Relationships between CE Departments and ICT Departments
An Australian colleague asked:
“Within the UK, what respective inputs and roles do Clinical Engineering (CE) and Information and Communication Technology (ICT) departments have into the management of medical IT systems such as, PACS, CIS, Sleep Lab Monitoring, Holter Monitoring, ECG Archival Systems and Hemodynamic Monitoring Systems?”
Justin’s response was:
“Regarding the role of ICT departments, this is more than a bit variable and I have been out of direct involvement for very nearly 8 years now. Others may well be able to comment from a more knowledgeable perspective.
My perception from Fran’s leadership of our book project, is that in Ireland, not part of the UK, there is pretty good involvement of clinical engineers in ICT matters that relate directly to delivery of healthcare. See Case Studies CS7.11, CS7.17, CS2.3, CS5.10. Ireland seems to have implemented the ISO 80001 series of standards (which has not happened in the UK). See:
- Hegarty F.J., MacMahon S.T., Byrne P. and F. McCaffery. 2014. Assessing a hospital’s medical IT network risk management practice with 80001-1. Biomedical Instrumentation and Technology 48(1): 64–71.
- Eagles S. 2008. An introduction to IEC 80001: Aiming for patient safety in the networked healthcare environment. IT Horizons, 4: 15–19. http://www.aami.org.
Stresses between CE/Medical Physics and ICT Departments can arise when there is a lack of mutual recognition of roles and responsibilities. This has led to what appears to be a very controlling attitude on the part of some ICT Departments. This can get particularly acute in Radiotherapy Physics Departments where the Medical Physics people often have problems keeping the ICT people out of systems that are running software which is a medical device such as treatment planning systems.
I know of one case in Wales where new ITU network connected monitoring equipment was being installed and the ICT people said that, because the equipment was network connected, therefore the equipment was their responsibility. Fortunately more in depth discussions led to greater mutual understanding and appreciation of the responsibilities of CEs.
On the other hand, there are situations where clinical engineering and medical physics work very collaboratively with ICT. That what we want.”
John commented further:
“The HTM book stresses the need for team work, and a multidisciplinary approach. This implies that / requires that there is mutual recognition of skills and knowledge and the shared responsibility to work together to add value to the patient care.
Justin has given examples of where we deal with this in the book in several case studies; I add referral to Case Studies CS4.4 and CS4.5 that look at the difficult issue of ensuring compliance with data protection when disposing of medical equipment (after an evaluation trial or end of life disposal) - sometimes the responsibility of IT, sometimes of Information Governance, but we would argue a shared responsibility with us HTM types. In my past job I worked collaboratively with both IT and Information Governance to attempt to address this, seeking to put in place, for example with equipment on evaluation, steps to ensure compliance, bringing suppliers into the dialogue. Much more could be added and developed along this theme.
We introduce the relationship between CE and ICT early on in the book. In Chapter 1 (page 9 of the print copy, paragraph beginning "In managing the ..") we write about connectivity and information sharing and the convergence of medical equipment and ICT. This convergence is briefly discussed further noting that the disciplines should recognize their common purposes and the need for coordinating their efforts.
Some of the reasons for ICT / HTM conflicts arise from the responsibility of ITC to safeguard hospital systems from cyber attacks. We discuss this briefly in Chapter 9, page 501, again stressing the importance of co-operation. I know of instances where this is particularly irksome to clinical staff, particularly those ITC-literate who have sophisticated home systems.
There is much more to be developed on this theme, but it is helpful to stress that good co-operation is possible.”
What level of recognition is given to CE and ICT departments?
One area of concern is the lack of recognition of the respective responsibilities, roles and contributions of Clinical Engineers and ICT professionals amongst senior management and health service executives. This lack of appreciation occurs within individual hospitals and also at national levels. ICT is widely perceived as providing the means to improve effectiveness and efficiency whilst controlling costs. This can and has led senior hospital and national planners to vest control and authority over any technology that uses ICT to ICT departments. The head of ICT will be accorded a high status within the organization, probably at executive level. In contrast, the head of Clinical Engineering will be regarded at best as an equipment controller or perhaps only as a maintenance provider, with lower status and rank within the organization. This exacerbates the lack of mutual recognition of these two professional groups.
It is important that Chief Executives understand the respective roles of CE and ICT departments. Furthermore, the heads of CE and ICT departments must engage in regular dialogue to understand each other’s responsibilities and concern. From this they should develop co-operative working arrangements to optimally apply their respective technologies for patient care. This recognition at Chief Executive level and mutual co-operation between CE and ICT must occur at all levels, at national levels and within individual healthcare organizations.
- By Justin McCarthy
- 15th Apr 2017
- 2
- Ict, Co-Operation
Justin McCarthy said...7 years ago / Reply
Please let me bring this blog from AAMI to your attention.
https://aamiblog.org/2017/04/18/samantha-jacques-clinical-engineering-has-crucial-role-in-facilities-projects/
It complements and builds on the discussion above. My experience has been that the users and that includes CE are often excluded from detailed involvement in major building projects if not from initial planning but especially from the ongoing checking of progress against agreed plans. These often get changed, maybe in small way such as positioning of doors or services that contractors thing are insignificant but can be profoundly affecting of the final usability of the space.
Any further input?
Justin
Fran Hegarty said...7 years ago / Reply
In Ireland Clinical Engineers have traditionally been responsible for ICT elements that are part of Medical Equipment Systems. So phys mon central stations, Sleep Lab Monitoring, Holter Monitoring, and Hemodynamic Monitoring Systems have been under the management of Clin Eng. The reason is that these ICT elements started to be introduced as parts of wider medical equipping projects and for many years they ran on stand alone networks, often delivered, configured and installed by the supplying company.
The arrival of CIS caused a shift. Here the phys mon and vents etc were still connected by a local physical network supplied by the medical equipment companies and managed through Clin Eng. However, CIS also requires a medical Grade PC network that sits on the hospitals network infrastructure owned by the ICT dept. In Ireland hospital ICT departments developed to meet Business Systems needs and so the ICT depts are light on engineers and clinical people and populated more with business admin and project managers who outsource a lot of the technical aspects of the ICT infrastructure. In my hospital I was lucky as my local ICT dept had supported a number of staff with an interest in network engineering to retrain, and had seconded a number of nurses to manage the interface with clinical departments, many of whom had undertaken an MSc in health informatics. Nevertheless we needed to find a way for a team to be established and take a collective responsibility for what was our first Medical IT Network i.e. a converged hospital network that contained medical equipment. We went slowly and pretty much kept medical equipment on a separate physical network and the carefully managed the single interface to the wider network.
Today, I am in a new organisation designing a new facility. There are valid financial and opperational pressures to put medical equipment onto hospital converged networks. This requires the hospital to establish a team who understand not only the ICT engineering aspects but also the medical equipment engineering theory and the clinical application that can be impacted by adverse events arising from network failure. So we have spent a considerable effort in discussing this as a shared responsibility between Clin Eng / Medical Physics and ICT. We are in a good place with that discussion and recent high profile cyber attacks on hospitals has given this discussion a profile at executive level. I think the way its going to fall out is that Clin Eng will establish a team to work with ICT on Medical IT Networks, just as we have an ICU team, an Dialysis team etc.
In this world of hyper specialisation it seems very hard for ICT folks to work into clin eng space, but we as clinical engineers can learn the ICT engineering and reach into their space. Important to work as a team and keep the focus on supporting activity that benefits patients and avoid professional power games…… Clinical Engineers working constructively with ICT to deliver better and safer Medical ICT Networks in a value add.