Creative Problem Solving and the Future of HTM

Published on May 9, 2016

This article will appear with 24×7’s June 2016 anniversary coverage.

 It’s been more than 30 years since my first exposure to clinical engineering. Many things have changed, but some key principles have stayed the same.

I became the director of Environmental Services at a 160-bed Level 3 trauma hospital in central Minnesota in 1985. Given my construction background, this healthcare environment was brand-new to me, including managing Clinical Engineering. Fortunately, I met Jon Hilleren, CBET, who immediately impressed and relieved me.

I was impressed because not only were Jon’s technical skills sound, but he was a visionary for the time. Shortly after I started, he shared an idea to begin reaching out and supporting smaller hospitals that did not have skilled clinical engineers to perform scheduled preventive maintenance (PM) or repairs. Together, we grew the program to include a clinical engineer who would travel on a circuit in a van to help these smaller organizations. I was relieved when Jon assured me I would never have to be concerned about the medical equipment missing a scheduled PM, and that all our medical equipment would be reliable and safe for patient care.

What Jon had was the ability to be a creative thinker and problem solver—the two key attributes of a great healthcare technology management (HTM) professional. Despite all the changes to clinical engineering and healthcare technology, time and again these two traits make the difference.

Take my next significant encounter with healthcare technology. I worked with the American Society for Healthcare Engineering (ASHE) as the director of codes and compliance in the late 1990s. This was just as digital high-definition (HD) broadcasting was being rolled out. I recall one Saturday afternoon when a telemetry unit was knocked offline. When the clinical engineer arrived to troubleshoot, he first rebooted the equipment, which immediately started up. The next day the telemetry unit went down a second time. Only, when the clinical engineer arrived and attempted to reset the system, it did not respond although the equipment was fine.

Thinking outside the box, he recalled that a TV manufacturer was planning an HD demonstration across the street at a local mall. A bit of investigating revealed that the TV was broadcasting on the same frequency as the hospital’s telemetry unit, causing the telemetry to fail. (This discovery later led to an agreement with the Federal Communications Commission to protect hospital-based telemetry, managed by ASHE.)

There was also the instance a few years back when endoscopes were first being identified as contributing to healthcare-associated infections. I reached out to the HTM community, asking it to begin adding scopes to its equipment inventory. My intent was not so much to track endoscopes, but rather to motivate the HTM community to get involved by going to the endoscope processing room and reviewing the sterilization procedures. The skills HTM brought to these rooms made a real impact on these processes.

Creative thinking and problem solving were integral to these examples. Fortunately, those same character traits are evident today wherever I speak or meet with HTM professionals—and they need to be now more than ever.

Moving from the bench to patient care delivery, today’s clinical engineer must develop the relationship between IT and patient care. Our industry is about more than just performing scheduled maintenance and repairs on an IV pump. Now more than ever, it requires systems thinking to understand how an IV device is part of a medication-delivery system that needs to correctly identify the patient, communicate with the pharmacy to verify that the drug is appropriate and won’t interact with other medications, is prescribed at the right dose, and will be delivered at the correct dose rate. This requires HTM to understand all the systems involved behind the scenes, train and develop the users, ensure the equipment can be supported by the organization’s intranet, and provide council to leadership as new equipment and technologies are
being considered

This same initiative must be evident when new equipment is brought into the organization. Often it is not the IT department that will be troubleshooting the installation, but the HTM team. IT may be able to program and prepare the network, but ensuring that the system’s clinical requirements are met often falls to HTM, especially when it comes time to verify that a system actually delivers the intended outcomes. HTM must be able to work with IT to ensure that the network can support the medical equipment, and that the medical equipment is readily available and reliable.

Over the past 30 years, including since my return to The Joint Commission in 2005, I have become convinced that the resources available from the Association for the Advancement of Medical Instrumentation, the American College of Clinical Engineering, and 24×7 continue to strengthen the HTM industry. Certification opportunities confirm the skills and dedication of its members to the field. New higher education programs are available, equipping the next generation of technicians with the skills to continue to protect patients.

Today’s HTM professionals must be competent, creative problem solvers. They must be an established resource to all clinical users of medical equipment. They must be a stable, reliable team that manages today’s healthcare technology—just as they were when I first encountered them more than three decades ago.

George Mills, MBA, FASHE, CEM, CHFM, CHSP, is director, Department of Engineering, The Joint Commission.

Source: 24×7 Magazine

Top 6 FAQs when Choosing Healthcare Power Products

Selecting compliant power products is an essential but often confusing part of a healthcare manager’s job. If you purchase power strips, surge protectors, isolation transformers or uninterruptible power supplies for your facility, the following questions and answers will help you make an informed choice.

Top 6 FAQs

1. How does location affect my choice of power products?
Where you install your power products can determine the type of product you need to purchase. From a regulatory standpoint, there are two distinct areas within healthcare facilities: inside the patient-care room and outside the patient-care room. If a power product is installed inside a patient-care room, it must be “medical-grade” and UL 60601-1 compliant.

2. How is a “patient-care room” defined?
A patient-care room is “any area within a healthcare facility where patients are intended to be examined or treated.” Patient-care rooms include both general- and critical-care areas:

  • General-Care Areas—patient bedrooms, examining rooms, treatment rooms, clinics and similar areas where patients come in contact with “ordinary devices” such as nurse call systems, electrical beds, examining lamps, telephone or entertainment devices and electro-medical equipment.
  • Critical-Care Areas—special care units such as intensive care units, delivery rooms, operating rooms, coronary care units, angiography labs and other areas where patients will be subjected to invasive procedures and connected to on-line electro-medical devices.

3. How is “patient care vicinity” defined?
Patient care vicinity is “a space within a location intended for the examination and treatment of patients (i.e., patient care room) extending 6 ft. beyond the normal location of the bed, chair, table, treadmill, or other device that supports the patient during examination and treatment and extends vertically 7 ft. 6 in. above the floor.”

4. What is the difference between “medical-grade” and “hospital-grade”?
These terms are often used synonymously. “Medical-Grade” power products are UL 60601-1 compliant and designed for use inside the patient care vicinity. They are not to be confused with power products that feature a “Hospital-Grade” plug and/or receptacles.

Many healthcare facilities unknowingly install non-compliant power strips, surge protectors and backup power supplies in patient-care rooms, believing that all models with hospital-grade plugs and receptacles are UL 60601-1 compliant. They are not. The use of non-compliant products can be dangerous and should be immediately replaced by fully-compliant models.

5. What is the difference between “UL-Listed” and “UL-Recognized”?
Two power strips can meet the requirements of the same UL standard (60601-1, for example) but receive two different UL ratings: either “listed” or “recognized.” The difference is simple: UL “lists” a stand-alone product, but “recognizes” a product that is a component of a larger system. In healthcare applications, power strips that stand alone and are not designed as components of a larger system are UL-listed.

6. What standards apply to mobile applications?
Some diagnosis, treatment, or monitoring equipment can be moved in and out of the patient-care vicinity and is therefore subject to the UL 60601-1 standard. Specialty purpose power strips and backup power supplies are available as components of larger medical systems. These products are UL-recognized for 60601-1 and 1363a standards and can be used both inside and outside of patient-care rooms.

  • UL 60601-1: patient shock-prevention measure required for all devices that potentially come in contact with patients and staff.
  • UL 1363a: standard for power strips that are integrated as components of a larger system, where they supply power to equipment in movable assembly that is rack, table or pedestal-mounted.


Managed facility contracts in the NHS – Trends and benefits

Given the current financial climate, many NHS Trust are looking at their facilities, assets and services with increasing concern at how they will keep their service quality with current levels of funding available. All NHS Trusts are focussed on delivering improved healthcare services whilst also looking at ways of reducing costs and improving productivity. Senior executive are seeking new ways to update facilities, assets, and services to enhance their patient services whilst minimising their costs; maximising the value delivered through their facilities, assets and services.

The worldwide facilities management outsourcing market will be $1.314 trillion in 2018. (Glenn Hodge, 2014)  Managed services (including the provision of capital equipment) form part of this growth and is estimated to grow from $107.17 billion in 2014 to $193.34 billion by 2019, at a Compound Annual Growth Rate of 12.5%. North America is expected to be the largest managed services market in terms of revenues generated, but Asia-Pacific is expected to emerge as a high-growth market. (MarketsandMarkets, 2016)

Growth is evident across all outsourcing markets, from North America and Europe to Latin America and Asia Pacific. The market is not just expanding, however; it is evolving, with growing public- and private-sector demand for managed facility solutions that are both global and integrated.  Along with this evolving market, customer expectations are broadening to include more value-added services; customers increasingly expect service providers to assume responsibility (i.e., accept risk transfer) for regulatory and labour law compliance, for example, and to take an active role in advancing the healthcare organisations strategic mission (Alexander Redlein, 2014). To this end, current service providers have to evolve from being service providers to becoming strategic partners.

Moving from traditional in-house to contracted-out facilities

Hospital executives and politicians have to respond to increased social, economic and regulatory pressures. Their decisions whether or not to outsource can have a significant impact on the productivity and organisational costs. Having modern facilities with modern equipment and Information Technology can allow greater throughput of patients, thereby impacting on revenues and costs. Within these modern facilities, NHS staff can access cutting edge healthcare technology, such as up-to-date Magnetic Resonance Imagers (MRI), with high speed connectivity enabling improvements in organisational efficiencies.

FM 1

NHS Trusts are working with companies that can partner with them to enhance the effect that technology has within their facilities, providing assets (MRI) and services (Maintenance and training) as part of the facility has a positive impact on staff morale, patient care, and budgetary control. An outsourced managed facility, such as an MRI facility can bring benefits to their core business of the Trust by increasing diagnostic capabilities. These managed facility type partnerships work best through development of strategic relationships with companies that are facility and asset management experts.


NHS Trusts are also looking to save money through simplification of procurement processes and have a target to deliver £1.5Billion on non-pay spend by the end of 2016 (NHS England, 2013). This simplification can be accelerated by working with facility management partners that have experience and scale to deliver a broad range of healthcare management services, including multi-year refreshment planning and replacement of assets within the facility. Another benefit under current Treasury rule is the ability to reclaim VAT on a managed facility contracted out service.

 FM 2

 Contracting out rule 45 for VAT recovery:

Operation of hospitals, health care establishments and health care facilities and the provision of any related services:
This heading is concerned with the provision of a fully operational managed hospital; or healthcare facility, where all services relevant to that facility ‘short of medical and nursing services’ are supplied to the NHS by the managed facility provider. It includes the ancillary provision of equipment together with the service of operating and maintaining that equipment, and it includes utilities when provided as a part of the whole package and paid for within the single unitary charge.

When assessing the level of services provided within the facility, it is important to consider the actual use of that facility and that the services provided are consistent with that usage. (Establish if there are sufficient services to facilitate the operation of a hospital, healthcare establishment or healthcare facility).

VAT is recoverable if a full package of services necessary for the operation of that hospital; healthcare facility, etc. – for example estate management, reception, porterage, cleaning, laundry, catering, security, equipment maintenance, technicians. i.e. As outlined earlier, arrangements for MRI scanners and similar medical equipment, within a facility that is supplied with staff presence of labour and expertise, remains eligible for VAT to be recovered under heading 45.

The contracted out services normally require longer-term contracts, Trusts should be looking for provider partners that are strategic thinkers and can deliver increased value through their facility assets and services. Ultimately they are looking for vested partners that are experts to guide them in getting the best out of their facilities, assets and services.

The NHS is already under tremendous pressure to save money. Contracted out services could be a way of replenishing assets at a lower cost with higher rates of efficiency and productivity.

Dr John Sandham CEng FIHEEM MIET


Healthcare Technology Procurement Policy

Last Updated: Sunday, 26 July 2015 18:57


Healthcare technology procurement, use, maintenance, and management policy is a serious issue recognised by research undertaken worldwide. Some of the critical literature discussing ‘healthcare technology issues’ come from the National Audit Office, the National Patient Safety Agency, the Medicines and Healthcare Products Regulatory Agency and the World Health Organisation.
Old Healthcare technology is being used within many healthcare organisations, with no replacement planning, and a lack of standardisation across individual technology groups. This leads to technology being bought only when it is beyond economical repair, creating a pool of devices in the Hospital that fulfil the same function but have been bought from a variety of suppliers. Many devices in use are more than ten years old and already past their useful life. This issue happens as a result of poor planning, multiple budgets, multiple purchases by different budget holders, and limited or unplanned funding. As long as there are multiple budgets, then device users will continue to have individual choice and the risks will remain.

HTM policy

Procurement and EBME managers must work together to understand this issue and find policy solutions that improve use and availability, thereby leading to fewer incidents and lower costs. Device users, such as nurses and doctors, need equipment that they are trained to use safely, is up-to-date, and functions well. EBME managers, engineers and technicians also want standardisation, and want users to be trained because with standardisation they could carry less spare parts and become more expert in repairing devices, thereby reducing down-time.

Moreover, with trained users there would be fewer callouts to equipment that is not at fault. EBME engineers often discuss the number of calls they receive because users do not know how to use the equipment correctly and therefore ‘think it is faulty’ rather than there being an actual fault.  Governance managers are also concerned about meeting inspection standards from the CQC. To achieve this, they work with internal stakeholders to ensure that healthcare technology management policy is inclusive not only of the internal requirements of the hospital (such and procurement conduct, user training and maintenance), but must also meet external regulatory requirements from the CQC and other government agencies. Therefore, it is the responsibility of a wide range of healthcare professionals to bring together their joint knowledge to develop policy that leads to best practice.

As illustrated below, there can be many wards and departments with their own budget lines for equipment. The current state of device procurement does not easily allow for equipment standardisation that can reduce costs and risks. Users of equipment at the Hospital have a great degree of choice when buying devices. This would be understandable if they were buying something for their personal use, but when it comes to thousands of devices being used across the hundreds of departments and wards it becomes both a financial and a patient risk.

Current State of device procurement
If purchase requests are analysed and authorised by the Medical Devices Committee to improve standardisation, hospitals can develop strategies for filtering purchase requests; the preferred future state for device procurement policy should be a planned process in accordance with best practice guidelines. ?
This would mean that all wards and departments would have their equipment budget lines removed and put into a central budget that the medical devices committee could use in a planned way to buy devices strategically for the Hospital, as in the figure below, preferred future state of device procurement.

preferred state of device procurement
The purpose of healthcare technology procurement policy is to reduce risk, give better access to newer technology whilst reducing the costs through improved acquisition, and improved productivity. The government should agree a technology procurement policy on which a code of conduct must be met by the health services in general.
These may cover areas such as:

  • Investment planning, replacement planning
  • User training
  • construction of facilities, commissioning works
  • healthcare technology maintenance
  • safety
  • the environment
  • quality management.

Issues around poor standardisation, poor utilisation, poor access to modern technology and reducing risk of misuse of technology can only come about through a concerted effort from all stakeholders in healthcare.

Healthcare technology procurement policy should guide healthcare practitioners to procure technology in a strategic manner, rather than the current ‘make do’ mentality that actually increases risk, and cost, whilst reducing efficiency.

Source: Healthcare technology procurement policy

The HTM Outlook for 2015: Consensus and Concern

Published on December 19, 2014

John Bethune As the 24×7 editorial staff put together the January 2015 print issue of the magazine, we decided to look ahead at the year to come and what challenges and opportunities healthcare technology management departments might expect to encounter. After interviewing biomedical and clinical engineers from across the United States, contributing writer Phyllis Hanlon found a broad consensus in the profession about the HTM outlook for 2015: More of the same, only more intense.

– See more

What Young Biomeds Need to Learn, and What They Can Offer

Clarice Balconi Lamica 500 I was in sixth grade when I decided I wanted to be a biomedical engineer. Before then I thought I would pursue medical school, but once I learned about the biomedical engineering profession, how it fuses both modern medicine and modern technology, I was captivated. The biomedical world I originally envisioned was one of research and development. But once I graduated from university, I realized I wanted a job where my work in the morning would have a direct impact on people in the afternoon. I found it in the best-kept secret in healthcare: the role of the hospital biomedical engineer. – See more