or HTM,\ sector. While the name healthcare technology management hasn’t quite caught on outside the immediate confines of the biomed sector, other challenges facing the biomed field continue to be far-reaching, impacting every facet of health care. This year, we revisited with some of last year’s contributors and added some new names to the roster to talk about those challenges. The big topics of discussion include the changing role of biomeds, the impact and concerns surrounding the Centers for Medicaid and Medicare Services guidelines for preventative maintenance, and the post-Affordable Care Act world of health care and how it will shape the future of the biomedical field.

HCBN: The U.S. Bureau of Labor Statistics anticipates a 30 percent growth rate in health technology management, or nearly 13,000 more jobs in the field between 2012 and 2022. Clinical engineering is under that umbrella — have you noticed any change in the level of demand for clinical engineering that would justify that prediction? What do you think the future will look like for health technology management?

Patrick Lynch, president of Healthcare Technology Management Association of South Carolina: Clinical engineering is in less demand than ever before. Hospitals are jettisoning clinical engineers in favor of BMETs who can fix equipment. Unfortunately, many hospitals are dumbing-down the HTM department into a fix-it department. This is because of intense cost pressures. They feel that money can be saved by performing repairs in-house, but engineering better systems design is not seen as an immediate need.

Greg Mika, clinical engineering manager at Martha Jefferson Hospital; president of the Virginia Biomedical Association: We haven’t seen enough here to justify new positions to be added yet, but we’re certainly seeing activity in new areas where we haven’t before — integration of medical devices, EHR, connecting devices, things that require more expertise. We’re still doing safety checks and PM and certification, but more things are being tied into the EHR. Even sterilizers — they’re all networked and tied into a system.

Steve Vanderzee, manager for clinical engineering technology at Advocate Health Care: As health programs continue to consolidate, clinical engineering will continue to consolidate as well. So if a hospital with an outsource merges with an in-house, it can go either way. Depending on the structure of the program, there can be some redundancy, so there’d be an opportunity to consolidate, and that could lead to a reduction of positions. I don’t think that’s the case on the technical side (the actual physical repairs), but could be on the support side (management, clerical).

Heidi E. Horn, vice president of SSM Health Care’s Clinical Engineering Service department: I have not noticed a demand for more BMETS/clinical engineers, but I suspect that is due to the fact that capital budgets are indeed tightening at hospitals across the country, and hospitals are therefore not buying more clinical devices to warrant increasing their HTM staff. I have noticed a demand for the existing HTM staff to do more than they ever had to in the past. Because hospitals are becoming more and more dependent on clinical technology, and that technology is becoming more sophisticated. A typical clinical department leader does not have the expertise to sort through what the facility needs versus what the salesperson is trying to sell them and how that system will interface with the network, other hardware and software. In addition, when a hospital wants to interface a clinical device, IT can’t do it alone — HTM now needs to be involved.

Ron Padgett, director of Radiology Engineering, Radiology Services at Carolinas HealthCare System: I believe we will see a very slow growth, mostly due to higher expected efficiencies from all staff; and even though there is a demand for more in-house services, for every job in-house, someone in the outside sector generally loses.

Scott Bosch, manager of Biomedical Engineering for Park Nicollet Health Services: There’s a change in demand that has been apparent to everyone for some time now — the shift from bench tech to equipment specialist. We are asked directly and indirectly to fill roles in selection, acquisition, clinical operation support, interoperability and disposition of medical equipment along with the old roles of maintenance and safety. The desire for a competent clinical engineering/ HTM team will grow at a rate consistent with emerging technologies and the features of medical devices and systems.

HCBN: With budget tightening the continued norm, what steps are clinical engineers, or HTM taking to prove their value and maintain or increase budgets for their departments?

Rus Magoon, president of the Oregon Biomedical Association and Imaging Service Technicians with Legacy Health: One thing that I think most hospitals do is that they train their people because they need specialty service schools for a lot of equipment. It makes fiscal sense — the cost of having service contracts incredibly outweighs the cost of the service school — you might pay $15k for service school but $150k on a service contract that the training can alleviate.

Greg Mika: The biggest thing we’re doing here to maintain our budgets is making it clear as to what we do and why we do it. We are reporting to committees that report to the top and we send monthly PM reports to show that we’re critical. We haven’t done things to increase our budget, but we’re doing everything we can to maintain what we do. We’re part of patient care and decreasing our budget would have an adverse affect in the long run.

In the last year or so, we’ve started a safety huddle at our hospital, where people from different areas of the hospital and all the nursing areas report to discuss — we do 15 minutes every morning. It heightens awareness, and reinforces safety practices. It’s not only important because we have input, but it also puts us in front of the team and lets us communicate and reinforces our position and value.

Heidi Horn: I am finding that being able to justify my staffing levels and department’s expenses is more important than ever. I’ve always benchmarked my staffing and expenses, but now those justifications are being reviewed very closely at all levels of the organization. There is a lot of pressure not only to hold the line on expenses, but also to decrease it. In addition, we’re being asked to do more with the same staff. Ten years ago, we maintained clinical equipment. That’s pretty much all we did. Today, we are taking the lead role in almost all clinical device purchase reviews and contract negotiations. We’re negotiating service and parts agreements with vendors. We’re the project managers on all clinical device installations systemwide. We work closely with IT on a daily basis to interface devices with the network, and other hardware and software. We’re also much more involved in clinical device safety issues — everything from identifying emerging safety trends to facilitating system-wide teams to correct them. We’re also spending a lot more time consulting with department and system leadership on health care technology issues.

Steve Vanderzee: What I see in Advocate HealthCare is that we’re being asked to extend the life of the equipment, so we’re not replacing as quickly as we have in the past, so that’s obviously adding value by extending the life of the equipment and saving some capital dollars that can be used in other places. At the same time, we’re being asked to look for opportunities to reduce our overall budgets. So we’ve been looking for the past couple years at our service contracts and seeing if there are opportunities for us to take the service in-house, or roll the dice sort-to-speak and go without a contract. Sometimes, time/materials/service is a better risk than staying on contract. But in addition to the volatility we have in the budget and the customer service and software updates, all those types of things are generally part of a contract, not as a time/material/service situation. Justifying up to eight to 15 percent of acquisition value is typical versus three to five percent cost we’ve even seen as low as two percent on the time/material/services.

HCBN: Have the actions and initiatives undertaken by CMS in recent years regarding maintenance rules and requirements changed your workload and responsibilities? Do you anticipate a change and if so, in what ways will it change?

Frederick McMurtrie, clinical biomedical engineering supervisor for Broward Health Medical Center; immediate past president of the Florida Biomedical Society: Yes, from my standpoint, I have seen a direct impact on my job here at Broward Health. The CMS Directive that was issued in December of 2011 is filtering down to the State inspectors and they have to start to ask more direct questions. In some case, as with us at Broward Health, they rejected the risk-based assessments that we had used successfully for years.

Of course, after the industry pushed back, CMS changed its position to accepting risk-base under certain condition and has laid those exceptions out in a letter sent out December of 2013. However, it will take years for the damage to be undone since a lot of departments, if they have been cited previously, will be reluctant to be burned twice. This is a shame because the monies redirected to pay for unnecessary inspections are taking dollars away for more meaningful use in the patient care areas or for more imposing problems like alarm management for example.

Patrick Lynch: CMS is struggling to understand what we do. By not being professional maintenance people, they do not understand how we constantly tweak our procedures and frequencies based upon the evidence we find in our facilities. If they are not careful, they will add a lot of cost to health care without adding any commensurate benefits. Their mandates to follow manufacturer procedures without mandating the providing of those procedures to hospitals reflects the political nature of their actions, bowing to the super-large medical imaging manufacturers.

Rus Magoon: It hasn’t greatly changed my workload, but it has changed the workload of some of the technicians in my hospital slightly. I don’t know if we ever want to completely follow manufacturer guidelines because some of the documentation, we can’t even lay our hands on. For imaging and radiology, we do follow the manufacturer’s guidelines, but a full-on PM — some of them require the system to be down for two days to follow the guidelines they call for — no radiology manager will let their system be down for that long.

Steve Vanderzee: For the most part, imaging and lasers never really had alternative maintenance. There may have been some minor things that we deviated from in the past, but it’s only about 20 percent of our equipment. The recent changes, before there was no clarity. We were in a holding pattern, so it wasn’t affecting us because we were waiting for further direction, waiting to see CMS’ response to the information AAMI submitted. But we also found that we were doing more than what we needed to be doing. We don’t anticipate the new guidance will have a significant impact on us. We’ll have to get better on the imaging side to make sure we’re following the recommendations, but I don’t believe it’ll be any significant hardship.

The one section that troubles me is that it could restrict hospitals that want to go with alternative service — we’re unsure whether we can use the system’s source of evidence-based service. So are we only able to use only our own personal evidence-base or can we use information provided by other sources — ECRI or another similar-sized organization for instance. If I go to another organization with 5,000 infusion pumps from Alaris, can I go to another system with that number and use that knowledge?

HCBN: Do you believe that CMS’ changes, if enacted to the extent they’ve desired, would cost hospitals more or less or will they not have an impact on the bottom line?

Horace Hunter, executive director of the Georgia Biomedical Instrumentation Society: Hospitals that have not been using good technical management strategies will be impacted the worst. The biggest impact will be a demand to have OEMs to service the equipment in a contract.



Scott Bosch: Considering the resistance of the HTM community to CMS’ changes, it’s evident that it will affect everyone’s bottom line (by costing more) to some degree. The facilities that are familiar with change and can absorb more tasks will be less affected.

Ron Padgett: CMS is nothing but a large political government machine and changes are and will be expensive to hospitals.

HCBN: Are there any skills that health technology management as a group will need to improve — be it managerial or technical — to thrive in the developing health care environment?

Greg Mika: The biggest thing that I see for technicians and probably management is more and more understanding of computer networking and wireless and all that technology connection. We need to understand a lot of the terminology going on to work with IT to make it work. It’s hard to communicate with them if you don’t know the terminology. Having that knowledge is almost a 100 percent requirement in my opinion. So taking networking and network security classes will be beneficial.

Heidi Horn: From a technical standpoint, IT skills are no longer “nice to have skills.” They are a necessity. Most clinical devices already have some programming component, and in a few years, almost every clinical device will be interfaced in some way to the network, wireless network, other hardware, clinical software or an electronic medical record. It’s hard to train HTM technicians on information technology. It’s almost impossible to train an IT person on how to be a BMET/clinical engineer. I now have at least one clinical engineer who is an IT “expert” at every one of our hospitals. It’s a source of constant amusement to me to see the look on some IT staff person’s face when they realize a clinical engineer knows as much about their IT equipment as they do. All amusement aside, though, it helps tremendously on projects when my team can talk IT with the IT people and both sides understand the IT security, infrastructure, support and cost implications of a project.

On the business skills side, HTM professionals — especially those in management — must be able to manage their costs and budgets. It’s also a necessity to have project management skills to manage large projects that involve multiple departments and functions, and take weeks, months or years to complete. Due to the fact that we are now being sought out for our medical device expertise at the highest levels of the organization and are now being invited to high-level meetings, HTM professionals are now interacting more with hospital and system administration. Throw away the pocket protector, short sleeved dress shirts and corduroy pants you’ve had for 20 years. Cut off the pony tail. If you want to be treated as the professional you are, you need to look and act the part. That also includes being able to communicate effectively verbally and in writing to all levels of the organization. In my HTM organization, five years ago, we only had two managers with bachelor’s degrees. Many have gone back to college, and soon, half our directors/managers will have master’s degrees. Likewise, many of the technicians have gone back to get bachelor’s degrees, because they want to improve these soft skills. I wouldn’t directly correlate the two, but it’s worth noting that all of my HTM departments have gone from being packed into the darkest part of the basement at every hospital to all having large, professional-looking departments.

Horace Hunter: Biomed is an ever-changing field and new skills and improvements are always demanded. Biomeds need to get more involved with C-Suite, biomed societies, computer and network technology and more. Biomed needs to develop a close relationship with IT health professionals to work together.

Rus Magoon: I think that IT skills surrounding networking are the key to moving forward. At some point I see clinical engineering being part of IT in more and more hospitals. There’s always going to be some relationship because there’s a lot that IT can learn from clinical engineering as far as responsiveness, urgency of calls — I think the model tends to be, “we received this we’ll get to this,” whereas IT normally has a request protocol and the response isn’t as fast. I think that clinical engineering can learn from IT as well — on the technology side of things, there’s a lot to learn. Some of the IT people are absolutely brilliant when it comes to software and hardware issue and there’s a lot that we can learn from them. Some type of cross-training in servicing would be would be really beneficial.

I think whether or not they’re titled that way — there are already IT/clinical engineering people. I foresee that being in job hiring descriptions in the future. “This person needs to have biomedical training as well as IT networking and software/hardware skills.” I think the U.S. biomedical market is already moving into that direction as far as the training goes.

Frederick McMurtrie: Sure, like any technology-based profession continuing education is a given, but if I had to offer specifics as a Biomedical technician, it would have to be networking and understanding both the firmware as well as the infrastructure of WAN and LAN on my short list. Also, I would push more management training since as technology increases in complexity and integration there is less to repair and more need to manage outcomes. In addition, the management training will provide the skills to generate meaningful reports, benchmarks and dashboards.

Patrick Lynch: Today, more than ever, we spend over 50 percent of our time fixing the customer instead of the equipment. And are we ever taught how to provide excellent service to our customers? No. We still have about half of the biomeds in the country that will not look you in the eye when talking to you, offer a limp-wristed handshake, and mumble their name when forced to introduce themselves. We need a lot more personal skills. This is reflected by every hiring manager I have spoken to in the last 10 years — personal skills over technical skills. We can teach the technical skills. It is tough to turn a painfully shy person into an extrovert.

Scott Bosch: HTM professionals must have a working knowledge of the technical functions of every division of IT — database admins, application owners, network engineers, enterprise solutions admins, interoperability/EMR engineers, PACS admins, IT security, BI/BA analysts.... the complete function of many medical systems depends on the work done in these roles. Managerially, I work in five areas (medical device inventory management, operational leadership, standards and policy admin, project management and contract management); there may be more roles in your hospital depending on your org chart and who leads your team, but you should be involved in each of those areas as an HTM professional.