TechNation invited several industry leaders to share their insights regarding patient monitors in this roundtable article. A trio of experts accepted the invitation to share information with our readers regarding some new features HTM professionals should be aware of as well as cybersecurity concerns and more.
Participating are ReNew Biomedical’s Biomed Director Neil Davidson, Medical Equipment Doctor CEO Albert Negron and Southwestern Biomedical Electronics Vice President Larry Neilson.
Q: What are some new features biomeds should seek out when a facility purchases patient monitors?
Davidson: Data transmission is important on any new piece of equipment. Assuring that the unit’s software is compatible to EMRs is always pertinent when preparing for a change. New technology displays are featuring useful reporting capabilities for service technicians. Ask for a sample of the reporting technology. These “smart” units have the ability to tell you what is wrong and where to look first. Both are helpful when the units are desperately needed and you are in a time crunch. Plug and play technology makes any unit easy to use so look for that. Remember to ask questions such as: Is it easy to do software updates on the units? Is it configurable to meet the needs of the medical practice? Does it have a battery backup and what is the lifespan of the battery? (Be aware that touch screen technology may bleed the lifespan of battery backup.) Touch screen versus button technology may present different challenges too. Is there a simple preventative maintenance plan for the unit or does the unit need a OEM-certified technician to do the work?
Negron: Integration ease with hospital electronic health records, ease of calibration and clear cyber protection plans. We are currently in an integration environment which allows departments to function more effectively. A product that can deliver more health information into the patient’s medical record would be ideal for the access and patient flow within a health care organization. Non-invasive blood pressure calibration during preventive maintenance on certain monitors is not an easy process and biomeds should have a clear procedure to get it completed. A clear cyber protection plan that is innovative and developed for future vulnerability mitigation is another feature that should be considered. Patch management, configuration management and virus protection should be detailed and put into a plan by the manufacturer to reduce the cyber risk.
Neilson: In a perfect world, a facility would replace all patient monitoring from ER to all critical care areas at the same time, but that doesn’t usually happen. Look for compatibility with what other areas are using. Look for improved patient vitals that are not on previously owned equipment and if these features are needed in every area to be populated with new equipment. Make sure to purchase equipment that can use currently stocked accessories as this can be an unforeseen headache if not considered early. Today there are more choices in pulse oximetry, meaning different OEMs can be installed in newly purchased equipment. Nellcor and Masimo are two that come to mind for oximetry and are available in most manufacturers.
Q: What measures should be taken concerning cybersecurity?
Davidson: Nothing could be more underrated than the importance of cultivating a good working relationship with the IT department. Having an open line of communication with the OEM service department will also go a long way to resolve issues fast. Most newer models have software that requires updating periodically. It’s important to follow through on those updates because most manufacturers are offering solutions before problems occur.
Negron: Cybersecurity is like predicting the future and being innovative enough to anticipate future vulnerabilities. Developing a product that has reduced remote access to limit vulnerabilities or a product that can be networked to include intrusion protections. Patch management and clear instructions on what needs to be done as operating system updates are released. Education to the risks should be provided and MSD2 forms should be reviewed during the incoming inspections. A cybersecurity plan should be developed for each network-capable device and tracking of cyber protection activities should be documented.
Neilson: Cybersecurity is a serious consideration and will need to be addressed by the facility’s IT specialists in-house or otherwise.
Q: How can biomeds help extend usefulness of an older patient monitor?
Davidson: Yearly cleanings of the internal and external components of your units will certainly extend the life. Replacing the coin cells and batteries on a yearly basis or sooner will ensure that there is no unexpected down time. Make sure that your biomed staff has access to all of the product manuals and each book is open to assist when necessary.
Negron: Resource management and establishing relationships with parts/service vendors that can supply the refurbished parts needed for continual service is key. Knowing the difference between “end of life” and “end of service life” is also an important aspect of extending the usefulness of a patient monitor. Providing assessments on an annual basis that consists of contacting vendors and getting par levels on parts that are high volume replacements.
Neilson: A regular maintenance schedule is the best way to extend the life of most monitors. If equipped with a cooling fan, that will need to be replaced as will any display using CCFL back lighting, and usually only the light bar. If kept clean and maintained, monitoring can run for years. In many opinions, too long as parts will eventually become an issue.
Q: With systems transitioning, how can biomeds ensure that monitors are compatible?
Davidson: Never underestimate the value of research. Many OEM sales technicians can answer your questions before you sacrifice your budget on a unit that is not compatible with your EMR or other medical devices.
Negron: Standardization of medical device manufacturers is always the proper approach for integration and compatibility. It also ensures that the clinical staff remains educated and it reduces the risk of errors. It’s also important for biomeds to know the back-end technology (networking) and how it can be integrated so the proper decisions are made when there is transition.
Neilson: The only way to ensure compatibility is through testing. If the sales presentation says it is compatible and the literature says it is compatible, it still needs to be tested for peace of mind. Can a new device be swapped into the position of an older device? Will all cables (video, communication, PS, other) work without having to use adapter after adapter to make it work?
Q: What are the most important things to consider during a PM?
Davidson: Invest in top quality testing equipment. Do your due diligence and check every box suggested by the OEM when testing. Keep clean documentation and file it away with the product’s serial number and additional materials. Clean the units with safe and gentle solutions. If you are outsourcing your service, make sure that your company of choice is ISO certified. Quality equipment can only stay in excellent condition if it has been serviced properly.
Negron: PMs should always be conducted as close as possible to the real time operation. For example, ask the end user or clinician how the device is used and then perform your operational test to their settings. Manufacturer specifications and PM procedures can still be utilized but trying to re-enact a daily function is ideal. AEM programs should be developed with this intent.
Neilson: It has been our experience at SBE Inc. that thorough cleaning can be one of the most important things done during a PM. If batteries are used in the device, they can be a problem waiting to surface if left overlooked.
Q: What else do you think TechNation readers need to know about purchasing and servicing patient monitoring devices?
Davidson: Take the time to do your homework and do your best to foresee the work arounds of ever-changing technology. Ask about the manual overrides, warranties or OEM service department contact numbers in case they are needed for future use. Saving all of that information in one file folder will go a long way in securing accurate information fast. Don’t forget how valuable that information can be in increasing the resale value of the unit. Consulting your service team when purchasing units will help to answer many unforeseen problems with new equipment. Most technicians have enough experience to assist any buying agent through a necessary equipment purchase. Allowing a service technician and a medical professional to test drive a unit before purchase should answer most questions ahead of time. Renting a new unit can also save money and worry. No one wants to make the wrong decision, and many need more information than what the product manual provides. Our motto is, “It never hurts to ask.”
Negron: Servicing procedures should be changing with technology. There are new risks associated with new technology. It is important to think outside the box and develop plans that are innovative and creative. Patient safety should always be a top priority and now that includes physical and personal protection from cyber risks like identity theft.
Neilson: At the time of purchase will be your opportunity to secure multiple technicians receive manufacturer training on use, maintenance and service. At this time, service documentation should be secured by the facility. And, of high importance, software updates must be included in the purchase as well as the reason for the updates, which are often not disseminated to the user.
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