Medical equipment and health IT are becoming increasingly intertwined in modern hospitals. For health care technology management professionals, this trend has led to some drastic changes to the work they do — and keeping up with the changes is crucial to remaining valuable to the facilities they serve.

Workloads have increased. Understanding network architecture is now important. Even attending webinars has become a prominent activity. To gain insight into the evolving world of clinical engineering, HealthCare Business News interviewed various professionals in health care technology management, including:

• Gary Barkov, clinical engineering multisite manager at Advocate Health Care and vice president of the Clinical Engineering Association of Illinois.
• Raju Bharaj, clinical engineer at Good Shepherd Hospital in Barrington, Illinois.
• Izabella Gieras, clinical technology director at Huntington Memorial Hospital in Pasadena, California.
• Stuart Grogan, radiology equipment manager at Medical Center Boulevard in Winston-Salem, North Carolina.
• Patrick Harning, division vice president of clinical engineering at Catholic Health Initiatives in Erlanger, Kentucky.
• Heidi Horn, vice president of clinical engineering service at SSM Health in St. Louis.
• Joseph Kaminski, director of imaging services at Geisinger Clinical Engineering in Danville, Pennsylvania.
• Russ Magoon, imaging service engineer at Legacy Health in Portland, Oregon.
• Rob Maliff, director, applied solutions group at ECRI Institute in Plymouth Meeting, Pennsylvania.
• Courtney Nanney, national quality manager, clinical engineering, physical asset services at Catholic Health Initiatives in Louisville, Kentucky.
• Curt Rodriguez, clinical engineering and device integration at Cedars-Sinai Medical Center in Los Angeles.

HCB News: How have your day-today activities changed because of EMRs and EHRs?
Stuart Grogan: My team takes care of the imaging equipment from purchase through installation, and maintenance of it. The main way it’s changed is we have more rules and regulations around making sure the equipment doesn’t contain any EMRs before it leaves the facility. If it’s a retired device or a demo, we are very conscious about medical records getting out without our authorization. We have also become more aware of the potential for imaging systems to be “hacked." We are currently putting measures in place to prevent this.

Heidi Horn:As far as day-to-day, I would say the biggest impact is when data does not appear to be flowing from the medical device into the EMR. The first thing people think is that it’s a medical device problem, so they call us all the time, when most of the time, quite frankly, it’s an issue with the middleware, or the EMR itself. We find ourselves having to disprove to IT that there’s an issue on their side.

Rob Maliff: A lot more medical devices are becoming more integrated into EMRs, so biomedical engineers have to collaborate more with the IT staff members. There are things that the clinicians have to figure out. For example, if an anesthesia data management system isn’t working, we have to figure out what the problem is. Is it a network issue or device issue? We have seen a lot of centralization of call centers or work order systems, so it is a “one-stop-shop." If there’s any problem with system performance, the clinician enters one number into their online system and then it is parceled out to the IT department or HTM department.

Curt Rodriguez:With the higher demand for device integration, and with the incorporation of newer medical device technology, the support models have changed quite drastically in some cases. We’ve had to develop and implement support models, workflows and process improvement strategies to meet the level of service the new technology might require.

For my team, this means looking at the technology and becoming familiar with its interoperability with the EMR. What if the device goes down? What is the impact on patient care and data flow to the EMR? Do we have contingencies and redundancies built into our program? We have to determine what the risks are and figure out how to minimize those risks while increasing efficiencies and throughput. We also take a much broader look at training, and information resources based on the scope of incorporated services we provide. We also evaluate our competencies within our on-call first responder programs on a continuing basis.

HCB News: How do you stay current with the newest technology in medical equipment and maintenance?
Raju Bharaj:There are many possible choices to choose from with staying current on the newest technology. I read medical technology journals and conduct research if my department’s input is needed when purchasing new equipment. Once a month, my department has a one-on-one discussion on what is needed, and we also get weekly calls from the imaging department, which keeps us abreast of changes. I also work with engineers from OEMs and do training with them.

Izabella Gieras: I try to attend professional conferences and different webinars that provide tons of information. Many professional journals have relevant topics to what is going on in the industry. We also have local organizations such as the California Medical Instrumentation Association (CMIA), which provides not just meetings for the members, but also educational sessions. These local organizations can provide much valuable exposure to the HTM staff as well.

Patrick Harning:We make sure every time we buy capital equipment, we get training for our people. When we go out to buy a piece of equipment, we negotiate with the vendors to make sure training is included in the purchase. We should negotiate not only clinical training (end-user), but also technical training for our folks in the department.

Curt Rodriguez:By networking, attending and speaking at events such as the Healthcare Information and Management Systems Society (HIMSS), Association for the Advancement of Medical Instrumentation (AAMI), CMI and MD Expo, to name a few, and, of course, training. We also participate in clinical trials for new medical equipment. As new medical equipment technology is being considered we are typically involved with providing the options available for the technology, quotes, capital purchasing, implementation and support.

We offer input regarding interoperability, device integration, serviceability and the various options medical equipment-wise. We are directly responsible for the care and service documentation of medical equipment
in the hospital, whether it is through OEM contracts or in-house support.

HCB News: What values do you think are most important for an HTM professional?
Gary Barkov:Having a holistic focus on safety is vital. Not just with the work that we do, but we also need to have an awareness of the environment that the equipment operates in. I think biomeds need to have the same values as health care workers, which includes a calling to serve the well-being of people and to promote healing. You also have to be very inquisitive, enjoy problem-solving, have a questioning attitude and have confidence in your mechanical and/or electronic skills.

Izabella Gieras:The ever-evolving technology and exposure to it brings a great number of opportunities, including medical device integration. I also enjoy the world of human factors engineering, which is a great asset when you evaluate new equipment and look at its design and any anticipated medical errors when in use. The other big thing is the people that you work with. Whether it is the people that you work with in the hospital, or professionals you may meet outside. Having the ability to interact with them and network with them makes you realize how much you can learn from your colleagues.

Heidi Horn:I would say a good work ethic, more than anything. We are investing in our training and our people, but you can’t train a good attitude. What we found is that if we hire a person for their attitude and willingness to learn, we can succeed. If you hire a highly skilled person, and yet they don’t have a passion for what they’re doing and view it just as a paycheck and cut corners, then you are going to pay for it in the long run.

If someone truly understands that what they are doing does have a direct link to patient care and that they are truly impacting the care we give our patients, that will drive them to take pride in the quality of their work and be engaged in developing their skills. After you hire for attitude, then you can develop the other required skills necessary to be a good biomed: mechanical; electrical; IT; project management; troubleshooting; and customer service skills.

Joseph Kaminski:No. 1 is being objective. You always have to make sure, when you deliver service, that you put the patient first, and you are supporting the people who do the delivery of that patient’s care. By being objective, you should not be vendor-specific. You are outsourcing, trying to buy the best-in-class solutions for the organization you are working for.

Russ Magoon:I think biomeds need to be willing to speak up when they don’t understand a piece of equipment and get input from other technicians. There is too much equipment for one person to be an expert on everything. Put the ego aside and get assistance when needed. It’s a team effort to support the users to help the patients. I don’t believe there is one value that is most important, but you have to know that your work impacts people’s health. Be a team player.

Courtney Nanney:Patient safety is extremely important for biomeds. But there also has to be the willingness to continuously learn and share your knowledge. By sharing our mistakes and close calls, we can prevent patient injuries. A biomed should have good communication skills and work well as part of a team. We have to be able to speak two languages (medical and technical). I joke that when you are with technical people, you talk medical. When you are with medical people, you talk technical. Folks will think you are smart. In reality, you never know enough technology or medicine.

HCB News: What can you offer as an HTM that third parties or OEMs cannot?
Gary Barkov: We offer “heart,” commitment and financial returns. I do believe that everyone, whether OEM, in-house or third party, has a safety focus in mind. This is vital. But I feel an in-house person will definitely take that to heart the most. Also, one’s loyalties will always be to the person signing their paycheck. While we are definitely motivated to do what is safe and what is right for the organization, the added benefit is that any savings an in-house department makes goes right back to the hospital they’re working for. Because of that, there’s no conflict of interest in terms of trying to make profit targets versus giving the best value to the customer.

Raju Bharaj: Since HTMs are on-site, the response time is much less. An HTM provides accurate reporting of relevant technical information in first look, compared to third parties or OEMs. And the first look helps in diagnosing problems and drastically cutting down the time spent by these vendors. It also reduces overall costs by cutting OEM time. An OEM/ISO can be placed in a hospital environment, but they are limited to the products they handle. We have more insight in the day-to-day, and participate and negotiate in capital and service of all equipment. We have more visibility and we handle multiple product lines.

Patrick Harning:Since we are CHI employees, we are invested in the organization and its success, and not in the market to make a profit. When we analyze the situation and present a solution, we are not looking to make a buck. We are looking to save the organization as much time and money as possible and make the right decision for the patients we serve. Third parties and OEMs are looking to make a profit. I can give an honest and straight answer and still sleep well at night.

Rob Maliff: An in-house HTM knows a lot more about the culture of the hospital and practices how to find the right person to get things done. They are also on site, so their immediacy for response is much better. Not to say that ISOs don’t bring value to a hospital, but an in-house HTM is oftentimes seen as employees and partners. But sometimes contractors can be seen as part of the problem. They’re blamed for being unable to fix a device if they cannot fix it within two hours. Another contributing factor is the capital planning process, since it can be a contributing factor to having an aged inventory, which is costly and difficult to service.

Curt Rodriguez:We get training directly from manufacturers for our medical device technology, and then provide those services to our customers. By doing so, we get a much faster response time, accurate documentation and gain expertise. Where an OEM might take several hours, or even days, to respond, we have trained staff that can respond within minutes.

Also, as we become more and more familiar with the technology that we are managing, it makes more sense to have an in-house organization, so that we are self-reliant upon our own resources and staff, that we are the experts and resources for information. We are always looking at ways to reduce outsourced spending and reliance on service agreements. By incorporating a highly trained in-house clinical engineering program, we can either reduce a contract to a lower level of service or parts only, or choose to not carry a contract at all.

As an HTM, I am driven and impassioned to find ways to improve upon our program, how to add value and efficiencies to our service models and, of course, building the relationships within my facility, which does not carry any agenda other than the same mission we all have, improved patient experience.