About twenty years ago, Scot Mackeil installed the first hospitalwide Ethernet-connected patient monitoring network at his 120-bed community hospital. A senior BMET on the install team, Mackeil specified that all cat5 cable and patch cables be a unique color, so IT staff would know not to accidentally disconnect medical devices in the shared data closets. He also added CE numbers and inspection stickers on the monitoring system’s full disclosure servers and racks as they were installed.

The IT manager, however, was not impressed, and reported the matter to the hospital CFO who criticized Mackeil for his actions.

“He insisted ‘computer equipment’ was NOT biomed equipment and I had no right to tag the servers and equipment in the data center,” recalled Mackeil. “I was told to remove the asset numbers and tags and mind my own business, and was also written up for my ‘transgression’.”

The IT staff was also not happy with Mackeil’s idea of putting the full disclosure servers on the biomed PM schedule and that he asked them to keep him in the loop so he could document service and maintenance of monitoring network servers and equipment in the biomed database.

Fast forward to 2019, and Mackeil, now honored by AAMI as 2018 BMET of the Year, works at a 1200-bed academic medical center in Boston as part of an enterprise-integrated HTM team that responds to any type of service call, from monitor failures to a major server outage, all while coordinating needed resources with informatics team members, including application, software, PC, BMDI, network, and server support specialists.

“Today’s BMETs need to be able to mitigate many common IT/PC/integration problems and know how to collaborate with their IT resources to solve more complex problems.” said Mackeil. “Often a BMET with good computer and IT skills can solve a lot of common problems that would otherwise impact patient care. If a caregiver calls in a specific problem with a certain device or system, BMETs need to know how the device that caregiver is reporting or the system they are having issues with is connected because you need to know what, where and how things are connected to help the team solve the issue when the service call involves connected and integrated medical devices and systems.”

Mackeil and his facility are hardly alone in this changing paradigm. As medical technology takes on a greater IT component, biomedical engineers and HTM professionals are combining forces with the IT department to address issues that require both sets of expertise. Developing these collaborations, however, is not simple, and requires communication, prioritization and most importantly, an understanding of one another’s role and needs.

Who’s responsible for this?
Maintaining and repairing medical equipment was largely an HTM job fifteen years ago. Most devices back then were stand-alone with no connection to computers or other systems. Today, a majority are digital-based and transmit data to EHRs, making them both an HTM and IT priority.

“We need to identify and define what are the other jobs, roles, and responsibilities.” said Mike Busdicker, system director of clinical engineering at Intermountain Healthcare in Utah. “Where is there crossover? What do we need to be working together on?”

Asking the right questions is a good start, but figuring out the answers is easier said than done.

“Identifying who has responsibility for what is a challenge, particularly when the HTM systems bleed into the IT realm,” said Busdicker’s colleague, Shawn Anderson, a cybersecurity analyst at Intermountain. “Another challenge is the rapid merging of traditional device systems with what IT would consider IoT. Supporting these kinds of systems takes a different set of skills and different forms of collaboration.”

If a software issue arises within an EKG machine, or it does not display correctly, the responsibility of fixing it falls on a provider’s HTM department. But if the machine stops transferring studies to a network storage platform, is it an issue for the HTM or IT personnel?

The answer, according to Codi Nelson, CBET | HTS Team Leader for Crothall Healthcare, could be either one, depending on whether the issue is considered device-based (an HTM responsibility), or within the larger system where the device is integrated (IT). If the responsible party is not identified, confusion can ensue, leading to delays in essential and lifesaving procedures.

“The more devices look less like medical equipment and more like computers, the more nurses are confused as to who manages these devices,” he said. “Depending on the issue, nurses will have to decipher who they should call.”

The frontline of defense is for HTM and IT to educate nursing staff on the proper party to contact for specific issues, according to Nelson. Both departments require a system of communication in which they can break down what their needs are and establish common ground on who is needed for what separately, and which issues require both their expertise.

For instance, some HTM departments report to the CIO in a process that is somewhat streamlined. Others must use different approaches to ensure two-way communication with IT, like SSM Health in St. Louis, where the HTM department reports up through the COO.

Heidi Horn, vice president of HTM at SSM Health, is a member of the health system’s IT Executive Committee, which ensures HTM is aware of all large IT initiatives and can provide feedback. HTM managers there also sit on special IT teams – such as Change Management, Application Approval and Technical Risk Assessment – strengthening collaboration and awareness between the two groups.

“In recent years, we created a Medical Device Security Analyst position that reports to HTM but meets regularly with the IT Security team,” recalled Horn. “We participate in IT's annual risk assessment and adopt IT's security policies that impact medical devices.”

SSM Health also has a whole team of people responsible for clinical device project planning, device integration and clinical systems management. According to Horn, this team serves as a “bridge” between IT and HTM. The two groups also share the same call center, and their CMMS is on the same ServiceNow instance, which means they can transfer tickets/work orders when needed.

In some hospitals, biomedical engineers and HTMs are divided into various teams and have varying skills, which, according to Busdicker, can increase the challenges of good communication. At the same time, IT processes like change management and risk assessment may seem cumbersome or time-consuming to HTM departments focused on repair and maintaining equipment.

“As technology has advanced over the years and assumed a greater IT component, that’s required us to step outside of that mindset and integrate more with one another, especially when it comes to rising issues like cybersecurity,” he said. “That includes the networking piece, the security piece, ensuring patch management and upgrades, and encryptions. They require us more to work hand-in-hand with one another.”

It’s also important to remember that HTM and IT should be consulted by the greater hospital enterprise concerning purchasing decisions being made by executives and clinicians.

"If IT and HTM professionals aren't at the table when decisions are being made about acquiring new equipment, sometimes the intermediary devices that are needed in order for data to flow between systems are left out of the purchase," said Danielle McGeary, vice president of healthcare technology management at AAMI. "While you can go back and buy them later, this miss delays the installation process and often was not budgeted for.”

It is also common that when new equipment shows up on site, providers want it set up and installed immediately, according to McGeary. This puts HTM and IT in a difficult position since they are faced with telling the provider that their new equipment can't be hooked up immediately because they don't have all the pieces.
Surpassing these challenges requires HTMs, IT and providers to teach one another about their individual work processes and roles, as well as educate staff on how to address different scenarios to avoid hindering patient care.

Good collaboration leads to more capable individual teams
Like anything else, working efficiently on medical equipment requires a strong awareness of who does what – and good manners go a long way.

"Knowing these people personally helps speed up troubleshooting, because when you've established a personal relationship with someone and have engaged them throughout a project, they are more likely to help you faster,” said McGeary. “You're not at the bottom of their to-do list."

Being courteous and showing gratitude for taking up someone’s time after working with them is an easy way to do this. McGeary also recommends asking for a seat at routine meetings, if only as an opportunity to get a better idea of how the partnering department operates and who is in charge of what.

“In some organizations, HTMs report to the chief information officers. Collaborations like this tend to be a more natural occurrence due to having a single directive for both parties," said Nelson. "In others, HTMs can report to a variety of positions, including facilities and maintenance directors, vice presidents, or chief executive officers. In these situations, those heading the project may not have a strong technical background, and we can do our best to help them understand how we can achieve the best possible outcome by coordinating our activities.”

While the main objective is to provide safe, fast and quality care for patients, another is to teach the ins and outs of each department and the skills each team brings to the table, so that IT and HTM personnel can distinguish problems they can handle alone from ones that require both of them. In addition, exposure to one another enables the exchange of knowledge and skills that could prove handy when working together or alone.

“By keeping up with technology advancements, we can lean on and utilize the knowledge from the IT side to help advance our level of expertise amongst our staff,” said Busdicker. “It goes in the opposite direction too, there’s some information on the clinical side of the equipment HTM can provide to IT personnel, who may not have this knowledge when they come into the healthcare field.”