By Steven J. Yelton
One of the nuances within the hospital environment is the interaction of HTM and IT. We have written in the past about the CE-IT technician sometimes called the HTM-IT technician. We have described the need for this profession and also the training required for the position. I felt it would be helpful to define HTM and IT and discuss where they do and don’t converge. My colleague, Greg Herr, and I have been discussing this subject and getting the message out within our organization to help people understand the mission of the HTM-IT collaboration. The following is an overview of our structure and training.
Clinical engineering is now often referred to as Healthcare Technology Management (HTM). HTM works in the world of the medical device/FDA environment and systems closely aligned with these systems.
Information Technologies (IT) structure has different types of information services; hardware (server, desktops, printers, network services, software applications, interfaces, etc.). Applications vary from clinical applications, to business (financial, revenue stream, purchasing) across the enterprise.
In our world, where do IT and CE converge?
These converge when medical devices/systems are both a medical device and an IT system, or component of an IT system. If the system is an FDA-approved device/system or is critical to the clinical department work, often these devices/systems will fall into clinical engineering. This requires the knowledge of both medical systems (biomedical or imaging) and IT (various fields). Devices integrated into the Electronic Medical Record (EMR) or other IT-type system (PACS, EKG, etc.) require a skill set to work with the clinical staff, OEM and IT staff. These staff members must also understand budget impacts.
IT services tend to handle non-FDA devices and/or services. Typically IT services are geared around non-medical technology, often referred to as IT devices or systems. IT usually uses a “Help Desk” access number or site to provide user access to a knowledgeable staff person to answer questions. Service and repair functions are usually secondary.
CE and IT departments converge on the area where medical systems and IT systems converge. Physiological monitoring, imaging equipment, cardiology information systems, PACS and device integration are a few examples. Medical devices and the HTM field are constantly changing. We will see more changes with advances in home health, tele-health and other remote access technologies.
Where do we see HTM and IT not converging within our organization?
Stated simply, where devices are not IT or computer based.
The following are some examples: Surgical beds, surgical lights, general biomedical devices, electromechanical devices, probes, endoscopes and hydro-mechanical systems. Probably 60% of the biomed technology does not communicate to the EMR or is not able to be integrated. Ten years ago, it was 70% and 35 years ago, only very proprietary networks and systems sold by OEMs were networkable (in the sense of what was a network back then).
HTM is a call and dispatch operation. If users have a problem, they usually need to get an immediate on-site response by HTM. A typical situation is the patient may be on the table, or patient work may be delayed. IT is generally a “Help Desk” where the questions and answers are initially directed, and if they cannot answer, then someone may be dispatched, or more likely call and ask if they can log into the system.
HTM generally is less siloed and more horizontally integrated. Major groups in our HTM department are biomedical systems, imaging, CE-IT, laboratory (outsourced in our case). Other areas HTM may take care of in some hospitals are nurse call, patient beds, sterilizers, laboratory equipment and “central management of equipment dispersion” (central service).
More and more equipment is being integrated into the EMR or other hybrid systems. CE must be able to communicate with clinical users, vendors, IT, management and understand the legal and regulatory environment.
How do we attain training for these persons? What do they need?
We have found that these technicians and engineers require biomedical and imaging backgrounds, IT knowledge, as well as mechanical and electrical knowledge. In addition, much equipment runs on software and hardware systems, so they must also be software aware.
We have found that we have our best success when our HTM technicians start out with a solid background and training in HTM. This is usually an associate degree in HTM or a similarly named program. From there, they may have background and training in imaging systems. We then suggest that they return to school on a part-time basis to complete training in a computer-networking program. With this training, in addition to the experience they receive on the job, they become a very valuable resource to the organization.
Steven J. Yelton, P.E., CHTM; is a senior HTM engineer at a large health network in Cincinnati, Ohio and is an HTM professor at Cincinnati State Technical and Community College. He is Chair-elect of AAMI’s Board of Directors, AAMI Foundation Board Chair, former Chair of AAMI’s Technology Management Council (TMC), Chair of AAMI’s HTAC Committee, Accreditation Board for Engineering and Technology (ABET), Board of Delegates and Board of Directors, World Seniors Golf Federation.
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