By Rebecca Crossley, CBET
Healthcare technology management professionals, such as biomedical equipment technicians (BMETs) and clinical engineers (CEs), are used to working in hospital environments. However, in the last several years, many of us have had to learn more about a relatively new health care setting – a patient’s home.
A boom in remote health services resulted in several factors, including the demise of many rural hospitals and the financial difficulties faced by smaller hospitals in general. This has led to larger health systems joining with or outright buying smaller systems. In some cases, those larger systems have kept the smaller systems essentially intact. In many instances, however, the smaller systems are simply disappearing.
The closure of smaller hospitals, especially in rural areas, has provided opportunities for other health care approaches, like urgent care centers, surgery centers, and micro hospitals, to fill gaps in care.
No Cookie Cutter Fix
There is no cookie cutter solution to the problem of the growing need to provide remote health care services. Maybe this is a good thing. Why? Because it has allowed larger health systems and state departments of health to be more creative and to find innovative solutions that work in their communities.
The Future of Rural Health Care Task Force, formed by the American Hospital Association (AHA), recently published a report detailing final recommendations on promising care alternatives in the rural sector.
The report indicated that there are multiple ways to deal with the disappearance of smaller hospitals. One obvious pathway is telemedicine. The COVID-19 pandemic propelled the geometric utilization of telemedicine technology forward. This telemedicine model includes virtual hospitals in which patients can go to a single location to be assessed by a remotely located physician. Virtual pods are another viable pathway where patients with similar health problems are monitored remotely while they remain at home.
These remote alternatives are ultimately only possible because medical equipment has become smaller and smaller over time. Patients are now able to wear medical devices for continuous monitoring. Higher-end equipment that never would have been able to be moved to a patient’s home is now much more accessible to patients who need home care. For example, take dialysis machines like the NxStage System One by Fresenius Medical Care. It is currently the only portable dialysis machine authorized in the U.S. for at home dialysis. It weighs 75 pounds and is one foot tall. This system requires no special electrical connection or plumbing connection, allowing patients to be treated at home. One might expect this device to be a trendsetter, not an outlier, for future device innovation.
In addition, the increase in the use of paramedics and funding for these types of programs has led to a trend where communities are employing paramedics to go to homes and assess patients under the remote supervision of a physician. Under these programs, patients are identified, and paramedic teams take their equipment and knowledge to the patient. They perform an assessment under the supervision of a physician, who then recommends the form of treatment. This type of program also has proven very useful in large cities where some patients are shut in and the health care institutions are overwhelmed. In these instances, it enables the patient to be evaluated quicker and gives the health care facility time to process patients that, in theory, would be higher acuity.
The Pennsylvania Department of Health has been looking at various innovative hospital models and has started to offer three initiatives in its efforts to ensure patients have access to the best quality care that supports effective and efficient care. These programs are micro hospitals, telemedicine emergency rooms, and outpatient emergency departments. Micro hospitals are acute care facilities with at least 10 in-patient beds. There are no surgical services offered. This allows for acute care in those rural, smaller facilities. Telemedicine emergency rooms are those smaller rural facilities that are staffed by advanced practice providers and a remote physician. These facilities are open 24×7, 365 days a year. Outpatient emergency departments are outpatient facilities that do not offer any inpatient beds.
Biomedical or clinical engineering departments are rapidly trying to support these developments in remote care. Some systems are employing technicians to travel to these remote facilities and continue to offer maintenance and repair services. This approach often proves costly. Many hospitals grapple with providing services in a cost-effective manner. This can result in technicians driving their own cars and being reimbursed by mileage or purchasing a company vehicle. Neither seem to be very cost effective. Another approach is to position technicians as close as possible to the remote hospital and have them rotate among several facilities, thus reporting to a different facility as their place of work for a given day. This also has its limitations, including legal ones.
As the remote health care industry continues to evolve so must HTM and clinical engineering departments. I believe the HTM field is in the infant stage of learning and deciding how to address the issues that come along with higher acuity and sheer volume of equipment that is and will be in patient homes. We will need to come together with AAMI and other standards-development organizations to meet these needs head on. We will need to change from strictly thinking of hospital-based equipment to embracing work in a patient’s house when it comes to equipment maintenance.
I have no doubt HTM professionals will continue to lead the way in equipment maintenance.
