Whether you call them health care technology management professionals, clinical engineers or biomeds, the people responsible for keeping medical equipment up and running at a hospital are up against a tall task. Changing legislation, challenges with accessing OEM equipment’s diagnostic tools and software keys and the rapid expansion of health IT are just a few of the factors that keep these important members of the hospital team on their toes. HealthCare Business News spoke to several people on the front lines of health care technology management to find out more about the forces impacting them.

Blurred lines
As hospitals become more integrated, it’s not always clear who is responsible for what device. Heidi Horn, vice president of clinical engineering service at SSM Health in St. Louis, recalls a scenario involving a medical device that had both PC and different workstations as part of the system. At first, Horn reported, it wasn’t clear who should be responsible for the workstations. But ultimately the HTM and IT departments agreed that since the workstations were connected to the device, the management should be handled by the HTMs.

“What we have to understand is that it is not going to be ‘this is mine and this is IT,’” she said. “The blurring of lines will continue and we have to be nimble enough, and make sure our skill sets are there, so we can cross those boundaries more and more,” Horn added. For Cedars-Sinai Medical Center in Los Angeles, the HTM department now has service models for application support, which create unique opportunities to support technology, not only from a hardware standpoint, but also from a middleware and software standpoint, all under the clinical engineering umbrella.

Curt Rodriguez, clinical engineering and device integration at Cedars-Sinai, believes that’s never been done before anywhere in the country. “For our newer nurse call system, clinical engineering supports not only the hardware involved like the staff terminals, nurses stations and pillow speakers, but we also support the application. We assign new users so that nurses can get the alarms sent to their phone, and resolve issues with end users utilizing tools within the application,” he said.

Evolution in health care
The Centers for Medicare & Medicaid Services (CMS) recently implemented requirements for inspection and preventive maintenance of equipment, and who can repair and remanufacture equipment. “An HTM professional should not only know how to maintain equipment, but also what the decisions on maintenance mean to the finance and operations departments of the health system they work at. You have to break out of your shell of ‘just repair’ to look at the bigger picture,” said Rob Maliff, director, Applied Solutions Group at ECRI Institute in Plymouth Meeting, Pennsylvania.

Gary Barkov, clinical engineering multisite manager at Advocate Health Care and the vice president of the Clinical Engineering Association of Illinois, believes that HTM professionals need to do their work in an “evidence-based” way and constantly audit and analyze their performance by getting customer feedback.

OEMs can put software keys or licensing keys into their technology. By doing so, a facility will not be able to use its in-house department for that specific machine, but would have to call in the services of the OEM technician. When OEMs are unable to send a technician to the facility, it would have to send the equipment out to the manufacturer, creating a longer turnaround time. “Many of our end-users need to have their equipment back as soon as possible, especially if no loaners are available,” said Izabella Gieras, clinical technology director at Huntington Memorial Hospital in Pasadena, California.

HTMs may soon be able to access these keys that OEMs use on their devices. “We’ve spent a lot of time and money over the decades to build the tools and technologies for our own engineers to service equipment effectively,” said Matthew McCallum, head of service business management at Siemens Healthcare. “We are in the process of opening those tools up to HTM organizations so they can have the same tools as us.” There are two types of services that OEMs can provide: shared service, where an in-house HTM group would try to repair a piece of equipment, and if unable to, will call in the OEM; and full service, where an OEM does all the repairs.

There has been a narrowing gap between the prices of the two contracts, which some HTM departments are unhappy with. “We are now only looking at a $10,000 difference in some cases. We’re also seeing the diagnostic software [prices] for some high-end diagnostic imaging devices go up,” said Horn. “We used to get it for a few thousand dollars. Now it’s not uncommon to spend $24,000 a year just on that diagnostic software. If you multiply that across all the equipment throughout the hospital and system, it adds up.”

Service contracts may require the HTM customer to be trained in a specific device, and in exchange for that training, the HTMs would have more exclusive access to trouble-shooting keys and event logs. For OEMs, keeping unqualified workers from tampering with their devices is a matter of patient safety. “We might not want to give a customer that has not been verified and trained on the equipment access to the equipment,” said Siemens’ McCallum.

Stuart Grogan, radiology equipment manager at Medical Center Boulevard in Winston-Salem, North Carolina, said his team has been able to develop relationships and tailor support agreements to access OEM tools. However, the facility typically would not buy imaging equipment from OEMs that are not willing to make tools available at little or no cost.

Cooperation is crucial
Forming a partnership is important for both parties, according to some HTM professionals. Barkov, with Advocate Health Care, said many OEMs partner with his organization in shared-risk relationships, and they collaborate to reduce cost and service issues. He believes that HTMs will always need the OEMs and to dismiss them, whether for purchase or warranty expiration, is not a responsible approach. OEMs seem to be increasingly aware of the benefits they gain from having trained professionals on site.

Siemens’ McCallum said, “[HTMs] can be an extension of our own service department in the sense that they can begin the troubleshooting process and can attempt to repair the system before we even arrive on site.” GE Healthcare takes a similar approach to working with an in-house department due to the fact that they are both customers and fellow engineers.

Aaron Goryl, general manager of inhouse and on-demand service sales at GE Healthcare said, “We integrate in-house engineers in with GE engineers during training and begin to develop that relationship from the start. Our local field teams have excellent relationships with their in-house partners, as it helps the overall service delivery process of assisting, ordering parts and ensuring compliance.”

“The more we work together on identifying and minimizing equipment abuse and error, the better it is for everyone, especially the patient,” said Courtney Nanney, national quality manager, clinical engineering, physical asset services at Catholic Health Initiatives in Louisville, Kentucky. “In the end, we serve the same customer, clinicians and patients, so it is critical for an OEM to have a solid relationship with their in-house partners,” said GE’s Goryl.

For Barkov, as equipment becomes more reliable, HTMs should continue to move away from just repair to being true technology managers. “We are at risk because we will not be able to use our expertise in terms of reliability-centered maintenance. Our work could begin to resemble more of an assembly line if we have to follow manufacturers’ procedures more than anything else,” he said, referring to CMS guidelines. “I hope to avoid diminishment of our profession.”

Cybersecurity also presents new opportunities in HTM departments, since more equipment has an IT component or a security implication, according to Gieras. “Many of the medical devices are IT based and have means for potential breach from the outside, so it is important for the HTM professionals to be able to assess the technological vulnerabilities as part of the new equipment evaluations,” Gieras said. “This includes application of ongoing patching, and updates and upgrades to ensure the technologies are safe and secure.”

HTM service is not for everyone
When it comes to managing technology there is no one-size-fits-all solution. Some facilities are content depending on external support from OEMs and third-party vendors. According to ECRI’s Maliff, the size of the facility can play a role in that preference, and ease of management and operations could be contributing factors to the preference for outside servicers.

Some hospitals look at maintenance of equipment as a contract service, said Maliff. They could hire someone to fix their machines and buy spare parts without having to worry about providing space for an HTM department and HR-related benefits. For hospitals that establish in-house HTM support, a cost savings in comparison to OEM service is a frequently cited benefit. According to Barkov, that savings is around 15 to 20 percent when compared to other options.

Third-party vendors are another cost-saving alternative to OEM service that many hospitals have successful partnerships with. “A hospital may contract with a thirdparty provider if they are not in compliance with Joint Commission regulations and hospital leadership hires them to ‘correct’ the problem,” said Maliff.

“OEMs and ISOs may claim they are able to ‘cut costs,’ but I question if they are providing the same quality in a timely and cost-effective manner,” said Patrick Harning, division vice president of clinical engineering at Catholic Health Initiatives in Erlanger, Kentucky. “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.”

Competition intensifies
With competition increasing between organizations servicing medical equipment, HTMs are using different approaches to stay relevant. They are increasingly attending exams, conferences and meetings to gain a firmer understanding of software-based equipment and project management. “If HTMs are just a group that repairs broken equipment, they will never earn the respect from senior leaders to see that they bring value to a hospital,” said Maliff. “They need to show their expertise so they can become a trusted partner, a sought-after partner when there are problems.”

At Medical Center Boulevard, the staff always receives OEM training whenever they purchase a new machine, and they are constantly sending people to refresher courses. There is a lot of on-the-job training, so if the main technician is unavailable, someone will always be able to service a specific piece of equipment. For HTMs, there is more to servicing equipment than just the bottom line. “It’s the idea of understanding that what [we] do really can have a life or death impact,” said Maliff.