By K. Richard Douglas
George Orwell died in 1959 at age 46, but his final novel “1984,” which was finished in 1949, would prove profound in many ways. Many elements of the book look very familiar in 2020. Orwell’s ability to look into the future with such accuracy is unnerving.
While the British novelist let his imagination create fiction that provided glimpses of the technology familiar today, the ability of most people to get the future right comes out of educated guesses and the observation of trends.
Looking into the future, with the help of several members of healthcare technology management (HTM) leadership, allows for some speculation along with accurate predictions based on current knowledge.
What will the future of the HTM profession look like? Technology will continue to advance and the skill set of the average biomed will need to continue to adapt. There will continue to be more cross-over with IT – networking skills and cybersecurity knowledge will be important.
Will HTM own 100 percent of the product life cycle in every facility?
Will any final rules from the FDA change the direction of HTM? Will national standards be adopted? Will the efforts to generate interest in the field among high school and college students succeed? Will continuous advances in medical technology change the nature of the job? These are some of the questions the HTM field faces.
Human resources will continue to be a challenge and future FDA rules could change procedures.
“I believe we will be moving past alternative maintenance practices and progressing to more maintenance practices based on specific clinical operational needs of an organization as well as infection prevention-focused activities of the equipment. I also see IT skills being more of a mandatory skill set and the compensation practices moving out of the shadows of the IT industry,” says Matt Royal, MS, CTM, CHSP, CHFSP, CHEP, CHTM, CLSO-M, CHC, CHFM, CBET, director of biomedical engineering at Eskenazi Health in Indianapolis, Indiana.
“HTM will also need to evolve into more clinical education activities; there is a need for HTM professionals to assist clinical staff with application support on a regular basis. The importance of HTM is going to be a larger investment by an organization and those larger organizations with more resources will look to move away from third-party service companies to in-house programs with more flexibility for customization of services,” Royal says.
Mike Busdicker, system director of clinical engineering at Intermountain Healthcare in Salt Lake City, Utah says that over the past 20 years, the level of change in HTM has been accelerated by health care reform and the advancement of technology.
“HTM must be positioned to evolve into the future by addressing past, current and future changes facing the entire health care industry. This means we need to be more than an equipment fix-it shop located in the basement and will require involvement of personnel across all levels. Also, HTM staff will need to stay on top of technology advancements and continue to grow personally and professionally,” Busdicker says.
Gregory Herr, BSEE, MBA, CCE, CHTM, Director of Healthcare Technology Management with The Christ Hospital Health Network in Cincinnati, Ohio, says that he has been in the field since the mid-1970s and has watched HTM evolve from an electronics (some mechanical) support to today’s multi-specialty programs. He says the evolution has resulted from the needs and requirements of the provider and requests of clinical users. Through training and supporting systems, he says that HTM has been able to offer these services in a cost-effective manner with reduced or no service agreements.
“Going forward, HTM is actually moving out of this ‘cost savings’ mentality – still a requirement, but not the only requirement – to actually support systems that require HTM support, along with IT, facilities and, of course, OEM/vendor support. The opportunities for HTM will depend on the situation of each provider (size of hospital, patient acuity, procedures performed, etcetera) and since no two hospitals are the same, we can expect some variation in support models,” Herr says.
“HTM needs to become the ‘technical owner’ of a health care’s medical systems, providing the long-term planning for capital budgets, expense budgets, recall/alerts, incidents, recommending if more or less systems are needed, and closely partnering with the clinical service or business owners. We must be in sync. Then, add IT and facilities overlap, HTM needs to be elastic with the ability to adapt to change, and not be left behind. Change is inevitable and HTM needs to keep preparing for it,” Herr adds.
Will there be a fusion of HTM and IT that coalesces the departments together? It is possible according to Matthew Kenney, CHTM, director of HTM/biomed at Aiken Regional Medical Centers in Aiken, South Carolina.
“Every year, it seems we get further and further into the IT world. I think, in the future, HTM will be even more intertwined with IT to the point that a basic requirement will be to have networking experience,” Kenney says.
“It is possible to see HTM and IT become one and share one office space and work even closer; side by side. With just about all new equipment going into EMRs in this day and age, I see a lot more service calls for equipment not communicating. With IT by your side, the troubleshooting would be more flawless which would help in keeping the equipment online and allow nursing to focus more on patient care,” Kenney adds.
Part of the evolution of HTM may be closer collaboration with clinicians.
“I feel that in order for HTM to continue our contribution in patient care, we need to be on the front lines with the clinicians. Transitioning from a break/fix support model to a real-time collaboration model at the bedside. I am sure everyone in the profession has repaired their fair share of ‘broken’ equipment, we need to fix the ‘broken,’” says Neil Feldmeier, MBA, CHTM, director of biomedical engineering for Norton Healthcare in Louisville, Kentucky.
Maintaining an Adequate Workforce
One of the biggest concerns in HTM is the question of adequate staffing. A generation of biomed professionals have retired in recent years and training new biomeds to replace them presents a challenge. With fewer training programs nationwide, and the obscure nature of the profession, the number of trained applicants to replenish a departing and knowledgeable workforce is difficult at best.
According to AAMI, 60 percent of those in HTM are over age 52. This portends a mass exodus from the field in the next decade. With only 400 new candidates graduating from HTM training programs nationwide each year, the effort to replenish retiring biomeds will be challenging.
One answer to the shrinking HTM pool of candidates is AAMI’s “HTM in a Box,” which is an initiative to bring the career field to those in middle school, high school or college and adults. The online resource brings the profession of HTM to an audience of likely candidates.
The online resource can be used when presenting to any of these groups and provides an oversight of the profession. The adult presentation can be tailored to the group that is the audience for the presentation.
The AAMI “HTM in a Box” presentation slide deck can be found at: https://www.aami.org/htminabox.
The AAMI effort is one reason Matt Baretich, PE Ph.D., president of Baretich Engineering Inc. in Fort Collins, Colorado, is optimistic.
“I’m a baby boomer myself and, although I’m not planning to retire any time soon, there is a genuine need to bring more professionals into the HTM profession. But there are hopeful signs. AAMI is doing great work with its #IamHTM and “HTM in a Box” initiatives. It’s no longer remarkable to see women at every level in HTM. Creative alternatives to traditional education are getting off the ground,” Baretich says.
Even before the departure of many of the senior technicians and managers, there exists tighter resources as departments try to make due with constrained budgets.
Busdicker suggests that concerns about a thin candidate pool might be replaced with a focus on tweaking available resources.
“The first thing a department needs to do is work smarter and not harder,” Busdicker says. “We need to think outside the box and look at the overall operation of the department. Ask questions like: Are we doing things we shouldn’t be doing? Can we eliminate waste or inefficiencies that will allow staff more productive time?”
“Sometimes we go straight to the need for more staff when the issue could be resolved through creative thinking or refining work flows and processes,” he says.
He also suggests being proactive and not reactive when staffing a department.
“Understand your staff and talk with them about the future of the department and the organization. Every HTM leader should have a succession plan for their department(s) along with understanding the future of the HTM industry. Success planning can fill the voids created by staff moving on to other opportunities or retiring after a successful HTM career,” Busdicker adds.
Feldmeier says that his department has established connections with local colleges to provide shadowing and co-op opportunities.
“This is building serious excitement with the students that we have worked with so far. This should help increase word-of-mouth about the profession,” he says.
Royal says that with the exception of two in his department, most of the baby boomers have retired.
“When a retirement was expected, we removed routine work for those employees such as PMs and some repairs and had them focus on knowledge transfer and training a back-up or replacement,” he says.
“Management has also advocated for a robust training budget, not only to close the skills gap, but to help with employee satisfaction and retention. The team has also had formal IT training classes presented on-site to promote IT certification. Job descriptions were also added to allow for an IT designation which the HR department allowed for an increase in pay as incentive. We also have created positions that are meant for succession planning such as a biomedical/imaging hybrid to back fill vacant radiology repair technician roles,” Royal adds.
Royal says that the HR department also has offered customer service classes that focus on difficult conversations and leadership classes that have developed leadership skills in higher level techs.
“We have also utilized interns and volunteers. We have agreements with a local university, high school and a program through the hospital foundation. Our goals with interns and volunteers is to have them job ready at the end of their program as they would be a potential hire for open positions,” he says.
Many changes throughout culture come from government. New regulations and rules are passed into law to enforce safety standards or standardize procedures.
“The techniques we have developed for AEM programs will become standard practice for all planned maintenance (PM). We can save time and improve equipment safety while staying in compliance with regulatory and accreditation requirements,” Baretich says.
“Following the 2012 edition of NFPA 99 Healthcare Facilities Code, adopted by CMS and accrediting organizations like The Joint Commission, we’re finally starting to see the end of routine electrical safety testing,” Baretich adds.
Addressing the Threat
Cybersecurity was once the province of specialized departments in the Pentagon, major intelligence organizations and home and business anti-malware software.
As criminals have become more sophisticated, health care organizations have become a more frequent target. This has required the involvement of HTM with the growing number of connected devices and those storing patient information. This reality has positioned HTM, alongside IT, in the trenches to secure their facilities.
“In order to reduce the cybersecurity risk and threat to health care organizations and patients, the HTM department must be involved at all levels. This will require an understanding of existing vulnerabilities, implementation of security controls, ongoing monitoring of risk, and knowledge of threats by all staff,” Busdicker says.
He says that the HTM department will need to be involved with the continued education and ongoing monitoring of medical equipment cybersecurity for all caregivers in the health care facility.
“Also, the department will need to ensure all data and information related to medical equipment cybersecurity is up to date in the asset record and be able to quickly identify devices when threats are published,” Busdicker adds.
The future of HTM and its cybersecurity focus can include a vigilant approach along with more hybrid specialists.
“I think HTM is another advocate for the information security officer and program. HTM frontline staff might spot a vulnerability or poor security practice. HTM can also offer mitigation solutions such as encrypted USBs or outdated operating system. Some devices may need to be removed from the network or disabled such as USB ports or network ports,” Royal says.
Herr says that cybersecurity is still an evolving area and his department has developed a specialist to work alongside their IT counterparts.
“Our department has been able to develop an HTM cybersecurity specialist to work with IT’s cybersecurity team. This position helps keep HTM aligned and knowledgeable about what the enterprise cybersecurity effort is planning/implementing. Several of us, including the HTM specialist, sit on various committees run by Compliance and IT Security to address the medical systems,” Herr says.
Herr says that HTM’s role is also to educate those who may not be familiar with current medical device security limitations (e.g. patching, virus protection, etc.) and help them understand what can and cannot be done using their tools.
“Also, we work with the vendors/OEMs to make our requirements known as new systems are purchased. Everyone in HTM will need to become better educated in the cybersecurity and IT processes, IT will become the new electrical safety, and until OEMs have developed standardized processes for medical systems, then HTM needs be on the frontline to protect the patients/customers,” he says.
“HTM needs to ensure we have all of the operating systems, firmware, IP addresses and MAC address documented in their CMMS to be able to track where they may be vulnerable when alerted to a possible attack. This will lead to a quicker response and hopefully safeguard against any and all possible attacks,” says Kenney.
Taking on More Responsibility
Biomeds already serve a purpose in health care that is critical and is directly instrumental in patient health and well-being. But, in the future, the role of the biomed will expand, in part, because of technology, security and resources.
“HTM must continue its transition from stand-alone medical systems to networked systems. Many of these systems are in a grey area. Are they under IT, HTM or even Facilities? HTM should not be afraid to take on systems that are both clinical and medical devices, or those that are essential to the medical device’s capabilities,” Herr says.
He says that each HTM department works in a unique environment, and the opportunities vary.
“Chose those opportunities that HTM can provide clear benefits. For example, support is a challenge for IT to deliver on medical systems because IT may try to fit medical device support in the same bucket as its EMR. Medical devices often require onsite support at the bedside, operating room or other patient care delivery area. IT support models are geared for enterprise support, not necessarily an individual user standing at the bedside performing a procedure,” Herr adds.
Busdicker says that, in his opinion, the advancement of technology will continue to move at a rapid pace and will require more involvement from HTM.
“This will include the use of medical equipment in the home, wearable devices and more outpatient treatment settings. This equipment will require HTM to become more mobile and adapt to work outside of the acute care setting,” he says.
“Over the years, I have seen things like nurse call systems move from sole responsibility of plant engineering to a combined effort of information systems, HTM and plant engineering. Each department plays a role in the service and maintenance of the system. This trend will continue and involve even more departments like pharmacy, laboratory, materials management, telemedicine and home health,” Busdicker adds.
Biomeds will continue to have an increasing role in every consideration throughout the device life cycle.
“HTM needs to be involved more and more with the equipment life cycle process. This includes having access to capital funds to efficiently apply medical equipment technology. Cybersecurity assessment will also increase. We need to ensure that proper software patching is applied and equipment that is selected for use in the facility has been vetted for potential risks,” Feldmeier says.
“We are also trying to find new ways to provide HTM services. We have a very repetitive profession, every year we have to climb the same mountain. How can we add a few more destinations in our yearly journey that actually re-energizes the team? The utilization of a solid AEM program should provide some breathing room and introduce some changes that allow for a change of scenery,” Feldmeier says.
In what areas might HTM work more closely with other departments?
“One of the major areas of collaboration is design and construction. HTM needs to ensure that utility specifications on replacement equipment and renovations meet higher standards for power quality and water quality if applicable,” Royal says.
“Another area that HTM can work closely with is the infection prevention and environmental services team (EVS). EVS often covers more ground than the HTM department and help with locating or reporting equipment issues such as bed cables or damaged devices. Offering education from HTM to EVS is also impactful for infection control to ensure equipment is cleaned appropriately,” Royal adds.
Orwell may have predicted “big brother” in his fictional tale, but he may not have foreseen the complexity of medicine, medical devices and the health care environment in the future. That is left to HTM leadership, who must look at trends and educated guesses to ensure the role of the HTM professional is fully utilized.
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