ce-it interdepartmental collaboration - ce-it webinar … · ce-it interdepartmental collaboration...

7/25/2012

1

CE-IT Interdepartmental Collaboration

CE-IT Community Town HallJuly 18, 2012

David W. Braeutigam, MBA, CBETDirector Biomedical EngineeringBaylor Health Care SystemDallas, Texas

July 18, 2012

© 2012 Baylor Health Care System

2

Agenda

• Overview of Baylor Health Care System• Overview of Biomedical Engineering and IT• Handoffs between Biomed and IT team• Issues and Lessons Learned• Questions

7/25/2012

2


Baylor Health Care System Overview

• 13 Hospitals in the Dallas-Ft. Worth area• 170+ Physician offices• 15+ Satellite Outpatient Centers (Imaging/Pain/Radiation)• 62,500 pieces of medical equipment

• 61,000 biomedical engineering• 1,500 imaging

• 4,700 wireless IV pump channels, 1,300+ telemetry transmitters, 690+ defibrillators, 330+ ventilators, 240+ EKG carts, 190+ anesthesia machines, 43 CT and 34 MRI

• 65,000 work orders a year• 40,000 scheduled PMs• 25,000 unscheduled work orders

• $630 million in inventory

3

5 Hospitals are Magnet Recognized

#1 Rated Safe Hospital in Texas


4

Director Biomedical Engineering

Director Imaging Services

Manager Clinical

Technology Services

Manager Biomedical Engineering5 Hospitals

Manager Biomedical Engineering1 Hospital




Manager Imaging Services

1 Team Lead and 13

BMETs

7 BMETs

7 BMETs

6 BMETs

5 BMETs

8 RES

2CEs23 - CBET

1 - CLES4 - A+4 - Network+2 - MCP2 - MCSE2 - CCNA1 - CCENT1 – CCSFP8 – GE Essentials of Healthcare IT4 – GE Wireless in the Healthcare IT Environment

Vice PresidentHealthcare Technology

Management and Telecommunications

Biomed Org Chart

8 RES

7/25/2012

3


• You must have a person in biomed that can work as a liaison to IT

• Must be able to ‘speak’ IT• Must be able to work with server team,

field support team, network team, security team, applications team and the OEM on integrating medical equipment onto the hospital network

5

Manager Clinical

Technology Services

Key Role in Biomed

Technology Manager at Baylor*•CLES•A+•MCSE•CCNA•HITRUST CCSFP (Certified Common Security Framework Practitioner)•Member of IHE PCD working group representing AAMI

*This is similar to the Clinical Systems Engineer role recommended by Ray Zambuto and Stephen Grimes in their article published in the Sept/Oct 2010

issue of Biomedical Instrumentation & Technology “The Growing Move Toward Clinical Systems Engineering”


6

More than 500 applications:3M/SoftmedAbbott PoC

Risk Management DatabaseApollo Cardiology

Business ApplicationsChargemaster Database

CloverleafDocuDataMeditech

MicromedexHR applications

Microsoft ApplicationsLawson

Clinical DashboardsEclipsys (EMR)

Patient AccountingPACS

Pathology transcriptionLISRIS

QS Perinatal SystemPayroll

GE MacLabSleep Lab

Provation GI Lab system

Baylor IT Support

CPM – Certified Project Manager

7/25/2012

4


Overview of Biomed and IT systems

• GE MacLab• Patient Monitoring systems• Hospira Wireless IV pumps• GE MUSE ECG Storage with Wireless ECG Carts• Provation GI Lab system• GE QS Fetal Monitoring system• Masimo Centralized Pulse Oximetry• Bernoulli Centralized Pulse Oximetry and Ventilators• Eclipsys/Allscripts (EHR)

7


What is the goal of IT?

What is the goal of Biomed?

8

IT and Biomed Goals

7/25/2012

5


• Infrastructure Team• Reliable storage systems and

fast, reliable network• Applications Team

• Support of applications in the hospital

• Field Support• Computers available for use

by staff• Customer Service & Help Desk

• Support customers with technical issues

• Telecom• Reliable phone systems

• Project Management• Projects start and end on

time plus stay on budget• Security

• No virus infections or patient information compromised

• Biomed• Safe medical equipment

available for patient use

9

IT and Biomed Goals

These are basic goals – everyone has a much more complex set of goals and

responsibilities – but sometimes the goals conflict with other departments and each

will have to compromise to meet the overall goal of the hospital


How Did We Prepare Our Staff for IT?

• A+• Network+• MCSE• Brought instructor in-house to

teach A+ and Network+• Used empty ICU for two weeks

of training• Annual continuing education

classes on general IT support and specific IT support of patient monitoring systems

10

IT Training started in 1999!

7/25/2012

6


Examples of IT and Biomed working together in the Cath Lab

11


Cath Lab Issues

• Cath Lab equipment was crashing due to software updates being pushed to the system

• Anti-virus script was filling up hard drive

• Encryption software was causing issues

• Confusion over who was responsible for each part of the system

• Worked with Application team, Network team, Security team and Field Support team to understand responsibilities and issues

12

7/25/2012

7


13

Flow of cath lab with service responsibilities

BIO – BiomedIMG – ImagingCAPPS – Clinical AppsFS – Field Support

Whiteboard of Cath Lab Support


14



Photo of Cath Lab Support

7/25/2012

8


15



Photo of Cath Lab Support


Lessons Learned – Cath Lab

• Cath Lab equipment was crashing due to software updates being pushed to the system

• Moved anti-virus directory off system drive

• Excluded Cath Lab computers from encryption

• Excluded OS patches unless approved by OEM

• Developed support matrix between support groups

• Updated RAR (Risk Acceptance Request) after meeting with Security team

16

Support Matrix Spreadsheet

7/25/2012

9


17

Examples of IT and Biomed working together with Patient

Monitoring


Past Present

• IT and Biomed did not want patient monitoring on the IT network

• IT did not want patient monitoring network in their IT closets

• IT did not want any other network cable in their cable trays

• Patient monitoring• Nurse call• Fire

• Biomed did not have the IT expertise

• Patient monitoring is on IT network but separated through VLANs

• Two network closets created• Traditional IT closet• Low voltage closet used for patient

monitoring, nurse call, etc.

• IT and Low voltage closets are adjacent on the floor

• The closets were also stacked on the floor plan

• All networking cable has unique color

• Staff is trained in IT

18

Patient Monitoring Concerns

7/25/2012

10


Patient Monitoring Lessons Learned

• Training for staff – A+ and Network+• GE training – Essentials of Healthcare

IT Class and Wireless in the Healthcare IT Environment Class

• Supplemental follow-up classes on specifics of our GE Unity Network

• Document created with IP address and map of system layout

• Network folder created for GE network drawings and hospital drawings

• Notes created with information needed to troubleshoot system – user IDs and passwords for specific parts of the system (to be used on Outlook and Blackberry)

• Mini labs to help staff troubleshoot the GE network – very successful

• Network rack in each biomed office for troubleshooting and training

19

Added IP address of each medical deviceto the database


IT

Biomed

7/25/2012

11


21

Fiber run to biomed office

Mission Critical and Information Exchange network switches

ATS server

CIC

UPS

Fully configured ICU monitoring

setup

Every biomed shop is set up this way and it is part of initial purchase of patient monitoring at each hospital


22

Examples of IT and Biomed working together with

Hospira Wireless IV Pumps

7/25/2012

12


IV Pumps Issues & Lessons Learned

• 4,700 wireless IV pump channels in the system

• Some older IV pumps were still 802.11 ‘B’

• Transmitted DNS traffic constantly• Did not support WPA2 (used WEP)

• Had to build DNS servers to handle the traffic

• Created new SSIDs for medical equipment

• Upgraded network cards to 802.11 ‘ABG’

• Develop AP (Access Point) floor plans to identify each access point

23


24

Examples of IT and Biomed working together with ECG downloads (MUSE system)

7/25/2012

13


MUSE ECG System Lessons Learned

• Document created with IP address and map of system layout

• Continuing Education class for staff to understand system and to be able to troubleshoot the system

• Created folder with information needed to troubleshoot system

• Architecture of system• Server names for each hospital• Modem phone numbers• User IDs and passwords for specific

parts of the system• Troubleshooting document with key

contacts in ECG department and IT applications support for escalation

• Certain technicians given rights to configure wireless adapters on ECG carts

25


26

Examples of IT and Biomed working together with the GI Lab system

7/25/2012

14


GI Lab System Lessons Learned

• Defined roles for Biomed, Field Support. Server team and Application Support

• Biomed is first call to determine location of issue

• Hand-off to application support if there is a software issue

• Would hand off to server/network team if not an application issue

• Desktop support• Biomed responsible for video card• Field Support responsible for OS and

remainder of hardware

27


28

Examples of IT and Biomed working together with our Fetal Monitoring system

7/25/2012

15


QS System (Fetal Monitors) Lessons Learned

• Defined roles for Biomed, Field Support and Application Support

• Biomed responsible for initial call• Biomed responsible for

replacement of Equinox (serial to Ethernet convertor)

• Physical location of devices –hospital, building, floor, room number

• Access – key or badge access?• What team has access – biomed,

field support or network team?• What type of closet are devices

located (biomed - IT closet - other)• Typical issues – created

troubleshooting document and network layout

29


30

Examples of IT and Biomed working together with our Masimo Central Stations

7/25/2012

16


Masimo Central Stations Lessons Learned

• Entered as a Project• IT Project Manager assigned• Nursing champion for the system• IT technical support contacts

• Physical location of devices –hospital, building, floor, room #

• Biomed identified security issues with early release of system – worked with Masimo to resolve issue

• Created troubleshooting document and network layout

• Defined roles for Biomed, Field Support and Application Support

• Annual Continuing Education class over system

• Biomed staff can troubleshoot system from desktop in biomed shop

31


32

Examples of IT and Biomed working together with our

Bernoulli Pulse Oximetry and Ventilator Central Stations

7/25/2012

17


Bernoulli Central Stations Lessons Learned

33

•IT technical support contacts•Created troubleshooting document and network layout•Defined roles for Biomed, Field Support and Application Support

•Biomed responsible for initial call•Field Support?•Server Team?•Network Team?

•Mandatory software support contract required•Annual Continuing Education class over system layout, operation and troubleshooting


34

Examples of IT and Biomed working together with our EHR

7/25/2012

18


Electronic Health Record Lessons Learned

• Define roles and responsibilities• Biomed is first call and determines

source of failure• If not biomed issue then the call is

reassigned to the interface team• Identify skills needed to

troubleshoot network issues• Supply schematics of network

layout• Annual Continuing Education

class• Mini labs to educate staff on

network troubleshooting

35


• Risk Acceptance Request (RAR)

• Must be filled out and submitted to Office of Information Security (OIS) when a device does not meet Baylor security standards

• Describe exception being requested – such as anti-virus scanning exclusions, vendor approved OS patches, password management, encryption, etc.

• Describe the risk that will be assumed by not complying with standards

• Define the length of request

36

Risk Acceptance Request

7/25/2012

19


• Request for Change (RFC)• Change control process to gain

approval and to notify staff of downtime that might impact their applications

• Sent to IT Directors for review• Impact of downtime• Posted on downtime calendar

• Communication Plan

37

Request for Change


• Nurse call system down at Plano

• Nursing did not feel we effectively communicated the status of the down system

• We felt we already communicated well at the department level

• CNO requested we follow Engineering and IT’s lead and issue outage alerts to CNO, Safety Officer and House Supervisor

• Used existing software system for emergency contact used by Safety office

38

Outage Alerts

7/25/2012

20


Overall Lessons Learned

• Defined our processes and hand-offs much better• Know who the players are in IT

• Present a Project Request for medical equipment that communicates on the hospital infrastructure

• Understand HITECH* Act• Understand HIPAA• Understand HITRUST*• Understand MDS2*• Provided staff with resources to troubleshoot computer and network

systems• Educate staff and follow-up with additional training sessions• Replacing desktop systems with notebook computers• In-house, vendor-specific and general IT training

• VP and Biomed Director meets weekly with other IT Directors and above to review projects, issues, etc.

39

Gives you a better understanding of IT Security

concerns

*HITECH – Health Information Technology for Economic and Clinical Health – passed into law February 17, 2009*HITRUST – Health Information Trust Alliance

*MDS2 – Manufacturer Disclosure Statement for Medical Device Security


40

IT Governance Councils

• Governance Councils• Used to approve projects and understand

impact of different groups in IT• Approval at Director and VP level in IT• Approval at funding level to senior executives

at corporate level (CFO, COO, CNO, CMO, CMIO, hospital Presidents, etc.)

• Biomed sits on IT Director weekly meetings

• Local hospital managers attend monthly IT Governance meetings with hospital leadership (Hospital CNO, IT Director, Nursing leadership, Biomed Manager)

7/25/2012

21


41

MDS2 Overview

• Management of Electronic Protected Health Information

• Administrative Safeguards• Physical Safeguards• Technical Safeguards• Recommended Security

Practices• Explanatory Notes

You can get a generic copy of this file at:

http://www.himss.org/content/files/MDS2FormInstructions.pdfGE CIC Pro MDS2 document


42

Web Resources

GE MDS2•http://www.gehealthcare.com/usen/security/mds2_docs.html

Philips MDS2•http://www.healthcare.philips.com/us_en/support/productsecurity/mds2.wpd

Carestream MDS2•http://carestream.com/PublicContent.aspx?langType=1033&id=411680

HITRUST•http://www.hitrustalliance.net/

HIMSS (Healthcare Information and Management Systems Society•http://www.himss.org

ACCE (American College of Clinical Engineering•http://www.accenet.org/

IHE (Integrating the Healthcare Environment•http://ihe.net/

CE-IT Collaboration•http://ceitcollaboration.org

7/25/2012

22


What Can You Do to Improve Integration of Biomed and IT?

• Join HIMSS at the national and local levels• 37,000 attended HIMSS in February!

• Know your IT counterparts• Applications• Infrastructure• Help Desk• Field Support• Security

• Improve you and your teams IT knowledge• Be able to speak IT to IT!• Understand IT’s process and goals

43

What Can You Do?


• Everything we have adopted in working with IT on medical equipment in this environment has been spelled out in IEC 80001-1

• Project Management• Change Control• Security

• Adopt and understand 80001-1 as soon as you can• Form Team• Understand Risk

• Create a Clinical Systems Engineer or equivalent to handle the integration of IT and biomed devices

44

Conclusion

7/25/2012

23


45

Questions

Contacts:David Braeutigam

Director Biomedical [email protected]

Richard SwimManager Clinical Technology

[email protected]

ce-it interdepartmental collaboration - ce-it webinar … · ce-it interdepartmental collaboration...

Documents