AAMI HTM Grey Areas Report

Danielle Mcgeary from AAMI returns to the show to discuss the recently published HTM Grey Areas report. This was a collaboration effort of multiple surveys, data collection, and consulting from Joint Commission. It breaks down what falls under each department within a medical facility and were those responsibilities my coincide with one another. It a valuable conversation to have to lay out expectations and foster cooperation between each sector of a healthcare system. I would love to hear your thoughts on this report and the impact it could provide.

If you are an AAMI member it is free to download but if you are not the report is just $30. Follow the link below:

https://array.aami.org/doi/10.2345/9781570208553.ch1

Watch the video podcast on YouTube
https://www.youtube.com/playlist?list=PLisOVWzYA0rq9UrYCz7fU7HNBjXgwc8DG

Transcript

Chace Torres: 0:14

ladies and gentlemen, welcome back to an all new episode of the bearded Bobbitt. I am your host Chace and today I am joined with you know, are you lover Danielle from Amy, welcome back to the show. It's been it's been over a year since you've been on before. But now you're, you're an official friend of the show. So glad to have you.

Danielle Mcgeary: 0:33

I'm so glad to have you back. I always love being on your show. And I love watching your podcasts. So. So thanks for having me again, a

Chace Torres: 0:40

lot, a lot of changes since then. But yeah, we are joined by Daniel today because we have something very interesting that Amy put out to the masses that I think is more beneficial than probably a lot of people understand or just haven't really dove into the information of what this collection of data proposes. So what am I speaking of? I'm talking about that the HTM gray areas report. Before we get into the the nitty gritty of the details, how, what spawned this, this whole endeavor that you guys took on for this project?

Danielle Mcgeary: 1:19

Sure. So everything that we do at AMI really comes from feedback from the field at large. So you know, anyone that's listening, please don't ever hesitate to email me directly or email people on the Technology Management Council or healthcare technology leadership committee with suggestions. Our TMC group last year, we started, we take on about three to four projects a year. And one of the suggestions was, you know, the unclarity of gray areas within you know, between medical equipment and what each TM should be supporting, and what really isn't considered a medical device. So that whole project came from their suggestion. And we made a subgroup that was led by Mike bustier, who's now the Technology Management Council Chair. And we had a committee of folks on there and we work together we did, we sent out a survey to the field at large, we got about 120 health systems to respond to it. And we helped identify gray air, you know, equipment that can be classified as kind of a gray area in hospitals. And we had folks, you know, vote or let us know whether htm was servicing IT facilities it or someone else?

Chace Torres: 2:42

Well, I was looking through it. And a lot of it speaks to my soul because I've had

Danielle Mcgeary: 2:50

to hit deep with this.

Chace Torres: 2:51

I think a lot of biomed 's out there will have experienced some spectrum of you know, the gray areas of medical device, whether its responsibility, what's expected to be inspected electrical safety checked or just inventoried by the biomed. I mean, there's a lot of data here, which makes sense to me. And what's interesting about it, for those of you that have not seen the report, it's not just broken up, just, you know, based upon equipment and biomed. Y'all went so far as responsibility percentages based upon facility security it and even that other space, because let's be fair there, there's some overlap and some things, which is what causes great areas. Well, most of the time, it's biomed, and facility sometimes, but it can also be bombed and it especially today, with the integration of medical device telemetry, everything's hooked up via Bluetooth Wi Fi. What what was something that I guess was your first takeaway after y'all compiled this data together?

Danielle Mcgeary: 3:58

I think the first takeaway was that, you know, there's definitely not consistency across the board. Right. No matter where you go, you know, I think it's interesting, because I think we've become my optic as biomass at time. It's like we are, we're used to doing it, how we do it at our medical center, right. And everyone thinks that they're doing it the right way, which you may or may not be. So you know, some people are really proud maybe that they're, you know, taking on security cameras, but is that the right decision for the field. So I think instead, what our takeaway was, was that we didn't want to be prescriptive about you know, what htm or biomed department should be doing, but we wanted to give concrete data so htm and biomed departments could make good decisions. You know, they now have a report to go back to their C suite or whoever they report to, and say look This is what the majority are doing. And we either should or shouldn't be servicing these, as well.

Chace Torres: 5:08

Well, we have to look at it to is, out of all those hospital systems that you guys surveyed, I guarantee none are like, every, every hospital does something a little bit different, just based upon their staffing, their budgetary, their, whatever their accrediting agency may be. Whatever professionals are running the C suite, just management in general, because everybody's going to, you know, work and fluctuate based upon their prior experiences. And, you know, well, we used to do this this way. And that's why this report is so informative. I mean, you can have just just an example. I remember, the old adage was, if it's inside the wall, biomed typically doesn't work on it, that that's not always been the case, because med gas can translate into biomed limb can translate into biomed. I've even I've seen some like anesthesia. You know, supply lines that go into the wall have had some biomed maintenance either, you know, there's a lot of different things that can translate,

Danielle Mcgeary: 6:17

and especially with beds to like, the service, the low voltage relay that went from the TV to the pillow speaker, like, you know, and that's in the ceiling, you know, so it does really vary, you

Chace Torres: 6:29

know, product, probably one of the most arguable ones, I think would probably be nurse call systems. Yes, yes. And more often than not, you kind of have to share that responsibility, you know, with with troubleshooting, what what's actually the cause? Is it a, you know, an actual PCB board inside the bed communicating with nurse call? Is that the cord? Or is it the actual nurse call system hooked up into the wall. And more often than not, you have to coordinate with facilities to do that testing all together. I like your verbiage that you said, this is not a prescription. Because we don't want to get into make this a thing that you can take to C suite and make it almost argumentative. It's just more just providing the data based upon the medical landscape, that, hey, this is how it's been done. Because if we came across it as confrontational with, you know, this is how it is, and this is the only way it shall be well, it's going to be more often not having issues implementing, you know, what we're seeing in the survey.

Danielle Mcgeary: 7:34

Exactly. And we didn't want to do that, you know, we don't want to say like, you have to be doing beds, or you have to be doing nurse call, we just really wanted, you know, people don't know what they don't know. And they may be wondering, well, what do my peers do, and this really gives you comprehensive information to really understand, because we also sorted it by percentage. So htm at the highest that it works, its way down to the the lowest percentage as well. So hopefully, you know htm departments can find it useful. And also, like you were saying, like no two, htm departments are the same, you know, it's really going to depend, like, if you're a critical access hospital, and you're a one person show versus, you know, these large health systems that you know, have 100 people, you know, they can, they can have a biomed ITT within their ATM team. But that's not the reality everywhere. And, you know, if and this is really just to help,

Chace Torres: 8:33

well, there's a, especially in Texas, there's a lot of critical, you know, rural hospitals Eltechs that just don't have the staffing to, like you alluded to, you know, all these different responsibilities broken up, usually, you know, when I go on to those sites, or our company goes in and provides for them or assist maybe a one man shop, they're taking it all on just because they don't have the bandwidth to separate all these responsibilities. And what the percentage breakdown and what you guys have to you know, we have to tailor is saying it's a responsibility breakdown, I would almost format the speaking into existence as, look at the percentages, and this is the percentage of each department that should be involved in that project.

Danielle Mcgeary: 9:18

And that's a great way to look at it too. Because, you know, as we know, everything in a hospital is a multidisciplinary disciplinary approach, like even telemetry center, you know, your telemetry unit. I mean, it goes back to a switch in the closet somewhere and if that switches down, you know, you may need an IT person to help you, you know, it all goes back. So,

Chace Torres: 9:39

I mean, I, I still lean back to there was a service call is a couple years ago that I had it was it was in critical access hospital, that rural middle of nowhere in Texas, and it was at like two in the morning. And all of their telemetry system went down. They were unable to monitor any of their patients. And they called Then of course, because gotta call the bomb if or something like that. And I traced the problem all the way to a it tower that was locked in a closet that of course, I had no access to no security keys, no nothing. And the it tower actually belonged to a prior company that no longer was in that hospital. And we still brought the other IT department in that is now in there because they had the best chance of getting us to help reboot the system. And, again, if we go and go into the mindset of it's just one person or one department's responsibility to do something, that's that's usually going to lead to more downtime for equipment, and making it inaccessible for the end users, the clinicians, the and also this reflects back to towards the patient as well, of not guaranteeing that higher level of health care that we want to provide. So it was just it was a joint venture, which I think is to me what solidifies the survey is it shows that there is a need for cooperation between all the departments,

Danielle Mcgeary: 11:11

yes, and to also have an at the end of the document, it talks about best practices and having almost a responsibility agreement that like, you know, if we decide we're handling, you know, a certain part of a system that that's clear throughout all the departments that could be involved. So that way, you know, on a weekend, or when you get called in on Christmas morning, God forbid, we're not making like 30 phone calls, we know, you know, Who is that next person of escalation, or you know, I've exhausted troubleshooting this monitoring problem, and it looks like it's, you know, back to an IT issue, or the Wi Fi is out, you know, for the hos you know, it just having people understand because, you know, sometimes, you know, I used to cover Muse at an old hospital, and, you know, I could bounce the interfaces on my side, no problem. But sometimes the interface from the EHR would be down. And the minute someone said news on the phone, it'd be like, That's Danielle, that's Danielle, but like, once you troubleshot it, you know, you might have needed the EHR team to come in and help and, and those are things you know, if we can agree, like, where the responsibility is that I get first call, like, troubleshoot it to, you know, as far as I can, but once I've determined that it's something outside of that system. Now we need folks to, to understand, I'll never forget, I called back the help desk with an update with a muse problem once explaining to them that I needed someone from the EHR team, and they said, You're gonna have to call Danielle McGarry and I said, I am Daniel McGarry, I'm calling you from elsewhere. So

Chace Torres: 12:56

the one of the things that can bug me, when I look back at just interactions that I've had with biomed, across the landscape, either those that have been, you know, in the field for as long or longer than me or even some of the newer technicians. One of the the verbiage is that I hear some times that can kind of annoy me as a biomed is that, well, that doesn't fall under my area of responsibility, or that's something that I'm not in charge of taking care of. And I think this is also beneficial for that. So to re acclimate the landscape of our career field and say, Okay, again, we understand that not every facility is going to be the same, we understand that areas of responsibilities, depending on the type of equipment and what they're asking you to do, might differ. But I would encourage the field to look at this report and take it almost as a recalibration almost of what your expectations for your daily job should be. You know, if if there's an issue that per se, I've came across, and I don't necessarily have had the responsibility or the expectations on me to take care of it, but it's something that I feel I can assist with, I'm going to do it because at the end of the day, that's what we're there for. We're there to get the equipment up and running as quickly as possible and to make sure that it's ready for patient use in an unsafe way. And if it's something that falls within this gray area, well, this is a this is a call to arms, almost I would say for you know, maybe some of you out there that don't really have the expectations to have worked on some of this stuff before to maybe just go about it a little bit more, go with the flow wise just, you know, realize that there are areas of responsibilities that can fall on the biomed that maybe you haven't experienced before.

Danielle Mcgeary: 14:55

Absolutely. And I think it shows that you know, really If you look at it, there was, for most areas, there was never like a 0%. htm, you know, I mean, so it wasn't. So I mean, it shows that you know, anyone can really be doing anything to. So I think that was really telling as well. So

Chace Torres: 15:18

well look at it this way too, if if something, God forbid, happens to a patient, who's one of the number one departments get drawn into anything, if it was something that was used to treat a patient, it's the biomed. department. So whether you like it or not, whether you worked on it or not, you, you might get pulled into that, that discussion just because of what our job entails. And the thing I want to carry over to is, after the survey, or I think what I want to allude to is, I would assume there was some amount of joint commission, maybe DMV interaction with Amy, of going through the, you know, the chronicles of this report. So I'm kind of curious about how that went, and maybe some of the intricacies of that that conversation.

Danielle Mcgeary: 16:10

Absolutely. And thanks for bringing that up, because that's a big part of this. So we did work with Herman McKenzie from the Joint Commission. And one of the things that we did learn is the Joint Commission, and I actually didn't realize this, you know, they're really big on having a policy and following your policy. So I knew that part. So if you have a policy written, and they come in and ask for your policy, and find that you're not following your policy, you're gonna get cited, right? Would you say? So what you do is you do exactly, but they actually because they are auditors, they are not allowed to write policy for a biometric htm department. So if you came to them and said, Oh, can you help me write my me MP, they can't do that. That's not within their, their jurisdiction. So while they vetted this policy, they couldn't, you know, say, every htm department needs to adopt this policy, because, like you'd like we said, you can't treat all hospitals the same. And the Joint Commission clearly knows that. And, you know, going back to our earlier discussion, so Herman McKenzie went through and looked at it. And he helped us though, define what in that list is medical equipment and what is something else. So he made the fabulous point, that just because htm slash biomed is servicing something or it's in your responsibility, it doesn't mean that it's technically medical equipment, and that it has to fall into your M EMP. So he said, it's very important to go back and look at everything you're servicing. So let's say you're in charge, your biomed department is in charge of microwaves. That is clearly an appliance, not a device.

Chace Torres: 17:56

We still weasel electrical safety tests don't

Danielle Mcgeary: 17:59

know, if you have to find it in the Joint Commission eyes as an appliance, it does not need a yearly check. So if that's so he's saying that you need to just because it's you service, it doesn't mean it's medical equipment, it doesn't mean because of medical equipment, they want you to follow manufacturer's recommendations. But if you're not defining something as a medical device, now, that does not apply.

Chace Torres: 18:26

And again, that definition is based off the facility's policies and procedures,

Danielle Mcgeary: 18:31

yes. And he said, You can redefine that. But again, that if you're gonna if you're currently calling them that, a microwave a medical device, you know, again, you need to follow your written policy. So if you're gonna change that you can, but it needs to go back to your EOC. And then you can get it approved. So you can't and the same thing with this whole paper, I just want to be clear that if you look at this and say, Hey, I've been servicing this widget for years, and, you know, the paper says that most htm departments don't, you know, you still need to go back and get approval and change your policy. Don't just start changing your policy without without getting approval from your EOC.

Chace Torres: 19:14

Yeah, because there's there's facilities out there that we tag, this patient nutrition, refrigerators, microwaves, coffee pots, TVs, you know, yeah, exactly. Pyxis. And usually the verbiage that I guess this would Intel back to the facilities, if it's patient accessible than it needs to be electrical safety tests that didn't take. So it seems like this seems like some of the gripes I have I need to talk to some of these facilities? Yes, good information to know.

Danielle Mcgeary: 19:47

So when you go through that list, everything that was a gray area Herman went through with me, and helped to define so whether it's an appliance, whether it's like Like an H vacuum or something, you know something that's nurse cart? crash cart. Yeah, yeah. So he's gone through. So I mean, if you are servicing any of this stuff, that's a gray area, you can at least go back through and see, okay, this should or should it be called a medical device and potentially make a change if you get the buy in from your medical center?

Chace Torres: 20:26

I feel like I need to have Herman on the show. And this talk about a lot of things I've experienced, because I've heard so many, just, from what you're conveying is, the guy's just a plethora of knowledge. Yeah, just I want to share. So, you guys did the survey, multiple facilities, you had joint commission come in, and you know, Herman vet through what, you know, his opinion on things? What What else was entailed in the process? And then where do you foresee this going in the future now that this gray area report is out?

Danielle Mcgeary: 21:02

Yeah. So you know, it was vetted by Herman he was very gracious to look through it. Herman is an AMI board member, and he's a great friend of Amy's. So you know, we love working with them, and he's very gracious with his time helping us out. And for the future, you know, obviously, the field is continually changing. And because of that, so will our responsibilities. So our goal is every five years ago, of every five years or so, maybe redo the survey and see how it's changed. You know, back beds are a great example, right? Back in the day, they were standalone, you know, now their network, they do patient weights, they speak 30, they

Chace Torres: 21:43

have so many different things built into.

Danielle Mcgeary: 21:45

Yeah, exactly. So, you know, now there's a stronger argument that we should be doing beds, because they are more of a medical device, and they were like a piece of furniture years ago. And, you know, with this advent of home health, telehealth, and, you know, wearables, I mean, we're gonna see a lot of stuff changing. And, you know, that may change, you know, what we service in the future, and even our jobs. So, you know, I think it's important that we continually survey the field, see where we're at baseline and continue to provide this resource back to the field. So you know, people have that data, and they can stay current, and at least just know what their peers are doing.

Chace Torres: 22:28

There's something on here that I'm loving the percentage I'm seeing right now, and it's wheelchairs. I've had to fix somebody's wheelchairs in my, in my life, it's not even funny. You raise a good point, with the home health aspects, because more and more devices are getting implemented for home care. And I think that's going to be an interesting next step for our field. And just understanding the the scope of caring for those devices and managing them, because there's so many more home health care, urgent care, everything that's popping up everywhere, especially with the implementation of telemedicine, where it how's the bottom end, again, to navigate that field? So I could definitely see the survey transitioning as you move forward. So that that is good to hear that it's gonna update with time.

Danielle Mcgeary: 23:21

Yeah. And you know, it's really interesting when you talk about home health and telehealth, because, you know, like we talked about our jobs used to be nothing in the wall, nothing in the patient, everything from the wall to the patient. And our primary customer was the clinician or the, you know, the person on the floor that you're dealing with when the equipment's not working. If we end up with hospital at home, you know, these medical devices or dialysis machines in people's homes or running an ICU out of someone's bedroom. Now our customers change, because we're going into homes, and now we're talking to patients, you know, so it's really interesting to think of what could be and what could come of all of this?

Chace Torres: 23:59

Well, a couple of the clients that we have, you know, for instance, dialysis, it's not just dialysis equipment, patient lifts, I've gone into a person's home set up their patient lift, calibrated their scale in their living room on the lift, showed them how to use it. And we go out there once a year and check in a verified if they're still using it. So this is definitely a wave of the future. So I mean, it's going to be interesting to see how that all falls.

Danielle Mcgeary: 24:27

Exactly. I'm really excited. I think the future is bright, for sure. And I think there's a lot of change a lot of you definitely want to stay at the forefront of it and help the field as much as possible with valuable information. So

Chace Torres: 24:40

well, this is one of those things where it's better to be proactive than reactive.

Danielle Mcgeary: 24:44

Exactly.

Chace Torres: 24:46

So, of course, Amy does so much more than just biomed. But the fact that y'all guys took this project on and really kind of delineated the areas have responsibility. I'm not the only one excited about this. I'm sure many people can seek benefit from this. So we want to let people know where to find this report. So where what's what's the the, the way to go about getting it?

Danielle Mcgeary: 25:16

Yeah. So if you go to the AMI store and type in gray areas, it's free to all AMI members, and I believe it's$30 if you're not a member, so So

Chace Torres: 25:27

that's, that's affordable, and possibly save yourself some work, maybe get some more work? Who knows?

Danielle Mcgeary: 25:33

Yes. And, you know, all of our documents for htm are free to our members, we want to do that for our members. We know a lot of you have individual memberships. And, you know, so if you're considering like being an emu member, it's 100 bucks for the bronze membership. So even if you buy three documents or need to maintain your certification, the membership itself right there. Yeah, so. So yeah, but if anyone has any questions, you can always reach out to me. I have a direct email, or you can just email htm@ami.org We're always happy to answer questions. And we're always looking for volunteers. So

Chace Torres: 26:10

y'all are in that window right now for the TMC Council and when is the due date for those

Danielle Mcgeary: 26:16

it closed, we've already made our selections. But we do that in in the spring, and you do have to be an AMI member to apply and be selected. That is a requirement.

Chace Torres: 26:29

Well, there's always something exciting happening. And Amy, of course, we got the AMI exchange coming up in June in LA Ah, yeah, I won't be there. Because I'll be having my kid. And of course that I know you're expecting your soon. So it's going to be a I'm going to be sad. I won't be there. But that's okay. We'll get the next one.

Danielle Mcgeary: 26:49

Next year.

Chace Torres: 26:50

Okay, that should be fun. Yeah. So before I let you go today, I just I want to thank you, and Amy, and of course, the council and Herman and everybody that played a part in this because this isn't just something that's an overnight process. It's a lot of just going through communication, trial error, working together and collaborating. So it's things like this that really help enrich the biomed field. So thank everybody that played a part in it for providing this I think it's really cool. And I'm going to do my part and just promoting it and letting people know what's out there.

Danielle Mcgeary: 27:23

Well, thank you. And I also want to thank everyone that took the time to take our survey, you know, the fields feedback is so important. So when we put these surveys out, please don't be shy, please, you know, respond and give us your feedback. Because this is how we're able to make documents like this and cheese, I want to sincerely thank you for being such an advocate for the field your shows amazing and being a supporter of Amy now. We love working with you. So I look forward to seeing you in person soon, hopefully, and good luck with your upcoming baby.

Chace Torres: 27:50

I appreciate it. We'll do a lot more in the future. Of course. For anybody that is listening to the show, either Spotify, Apple wherever you may be taken in your podcasts if you would be so kind as to either leave or review, like subscribe. Spotify actually has a q&a section now. So if you have any questions about the show, or just want to leave comments, you can do that on Spotify. Now. Of course, if you're watching on YouTube, Like subscribe, leave a comment continue the conversation. let's uh, let's keep this going, folks. So, Danielle, thank you as always for being on I always love just talking biomed with you and appreciate you being on today.

Danielle Mcgeary: 28:26

Thanks for having me the beard be with you. Beard