The Future of Clinical Is there a future for hospital

Engineering: affiliated Clinical Engineering?

Hospital Affiliated „ Outsourcing efforts in the 1990’s
„ Multi-vendor service

Program Perspective „ Manufacturer’s policies

„ Proprietary systems, lack of service
information, remote diagnostics and fixes
J. Tobey Clark
„ CIO not CTO
University of Vermont
„ Information systems have been a focus of
Burlington, Vermont, USA resources by hospitals
“Change is not merely necessary to life.
World Congress on Medical Physics and Biomedical Engineering It is life.” (Alvin Toffler)
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia
Sydney, Australia 28 August, 2003

Global Trends Key Technology Trends

„ Terrorism, military actions and
„ Biotechnology
presence, and surveillance
„ Economic downturn
„ Genetic Engineering
„ Environmental concerns
„ Nanotechology
„ Biotechnology revolution
„ Drug delivery
„ Global communication via the Internet
„ Artificial organs
and wireless technologies
„ Probes and detectors

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 Key Technology Trends Key Medical Problem Areas
„ Wireless communication
„ Chronic diseases
„ WiFi, Bluetooth, WMTS…
„ Most healthcare $ will go to chronic versus
Mobile systems
acute care problems
„

„ Internet/Intranet „ 40% of US patients with chronic conditions

„ All information sucked into the web have multiple chronic problems
60% of healthcare dollars to chronic care now
Computer hardware power increases,
„
„
„ 80% by 2020 - elderly
cost decreases
„ Expert systems “autonomic” (from CDC website and Wu, et al Rand Health 2000)

wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

The Aging Population and Examples of Elderly Focused

Their Medical Needs Research
„ Life expectancy increasing
„ Intel and Honeywell developing daily
U.S. Baby boomer generation over 65
activity monitors to assess Alzheimer’s
„

„ 35 million in 2000
„ Estimated 70 million in 2030
and Parkinson’s
RF tags and magnetic sensors on dishware
Growth in services for diseases of aging
„
„
„ Kitchen tasks monitored with complex
„ Cancer and cardiac care
software routines
„ Osteoporosis and prostrate care
„ Long pauses may be predictive of future
„ Alzheimer’s and Parkinson’s diseases Alzheimer’s and Parkinson’s disease
„ Mobility focused care - rehabilitation
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 Healthcare Practice Changes:
Inpatient-->Outpatient-->Home US Health Care Market
„ Care moving to the patient „ Describe as one of the most fragmented, complex
„ e.g. glucose monitoring and delivery, and rapidly changing markets in the world.
Heartstart home AED, Kamen stair climbing „ Labor intensive, employing > 10 million Americans,
wheelchair „ Expenditures > $1.2 trillion in 1999
„ Patients are more knowledgeable, want „ 13.1% of GDP - the highest of any major developed
economy.
more involvement & have higher „ 42 million Americans remain uninsured under the
expectations regarding in their care current system
„ Diagnostikzentrum Graz - teleradiology „ Care ranks #37 according to WHO
images accessible by doctors and patients „ High administrative and support costs.
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

Total Cost
Cost Drivers of Inpatient of Ownership
Œ
Expenditures in U.S. Healthcare The “TIP” of the Iceberg
Equipment Purchase Price
„ Medical Wages
Below the water:
„ Medical Technology Installation and
New higher cost technology
„
ongoing Life Cycle
On going costs, retraining, facilities
Costs may make up
„

Consumer demand
the bulk of the
„

Hospital Market Structure

total cost of
„

„ Hospital Efficiencies ownership!

„ Hay, Hospital Cost Drivers, Amer. Jour. Of
Managed Care, Blue Cross/Blue Shield From Yadin David, TCH
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 Key Standards and
Institute for Medicine Report:
Regulations To err is human: building a safer health system
„ European Union and US Food & Drug „ 44,000-98,000 die each year due to
Administration medical error
„ ISO 9000 „ Mostly medication errors
„ Integrating the HC Enterprise/DICOM „ More than 2/3rds due to “human error”
„ HIPPA „ Medical Device related estimated at
„ Hospital Accreditation Bodies (JCAHO) about 1-2% of total (M. Shepard)
„ Insurers and Employers in US „ Ventilator, transfusion, infusion, defibrillator,
utility systems, electrosurgery, trocars &
„ WHO and Practice groups - outcomes anesthesia units
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

Telemedicine
Key Clinical Technology
Trends
„ Electronic Medical
“The electronic
Record exchange and
„ Automation use of medical
data and
„ Lab automation information from
„ Computerized one location to
another for the
Provider Order purpose of
Entry patient care.”
„ Robotics
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

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 Key Clinical Technology
Trends
„ Cancer treatment
„ Radiation therapy advances, e.g. IMRT
„ Radioactive seeds planted at tumor site
„ Advances in screening techniques
„ Pain management improvements
„ Biotechnology advances
„ Diabetes care
„ Non-invasive and continuous glucose
monitoring
„ Automated insulin infusion
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

Key Clinical Technology Key Clinical Technology

Trends Trends
„ Cardiac care „ Imaging
„ Advanced pharmaceutical diagnostics and „ Multi-modality, simultaneous imaging
treatments „ GE - CT & SPECT
„ Implantable therapeutic and monitoring „ Philips and Siemens - CT & PET
devices „ Functional imaging
„ Image guided diagnostics and treatments „ Computer-aided Diagnosis
„ Orthopaedics „ Mammography

„ Custom implants „ Digital imaging, PACS, and teleradiology

„ Back pain progress
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 Centralized Clinical Data Development of Surgery
Analysis Centers
„ Imaging Centers
„ Digitized images transferred to central
server for Internet transmission
„ Teleradiology images read by central
review and diagnostics center
„ Physiological monitoring, ECG, EEG…
Similar in operation to flight control
center today
1800’s Surgical Theater Cut…See…Clear field
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

Remote Telesurgery
Development of Surgery (From Computer Motion Inc.)

Modern Day Surgery

Image(s)…See…Plan…Cut
•Minimally invasive

•Image guided Tele-surgeons and control center

Patient and surgical
in the United States
theater in France
•Robotic
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 Key Medical Device Key trends in healthcare
Industry Trends technology management and
„ Consolidation
support services
„ GE, Siemens or Philips for all physiological „ Outsourcing
monitoring and imaging needs „ Half of U.S. hospitals, but changing back to
„ Proprietary support information and inhouse
diagnostics „ Comprehensive asset management
„ Multi-vendor service „ Clinical and non-clinical
„ Service as a prime profit center
„ Asset, operations and finance providers
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

Changes in Scheduled Where does the “Clinical

Equipment Support Services Engineer” fit in?
„ Device histories will set scheduled „ ACCE - “A clinical engineer is a
maintenance intervals professional who supports and
„ Standardized data sharing and analysis will advances patient care by applying
result in maintenance sensitivity rating engineering and managerial skills to
„ Environmental scan healthcare technology”
„ Automated test systems
„ Decreased focus on go-to-device testing Engineer = Problem Solver
„ Remote testing via network
Focus on “real” maintenance Don’t be a “victim” of inaction
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 Clinical Engineering at Preparation for the Future:
The University of Vermont USA Actions
„ Started in 1973 „ Understand what biotechnology, nano-
University department
„

aligned with BME

technology and genetic engineering is
„ Staff of 50 engineers & and means to healthcare
technicians „ Prepare for patients, manufacturers,
„ Contracts with 28 and other stakeholders besides
hospitals in Vermont, New
Hampshire and New York hospitals to be your customer
„ Also services university „ Get ready or deal with financial crisis in
equipment, and designs healthcare
and fabricates research
instrumentation „ Technology may be viewed as the villian
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

Focus on Technology
Preparation for the Future: Life-Cycle Model
Actions EVALUATE /
„ Understand IT standards and show value ACQUIRE
„ e.g.PACS administration, interface specialist DETERMINE INSTALL /
„ Don’t do unneeded inspections! FEASIBILITY TRAIN
„ Use your data to right-size scheduled PM TECHNOLOGY
„ Be the medical device safety expert MANAGEMENT
„ Know the tools (FEMA, root cause, forensics)
MONITOR /
„ Apply and communicate equipment Total ASSESS SERVICE /
SUPPORT
Cost of Ownership and ROI SELL /
DISPOSE
„ Comprehensive asset management
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 Preparation for the Future: Preparation for the Future:
Actions: PARTNERSHIPS Actions: PARTNERSHIPS
Fluke Biomedical Corporation
Training session
Carson City, NV USA „

at the Univ. of
„ We provide
„ Product development
Vermont
„ Device evaluation and Beta testing „ Personnel from
„ General consultation the Government
„ They provide of Egypt
„ Analyzers, simulators, etc. „ Combined Fluke
Other departmental assistance including
„

support for this talk

and UVM training
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

Preparation for the Future: Analyze the Present to

Actions Prepare for the Future
„ Understanding, communication and „ SWOT analysis, your -
high performance working relationship „ Strengths - Technical
with other healthcare departments Expertise
„ Clearly establish a value for your „ Weaknesses - Business
services - justify Expertise
Opportunities - CT and MRI
„ Develop expertise in business language, „

Warranty will be up
skills, finances, communication,
Threats - Local Service
marketing and savvy
„

Group
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 Organizational Improvement
Education of Clinical Engineers
Critical - Toolkit
Performance improvement based on „ Classical engineering disciplines
Systems engineering
measurement, actions and monitoring
„

„ Biophotonics & Medical physics

„ Six Sigma „ Life sciences
„ ISO 9000 „ Gross, molecular and clinical
„ Balanced Scorecard „ Information technology
„ Baldridge Performance Excellence „ Robotics, networks, telecom, software
„ Agility, ethics, & community „ Business
„ Management, operations, financial, marketing
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

The Future depends upon

YOU!
„ Practice Personal Accountability
“The window of opportunity won’t open
itself”
„ Ask the Question Behind the Question
„ How can I make the organization better?
„ What would it take to move my CE
department into…
A SUCCESSFUL FUTURE!
wc2003 - World Congress on Medical Physics & Biomedical Engineering - Sydney, Australia

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