The integration of medical technologies with hospital information systems is increasing exponentially as medical monitoring, diagnostic, and therapeutic devices are tied to the hospital enterprise network. An increasing number of biomedical engineering departments today are now under the management of IT departments, reporting to the chief information officer or vice president of information services. Opportunities exist for certificate programs to better prepare graduates for these specialized positions and to enhance the skills of working professionals.
An additional 40,000, or 40%, more healthcare information technology specialists will be needed nationally. Biomedical equipment technicians will grow by 21% nationally and in Texas by 2014. Biomedical equipment information systems specialists (BEISSs), picture archiving and communications specialist (PACS) engineers and biomedical PACS specialists have posted starting salaries of between $45,000 and $70,000 per year. The integration of medical technologies with hospital information systems is increasing exponentially as medical monitoring, diagnostic, and therapeutic devices are tied to the hospital enterprise network. As the need for these two previously separate hospital departments to collaborate increases, the necessity for a specialist to serve as a liaison is becoming more apparent.
Biomedical equipment technology programs in Texas and around the U.S. should consider revising curriculum to include information technology components such as computer hardware and software, networking, digital imaging and communications in medicine (DICOM) and Health Level Seven (HL7) standards, and PACS. Retraining opportunities should also be made available for experienced biomedical equipment technicians and clinical engineers to gain knowledge and skills in these areas. BEISS, biomedical PACS specialist, and PACS field engineer positions requiring skill sets from both biomedical equipment technology, medical imaging, and information systems are already being posted in Texas and nationally, with most requiring experience in both medical equipment repair and information technology. Students graduating with skills in medical equipment repair, medical image transmission and management, networking, database, and computer hardware and software will find job opportunities at medical centers, independent service organizations, and manufacturers of both medical imaging and PACS units.
Medical devices have evolved from being stand-alone devices supported by clinical engineers, biomedical equipment technicians, and vendors to integrated network attached systems with the capability of sending and receiving patient data within information technology systems. The border between the medical devices domain and the hospital network domain is blurred.
Biomedical equipment technicians are frequently called to troubleshoot network problems involving connected medical devices. Some medical equipment networks are physically segmented from the hospital enterprise network placing them under the responsibility of the biomedical engineering/clinical engineering department.
Examples of integrated medical systems include database servers used in physiological monitoring, cardiac catheterization laboratories and diagnostic cardiac ultrasound systems, endoscopy systems, surgery video, cardiology archiving systems, labor and delivery archiving systems, PACS for medical imaging, laboratory information systems and pharmacy systems. Physiological monitoring systems (patient monitors) automatically chart patient data to electronic medical records (EMR). Closed-loop systems feature outputs from diagnostic devices such as heart rate monitors and pulse oximeters affecting inputs on therapeutic devices such as infusion pumps.
Other closed-loop systems are used in robotic surgery and in image-guided surgery. Radio frequency identification systems (RFID) are being used in hospitals for asset tracking.1
Medical devices such as physiological patient monitors, pulse oximeters, infusion pumps, X-ray machines, CT machines, ultrasound scanners, MRI machines, and others are connected to hospital enterprise networks, radiology information systems (RIS), and laboratory information systems (LIS). Connected medical devices feed EMR increasing efficiency of clinicians and reducing transcription errors.
Standards used in medical equipment networks include: DICOM, the image exchange format for networked devices; HL7, data exchange protocol for healthcare messaging (involving the electronic medical record); IEEE 802.11x , standard for wireless networks; Bluetooth, for short range device based wireless; and the wireless medical telemetry standard (WMTS), which defines frequency band allocation for medical telemetry. IEEE 11073 is known as the medical instrumentation bus. Integrating the healthcare enterprise (IHE) is not a standard but rather a joint effort of the Radiological Society of North America (RSNA), the Healthcare Information Management Systems Society (HIMSS), and medical equipment vendors to improve the way computer systems in healthcare share information.2
According to U.S. Department of Labor, Bureau of Labor Statistics, and projections and projections from the State of Texas Department of Labor, medical equipment repairer (biomedical equipment technician) positions will grow by over 21% nationally and in the State of Texas by the year 2014. (Texas LMCI Tracer) An additional 40,000, or 40%, more healthcare information technology specialists will be needed nationally.3 The need for biomedical equipment information systems specialists will continue to grow as a result of the convergence of these two specialties.
A recent review of biomedical equipment information system specialist and related postings found 158 positions. Seven of these positions were located in Texas. Position descriptions included:
For these positions, information technology experts should acquire skill sets in the field of clinical engineering/biomedical equipment technology such as those found in the certified biomedical equipment technician (CBET) and certified radiological equipment specialist (CRES) certifications offered through the International Certification Commission.
Biomedical equipment technicians should learn skills normally belonging to information technologists. Suggested information technology education and training include: network and network architecture; database platforms and architecture; device interface including a working knowledge of network infrastructure (LAN, WAN, VLAN, and VPN); 7-layer OSI model; real-time data issues such as timing, bandwidth and frequency response; HL7, DICOM, IHE; RF and wireless communications; HIPAA and data security; high availability techniques such as RAID, UPS; and remote access and control.5 Some field service positions list the Microsoft Certified Systems Engineer certification as a requirement.
Historically, biomedical engineering departments in hospitals worked under the guidance of the plant engineering or maintenance department, performing preventive maintenance, testing and repair activities to stand-alone medical devices. Over the last decade, more computer-controlled medical devices operate in enterprise networked environments, presenting new challenges and risks for patient safety and the security of patient information. Many biomedical engineering departments today are now under the management of IT departments, reporting to the chief information officer or vice president of information services.
Because so many medical devices in the hospital are computer controlled and provide patient data over hospital networks, the Food and Drug Administration (FDA) has reconsidered the definition of a medical device data system.6 “Since 1989, the use of computer-based products and software-based products as medical devices has grown exponentially. In addition, device interconnectivity and complexity have grown in ways that could not have been predicted in 1989. This growth and expansion have created new considerations for elements of risk that did not previously exist.”
Electronic medical record (EMR) initiatives are leading to a more integrated medical device environment. Patient monitors and other medical devices are now part of a larger, enterprise-wide information system. Clinical systems and applications using medical device interfaces are life-critical with specific requirements for infrastructure, availability, and performance.7
A new voluntary standard, IEC 80001, Risk Management of Medical Devices in Networks, is being developed to apply risk management responsibilities to enterprise networks incorporating medical devices. The configuration and interaction of medical devices and the infrastructure of enterprise networks introduce new and unanticipated risks such as loss of patient data, inappropriate data exchange, corrupted data, inappropriate timing of data, and unauthorized access to data. Managing these risks requires cooperation and collaboration of both clinical engineering/biomedical engineering departments and information systems departments.
Integrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical need in support of optimal patient care. IHE, previously primarily focused on radiology applications, has expanded to include cardiology and other clinical specialties.
Applications such as RFID, patient alarm management, remote access, telemedicine, medical telemetry, Bluetooth devices, and wireless devices using IEEE 802.11x standards have also blurred the boundaries between information systems responsibilities and those of the biomedical engineering department.
The previously different missions and cultures of information systems and biomedical engineering departments make communication imperative to successful collaboration. Biomedical engineering departments have a more patient-centric focus (life-critical) with an emphasis on patient safety. Response time for problem calls for biomedical equipment technicians (BMETs) is typically measured in minutes or hours. Information systems have historically had a more systems-centric (mission-critical) focus with an emphasis on the integrity of data and processes. Response time for information systems professionals is typically measured in hours or days.
Certifications and education are also different for biomedical equipment technicians and information systems professionals. BMETs typically have associate of applied science degrees in biomedical equipment technology or are military-trained. BMETs may be certified by the International Certification Commission as certified biomedical equipment technicians (CBET), certified radiological equipment specialists (CRES), or certified laboratory equipment specialists (CLES). Education for BMETs has primarily been focused on electronics and troubleshooting skills as well as the operation and clinical application of medical devices.8
Information systems professionals may specialize in network administration, computer hardware and software support, database administration, and others. Information systems professionals may have associate or bachelor degrees in information systems or computer science. Education for information systems specialists has focused on computer hardware, software, programming, networking, and database systems, depending on specialization. Dozens of certifications are available to information systems professionals, also depending on specialization and level of responsibility.
Computer hardware, software, and networking courses as well as courses covering DICOM, HL7, and PACS should be included in biomedical equipment technology curricula. Information systems programs preparing students for work in healthcare should incorporate DICOM, HL7, and PACS into the curriculum. Programs to prepare BEISSs should focus on information technology skills such as computer hardware, software, networking, and database, along with DICOM, HL7, and PACS, and should include elements of biomedical equipment technology curricula such as applied medical equipment operation and troubleshooting, safety, and imaging modality operation and application.
Skills required of BEISSs are extensions of current biomedical equipment technology programs, medical imaging systems programs, and information systems programs offered at technical and community colleges in Texas and the U.S. Job postings for BEISSs, biomedical PACS specialists, and PACS field engineers require skill sets from each of these curricula. Opportunities exist for certificate programs to better prepare graduates for these specialized positions and to enhance the skills of working professionals.
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