It’s the fashion nowadays to describe what we biomeds and clinical engineers do as “healthcare technology management.” I know that my opinion may not be very popular, but I think the name does an injustice to us and to what we do best. Let me explain.
I will admit to being old and somewhat stubborn when it comes to our profession. When I entered the healthcare engineering field in 1962 (not 1862, as some may think), our function was to make items that were needed to treat sick patients, but always keeping in mind the admonition to first do no harm to those patients. Over the years, my fellow healthcare engineers developed some great technology that has saved countless lives and made the quality of life for many people so much better. We would go to meetings and freely talk about what we were working on and seek input from others. (Remember, this was before the Internet, fax, cell phones, and a multitude of publications on every specialty in medicine.)
A Series of Setbacks
Many of those designs were passed on to manufacturers. They marketed those devices, and healthcare jumped forward. Then there was a series of setbacks. One of the big ones was an article published in 1971 in that great technical journal, Ladies Home Journal, by Ralph Nader, called “Ralph Nader’s Greatest Exposé.” In it, he claimed that thousands of people were killed in hospitals every year by micro shock. Now, if anyone has any proof that a person was killed by micro shock from a medical device, please publish that information. Forty years with no proof is long enough to hold onto an error in data collection.
This development was a step in the wrong direction, as hospital lawyers—and I intend no comment on their value to healthcare—got involved and pushed hospital administrations to have every device tested on a regular schedule. This reaction led to another jump in health technology management positions—in my opinion, a waste of time and money. Then there was that group out of an Eastern state that was issuing ratings of devices and suggesting potential problems, and that was followed in 1976 by Public Law 94-295, better known as the Medical Device Amendments of 1976.
In its aftermath, where it used to take days to get a device to a patient, it now took months and, in many cases, years. The law added huge costs to the system, and had a significant repercussion on our profession: Healthcare technology management groups now had more perceived need to manage technology, rather than focusing on what was best for the patients and keeping costs down.
Are the Managers Succeeding?
One of the notable features of healthcare technology management is benchmarking. Well, I have yet to see a single publication or presentation showing that benchmarking has improved patient care, cut costs, or done anything else of true value. If the “managers” doing this work found value, you think that it would have been shared. A lot of the blame for not getting good information out to us all lies with the big institutions and service organizations that supposedly gather data but never share it outside of their groups.
It has been close to 25 years since some of the early “technology managers” started pushing the concept that all medical devices would be interconnected. The result of this development would be that data would flow easily and accurately between all devices, medical records, and, of course, the billing databases, reducing costs and improving patient care. They are closer than they once were, but we still have to fill out all sorts of paperwork every time we go to a doctor or get a flu shot. Outstanding HTM on this one! The fact that we still have so far to go after 25 years makes you wonder what these “managers” are doing.
Another pet peeve of mine involves the process for dealing with the Year 2000 (Y2K) problem. We poor, underappreciated biomeds and engineers worked long and hard making sure that the equipment we were responsible for would work, and that patient care would be continuous. We did all of that at a cost of about 10% of what the IT people spent. Plus, they have replaced the equipment they purchased back then at least twice in the last 15 years, while we still keep our technology working and safe for patients. Again, the managers were wrong and we were right. But who gets all the credit? Not us.
Keep Calm and Carry On
But we do have the comfort of knowing that our work helps so many people get better and we are always cost driven. If the OEM is trying to overcharge us for a part, we go to all the second sources that we know of to get that part and install it so patient care can continue.
And now we have had our profession renamed “healthcare technology management” by those who probably could not do any repairs or assist a nurse or help a physician treat a patient. Regardless, we will continue our work, knowing that what we do is very important and that anyone can be a manager or “leader.” Don’t believe that? Just look at Congress!
In closing, my wife and I are getting close to the age when we will need an increasing level of healthcare, which includes technology. So to all you technical people, thank you for your past services. We hope you are still around when we need you in the future (and that you learn how to use those 3D printers, since many of the new devices we will need will be generated on them). To the managers out there, I would just say this: Please stay out of the way of the technical people so they can do their jobs to support and improve healthcare.
David Harrington, PhD, is a healthcare consultant based in Medway, Mass, and a member of 24×7’s editorial advisory board.