Progress in medical technology has advanced at a mind-numbing pace over the past decade. Advances include imaging diagnosis enhanced by software and spectral computed tomography, wearable diagnostics, blue-violet LED light fixtures for disinfection, more advanced robotic surgery and electronic medical records and supporting systems. New technology has found its way into hospitals and other medical facilities as much as anywhere else in the modern world.
It was inescapable then, that the steady creep of technology would change the dynamics of the HTM professional’s role, moving beyond the high-tech characteristics that many medical devices already possessed, and into networking, cybersecurity, databases, informatics and data analysis.
Several years ago, the evolution of technology in health care began to require a collaboration between the IT and clinical engineering departments, like never before. It is a trend that will only deepen as the explosive pace of technology marches forward.
Although the two groups have differing cultures, and that may never change, the roles of many HTM professionals are evolving.
This changing dynamic has even been the stimulus for several “hybrid” roles within the evolving framework that includes clinical engineers, BMETs and IT professionals. Some of these new roles include clinical systems support specialists, radio frequency spectrum managers and clinical systems engineers.
In order to tackle these hybrid roles, along with keeping current on evolving technologies, the need for additional credentials falls upon the HTM professional. Network+ or A+ certifications can help move a biomed a step towards the IT culture. They may also help bridge the language gap, where the biomed is finding that speaking in IT’s esoteric language is becoming a necessity. Because of these differences, biomed may find itself extending an olive branch, while IT may not find as many compelling reasons to do the same.
There are some job description changes that accompany those certifications as the role of the biomed evolves. Reporting relationships may change also, and many have changed already to reflect the evolving nature of networked medical devices. Today, the biomed department may report to facilities or IT or supply chain. Regardless, the biomed must be able to speak everybody’s language.
“The increasing convergence of medical and information technologies leaves little question as to the need for better collaboration between HTM and IT services,” says Steve Grimes, FACCE FHIMSS FAIMBE, managing partner and principal consultant at Strategic Healthcare Technology Associates LLC in Swampscott, Massachusetts.
“General recognition of that fact has led many organizations to move their HTM programs within their IT service umbrella (from a few percent a decade or two ago to an estimated 30 to 40 percent today),” he says. “Unfortunately, many of these organizations overlook that simply changing lines in an org chart does not necessarily guarantee better collaboration between service support models that traditionally have been very different.”
Grimes won AAMI’s 2016 HTM Leadership Award, partly because of his pioneering work in “advancing the understanding of safety and risk management in the interface between medical devices and IT systems.” He has not only provided leadership to AAMI, but to ACCE and HIMSS as well.
“In order to establish a good working relationship, there must be an underlying trust as well as mutual respect and reciprocity. Historically, there has been distrust and the feeling that IT is after biomedical jobs or vice versa,” says Ali Youssef, PMP, CPHIMS, CWNE #133, principal mobile solutions architect in Information Technology at Henry Ford Health System in Michigan.
“The reality is that the skill sets are very different, but are beginning to have more intersections. From an organizational structure, it is logical to have both teams reporting up through the same structure. In order to promote manageable risk, the two organizations must work very closely together,” he says.
Grimes points out that another change, along with the reporting alignment, has been the alignment of organizations and education opportunities that have come together.
“On one positive note, we have developed much closer relation between HIMSS, AAMI and ACCE in the past 15 years and we have increased the number of HTM/IT tracks in our conferences and publications,” he says.
Two Camps; Two Choices
For many biomeds, who enjoy electronics or mechanics and found their way to the HTM profession, the profession remains rewarding on its own. Being on the patient care side, along with the diversity of daily experiences, are what many HTM professionals cite as rewards for their work. For others, whose motivation is financial, the IT world offers the lure of potentially more income.
Will HTM professionals, with new IT credentials, jump ship? Will there even be enough new HTM professionals entering the field? There are issues that biomed leadership must address. According to the 2015 HealthITJobs.com Healthcare IT Salary Survey, the average health IT salary was $87,443 and the average bonus was $7,990. HTM managers are concerned that when new students enter college, and consider HTM or IT, they may focus on income potential.
“I do believe there is a risk that reluctance or hesitancy on the part of the existing HTM community to embrace the integrated concept of medical and information technologies will lead to a new professional taking over the support for the new breed of medical devices and systems,” Grimes says.
“That new professional might very well drain significant potential talent from the ranks of the HTM community and may find its way to the typically better funded — and often better organized — IT service,” he says.
The previously mentioned hybrid roles, and IT-oriented credentials, may have to become more widespread and accelerated. Grimes believes this type of progress can’t occur too quickly.
“So, I believe the question remains whether today’s HTM professional can proactively adapt with sufficient speed to adopt the new methodologies and skills necessary to support the new converged technologies,” he says.
“If the existing HTM community does not evolve, they risk increasing marginalization, eventual obsolescence and replacement,” Grimes adds.
To stay relevant in this HIT leaning environment, HTM professionals must maintain and update their knowledgebase and competencies.
“The best way is to remain active in organizations such as AAMI and HIMSS to stay abreast of the latest technologies as well as network and learn from like-minded peers,” Youssef suggests.
“Usually the certifications are valid for three years and require either ongoing educational credits, or a retest. One of the tracks that I have personally leaned heavily on is the CWNP organization, which teaches the fundamentals of Wi-Fi administration, design, security and analysis,” Youssef says. “The other key mobility track is the IEEE WCET certification, which is focused on mobility, including cellular and other technologies, that may be in a hospital or clinic.”
Beyond the additional training that HTM professionals will seek for career growth, there are changes in HTM education programs and the recruiting standards that managers employ that are another dynamic of the HTM/IT synergy.
“In terms of recruitment, we recognize that there is a fine line between hiring HTM positions with strong IT skills and creating IT jobs in HTM. For some organizations, that might not be an issue, while for others, defining that fine line is a directive that must be addressed,” says Jennifer Jackson, MBA, CCE, director of Clinical Engineering and Device Integration within the department of Enterprise Information Services (EIS) at Cedars-Sinai Health System in Los Angeles.
“Initially, we struggled to identify candidates that were strong and experienced in HTM with the extra IT skill sets, so we started training internally with great success. We are fortunate to have CE, Device Integration and IT staff who are willing to take the time to teach and explain things to their colleagues,” Jackson says.
Jackson’s department has been fortunate to hire new technical staff with the right skill set. She says these were BMETs that left the field in pursuit of a more IT-focused career. When the opportunity came up to return to HTM, and still use the newer IT skills, they accepted the challenge.
“Since our medical device systems are more complex and more integrated, that knowledge is always put to good use,” she says. “We implement the systems and we get the calls to address problems when they occur at the point of care. If we can’t fix it, then we turn to another colleague, perhaps on the DBA team or the desktop support team. Those new IT skills come in handy to identify what we can fix and when it is time to consult other experts,” she adds.
Jackson’s role reflects the changing dynamic with her title including “device integration.” This is a growing trend. There are now job titles that represent the changing responsibilities, expanded skills and the realities of networked medical devices that are part of every biomed’s world.
Reporting structure, and its continued evolution, plays a role in the two groups’ relationship.
“There are certain barriers which are eliminated when HTM reports into IT, but the vision, mission and goals all still have to align. In our experience, here at Cedars Sinai, we’ve actually discovered that the result of building trust and teamwork has led to more robust technology management solutions,” Jackson says.
“I have learned so much about the care and feeding of other HIT technologies that I actually feel more empowered to work with my IT colleagues and we interact with the vendors together. It is helpful to design and architect the new systems together so that we can have the important conversations early on; security, maintenance, back-ups, etcetera,” she adds.
This topic is playing such an important role in the two departments’ responsibilities that HIMSS and ACCE introduced an award that recognizes efforts at developing a synergy between the two in 2006. Jackson won that award in 2015.
Responsibility for many tasks remains very clearly delineated. IT still handles servers and network infrastructure and biomeds still handle medical device repair and PMs. The specialization of both groups is fixed to a degree, with the exception of certain overlapping areas. One difference is that if a biomed is working in a hospital, they always remember that they are in a hospital.
There still exists some level of suspicion or a lack of understanding between the two groups as well.
“There is a self-induced ego to both groups. Which is more important; patient care and safety or patient, facility IP,” asks Matthew Du Vall, biomedical technician with Treasure Valley Hospital in Boise, Idaho. “The IT thinks the HTM does not maintain the same level of security as the IT do. This, of course is wrong. The HTM is all about security and safety, especially at the patient’s level. The IT are not told this in training. It is very hard to convince them of this.”
There are other contrasts as well. Biomeds are better prepared, and more comfortable, in the clinical environment. A person trained in IT has not had this eventuality as a part of any traditional training in the computer sciences.
The Eskenazi Health Biomedical Engineering Department has achieved bridging the gap between the two disciplines. It engages in an inter-department activity that brings the IT and biomed groups together periodically. They call it “Lunch and Learn,” where the departments get together on a regular basis for educational presentations. According to Matthew Royal, the clinical engineering department’s director, this “interaction builds relationships and knowledge among the two support teams.”
Royal says that the Lunch and Learn allows the biomed department to “give IT an overview of what that system is. And when we have an issue, it might be on their network, that they manage; say it’s a server or network infrastructure, that we’re scheduling downtimes together,” Royal says. “Sometimes changes that they don’t think affect our medical equipment, actually do, and so having that communication, when you schedule certain maintenance on an IT system; we need to have that communication from them.”
Royal says that if an anesthesiologist in the OR is looking to see the vitals and patient information coming over to the medical record, and has an issue, it could be an issue between the machine and the middleware or the EMR system. If you’re familiar with all of those modalities, he reasons, then you are going to be able to fix the problem a little bit easier and you’re introducing one less person into the troubleshooting process.
“I think that is our intent. We are the one-stop shop. We’re helping our IT department out by fixing it for them, without them coming into an environment that they’re not used to coming into, like a surgery room or clinical procedure,” Royal says. “That’s where we’re more comfortable. Just from a safety, an infection control, standpoint, you don’t want to introduce a whole lot of extra people into that clinical environment that could compromise it, particularly if they don’t have that kind of experience.”
Cooperation and coordination is still the name of the game between the two departments. Tedd Koh, CRES, CBET, CCNA, A+, NET+, Security+, a medical electronics technician at Olive View UCLA Medical Center, says that when his department upgraded a patient monitoring system, because of the connectivity to bedside monitors, central monitors and servers, there had to be cooperation with IT.
When a customer uses their Enterprise Service Desk to report an issue, IT and biomed come to the site to determine which group will take care of the issue, Koh points out.
Koh says that the relationship between the two departments has become better in recent years because projects like implementing an EHR or patient monitoring system could not be completed without that cooperation.
Grimes agrees and points out that HTM services that have best succeeded have been those that have recognized the convergence of medical and information technologies necessitates a strong collaborative approach between HTM and IT toward the support of these new integrated systems.
He says that both groups need to understand and appreciate how each has traditionally had different approaches to service support and that both can best succeed in supporting new technologies when they can adapt and adopt the best service support elements from each other.
Grimes says that initially there will be support gaps when HTM and IT begin collaborating and that success will only be achieved if the gaps are quickly identified and filled by an integrated team willing to step out of comfort zones and accept new responsibilities.
He adds that the need for medical and information technology support continues to change and that successful support requires a continuing evolution in HTM and IT services through education and the adoption of new management and technical skills.
He also says that HTM services that have best succeeded have recognized “that stakeholders, requiring technology support, have a single point of contact (e.g., a common service desk and integrated support system) so that the stakeholder is not being forced to manage who is taking responsibility between biomed, IT, a vendor, etcetera.”
The future of health care will continue to include more innovations and technologies that require cooperation between the two groups.
“There’s no question in my mind that the future is headed towards further embracing mobility and finding creative ways to leverage IoT and wearable’s for actionable clinical data,” Youssef says. “The end result is a stronger focus on wellness. Both biomed and IT will need to be educated and prepared for this inevitable evolution.”
Grimes says that while sophisticated health care technologies will continue to be developed and deployed, it remains to be seen which ones will translate to real benefits regarding patient care.
“Particularly, as the technology becomes more complex, care must be taken to judiciously select the right technology, systematically deploy that technology, consider necessary workflow changes, and ensure there is adequate life cycle support,” he says.
“Organizations that consider only promised benefits and focus on only the hurdle of initial capital costs likely will see some of their hoped for benefits, if any, only after making significant additional investments,” Grimes says.
Determining the usefulness and efficacy of any given technology falls upon both groups to guide their employer’s decision making process.
“HTM and IT can greatly improve future prospects of realizing the benefits of new technologies by educating their organizations’ leaders and users on the nature of resources needed to support those technologies after acquisition and the costs associated with that support,” Grimes adds. “To accomplish this, HTM and IT need to be able to effectively and convincingly communicate with those leaders and users. HTM and IT also need to acquire and develop the requisite resources, including management, technical and collaborative skills to ensure availability of the needed support.”
Grimes points out a third element.
“In the future, successful health care organizations will likely have – or contract with –an integrated technology support service that includes various HTM, IT, telecommunications, and other technology-related professionals, operating in a matrix, to provide those organizations with comprehensive support in such areas as acquisition, deployment, integration, workflow design, training, lifecycle management, and systems analysis,” he says. “The support model is likely to be built around the ITIL, COBIT, or ISO 20000 standards and systems engineering principals.”
Despite the different cultures and differing jargon, the current relationship between these important departments requires cooperation and synergy as illustrated by industry leaders.
“At the end of the day, we are still expected to be able to speak for the performance of our systems,” Jackson says. “In other big areas, like IT security, we collaborate closely with the bigger department team instead of trying to tackle medical device security by ourselves on a separate, isolated track.”
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