iHT2 Health IT Summit in Phoenix 2013 – Ken Maddock, VP Facility Support Services, Baylor Health Care System Case Study, “Maximizing the Value of your Healthcare Technology Management Program”
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iHT2 Health IT Summit in Phoenix 2013 – Ken Maddock, VP Facility Support Services, Baylor Health Care System Case Study, “Maximizing the Value of your Healthcare Technology Management Program”
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iHT2 Health IT Summit in Phoenix 2013 – Ken Maddock, VP Facility Support Services, Baylor Health Care System Case Study, “Maximizing the Value of your Healthcare Technology Management Program”
- 1. iHT2 Phoenix, AZ Maximizing the Value of Your Healthcare Technology Management Department Kenneth E. Maddock, VP Baylor Health Care System
- 2. Founding Statement “Is it not now time to build a great humanitarian hospital, one to which men of all creeds and those of none may come with equal confidence?” Dr. George W. Truett, 1903 Co-founder Texas Baptist Memorial Sanitarium, predecessor of Baylor Health Care System George W. Truett (In His World War I Uniform) 2
- 3. Circle of Care Guided by Baylor Values Integrity Servanthood Quality Innovation Stewardship 3
- 4. Baylor Health Care System – By The Numbers • Faith-based, not-for-profit health care provider based in North Texas • 30 owned, leased, JV, or affiliated hospitals • 196 HealthTexas locations • 81 Satellite outpatient facilities • 122,000+ admissions • 20,000+ babies born • 409,000+ emergency department visits • 603,000+ outpatient registrations (excluding ED and home care) • 3,653 licensed beds • 21,000+ employees • 3,200+ physicians on active staff • Largest hospital has 1025 beds; smallest community hospital has 69 beds 4
- 5. Technology Infrastructure: Responsive, Reliable, & Scalable • 2 Primary Data Centers • 1200+ Virtual Desktops, 40 virtualized • 2 Secondary Data Centers applications • 13 Satellite Remote Campus • 19,000+ workstations and 6,505 printers Communication Centers • 65 wireless controllers, 3100+ WAPs, • 150 Midrange Platforms supporting over 8,000 clinical wireless • 2 Robotic Tape Silos devices & 2,500+ guest users daily • 3000 tapes per silo and 300 • LAN – 390 FON closets, 78,000 terabytes of spinning disk Network interfaces , 2,308 switches, 179 routers, 501 Uninterruptable Power • 200 to 1600 GB per tape Supplies • Moving to Virtual Tapes • Speeds of LAN transmission: • 36 Actual Tape Drives In the two 100/1000/10000 megabits per second Primary Silo’s. • WAN – T1, Opteman, GigaMAN • Disk capacity with some form of RAID • 2, 1GB internet connections, dual ISPs • 2 Storage Area Networks (1600 • 28,600 phones (TDM & IP) Terabytes) • 7,700 centralized voice mail users • Imaging storage (2284 Terabytes) • 61,000+ biomedical devices • Total DAS and NAS • 38,000+ Exchange email accounts (1319Terabytes) • 2350+ Windows and Linux Servers • 235+ Citrix Servers Architecting future technology solutions to assist clinicians in improved clinical outcomes 5
- 6. Who or what is Healthcare Technology Management? • AKA Biomed or Clinical Engineering • Strong clinical and technical background with a focus on patient safety and customer service • Equipment installation, repairs, preventive maintenance, technology assessment, clinical equipment safety… • Small team; BIG BUDGET, SCOPE, and RESPONSIBILITIES 6
- 7. Healthcare Technology Management at Baylor • 64,000+ biomedical devices with a purchase price of $650,000,000+ • Directors – Biomedical Engineering – Imaging Support • Managers – Clinical Technology – 5 Biomed Managers – 1 Imaging Support Manager • 2 Clinical Engineers • Biomedical Equipment Technicians – 11 Senior BMETs – 25 BMETs • Radiology Equipment Specialists – 2 Senior Radiology Equipment Specialists – 14 Radiology Equipment Specialists 7
- 8. What Makes Healthcare Technology Management Tick? Healthcare! Involvement! Recognition! 8
- 9. How can they help you? • Include HTM leader in IS leadership meetings • Learn from their customer service skills • Learn from their cost-savings ideas • Take advantage of their medical equipment management database • Drive efficiencies 9
- 10. How can you help them? • Include HTM leader in IS leadership meetings • Help them manage their database • Help them develop more effective processes • Help them with project management and governance • Help them with the nuts and bolts of financial management • Help them to manage security on medical devices (not just cybersecurity-HIPAA!) 10
- 11. Interfacing Integration 11
- 12. BIS Perspective 12
- 13. The Evolution Biomedical Engineering <> Information Services • Prior to 1990 - We chatted about our hobbies • 1990 to 2004 - We worked independently, sometimes competitively • 2004 through today - We are unified Evolution of Biomedical Engineering • Initially device oriented • Devices became “smarter” • Devices were networked Evolution of CIOs • What’s Biomed? • What are they doing with our equipment? • They want on our network? • Why can’t we work together? 13
- 14. What kind of talent would you want? It’ll take a rocket scientist 14
- 15. No, it’ll take a brain surgeon 15
- 16. Actually, it’ll take a rocket surgeon 16
- 17. Strengths – A Biased Perspective Healthcare Technology Information Systems Management • Networking • Broad and specific • Application creation, knowledge of medical adaptation, and devices optimization • Regulatory implications • Governance of medical devices • Project management • Direct involvement in • Collaborative computing Patient Safety activities and interoperability - • Customer service interdependence • Sensitivity to clinical operations • Independence 17
- 18. Common Characteristics • Patient-oriented • Comfortable with technical complexity • Difficulty understanding those who are not comfortable with technical complexity • Need for high availability (.99999 or better) • Not always well understood by their peers • High marks on the “eccentric index” 18
- 19. Experiences: The Good, The Bad, and the Ugly • Separate networks for biomedical equipment and data • Medical equipment closets not designed for equipment • Getting a wireless policy into place – Impacts behaviors in areas with medical devices (rationale for development of WMTS) 19
- 20. Experiences: The Good, The Bad, and the Ugly Clinical Engineering Information Services • Change control • Awareness of clinical • Financial controls connection • HIPAA • Focus on processes to • Security the detriment of customer relationship – Governance – Project management 20
- 21. Experiences: The Good, The Bad, and the Ugly • Much of the good prevails – Help Desk – Clinical Sensitivity – Modifications to financial processes – Value of project management – Shared culture and shared vision – Awareness on both micro and macro levels related to medical and information technologies • New good is created – Understanding, appreciation, and admiration – Co-location – Professional development – Communications and internal marketing – Synergy necessary to improve availability (.99999) – Economies of scale and increased access to resources – Innovative solutions! 21
- 22. Advice on Management of Shared Organizations • Honesty • Deliberate and managed interactions • “What can I do to help you be more effective?” • Integration (or not) of processes and technologies – Governance – Budget management – Professional development – Supply chain processes – Help Desk functions – Escalation procedures and policies – Project management • Recognition programs 22
- 23. Convergence must be real and deliberate rather than an illusion. 23
- 24. 24
Notas do Editor
- Hardwiring STEEP. In our organization this primarily refers to building solid processes that support STEEP. But we also see it as building an infrastructure that provides our clinical staff with the maximum opportunity for success. We like to think of it as Dial tone! You don’t have to think about it, it’s just always there. When there is a disaster you still pick up the phone and expect to hear a dial tone (unless of course it’s one of those horror movies and the bad guy snipped the wires!! We have had our own horror stories and I’m sure most of you have as well. But we feel comfortable that we are providing a solid, dependable infrastructure.
- We have been known by many names over the years, most of them even repeatable in polite company! Recently a group of people representing just about every area of healthcare technology management got together to talk about the future of the field. Included in that discussion was talk about how we could better represent what we do in a manner that could be used consistently throughout the industry. The name that was proposed was Healthcare Technology Management. I’m not going to go into a lot of detail on this, but I promise you will hear that name more and more. I’m trying to remember it myself, so if I slip up and call my department biomed or clinical engineering you can call me on it!For those of you who don’t know, healthcare technology management technicians (current referred to as BMETs, biomedical equipment technicians, and they still will be as the name of the field is what is changing, not job titles) typically are educated in electronics, and more and more in information technology. But what makes them different is that they are also educated in anatomy and physiology and the application of technology in clinical care. I often have said that the best BMETs could just about step in and do the clinician’s job. It’s that knowledge of clinical care and the technology that the clinician’s use that sets them apart and lets them do a unique job. Typical jobs from slide.This is truly a unique department. Typically it is a relatively small department. But when you look at the scope of what they do it’s truly remarkable. They have responsibility for providing support for equipment that keeps people alive. They also support lots of non-life support equipment of course. But another interesting thing is the scope of the budget. You may have a 5 person department with a budget of over a million dollars if they support all equipment.
- They are extremely passionate about what they do and understand their positive impact on patient care. In fact, it is not uncommon for members of this department to feel that no one cares as much about the patient as they do. They are typically considered a great resource by the clinical staff. But because they are limited in number and what they do is typically behind the scenes and often unnoticed, they can have a bit of a chip on their shoulder about the lack of recognition for their contribution. Although they are talented professionals and indispensable to the organization, their appearance, dress, and actions do not always make it obvious that they belong in the professional class. To a large extent this is not their fault, as the need to do work that can be messy keeps a suit and tie from being a viable option. With some exceptions they are much more comfortable interacting with equipment, systems, and front-line staff than with members of the management team. They are literally lifesavers in their ability to confront difficult situations and develop innovative solutions to complex problems. Yet at times they can find it difficult to focus on the routine tasks that if performed properly can help to prevent some of these difficult situations from developing. Because of their passion and their belief in their own skillset and talent, they enjoy getting involved outside of their normal activities. Feeling like they are contributing to the greater good is a huge motivator for this group.The most important thing to do is to recognize and to make sure they know you recognize the value of what they do. They serve a critical, often underappreciated service to the organization and letting them know that you appreciate what they do is a great first step towards building a strong relationship.
- Include their leader in your leadership team meetings. This accelerates the feeling of teamwork that is critical to the success of your combined team, and again, makes them feel appreciated. The biomed department leader may also surprise you with what they bring to the table. One thing that almost all clinical engineering departments do very well is take care of their customers. Use their practices and ideas to help improve customer service throughout your department. They understand the importance of the equipment to the customers and that shows. They do everything they can to help the customer do their job. With that said, there are also some consistent problems that HTM departments have. The techs aren’t always the best at communication. They feel that doing the job is the important thing. Well, it is, but as we all know from our own personal situations, understanding what is going on is important too. So HTM and IS can learn together how to effectively communicate status to our customers. The clinical engineering budget is ALWAYS under pressure. Always has been and always will be. So they typically have a lot of experience with finding ways to cut costs while maintaining a high degree of quality and customer service. Just be prepared that they will push you hard to drop your service contracts. And they may be right. You need to challenge some of your paradigms. But that discussion is probably a topic for another session!Because of the strict regulatory focus on medical equipment, HTM departments have to have detailed databases. They keep good (not perfect) track of inventory. They keep detailed records of all of the work they do. Failure types, types of fixes, costs, parts used, etc. Because of this a strong manager can get great data. Data that can be used to drive improvements. You might want to consider tapping into that database if it is compatible with your needs. You may be able to do things with data that you have never done before. Another area which our organization has only tapped into minimally is driving efficiencies. One obvious example is with Field Support. Although Field Support is not trained to work on medical equipment and shouldn’t take on tasks associated with medical equipment that have a lot of risk, they can certainly pick up broken equipment if they are in the area, and they can be trained to do simple repairs on lower risk equipment. By the same token, biomedical equipment technicians can certainly be trained to take on tasks that Field Support traditionally performs. You certainly need to step into this area carefully and move forward methodically, but it is an area where significant efficiencies can potentially be gained.
- You will notice that when I talk about how you can help them, many of the topics are ones where I said they can help you. That is because many strengths are also weaknesses, and HTM departments are no exception when it comes to that issue. I mentioned earlier that the HTM leader can help you if you include them in your leadership meetings. But doing so will help them as well. It will help their development as a leader and expose them to more of the big picture. I mentioned earlier that the HTM database is a strength, and using it may prove to be of great benefit to you. But in general HTM personnel are not database experts. They muddle through, but the database could be much more effective if you provide them with the assistance of your database experts. They may be able to help it to run more effectively, and can certainly help them to create more effective reports. I am lucky in that I have a manager who has significant strength with databases. But even he benefits by reaching out to the real experts in the department. Working with those experts he has been able to create much more effective queries. We have a great deal of reports that are emailed directly to the management team without requiring them to run them manually. These reports are well-written, providing them with the information they need to run the department. Many of them won’t even be sent if there is no data. For example; we have reports that look at fields of newly inventoried equipment. If important information is missing, the manager gets a report with those fields highlighted. But the best part is that if their staff are thorough they don’t even get a report. Provides them with an incentive to make sure their staff do their job!HTM departments get things done because of their talent and dedication. But they aren’t always the best at developing and documenting processes. Okay, for that matter I’m not sure all IS departments are either! But in my experience many areas of information services work are better documented than in HTM. If you are a department that documents processes effectively, offer that assistance to HTM. You can build on their skills and talents and potentially help them to drive greater efficiency. Or you can work on it with them if your own department is lacking in this area. Just be careful that you aren’t trying to come across as if you are telling them how to do the job. They are the SME’s. You are just the facilitator. Speaking of processes, a specific area where you can help is with project management. This is a classic area where HTM departments typically do a good job, but they frequently don’t follow a specific process. That means that to get the work done they often have to do “hero” work when they shouldn’t have to. Something is forgotten and they have to work extra hours to get it done. Something isn’t ordered and they improvise. We have had several people go through the project management courses offered by our Enterprise Project Management team, and they have been very pleased with it. We also participate in the EPM process when medical equipment sits on the network, and we are looking at how we can customize the process for medical equipment.I mentioned previously how the HTM team can help you to identify potential cost-savings opportunities. But what you can help them with is overall financial management. Keep in mind that in a typical hospital you may have an HTM department of from 4 to 8 people. They don’t have a lot of resources to help them with financial planning. They know how to maintain equipment in a cost-effective manner. Building a budget or justifying additional staffing? Not so much! By offering them assistance in an area they struggle with you can definitely find a way into their hearts. Well, that and food!!One thing that is not specifically mentioned on the slide but is of increasing importance is related to the security of medical devices. All of the security-related concerns related to non-medical IT devices apply to medical IT devices. The problem is that it is a much more complicated issue. To my knowledge at this point most medical equipment vendors don’t support using encryption on their equipment. They also may not support the anti-virus solution used within your organization. That doesn’t mean you can’t do either; but you do so at your own risk. In addition you have all of the other applications, patches, etc., that routinely get pushed to workstations. All can cause problems with medical devices. This requires much closer interaction between the healthcare technology management, the information security team, the applications team, field support, desktop engineering, and any other stakeholders. This is a fairly new issue and we’re still finding answers, but the key is developing a strong working relationship among the various teams and effective processes that promote effective security without compromising patient care. DAVE BRAEUTIGAM INPUT: My feedback (in the section where biomed can help IT and IT can help biomed) would be for IT to educate biomed on the importance of HITRUST and other security concerns by having medical equipment on the network without OS patch control, virus protection, password control, etc. The other side of that would be for IT to understand the constraints put on the OEM by the FDA over this (at least that is what we are being told…)
- There has been a lot of buzz over the past few years, at least in the HTM community, about working more closely with information services departments. The medical equipment is evolving. It started off with the transition to digital circuits and microprocessors. Eventually the medical equipment manufacturers realized that it makes more sense to use off the shelf technology. This meant either embedding computers, or just using standard PC’s with custom interfaces and slightly modified operating systems. Eventually the equipment moved off of proprietary networks and onto regular networks. While some in HTM were slow to see the change coming, most understood it but weren’t sure what to do with it. Many have decided to create their own information services supplementary team; often recreating what already exists within information services. I hope it is obvious to everyone is that the most efficient method for service in today’s healthcare technology world is to use the strengths of each team. At the very minimum this means interfacing between HTM and information services. Effective handoffs so that nothing is dropped and the customer, our patients, is taken care of. You guys understand this, right? In today’s healthcare information technology world interfaces are incredibly important. You need to get the right information from one system to another and make sure that the right system is doing the job. But what’s better than interfacing two systems? Someone tell me…. That’s right; integration. You don’t just want to hand something over for someone else to do, you want to work hand in hand. We can do so much more together than we can separately, even with effective handoffs. We have to take advantage of the complementary strengths of each team, feed off each other, make the whole better than the sum of the parts. My team has been a part of Baylor Information Services for a long time. Progress has been slow. Partially due to my own team’s slow progress in understanding the advantages of integration, and partially due to a change in leadership within BIS. I have to say that the pace has accelerated since Dave joined Baylor. I’m a part of the IS leadership council. My biomedical engineering director sits on the IS communications council. My clinical engineering director works closely with his peers within BIS. Our calls are handled by the BIS help desk. So we have made progress, and we’re heading in the right direction. I can say that in my opinion we have moved from a handshake relationship to a hug!! And with that I’m going to turn it over to David Muntz, CIO and Senior VP for Baylor Health Care System, and my boss! His job is to tell you about his view of an integrated relationship between an HTM department and information services. David…
- And all the cool “stuff” in films
- Wireless Medical Telemetry ServiceThe nirvana that was the 1970s came to an abrupt end on February 27, 1998 at 2:17 pm, when, “WFAA-TV channel 8 television began broadcasting on digital TV channel 9 and continued until 10:35 p.m., shutting down transmission a few times to allow a tower crew to work on the antenna.” This and subsequent tests of digital television broadcasts by the Dallas broadcaster, knocked Baylor University Medical Center’s (BUMC) telemetry off the air. Fallout from this intentional (and completely legal) interference resulted in the creation of the new WMTS frequencies for use by telemetry monitors. Between that fateful day in 1998 and 2006, BUMC has spent $6.6 million shifting frequency and upgrading the telemetry systems at their hospitals. (You can read about BUMC’s ordeal reprinted from the AAMI publication Biomedical Instrumentation and Technology Journal story on this FDA web page.)So the new WMTS solved all our wireless medical device problems, right? Although some may differ, the bottom line to the foregoing question is a definite “no.”Chasm that is closing
- Help Desk implementationSeparate databaseshttp://www.rosswalker.co.uk/movie_sounds/sounds_files_20100522_76672091/good_bad_and_the_ugly/good_bad_ugly.wav2 groups with very passionate spirits very focused on the patientFocus – long-term, all patients, versus short term, one patient
- Lunches and webinars, shared audiencesShared Documentation systemMultidisciplinary service
- Memo of Understanding – is a legal document really requiredWarp speed is preferred – We need more speed, Scotty!