Clinical engineering

Clinical engineering is a specialty within Biomedical engineering responsible primarily for applying and implementing medical technology to optimize healthcare delivery. Roles of clinical engineers include training and supervising biomedical equipment technicians (BMETs), working with governmental regulators on hospital inspections/audits, and serving as technological consultants for other hospital staff (i.e. physicians, administrators, I.T., etc.). Clinical engineers also advise medical device producers regarding prospective design improvements based on clinical experiences, as well as monitor the progression of the state-of-the-art in order to redirect hospital procurement patterns accordingly.

Their inherent focus on practical implementation of technology has tended to keep them oriented more towards incremental-level redesigns and reconfigurations, as opposed to "revolutionary" R&D or cutting-edge ideas that would be many years from clinical adoptability; however, there is nonetheless an effort to expand this time-horizon over which clinical engineers can influence the trajectory of biomedical innovation. In their various roles, they form a sort of "bridge" between product originators and end-users, by combining the perspectives of being both close to the point-of-use ("front lines"), while also trained in product and process design. Clinical Engineering departments at large hospitals will sometimes hire not just biomedical engineers, but also industrial/systems engineers to help address operations research, human factors, cost analyses, safety, etc.

History

While some trace its roots back to the 1940s, the actual term "clinical engineering" was first used in 1969. The first explicit published reference to the term "clinical engineering" appears in a paper published in 1969 by Landoll and Caceres^[1]. Cesar A. Caceres, a cardiologist, is generally credited with coining the term "clinical engineering." Of course, the broader field of "biomedical engineering" has a relatively recent history as well. The first modern professional intersociety engineering meeting to be focused on the application of engineering in medicine was probably held in 1948, according to the Alliance for Engineering in Medicine and Biology^[2]

The general notion of the application of engineering to medicine can be traced back centuries; for example, Stephen Hales's work in the early 18th century which led to the invention of a ventilator and the discovery of blood pressure certainly involved the application of engineering techniques to medicine ^[3].

The recent history of this sub-discipline is somewhat erratic. In the early 1970s, clinical engineering was thought to be a field that would require many new professionals. Estimates for the US ranged as high as 5,000 to 8,000 clinical engineers, or five to ten clinical engineers for every 250,000 of population, or one clinical engineer per 250 hospital beds.^[4].

The history of its formal credentialization and accreditation procedures has also been somewhat unstable. The International Certification Commission for Clinical Engineers (ICC) was formed under the sponsorship of the Association for the Advancement of Medical Instrumentation (AAMI) in the early 1970s, to provide a formal certification process for clinical engineers. A similar certification program was formed by academic institutions offering graduate degrees in clinical engineering as the American Board of Clinical Engineering (ABCE). In 1979, the ABCE agreed to dissolve, and those certified under its program were accepted into the ICC certification program. By 1985, only 350 clinical engineers had become certified^[5]. Finally, in 1999, AAMI after lengthy deliberation, and analysis of a 1998 survey demonstrating that there was not a viable market for its certification program decided to suspend that program, no longer accepting any new applicants as of July 1999^[6].

The new, current Clinical Engineering Certification (CCE) program was started in 2002 under the sponsorship of the American College of Clinical Engineering (ACCE), and is administered by the ACCE Healthcare Technology Foundation. In 2004, the first year that the certification process was actually underway, 112 individuals were granted certification based upon their previous ICC certification, and three individuals were awarded the new certification.^[7] By the time of the publication of the 2006-2007 AHTF Annual Report (approx. June 30, 2007), a total of 147 individuals were included in the ranks of HTF certified clinical engineers^[8].

New name for the Profession

A group of 30 influential persons in Biomed met on April 28 and 29, 2011 in Arlington, Virginia to examine the future of the Biomedical / Clinical Engineering / Medical Equipment Maintenance field, and to select the most appropriate name for the profession. Most of the cost was born by AAMI, who contracted professional facilitators to guide the process. AAMI was a participant, like everyone else, but didn’t exert a domineering role in the process. After two grueling days, we did arrive at a best name, based upon all of the factors. The name chosen was “Healthcare Technology Management”. The finalists were Clinical Engineering, Clinical Technology, and a few others. There was debate as to whether the final word in the name should be Support, Service or Management. After careful debate, the vast majority decided on “Healthcare Technology Management”. Everyone in the room stated that they could support the new name.

We felt that this name was accurate, easily understood by the public and other healthcare workers, and allowed for expansion of the field in the future. The word “Engineering” was limiting (from the administrator’s perspective) and unworkable from the educator’s perspective. (A college would never name an associate’s degree program “Engineering”.) Likewise, the name “Clinical” was now clear, and limited the scope of the profession to hospitals, when healthcare is clearly moving outside of the hospital. Lastly, the names “Support” and “Service” seemed to be passive and imply a sideline role instead of a leadership role.

There will be much more released about this, with many more details. But for now, this is the main thrust of the meeting.

(Represented were biomedical educators, clinical engineers, BMETs, manufacturers, ISOs, directors, nurses, administrators, and the Office of Veterans Health Administration. )

Clinical engineering in India

Healthcare has increasingly become technology driven and requires trained manpower to keep pace with the growing demand for professionals in the field. An M-Tech Clinical Engineering course was initiated by Indian Institute of Technology Madras (IITM), Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum and Christian Medical College, Vellore (CMC), to address the country's need of human resource development. This was aimed for indigenous Biomedical Device Development as well as Technology management, and thereby contribute to the overall development of healthcare delivery in the country. During the course, students of engineering are given an insight into biology, medicine, relevant electronic background, clinical practices, device development and even management aspects. Additionally, students are paired with clinical doctors from CMC and SCTIMST to get hands-on experience during internships. An important aspect of this training is simultaneous, long term and detailed exposure to clinical environment as well as to medical device development activity. This is aimed at making students understand the process of identifying 'unmet clinical need' and thus, contributing to the development of new medical devices in the country. A unique feature of the course is clinical attachment which exposes the students to the clinical environment. The program also trains engineers to manage and ensure safe and effective use of technology in heath care delivery points. The minimum essential qualification for joining this course is bachelors degree in any discipline of engineering except civil engineering and a valid GATE score in their respective fields.

The Definition

A Clinical engineer is defined by ACCE as "a professional who supports and advances patient care by applying engineering and managerial skills to healthcare technology."^[9] This definition was first adopted by the ACCE Board of Directors on May 13, 1991. Clinical Engineering is also recognized by the Biomedical Engineering Society (BMES), the major professional organization for biomedical engineering, as being a branch within Biomedical Engineering. [1]

There are at least two issues with the ACCE definition that cause some confusion. First, it is phrased so broadly that it's not readily evident that "clinical engineer" is but one subset of "biomedical engineer." Many times the terms actually get used interchangeably: some hospitals refer to their relevant departments as "Clinical Engineering" departments, while others call them "Biomedical Engineering" departments. Indeed, as noted above, the technicians are almost universally referred to as "biomedical equipment technicians," regardless of the name of the department that they might work under. However, the term "biomedical engineer" is generally thought to be more all-encompassing, including engineers who work in the primary design of medical devices for manufacturers, or in original R&D, or in academia—whereas clinical engineers generally work in hospitals solving problems that are very close to where equipment is actually used in a patient care setting. The clinical engineers in some countries such as India are trained to innovate and find technological solutions for the clinical needs.^[10]. The other issue not evident from the ACCE definition is the appropriate educational background for a clinical engineer. Generally, the expectation of the certification program is that an applicant for certification as a clinical engineer will hold an accredited bachelor's degree in engineering (or at least engineering technology).

The future

The management of healthcare technology is becoming increasingly complex. The driving factors and opportunities presented are examined in The Future of Clinical Engineering, published in the IEEE EMBS magazine in 2003.

Eligibility Requirements

To be eligible for certification in clinical engineering (CCE), a candidate must hold appropriate professional or educational credentials (an accredited engineering or possibly engineering-technology degree) have certain relevant experience, and pass an examination. The Examination for Certification in Clinical Engineering involves a written examination composed of a maximum of 150 multiple-choice objective questions with a testing time of three (3) hours, and a separate oral exam.^[11]. Particular weight is given to applicants for CE certification (CCE) who are already licensed as registered Professional Engineers (PE) -- which itself has extensive requirements (including an accredited engineering degree and engineering experience).

See also

• Biomedical engineering

References

1. ^ Landoll JR and Caceres CA, Automation of Data Acquisition in Patient Testing, Proceedings of the IEEE, Vol. 57, No. 11, November 1969, 1941-1953
2. ^ Zambuto RP, Clinical Engineers in the 21st Century, IEEE Engineering in Medicine and Biology Magazine, May/June 2005, 37-41
3. ^ Cartwright FF, A Short History of Blood Pressure Measurement, Proceedings of the Royal Society of Medicine, Volume 70, November 1977, 793-799
4. ^ Shaffer MJ, Clinical Engineering: An In-Depth Review of Its Economic Potential, Medical Care, July 1977, Vol. XV, No. 7, 552-567
5. ^ Shaffer MJ, Clinical Engineer Cost-Effectiveness Measurements in the USA, Medical and Biological Engineering & Computing, November 1985, 505-510
6. ^ Minutes and Report of USCC Task Force on Certification Clinical Engineering Conference Call December 2, 1999
7. ^ ACCE Healthcare Technology Foundation 2004/2005 Progress Report
8. ^ ACCE Healthcare Technology Foundation 2006/2007 Progress Report
9. ^ According to The American College of Clinical Engineering.
10. ^ BMES - Biomedical Engineering Society
11. ^ ACCE-Healthcare Technology Foundation

External links

Some hospital-based departments include:

• Duke University Health System
• Flinders Medical Centre
• Haukeland University Hospital
• Partners Healthcare System
• Rapid City Regional Hospital
• St.Vincent's University Hospital
• University of Arkansas for Medical Sciences
• University of Virginia Health System

Some schools that offer Clinical Engineering include:

• Cincinnati State College BMET
• University of Connecticut Clinical Engineering
• University of Toronto - MHSc Clinical Biomedical Engineering
• Joint Master of technology(M.Tech) program of IIT Madras/SCTIMST trivandrum/ CMC vellore)

Some independent organizations include:

• Clinical Engineering Consultants, Inc.

Some independent industry sponsored Clinical Engineering Education and Training organizations include:

• EBME Biomedical & Clinical Engineering
• Clinical Engineering Network

Some industry associations include:

• American College of Clinical Engineering
• ACCE Healthcare Technology Foundation
• Association for the Advancement of Medical Instrumentation
• Bay Area Association of Medical Instrumentation "BAAMI", Tampa, FL
• META - Medical Equipment & Technology Association

And, other links of interest include:

• Online bio of Cesar A. Caceres
• Clinical Engineering Handbook
• Journal of Clinical Engineering
• BMET WIKI
• Clinical/Biomed Blog