Biomedical Engineering Reference
In-Depth Information
computer servicing. However, the picture is not so
simple. At the most basic level, the clinical engineering
program must be sure that it has the staff, money, and
space to do the job well. To assist in making this
determination, several questions should be asked: Will
computer repair take too much time away from the
department's primary goal of patient care in-
strumentation? Is there enough money and space to stock
needed parts, replacement boards, diagnostic software,
and peripheral devices? For those hospitals that do
commit the resources needed to support computer
repair, clinical engineers have found that their de-
partments can provide these services very efficiently, and
they subsequently receive added recognition and visibil-
ity within the hospital.
can provide technical support during the planning stage,
can assist in the development of requests for proposals
for a new system, and can help to resolve any physical
plant issues associated with installing the new system.
Thereafter, the clinical engineer can assist in reviewing
responses to the hospital's requests for quotations and
can lend a hand during installation of the system.
Facilities operations
Recently, some hospital administrators have begun to
tap the high-level technical skills that are available within
their clinical engineering departments to assist in other
operational areas. One of these is facilities operations,
which includes heating, ventilation, and air conditioning
(HVAC), electrical supply and distribution (including
isolated power), central gas supply and vacuum systems,
and other physical plant equipment (
Newhouse et al.,
1989
). This trend has occurred for a number of reasons.
First, the modem physical plant contains microprocessor-
driven control circuits, sophisticated circuitry, and other
high-level technology. In many instances, facilities person-
nel lack the necessary training to understand the engineering
theory underlying these systems. Thus, clinical engineers
can effectively work in a consultation role to help correct
malfunctions in the hospital's physical plant systems. An-
other reason is cost; the hospital might be able to avoid ex-
pensive service contractsbyperformingthisworkin-house.
Clinical engineers can assist in facilities operations in
other ways. For example, they can lend assistance when
compressed gas or vacuum delivery systems need to be
upgraded or replaced. While the work is taking place, the
clinical engineer can serve as the administration's tech-
nical arm, ensuring that the job is done properly, that it is
in compliance with code, and that it is done with minimal
disruption.
Telecommunications
Another area of increased clinical engineering involvement
is hospital-based telecommunications. In the modern
health care institution, telecommunications covers many
important activities, the most visible of which is telephone
service. Broadly speaking, however, telecommunications
today includes many other capabilities.
Until the 1970s, telephone systems were basically
electromechanical, using switches, relays, and other analog
circuitry. During the 1970s, digital equipment began to
appear. This development allowed the introduction of
innovations such as touch tone dialing, call forwarding,
conference calling, improved call transferring, and other
advanced services. The breakup of the Bell System also
changed the telecommunications field enormously by
opening it to competition and diversification of services.
Data transmission capability allows the hospital to
send scans and reports to physicians at their offices or at
other remote locations. Data, such as patient ECGs, can
be transmitted from the hospital to a data analysis system
at another location, and the results can be transmitted
back. Hospitals are also making increased use of facsimile
(fax) transmission. This equipment allows documents,
such as patient charts, to be sent via telephone line from
a remote location and reconstructed at the receiving site
in a matter of minutes.
Modern telecommunications equipment also allows
the hospital to conduct educational conferences through
microwave links that allow video transmission of a con-
ference taking place at a separate site. Some newer
equipment allows pictorial information, such as patient
slides, to be digitally transmitted via a phone line and
then electronically reassembled to produce a video
image.
Clinical engineers can play an important role in help-
ing the hospital administrators to develop plans for
a continually evolving telecommunications system. They
Strategic planning
Today's emphasis on health care cost control requires
that clinical engineers assist in containing costs associated
with the use of modern medical technology. To accom-
plish this objective, clinical engineers are increasingly
becoming involved in strategic planning, technology as-
sessment, and purchase review. During assessment and
purchase review, the clinical engineer studies a request to
buy a new system or device and ensures that the purchase
request includes (1) needed accessories; (2) warranty
information; and (3) user and service training. This
review process ensures that the device is, in fact, needed
(or whether there exists a less costly unit that meets the
clinician's requirements) and that it will be properly in-
tegrated into the hospital's existing equipment and
physical environment.
