New York, New Jersey and Connecticut are served by the NewYork-Presbyterian Hospital and Health System, comprised of six major campuses, specialty institutes and continuing care centers. The health care system is affiliated with major academic institutions. Those medical schools include Columbia University College of Physicians and Surgeons and Weill Cornell Medical College. The system is listed on the U.S. News and World Report Best Hospitals honor roll for this year and includes 6,000 affiliated physicians, 2,508 certified beds and 135 bassinets. With 70,000 assets to look after; it is a big project for any HTM department.
To manage so much equipment, the NewYork-Presbyterian Hospital and Health System Biomedical Engineering Department is comprised of 120 full-time employees. Heading the department is Director Chif Umejei, BBA, MS, PMP, PRINCE2, CSM. He is assisted by six division heads to run the large department. They include General Manager of Biomedical Engineering Operations Genevieve Redman, BSEE/BME, MSOL; Manager of Diagnostic Imaging Christopher Schaefer; Manager of Technology Integration and Planning Bokang Rapoo-Motlotle, MS, CCE, PMP, PRINCE2; Manager of Performance Excellence and Regulatory Compliance Carlos Chung, MSEE; Manager of Technology Systems Roman Szewczyk, BS, ITIL; and Manager of Finance Victoria Kutepova, BS.
The team has a wide range of expertise that allows for working on everything from anesthesia to Zeegos, with particular expertise in imaging. They also cover respiratory, dialysis, laboratory, physiological monitoring, medical device interoperability, project management and technology integration.
The department is split between two functions; Operations, which includes General Biomed, Diagnostic Imaging, Performance Excellence (Regulatory) and Finance and the Value function, which includes Technology Integration and Technology Systems.
Big Department/Big Projects
Integration with the Information Systems department is reflective of modern-day realities at NewYork-Presbyterian for the biomedical department.
“The Biomedical Engineering team reports into the Converged Technologies Division of Information Systems,” Redman says. “We are embedded in the IT infrastructure team. Within the Biomed Department we have an internal team focused on technology integrations, medical device interoperability and standards.”
Recent special projects and areas of concentration include the latest technology and cost savings.
Redman says that the department has worked extensively on reigning in vendor contract spend. She says that the department sold and successfully implemented the insourcing of several maintenance functions. This had a significant impact on hospital finances.
“We reviewed our database spend and we centralized the procurement of assets working very closely with our procurement department,” Umejei says. “We then put in controls, not only for the procurement of assets, but the service contracts get negotiated ahead of time. Once we were able to centralize that, it created a bottleneck for us to look at the contracts individually as they came due. What we determined was that a significant number of those contracts, if we compared the history of the spend to what we are paying in contracts, we were literally just giving money away.”
Umejei says that they then revisited their vendor relationships; which included about 400 contracts.
“Where it made sense, (we) switched from full-service contracts to time and materials; and we did this over the last four years,” he adds. “What we have been looking at is improving our technician talent to be as capable as the vendor talent would be and then pulling them to T&M and that saw significant reduction in our cost per device.”
The department was also able to bridge the physiological monitoring data from their proprietary vendor-managed network to a hospital-managed infrastructure.
“We actually looked at this more from a security and ease of use perspective. What we’ve done, with some investment, is build a secure mechanism whereby all the OR data is stored centrally,” Umejei says. “Clinicians can access them using the right hospital access controls, so therefore we’re protecting things from a HIPAA perspective.”
“We are also beginning to make people figure out what they really need,” he adds. “Before, people just stored everything. There were four hours of video, but at the end of the day, there were only 10 minutes of it that were worth anything. Because of the constraints on storage, the clinicians are only keeping clinically relevant information.”
Umejei says that clinicians can then edit video and store it.
“It’s been great and we’ve integrated with our AV teams to be able to do live broadcasts, which is something that our clinicians wanted, since we are an academic medical center; so it’s been really, really good,” he says.
They have recently rolled out a mechanism that matches patient to waveform and they are able to post in the right space in the EHR. The waveforms are available in EHR in real time and they were able to coordinate the installation of a state-of-the-art automated laboratory.
“The clinical team needed to come up with a way to ensure that clinicians documented clinically relevant waveforms in the EHR. Our department led the initiative to automate the process. This led to compliance with the initial goals as well as cost savings as it pertained to scanning and reprinting waveforms,” Redman says.
Biomedical engineering also led the creation of a clinical video infrastructure to enable the OR to utilize existing AV capabilities to broadcast clinical procedures.
The department has also deployed and managed the RTLS infrastructure for the hospital. They are expanding services beyond medical equipment.
“The biomed team is directly impacting patient care by leading automation efforts to ensure that the right equipment is available at the right time for the right patient,” Redman says. “We have aggressively educated the hospital on the capability of automated workflows using RTLS (RFID, BEACONS, etcetera.)”
The department’s clinical colleagues don’t have to wonder where an asset is or speculate that it might be sitting in the biomed shop.
“We are seeing a more transparent view of where pumps are, where the assets are. We are beginning to work with them (clinicians) to help them see where things are and how it can improve their flow,” Umejei says.
The department, and its managers, stay involved in the HTM community outside their facilities as well.
“We are actively involved in the New York Metropolitan Clinical Engineering Directors Meeting, AAMI, RSNA and ECRI,” Redman says. “We have representation on the examining board for the ACCE.”
When it comes to managing 70,000 assets, it takes a special team to do it while saving money and satisfying the clinical staff. NewYork-Presbyterian’s biomedical engineering department gets the job done.