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I wrote the following predictions in an article five years ago. It was my attempt to describe what our profession would look like in the “distant” future. Well, that distant future is here, so I’d like to review my predictions and score my accuracy. First, the original predictions from 2006: 1. The debate will still rage—are we “clinical engineering” or “biomedical engineering”? 2. No one will know how to solder (except a few old dinosaurs and a lot of managers). 3. Network certification will be a prerequisite to employment in biomed. 4. Everything will be wireless, except for high-security applications, which will have to be wired for security. 5. Windows 2009-Whizz-Boom-Bang still crashes every week and needs rebooting regularly. 6. Somebody finally builds a keyboard with a CTL-ALT-DEL key. 7. Everything has an LCD display, including coffee cups. 8. You still can’t get cell phone coverage in the basement. 9. Biomed is still in the basement. 10. The morgue is still beside biomed.

Almost every biomedical society has a small group who keep recirculating the leadership roles among themselves. They rotate offices and plead for someone to fill a vacant seat. When they get dog tired, there is no one to succeed them. There are many vibrant biomedical societies out there, but I can name several that are on the brink of collapse. There are many reasons. The current leadership: Many boards and officers have created a situation where the local society has become a “good ole boys club.” This occurs where there is a tight-knit clique and anybody not in the circle feels excluded. Meetings consist of a lot of private jokes, which reinforces the ties between the regulars. Ultimately, the newcomers quit coming. Ironically, though, this exclusion of new members from the leadership ranks is often not intentional. In fact, the opposite is true: Come! Attend! Join! Participate! Learn! Contribute! Unfortunately, the leaders of many biomedical associations unknowingly turn people off from the group. The bylaws: There are two fundamental leadership models for societies: the officer system and the board of directors system. With the officer system, people are nominated for specific offices and the members vote. The ones who do not win are relegated to the ranks of general members for another year. An alternative plan is the board of directors system. People are nominated to the board and a fixed number of slots (let’s use eight) are available. The membership votes for the number of open positions from a list of many candidates. The top eight vote getters are elected to the board (not to specific offices). Then the board, from among themselves, elects the officers. The board is able to choose not only the best person for each position, but also the best compatibility among the officers. A more efficient team can be created when the officers are evaluated for compatibility and cohesion. A larger number of leaders has many advantages. A board of 12 or 14 can do a lot more than a group of four officers. The work can be split up. If someone shirks their responsibilities, there are more to take up the slack. Also, think of the young biomed who has never been a leader before. If there are four officer positions, anyone who is elected is immediately put in a high stress position. Who would vote for a novice to be one of only four leaders? It’s no wonder that the same old veterans keep getting elected. There is no way for anybody to gain the experience to be a leader (not unlike the lament of the newly graduated student faced with job listings that require “experienced biomeds only”). The membership: Many members do not take ownership of their organization. All too often, they expect the leadership to magically know what they want and to deliver. In short, the membership is guilty of not making their needs known. If an organization I am a member of doesn’t give me my money’s worth, I can walk away or speak up. Unfortunately, many biomeds are walking away. The hospitals: Instead of sending staff to training, hospitals could use the local association to bring needed training to technicians. Healthcare costs can be reduced, but instead training is cancelled and even more costly outside service must be purchased because the staff biomeds do not have the skills to work on newer technology. The next time you are at a society meeting, estimate the average age in the room. I’ll bet it is over 45. Look at the leadership. What percentage is under 50? Many people leading the societies today will retire in a few years. Can your society survive the retirement (or sudden death) of a key leader? I issue a challenge to every biomedical society to create a structure that embraces new members and encourages future leaders. Create board positions that have enough responsibility so that a new generation of biomed can gain experience and develop some sweat equity in the organization. n

Most things are driven by money. A constant and recurring theme in hospitals is how the monies for medical equipment maintenance should be budgeted and managed. There are two main schools of thought. Distributed model: All charges are paid by the department that uses the services. This means that surgery would budget and pay for all surgery expenses, parts, and contracts. Centralized model: All costs are centralized into a single medical equipment maintenance budget, controlled by biomedical engineering. This budget includes all in-house costs, external costs, contracts, and all overhead for biomedical engineering department operations. In the decentralized model, finance allocates all expenses as closely as possible to the departments that generate the revenue. However, in order for product managers to set rates and manage expenses, they need to have ALL of the expense data to analyze. Missing such a large part like equipment maintenance costs would skew the break-even point and lead to incorrect pricing. The benefits to the centralized system include: 1. The biomedical manager or director is a service management professional. His or her job, training, and professional life have been spent in the maintenance, repair, and support of patient care equipment. Who in the hospital can better oversee contracts, parts, and outside maintenance? A surgery manager whose main focus is patient care, not equipment costs and performance, is not the optimal person to manage equipment costs. 2. A central budget allows decisions to be made across departmental lines. The same type of equipment is owned and used by many different departments in the hospital. The decisions and choices made by a single department are often different than if the entire facility is considered. 3. Outside vendors will always be used to some extent. These vendors must be monitored and their work added to the comprehensive medical device record. Compliance and cooperation from the outside vendors cannot be attained except by the person responsible for paying for the service. 4. Unless the funds are in the biomedical department budget, they will not be closely watched and scrutinized. Clinical department managers do not focus on maintenance activities. But a biomedical manager who must meet budget and explain variances can more effectively manage a single cost center than try to manage the costs of 30 or 40 subaccounts scattered across the institution. 5. If hospitals are ever to consider less costly (and often more effective) service options than the original equipment manufacturer, the control and oversight must be given to the biomedical department. 6. As required by the Joint Commission, every biomedical department maintains a complete and upto-date medical equipment inventory. The software that keeps this inventory generally has the ability to track costs of every medical device and generate reports of labor and parts costs. These reports can be as granular as necessary, all the way to the device level, or summarized for each department. These reports can be the charge-back mechanism product line managers need to identify and manage their department costs. If a hospital is going to employ a professional manager of medical equipment service, that hospital must not tie his or her hands by removing the most powerful tool available—the money to negotiate and control costs and activities of outside companies and vendors. A centralized medical equipment maintenance budget in the hand of a professional biomedical manager is the best and cheapest way to care for your equipment. n

There is a much-discussed topic that seems to baffle many but I have discovered an easy cure for it that I would like to share with you. When you hear it, you’ll marvel at its simplicity. There is language in The Joint Commission’s standards concerning the prohibition of extension cords. This is a far-reaching issue because it applies to simple extension cord, outlet strips, and octopuses. These are all subject to failure or degradation. Outlets are checked periodically, but outlet strips and extension cords are never checked. Add to this that they are frequently subjected to rough treatment such as coiling, uncoiling, and getting stepped on. Extension cords (and similar devices) are used for three reasons in a hospital: First, there are often more things to plug in than there are electrical outlets to accommodate them. Second, in many hospitals, lots of medical devices in surgery are outfitted with explosion-proof plugs, which must be adapted for traditional straight-blade outlets. Special adapter-type extension cords meet this need. Finally, medical devices often come standard with sixor eight-foot power cords. These often just aren’t long enough to reach all the way from the equipment to an available outlet. Thus, an extension cord lengthens the standard cord to the needed length. There are several steps that should be taken to rid hospitals of these issues permanently. First, renovate all areas of the hospitals and add three or four times as many electrical outlets to equipmentintensive areas, such as surgery. This is expensive and involves ripping into the walls and sometimes adding more breaker boxes because of the need for more branches. As these additions are made, remove all twist-lock and explosion-proof outlets. Next, replace all existing power cords on every medical device used in surgery (including cath labs and special procedures) with 20-foot cords. This is time consuming, but well worth the effort in the long run. (You should also require long power cords on all new equipment, or be prepared to change them yourself.) There—problem solved! Simple...wrong. This is a very expensive and long-term project. We did it in a hospital with 28 operating rooms and about 1,000 items of equipment in surgery. It cost many thousands of dollars in parts, and many more thousands in afterhours labor for the biomeds who did most of the work, and yet more money for the electrical contractors. But in the end, we had a workplace where not a single extension cord was needed. Electrical branches were distributed so that breakers did not become overloaded. Nobody tripped over cords across the floor. But your chance of getting this magnitude of project approved in your hospital, especially in these tight economic times, is almost nil. So what do you do? Banning all extension cords is not practical or possible. This leaves us with only one alternative—use extension cords where needed, but control them. How? Let’s step back and examine an extension cord. It is, in reality, just a very simple medical device. It has only three components: a male plug, a cord, and a female receptacle (or two, or six). What is to prevent us from classifying any extension cord as a medical device, giving it an asset number, putting it into the computer system, and applying the same risk assessment criteria to it as to any other medical device? At the conclusion of the assessment, you should assign it a certain preventive maintenance (PM) interval based on the traditional criteria of use, risk, and failure modes. This approach has been used in many hospitals and has always been just fine with surveyors. I have seen many old and defective cords and outlet strips that failed the ground integrity test, the polarity check, or the tension test. Eliminating them is best, but treating them as medical devices is a good fall-back. n