By K. Richard Douglas
One of the most fulfilling roles in the HTM profession has to be serving on a team that helps children heal. It is a specialty area in medicine that adds an additional layer of urgency and responsibility.
Northern California is home to one of the nation’s leading pediatric health care facilities. The city of Menlo Park sits on the west side of the San Francisco Bay, on the eastern edge of San Mateo County.
The city is one of the original parts of Silicon Valley. That center of high-tech dominance is at least partially attributed to Stanford University and one of its former provosts, Dr. Frederick Terman, who is commonly referred to as the “father of Silicon Valley.”
The Lucile Packard Children’s Hospital in Menlo Park is part of the Stanford Children’s Health network. The pediatric health care network provides health care services to those in northern California. It benefits through its academic affiliation with Stanford Medicine and Stanford University.
The 33-member Clinical Technology and Biomedical Engineering Department manages the hospital’s medical equipment along with the medical equipment at other local facilities.
In addition to the 361-bed hospital, the biomed team supports two different wings in two other local hospitals – Sequoia Hospital and El Camino Hospital – for a total of 400 beds. The team also manages medical equipment at approximately 70 clinics in the Bay Area.
The HTM team is led by Director Ilir Kullolli. He reports to Vice President and Associate Chief Information Officer Lisa Grisim. Managers include Danielle Cowgill, Jeff Fahsel and Sudhee Tumkur.
The team manages more than 20,000 medical devices.
“We have techs trained on servicing ventilators, anesthesia machines, surgical equipment, ultrasound, infusion and syringe pumps, patient monitoring, heart lung/ECMO machines, EEG/EMG, dialysis and mobile X-ray equipment,” Kullolli says.
He adds that the department also has a team of clinical systems engineers that support over 20 different systems, including cardiology PACS.
“Clinical engineering manages all service contracts for medical equipment for the organization. We may not be financially responsible for all of them (i.e., imaging contracts), however we negotiate all contracts for imaging, surgery and all other areas,” Kullolli says.
He says that they manage the contracts through their Nuvolo CMMS.
“Recently, we have taken over the ultrasound probes contracts as well, and we are paying for it. However, we charge back departments for each probe used. This way, we can pool the probes and get a cheaper price,” Kullolli explains.
“We use Nuvolo for equipment data, service data, IT/security information, ticketing system (ServiceNOW transfers tickets to Nuvolo), knowledge base (service manuals), service contracts and parts inventory – to an extent,” Kullolli explains.
The department is fully integrated with IT and has realized many benefits as a result.
“We report up to IT (we call it IS here); we do our CapEx and OpEx planning through IS, and we participate in all IS team planning meetings. I also sit on the IS leadership team,” Kullolli says.
A Unique Surgery Challenge
The well-rounded team has faced one of the biggest challenges that an HTM department can tackle; supplying and integrating medical equipment into a new hospital. They refer to it as Packard 2.0.
“This new hospital was opened in different phases from 2017-2019. It included four floors of patient care units (CVICU, PICU, HemOnc and MedSurg) for a total of 200 beds. It also included our heart center, radiology, EEG and respiratory clinics,” Kullolli says.
He says that on the first floor they opened brand new operating rooms, which included cath labs, IntraOp MRI operating rooms and multiple cardiovascular ORs.
“Our team was heavily involved and in charge of the deployment of all clinical technologies in the new hospital, and their integration with EMR, PACS and other systems,” Kullolli says.
“We were also in charge of deploying digital OR technologies and video integration, Synaptive and BrainLab technologies (for neurosurgery), and cardiology PACS integration for cardiovascular ORs. Such technologies help decrease patient time under anesthesia, help our physicians make faster decisions – because information is now at their fingertips – and ultimately achieve better clinical outcomes for our patients,” Kullolli says.
One challenge that the team faced more recently was because of the hospital’s unique reputation for performing more challenging procedures.
Kullolli says that during the COVID-19 pandemic, his facility faced the same issues as everyone else; patients were limited to how many people could be in the room with them and travel was limited.
“This provided us with a big challenge: How do we perform certain surgeries where we need surgeons from other parts of the country to come and assist our surgeons? Remember, we perform certain surgeries here that are not done elsewhere. In this case, we had a patient coming in with a spina bifida surgery that needed to be done on a fetus and the surgeon that was going to assist us was in Texas,” Kullolli explains.
He says that his team got together with the IS team, physicians and OR staff to brainstorm ideas.
“We were able to come up with a solution where we could show our OR video feed (from our Stryker in room system) in a Zoom session and have the surgeon log in remotely and guide our surgeons. We did a few test runs, and when we had the confidence this would work, we decided to proceed. The surgery was a success, and we have had dozens of surgeries performed since then,” Kullolli says.
Away from work, the team maintains its edge by attending training and various HTM industry functions.
“We participate in all ACCE activities (webinars, symposiums, etcetera) and different AAMI activities. We also attend our local CMIA meetings,” Kullolli says.
In one of the world’s most high-tech environments, this HTM team utilizes a cutting-edge skill set to ascertain that the youngest patients have the best chances for great outcomes.