For biomedical technicians, having a fundamental understanding of medical equipment and the ability to repair it is a critical skill set, if not typically attainable outside of a technical college, military service or certificate program.
The foremost credentialing institution in the healthcare technology management space, AAMI Credentials Institute (ACI), offers five certificate programs: Certified Biomedical Equipment Technician (CBET), Certified Laboratory Equipment Specialist (CLES), Certified Radiology Equipment Specialist (CRES), Certified Healthcare Technology Manager (CHTM) and Certified Quality System Manager (CQSM).
For professionals who want to advance their technical skills in the medical imaging space, getting that education can be somewhat scattershot. Professional certifications are provided by only a handful of individual organizations, specialized training schools, or from the manufacturers of imaging equipment themselves. Some of that technical training may be provided exclusively to employees of those manufacturers; some of it may come around infrequently, and only thanks to the efforts of HTM professional associations. Much of it is expensive to acquire, ranging in the thousands of dollars for some device-specific training, or bears the added costs of travel and lodging in addition to time off from work.
But when institutions invest in their employees’ professional development, there are savings to be had on a much larger level, to say nothing of improvements in departmental cohesion, the advancement of individual careers, and the overall quality of the patient experience.
At places like the Radiological Service Training Institute (RSTI) of Solon, Ohio, individuals can gain valuable training that enables them to competently repair and maintain a variety of medical imaging equipment.
RSTI offers four basic two-week courses. RSTI President Dale Cover said the time it takes to develop classes depends upon the complexity of the machine and its market availability (the sweet spot is those machines that have been on the market for three to five years). The company offers instruction in repairing devices from “basically every manufacturer and most modalities,” from basic X-ray up through CT and MR, Cover said. Students split time between classrooms and the workbench, and their rosters include OEM and ISO employees as well as those from hospital biomed departments. By hosting the classes at its Ohio headquarters, RSTI gets to separate technicians from the day-to-day interruptions they might find at their workplaces, while also offering an opportunity for practical education.
“We don’t talk about what the problem is; we go out to the labs and we go show you,” Cover said. “We interact with the machine. If a question comes up, we go to the lab and we can show you what works. Hands-on is the best.”
From Cover’s perspective, that technical expertise is critical for the safe maintenance of medical equipment. The more training that professionals receive, the more work they can take on, including specific devices or entire classes of equipment – which often, if not always, means an increase in pay.
Technical certifications don’t just help advance the careers of those who maintain the devices, they also help the departments that employ them to reduce or eliminate service contracts and save money. Cover estimates that standard service contracts can hit as much as 9 to 12 percent of the original cost of a piece of imaging equipment; training can allow a hospital to trim that figure to about 3 to 5 percent of the original equipment cost.
“Some machines are going to be loss leaders, and some are going to be gravy,” he said. “You’ve got portables, which don’t really have a high cost for actual maintenance, so you can cut that out right away. But if you look at your CT and MR, you might be looking at experience issues that put you behind the eight ball, where you still have to call the OEM in too often, and that eats into your contract or what you saved on the contract.”
Cover believes there’s a cost to the lack of education within a department, too; shying away from maintaining mission-critical equipment in-house means that health care organizations are prone to lost opportunity cost or potentially longer wait times for service when things break or need to be taken offline for preventive maintenance. Improved uptime keeps imaging departments safer and able to generate more revenue; it also can mean that patients receive a higher quality of service and a better overall experience.
“The depth of training has an effect,” Cover said. “In-depth knowledge will help the service technician identify correctly the part that’s needed so you don’t have to guess. [If you can] drop the contract, then you start whittling away what it costs to do the actual service work.”
Better in-house technical training can also build morale, he said. It shows staff that management believes in their capabilities, and supports cohesion in a team-centered approach to care.
“I’ve yet to see a good employer spend money on questionable employees,” Cover said. “Training shows your engineers you believe in their abilities. When you’re responsible for your own equipment, you develop an ownership mentality, and that leads you to be more proactive because that’s your reputation on the line.”
Robert Bell at Tri-Imaging Solutions of Madison, Tennessee, said that although very few biomeds are certified to work on medical imaging equipment, many more ought to be. Tri-Imaging offers a biomed-to-imaging certification, which Bell said underscores an institutional commitment to creating a culture of education. When employees can advance their knowledge bases, workplaces benefit on the whole, he said; especially those that ingrain supportive practices.
“Put study groups together; have people that want to work on making themselves and the workplace better,” Bell said. “OEMs and ISOs should be progressing towards a goal of 100-percent certification in your role.”
Beyond the workplace, Bell praised regional professional associations like CABMET, CMIA, CEAI and NESCE for helping biomeds and imaging technicians network on monthly, quarterly, and yearly schedules, holding symposia on how to troubleshoot typical failures, and offering external education or on-the-job experience.
Jim Rickner, Global Training Director at Conquest Imaging of Stockton, California, shares Cover’s perspective about the connection between staff training and cost savings, which Rickner said typically hits exponential levels when departments are fully schooled. Whether reducing full contracts to shared-service or parts contracts, or removing them altogether, in-house professional development can save an institution tens of thousands of dollars annually if it’s willing to invest in staff and wait for the payoff.
“There is typically a period of about a year where intense training is needed,” Rickner said. “What we have seen is that it can take up to four years to fully transition a biomed department off of service contracts to being fully self-sufficient.”
Measuring the savings in service costs over time is one metric of success, but Rickner points out that qualitative, overall patient-care metrics like system uptime, quicker responses to problems, and not having to reschedule patient exams, are less visible but no less significant benefits to prioritizing institutional professional development. Today, he said, that charge is being led by independent service organizations (ISOs), which advocate a right-to-repair approach to connect technicians to device-specific schooling that may sometimes be closed off to them by original equipment manufacturers (OEMs).
“This is a big trend right now, and it is not just about cost,” Rickner said. “It’s about patient safety and throughput. The qualified person who can respond and get in front of that down piece of medical imaging equipment the fastest is the in-house imaging engineer.”
“There is a big push [among ISOs] for the right to repair, and clinical engineering directors are taking a strong stand on this topic,” he said. “The director of clinical engineering at a facility told me that his department is now one of the leading decision-makers on capital purchases. If the OEM is not going to fully train the imaging engineer to have full access to operating and diagnostic software so they can fully maintain the equipment, then that OEM will not be invited to the table when it comes to capital equipment in that facility.”
Art Larson, general manager of global services training & documentation for GE Healthcare, said OEMs are aware of the fact that hospitals have a variety of choices “on how best to employ their ‘in-house’ biomedical and diagnostic technical staff,” and offer “relationship options” for cross-training and service needs.
“In-house teams can be very successful in supporting 80-90 percent of a hospital’s device needs,” Larson said. “In the end, it’s about having 100 percent availability of any piece of equipment when you need it. One should be able to measure Time to Repair (TTR) and Fix Right First Time (FRFT) for the technical staff, and that helps to give quantifiable metrics on labor and material spend.”
Larson also believes that “well-trained, well-balanced” in-house imaging service technicians contribute to “all the qualitative indices in a healthy organization: job support, work/life balance, teamwork, customer focus, safety, etc.” To achieve those ends, however, he believes the health care industry must overcome a talent gap on the technical service side if it is to provide the best quality of care for patients.
“OEMs, ISOs, and the variety of schools face a major challenge to train a new breed of engineer, and to do it in a way that takes advantage of the technology available today,” Larson said. He foresees an uptick in the use of augmented reality and virtual reality software overlays as part of training, but also as a replacement for “some of the intelligence that we assumed was part of our biomedical engineer.”
“Those OEMs and health care professionals that understand this dramatic change in both technology and skill profile will be able to keep up with the growing cost challenges of our industry,” he said.
That’s an attitude shared by Nanci Wozniak, vice president of education services at Siemens Healthineers, who said the educational content and strategy of customer support her organization has offered its clients has shifted in the past few years to outcomes-based training. Because so much is driven by the end-user or the technician servicing a piece of equipment, there are a number of indirect variables involved in making that calculation. Wozniak said that means the focus then becomes how to best create the outcomes clients say they most want to track.
“So much of our education has transformed into a complicated engagement and personalized education planning process,” she said. “If it’s not making a positive impact on their business, no one has the time for it. It’s got to be very personalized to the key performance indicators.”
To that end, Siemens Healthineers offers customized education programming for its customers, with plans tailored to metrics they define, such as quality of care, patient outcomes, operational efficiency, or equipment utilization. Wozniak says such calculations allow institutions to measure the effectiveness of their trainings against prior needs assessments. To her, service technician training is an important step in improving quality and efficiency in a hospital environment, but so is keeping technicians, clinicians, and physicians in the loop to limit re-scanning and improve the accuracy of images captured. The difference in value of a highly competent technologist versus that of a generalist is $155,000 annually, Wozniak said, citing an Advisory Board study from November 2016.
“Anybody that’s servicing that product can make sure they’re competent in what they’re doing and that the performance of that scanner is driving effectively,” Wozniak said. “If you have a less-than-competent technologist or just an average person who knows the basics of scanning, it’s costing money because they’re not able to generate the volume and quality of study that a competent technologist can.”
“The whole health care game is around decreasing costs and increasing the quality of care,” she said. “Looking at education and measuring quality impact from training and education, we’ve got programs around each of the imaging specialties. The machine operating effectively is a critical step, but if the repairs and annual maintenance is not being kept and done appropriately, it sets everybody else up for failure downstream.”
Preparing for the CRES Test?
There will be a CRES prep at the Imaging Conference & Expo, February 16-18, 2018, in Las Vegas. Visit attendice.com for more info.