By Garrett Seeley and Saul Ramirez
After the article on OEM software compliance, a question came up. How do biomeds maintain existing software?
The answer requires piecing together several of the previous Networking Notes articles and expanding on a new position in the healthcare technology management field; an IT/Biomed hybrid. We covered the tasks of procurement in the articles on NMDD and ERA and set up in articles for TCP/IP. All of this is important to the new position of Biomedical Equipment Systems Specialist in Information Systems; the Information Systems BESS, ISBESS, or simply “Info Sys.”
In the past decade, this field has grown to include more technicians with specific computer networking and server skills. They often save the day only to disappear to some limited access server room. The question is, what do ISBESS techs do?
WHAT IS A MEDICAL COMPUTER AND WHY IS IT NOT IT’S RESPONSIBILITY?
One of the most confusing issues is that Info Sys technicians focus on medical computers. Unfortunately, this definition can be facility specific. In general, if a computer or server deals with data other than text, if it operates with a medical device, or interfaces the patient; it is a medical computer. Basically, anything not used to access the patient record can be considered a medical computer and therefore not under IT management. Info Sys techs work on these systems. Additionally, Info Sys will work on medical device networking. They may be asked to contribute their expertise to anything that other biomeds need help on, particularly with networking these devices.
Info Sys technicians set up and maintain medical computer systems. They do this the same way an IT technician maintains networked computer systems. Info Sys are concerned with hardware and software, permissions and logins, and overall computer functionality. There are network concerns and security issues like the ones covered in the ACL and ICE articles. There are setup issues, such as in the TCP/IP or the Network Troubleshooting articles. Please read these articles for foundational material on these tasks. IT switches seem to be the only thing IT network admins will not give an Info Sys tech direct access to. However, IT has no idea about what to set in the ACL for a medical device communication. An Info Sys must work closely with IT to guide and help compile the ACL lists. This requires documentation and communication to the network admins, so please do read the articles on ACL, ICE, and NMDD for these tasks.
INFO SYS PROFESSIONALS SPEND 1/3 OF THEIR TIME MAINTAINING SOFTWARE
On top maintaining medical computer systems and networked medical devices, there is also the maintenance of the software itself. Software requires patches to fix and maintain its functionality. These patches are provided by the software manufacturer, listed on their websites, go through the 510K vetting process, and are safe for the computer they are being loaded on. These usually occur every year or two and maintain the application software. Additionally, there are operating system updates that need to be installed to a medical device. These are made by the company that programmed the main operating system (such as Microsoft) and released generally every month. Then, finally, there are system upgrades. This is where the application and operating system will be updated to newer versions. A good example of this is the upgrade from Windows 10 to Windows 11. The entire software of the computer is replaced with a newer version offering more features, better usage of hardware, and more functionality. This usually is accompanied with an application upgrade from the medical device manufacturer. Upgrades happen around every 3 years. The client end computers (used by the medical staff) can usually be updated automatically, but most still need to be verified after the upgrade. The server updates must be manually deployed and inspected to prevent service interruptions. Preferably, upgrades are tested on a system that is not being used or in a simulated VM environment called a Sandbox. We will have to explain Virtualization in a separate article due to the complexity and flexibility of this concept. More on this subject will follow this article. Let’s just say that there is something to update every month, and this is all the responsibility of the ISBESS. All this work is performed while maintaining other corrective repairs and installs. Just maintaining and updating the software can take up to a third of an Info Sys job tasks.
THE FUTURE OF AN EVER-CHANGING FIELD
We will have to change. Telehealth is an example of a grey area. It involves home health, IT, and biomed. Smart phones and Software as Medical Devices (SaMD) aren’t even a consideration to the average Info Sys right now. HTM will probably not touch a system unless it is directly dumping data to one of our machines. If it is Internet-based or cloud-based, or it its EMR related, then that is maintained by IT. We may only work on a back-end server and not the actual device or the software that is the source of the information. There really is no way of knowing what is around the bend, but we know it will involve IT and biomed working together in the future. This is before we involve new technologies from companies like Meta and Google, Cloud and AI applications. Stuff like that is best for another article.
When describing the Info Sys position, I found myself saying “another article” often. This is proof that Info Sys is an exciting and somewhat confusing hybrid position. It is something that most HTM professionals do not understand. As a testament to the Information Systems BESS, this article references no less than 6 other articles. That is a record in cross referencing for the Networking Notes team. That really means that it took the entire team at the Dallas VA team more than half a year of monthly articles to describe what the Info Sys does. That’s how multifaceted the skill set is to do this job. Therefore, if you have that ISBESS network wizard or Info Sys guru at your work, please thank them for all that is done behind the scenes to do their job. Honestly, they deserve it.
