By David Witt
In my 43 years in this field, I have seen the evolution of our industry. No matter how long you are in what is now known as the healthcare technology management (HTM) field one thing is constant – our knowledge and understanding must evolve if we are to remain a viable, supportive entity to the medical industry and, ultimately, to the patient.
When I entered this field through the United States Army Medical Equipment and Optical School, (USAMEOS) in 1978, we were still working on “real” Bovie electrosurgical units which operated using what is called a spark-gap (Google that one). I worked on devices that employed vacuum tubes made in Russia, performed actual repairs using schematics that sometimes took up several feet of the department floor as they were unfolded to begin the troubleshooting process and tested conductive flooring in operating rooms while wearing shoe covers with carbon impregnated straps. I remember the transition from tubes to transistors and semiconductors. I remember making our own circuit boards using skill sets now long gone, as wave flow soldering became the standard. I remember the first school I attended that taught “And, Or, Nan, Nor gates” and the “Not” symbol as new logic components. I recall troubleshooting techniques that required a lesson in binary math, “hi and lo” signal tracing and the new electronic symbols that came with them.
I saw technical skill sets eventually fall into disuse as component-level troubleshooting and replacement became what was called “in the day” as board swapping. I remember when there were great attempts to distinguish ourselves as biomed technicians as we pulled further from (what I saw as the parental influence) of what was then called maintenance, a.k.a. engineering, facilities or plant operations. I saw the rise of the Association for the Advancement of Medical Instrumentation (AAMI) as our strongest advocate in the representation and recognition of our ever-evolving discipline of which information technology (IT) has acquired prominence in the medical device industry.
There was a time when our field appeared to fragment as we attempted to distinguish evolving disciplines such as imaging, lab, respiratory therapy, anesthesia, lasers, information systems and a broad spectrum of other specialty technologies. Even within the imaging field, distinctions were made as technology introduced C-arm, CT, PET, MRI and ultrasound specialties. It happened again as each of those went digital, largely relegating wet film processing to history with the arrival of detector plates and the transmission of images to remote offices to be viewed by radiologist who were also found in distinct specialties. Yet through the many changes leading up to HTM, there remains a common core of management, training and best practices without which no organization can endure the tempest of change alone.
A major indicator of the importance of our field can be found in the interests of the many corporations recognizing the opportunities of sustained financial growth in HTM and buying up as many smaller businesses as they can in their quest for industry dominance.
There is, however, a kind of symbiotic relationship between HTM and our otherwise “non-technical” counterparts which have become the think-tanks in our field regarding finances, human resources, legal matters and even better best practices. How many “PI’s” have we gone through to get to our key performance indicators (KPIs), for example? Who would have ever thought of competing using ISO13485 and 5S? I assure you it is usually not in the technician’s interest to keep the place clean and organized, but it is now a mandatory KPI; a necessary tool in the competitive strategies of the “big guns” in our industry. If you are adept at looking at the “big picture” then these otherwise foreign concepts to many technicians can be seen as increasingly essential to the development, progress and financial strength of the aggregate of companies which now define our field, benefit from it and we from them.
During my career, I have often lamented about hospitals outsourcing their HTM support base; paying other companies to provide a service no longer found within the hospital’s infrastructure. For a time, one could predict the cyclic change from in-house to outsource and back to in-house again. For a long time, the cycle of transition was 5 years but I have not really noticed a return to hospital-owned HTM teams for at least 15 years. There are hospitals that have their own HTM employee base, but usually because the medical facilities are themselves a corporation of hospitals. However, the medical facilities which outsource for technical support usually retain this support for several years. By being imbedded into the client institution, an outsourced HTM team actually receives the sensation and, yes, benefit of being part of the in-house family. The only difference is where their salaries come from.
The merging of client and vendor policies and best practices have a strengthening effect to an in-house style program. I would think that imbedding technicians fosters the sharpening of skills, an increase in knowledge and the constant improvement of service delivery in order to remain competitive. Imbedded staffs then can arguably keep more abreast of the changes in technology management; an advantage to the service vendor and the hospital client. This is due, in part, to the diversity of skill sets, education, administrative abilities and shared knowledge that service providers are becoming well known for.
How do I see our future? I now see HTM as the collaboration between multiple disciplines and their associated technologies applied to the still changing health care environment. We who are biomedical technicians, clinical engineers, information systems. Cybersecurity, imaging service engineers, administrators, lawyers, accountants … the list goes on; we have become fused together through the collaborative drive to keep up with technology and the demands of patient care.
We are Healthcare Technology Management. We are diverse and we are strong in that diversity.
Well done!
David Witt has more than 40 years of experience in the international field as a technician, instructor and advisor. He is currently the director of clinical engineering at a major Las Vegas hospital.
