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July 15
Why Clinical Engineering, by Dave Harrington (Summer 2011)

One of the more difficult things to justify in our minds is the career that we have selected,

why clinical engineering?  It sure is not the highest paid of the engineering specialties, it requires us to be able to think and act like a mechanical engineer, as we try to jamb more technology in clinical area, also like an industrial engineer when we have to match technology to clinical needs, we have to understand finance as everyone seems to want the best technology but is not willing to payJust look at what we have now to what we had 20 years ago and compare the costs, most of us will be surprised that the actual costs of much of the technology has gone way down when inflation is factored in.

As a clinical engineer we have to understand that the users of much of the technology are not tech savvy, dont understand that the equipment is not meant to be bounced off the floors and walls.  It does need to be cleaned especially when the patients bodily fluids decorate it, but they will send it down to the shop without cleaning it.  Then the clinical people wonder why the infection rates remain high in hospitals.

As a clinical engineer we have to have a working knowledge of structural problems as departments try to cram more equipment into smaller areas which them brings up the problem of ventilation.  No one wants to handle that problem until the failures become too much for the medical personnel to handle so they call for the clinical engineer to solve the problems.  After we do getting thanks from the department is like pulling teeth.

So why do we stay in this unforgiving, stressful, and underpaid field?  Because we are the type of people who like to help others.  Thats how we get our satisfaction.  A high percentage of us travel around the world on medical missions, often paying costs out of our own pocket.  We try to help others around the world answer questions and help patients.

In 1989 a group of clinical engineers met at the AAMI convention to discuss setting up another organization that would be devoted to promoting clinical engineering as a profession.  For two years we worked out the details of what and how we wanted to do things and finally in 1991 the ACCE came into existence.  In the past 20 years we have had many successes and some not so successful ventures as an organization, we wrote a code of ethics, we started training programs, we brought the CCE exam back from the dead, we have teleconferences, we give out awards but we still have much more to do to be sure that we continuing helping others.

What do we need to do?  We need to communicate to others both inside and outside of clinical engineering problems that we find.  We need to mentor new people in the profession because we are getting old and will need someone to handle the equipment when we are in that hospital bed.  We need to push the government agencies to look at benefits and risks of new devices in a timely fashion so the good technology come out quickly and the bad items never get out of if the do they are not out for long.  We need to tell the IT people that interconnecting devices to their systems means that they cannot

change addresses of systems without telling us so no date is lost or procedures stopped.​

We need to work with the vendors telling them clearly what is right and wrong with their

products.  We need to push the vendors to provide us with current software to test devices in our hospitals.  But most of all we need to get involved as much as possible with the planning that goes on in the hospitals.  Too many of us have seen a bunch of boxes arrive for incoming inspections that we were never told was coming and that we would have to install the equipment, take out the older equipment, moving that to another floor or department and do it quickly.

Well in 20 years we have made some progress but there sure is sill at lot of progress needed by we have out profession and we are helping others so we can hold our heads high because we truly help others regain their health.  Now if they would only pay us little more.

October 02
Medical Devices through contributions from our clinical engineering colleagues, by George Johnston

I suspect that a lot of devices advances came about through contributions from our clinical engineering colleagues - either buy suggestions or by actual R&D development work.  I can provide two personal examples to perhaps get started something of a survey of our ACCE members to turn up more examples.  


1.  Al Starr around 1960 came into my shop along with Lowell Edwards to discuss problomes he was having with his mitral valve replacement development.  His and Edwards valve employed hinged flaps and blood pooled and coagulated around the hinges.  No dog survived for more than two hours with a valve replacement.  I happened to be familiar with the Hufnagel valve from my previous ex;perience at NIH and suggested he use  ball valve of the Hufnagel style.  He asked me top make hime one which we did.  A primitive caged acrylic ball on a teflon seat with teflon webbing for sutured attachment.  He came down a few days later to report that that dog lasted for over eight hours and thus began the development of the Starr-Edwards mitral valve replacement.  Made Starr famous and Edwards a fortune.


2.  Early catheter.  Charlie Dotter, professor and head of the U of O Med School's radiology department, was a hyper guy full of ideas.  He had a patient with a lower limb blockage and had the idea that "if we could just insert something in that vessel with an auger to break through that blockage."  So my shop gave it a try with a speedometer cable and a hand formed augur welded on the end.  And it worked.  Charlie wanted another but decided my shop prices were too high so wen to Bendix Spring in downtown Portland and had them do another.  Sometime later I got called into my boss' office - furious.  Seems the auger  came loose in the patient and my boss assumed I as the fabricator was to blame.  After repeatedly saying "Bill we didn't make that  one" he finally calmed down.  He was the school's business manager and I'm sure concerned about the potential liability even way back then.  Never did know what happened to the patient but that was the early beginnings of flexible catheters and of course cardiac catheters.


Contributions like this never make the news, but i'll bet there are a lot of similar stories within our ACCE community.


May 18
Why I joined ACCE

About a year ago, a small town kid graduated from the University of Rhode Island with a B.S. in Biomedical Engineering and not a clue with what to do with it.  The field of Biomedical Engineering is so vast and the opportunities that lie within it seem endless.  From research and development to sales, a new BME grad may get lost in the opportunities thrown his way.  So, how does someone ever stumble into a Clinical Engineering position?  And more so, end up joining the American College for Clinical Engineering (ACCE)?

      As you may have guessed, I was that small town kid.  I graduated college with a handful of job offers, but I knew immediately that Clinical Engineering was the specialty for me and accepted a training position through the VA's technical career field (TCF) program.  Working in a hospital and being involved in the day-to-day operations had always fascinated me, but to be honest, I didn't know the specifics of what a Clinical Engineer actually did.

      As the first few months passed at my new job, I began to see the big picture; how to procure and implement medical device and health information systems and cooperating with the individuals that contribute in maintaining the hospital's functionality.  It was all so intense.  The complexity of my job combined with almost two months of travel to different Clinical Engineering conferences and trainings, my life was a whirlwind. 

      Now, nine months in, things are starting to settle down, and I'm finding myself wanting to learn more about Clinical Engineering that requires me to gain a better knowledge of the field beyond my organization.  I want to network with Clinical Engineers outside of the government sector, and discuss the initiatives that are in place throughout the US and the world.  I want to stay relevant in the field that I have grown to know and love, something ACCE allows me to do.  From providing a monthly newsletter, to integrating Clinical Engineers in public, private, and government sectors, and even pushing for an international presence, this society allows me to grow my Clinical Engineering knowledge, a feat that would near impossible without the organization.

      I'm excited for the day that I am eligible to apply for an Individual member status in ACCE, once I have three years of experience, and I fully intend on doing that in my future.  I also plan on obtaining my Certification in Clinical Engineering (CCE) which will showcase my Clinical Engineering expertise.  But for now, I will not have to feel the "cluelessness" that I once felt in my own field of study.  ACCE has been integral in providing all the guidance and information that I need to further my career and excel as a Clinical Engineer.​


By Connor Walsh

January 03
My First Blog

​When thinking about kicking off this blog, I had a difficult time thinking about a topic. I wanted something that would appeal to others, that they could relate to; a call to action for other clinical engineers to add and respond to. In thinking through this, I reflected on a recent email I received- a former colleague reaching out with a request to connect me with their son on options they might pursue as a new biomedical engineering graduate. As I've gotten further in my own career I've received more and more requests like this; discussions over coffee, a quick phone call, even connecting people with former colleagues for job prospects. The best advice I give is based on where clinical engineering brought me.
 
I've progressed as a clinical engineer to a project specialist in a clinical IT systems group in the hospital, to a medical equipment planner in an architecture firm and currently to a director of telehealth and program technology in an international non-profit. It definitely hasn't been a straight forward path! I've really followed the technology, starting in medical equipment management, moving toward the convergence of Biomed and IT in managing clinical systems, getting into infrastructure and workflow design, followed by virtual patient care management. The most important skill that has followed me through this progression has been understanding and designing for workflow and "the need" as opposed to focusing on the technology and how to "make it fit" in an environment. An approach that is instilled in clinical engineering practice and that I've really found valuable and translatable in any position.
 
The foundation of clinical engineering has really given me an edge as I've moved outside of the hospital and into software design and program development; having an understanding UI/UX far before they became on trend in the tech world. When I share what I've loved in our profession, I mention the feeling of bringing a unique perspective to the clinical team and being valued for it. Even now using process mapping and innovation in the remotest parts of the world to bolster efficiency and allow clinicians in the developing world to manage the resource poor settings in which they operate.
 
During the last 12 years in practice, it's been invaluable to lean on a vast network of colleagues that have faced the same design decisions, tapping into the variety of backgrounds combined with years of experience to brainstorm solutions and avoid having to reinvent the wheel. This has been made possible by participating in organizations like ACCE, AAMI and HIMSS who give us a platform to come together and meet each other and attract and mentor new graduates that bring fresh ideas and new approaches to design and implementation.
 
I invite others to contribute to the blog, share your experiences on the path clinical engineering has taken you. Please encourage other prospective and current clinical engineers to share in the possibilities your career has paved for all of us!

 

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