By Keri Forsythe-Stephens

Editor’s note: The January/February 2025 print issue will feature exclusive salary charts and regional break-downs.

Let’s start with the positive: Salaries increased in six of the seven major job categories in 24×7’s 2024 compensation and job satisfaction survey. BMET 1s, BMET 2s, BMET 3s, clinical engineers, and radiology equipment specialists reported year-over-year gains of $3,400, $2,300, $1,900, $4,000, $6,700, and $1,500, respectively. Unfortunately, directors/executives didn’t fare as well. Their average pay declined from $148,500 in 2023 to $143,600 in 2024.

These inconsistencies were also evident regionally in 24×7’s 2024 compensation and job satisfaction survey. While median salaries for directors/ executives fell in seven of the nine U.S. regions, notable improvements were seen in the Mountain West and West South Central regions. Directors/executives in both groups experienced a $14,500 year-over-year salary increase in 2024, with those in the West South Central region slightly outpacing their Mountain West peers. (The median salary for West South Central-based directors and executives rose to $154,300 in 2024, $8,500 higher than in the Mountain West.)

BMET 2s in the Mountain West bucked this trend, however. Their median salaries surged $8,000, year-over-year, in 2024 despite relatively stagnant BMET 2 salary growth in the West South Central region. Fortunately, the outlook was much rosier to the east. BMET 2s in the East South Central witnessed double-digit salary growth, with their annual wages rising $10,800, year-over-year, to $70,100.

Radiology equipment specialists also saw strong financial growth in 2024. Their salaries broke the six-figure threshold in all regions calculated—a phenomena that one radiology equipment specialist deemed appropriate due to the workload.

“I’m responsible for servicing over 70 big iron imaging equipment as the primary engineer with no full-service contracts and often no secondary trained colleagues,” the survey respondent wrote. “I work eight to 10 hours of overtime per week but often can exceed 15 hours’ overtime with tube replacements, reburns, or afternoon scheduled repairs.  

Hefty workloads were a recurring theme in 24×7’s 2024 compensation and job satisfaction survey. A significant 46% of respondents described their workload as “heavy,” while a subsequent 10% labeled it “excessive.” In contrast, only 2% considered their workload “light,” and 42% rated it as “moderate.”

Not that the hard work deterred most respondents. Despite feeling stressed, the majority expressed a willingness to promote the profession to others. Nearly half—43%—reported being “very likely” to promote the HTM profession, while 30% said they were “likely” to do so. Additionally, 17% indicated they were “somewhat likely” to endorse HTM, while 10% stated they were either “somewhat unlikely” or “very unlikely” to promote it.

Telling Results

When asked about their favorite aspects of healthcare technology management, survey respondents cited the usual suspects: working with a variety of equipment, the ability to positively impact patient care, and the thrill of never knowing what each day will bring.

“No two days are ever alike,” one respondent wrote, while another praised the opportunity “to be a part of something big.”

Still, some respondents acknowledged the challenges of having a direct impact on hospital operations. “With risks ever increasing, cybersecurity, continued interoperability, and our consistent focus on patient safety, more is being asked of our industry than ever before,” one person lamented. “If you want to operate at a high level, you have to put in the work to be successful.”

Another recurring concern was the difficulty of finding qualified talent to replace those leaving the profession.One respondent described the lack of new talent entering HTM as troubling, citing an “awareness gap” about the field. Calling HTM a “relatively unknown profession,” the respondent stressed the need to attract more people—especially as medical technologies proliferate, increasing the demand for maintenance.

Attracting more women to the field is one potential solution. Not surprisingly, men accounted for the majority of survey respondents—81%—while females represented just 16% (with 3% choosing not to disclose their gender). These figures are consistent with 2023 data.

Also consistent is the percentage of respondents who are actively job hunting. Nearly one-quarter (23%) copped to exploring opportunities outside their current organization, with 41% rating their promotion prospects as “below average.” Only 12% viewed their advancement opportunities as “excellent”—unchanged from 2023.

But one data point that differed greatly from 2023 was the overall benefits picture. Benefits improved in every category—paid time off (PTO), health insurance, dental insurance, 401(k), life insurance, vision insurance, tuition reimbursement, and professional development. An overwhelming majority of respondents—96%, to be exact—enjoyed paid time off in 2024, up from 86% in 2023. Also notable was the increase in respondents receiving tuition reimbursement, rising from 55% in 2023 to 67% in 2024.

It’s yet another bright spot in an otherwise mixed report. While salary gains and enhanced benefits indicate progress, challenges such as heavy workloads, talent shortages, and limited advancement opportunities underscore the need for continued investment in workforce development and industry support, according to the respondents of 24×7’s 2024 compensation and job satisfaction survey.

Keri Forsythe-Stephens is chief editor of 24×7. Questions and comments can be directed to editor@24x7mag.com.

Click here to take the survey.

Your reply is critical—without it, the research may not do an effective job of representing organizations and positions like yours. You can look forward to seeing the survey results in the January/February 2025 issue of 24×7. As sincere thanks for your participation, you can enter a drawing for a chance to receive a $150 Amazon gift card at the end of the survey.

For reference, here is a link to last year’s HTM salary survey.

Biomedical equipment technicians (BMETs) are facing increased workloads and staffing shortages, which are expected to get worse as the current workforce retires. About a third of HTM professionals are over the age of 55, putting pressure on health systems to attract the next generation of BMETs. More than 7,000 additional BMETs are needed each year, but BMET programs are only graduating less than 400 per year. To address these challenges, health systems should leverage cutting-edge technology to draw in BMETs and provide them with a meaningful and fulfilling career.

A comprehensive, integrated CMMS with mobile capability will maximize technician efficiency, patient safety, regulatory compliance, and device availability–ensuring BMETs work smarter, not harder. Integrating technology such as artificial intelligence will also appeal to these sought-after professionals. Empowering technicians with modern tools, resources, and support can make health systems more attractive to top-tier talent.

Mobile Apps Can Improve Technician Efficiency

One key differentiator for health systems looking to attract BMETs is the availability of a mobile application that streamlines daily tasks including ordering parts, requesting service, and completing documentation—all without leaving the worksite. While working on equipment, BMETs have traditionally had to manually jot down notes and then return to a central workstation later to place part orders or input data on a desktop. This dated method is inefficient and increases the risk of errors, while reducing the time technicians can spend on their core responsibilities of servicing the medical devices.

Many clinical engineering teams rely on desktop-based systems for ordering parts and managing service requests, which limits technician mobility and slows down operations. By equipping clinical engineering teams with a mobile app that integrates with the computerized maintenance management system (CMMS), health systems can enable technicians to work directly at the medical devices, reducing the need for back-and-forth trips to a central workstation.

This can dramatically increase BMET productivity and satisfaction. BMETs working on a medical device can determine they need a part, request the part, and close the work order all in real-time. This reduces errors, allows technicians to stay focused on their work at the devices, and helps them avoid burnout. 

Health systems should work with a partner who specializes in clinical engineering and has an in-depth understanding of what BMETs need daily. That partner should provide a mobile app that allows technicians access to all the information and tools they need to service equipment confidently and efficiently from any location.

Automation and Predictive Technologies Enhance Productivity  

Automation is playing a crucial role in improving BMET workflow. One of the standout features of modern platforms is the ability to automate test results from equipment directly into the system, eliminating the need for manual entry.

TRIMEDX has found mobile, automated equipment testing can save technicians up to 10 minutes per equipment test. By automatically capturing test equipment results and integrating them directly into the work order system, health systems are ensuring accuracy and significantly reducing the time technicians spend on administrative tasks, allowing them to focus more on the technical aspects of their roles.

Health systems should also incorporate predictive work systems to monitor medical devices and proactively provide troubleshooting steps to technicians. Empowering BMETs with technology that identifies preventable failures and device problems before they happen, allows clinical engineering teams to address a problem before it results in a device failure. Not only does this make technicians’ jobs less stressful, but it also eliminates unforeseen equipment downtime and allows health systems to offer consistent care to patients.

AI: The Future of Biomedical Technology

Artificial intelligence is revolutionizing how data is analyzed, problems are identified, and strategies are implemented across all industries. While the HTM field is still in the early stages of AI adoption, the evolving technologies present many opportunities for health systems, particularly in data analytics.

AI’s potential lies in its ability to shorten the time spent analyzing data and identifying problems, which can be a game-changer in the fast-paced healthcare environment. While clinical engineering teams may spend days analyzing data to find out if there is a problem with a specific part or medical device, AI-powered technologies can dramatically reduce that process.

By using AI to quickly pinpoint issues, technicians can focus their efforts on resolving them rather than trying to identify what’s wrong in the first place. AI-powered technology can also recommend technicians order certain parts for medical devices based on historical device data. This will help BMETs act proactively and anticipate upcoming needs. 

Additionally, machine-learning engines collect and analyze the vast amounts of data generated during equipment testing to continuously improve testing accuracy, minimize equipment downtime, increase technician efficiency, and ensure equipment is consistently in working order.

AI can be used to optimize service strategies in real time. Factors like equipment downtime, technician availability, and changes in vendor pricing can affect service strategies. AI can help health systems adjust to these changes quickly, allowing them to stay ahead of any potential issues that could affect efficiency or revenue.

Regulatory Compliance: Simplifying Overwhelming and Complex Processes

Technology can also help simplify the increasingly complex regulatory landscape in health care. Regulatory compliance is a major concern for health systems, as regulations constantly evolve. By providing mobile platforms and automated systems that keep technicians up to date on the latest regulatory requirements, health systems can ensure compliance while minimizing the burden on their staff.

Automated updates to policies, procedures, and compliance requirements allow technicians to stay informed and prepared for any inspections or audits, without the need for time-consuming and often overwhelming manual tracking. While this would be a massive undertaking for a single health system, executives can rely on a partner with a strong regulatory team in place.

Recruiting and Retaining the Next Generation of Talent

Workforce challenges, including personnel shortages and staff burnout, ranked number one on the list of hospital CEOs’ concerns in 2023.  Embracing technology is key to both improving the efficiency of current BMETs and attracting BMETs of the future. The next generation of clinical engineering professionals grew up in a world where mobile apps, automation, and AI are the norm, not the exception. Offering cutting-edge tools that align with their expectations and skillsets makes the industry more appealing to younger, tech-savvy professionals.

These technological advancements can be a huge recruitment tool for health systems. Organizations that offer potential hires a more efficient, streamlined, and technology-driven work environment have a competitive edge in attracting the best talent.

Mobile platforms, automation, AI, and streamlined regulatory compliance are essential tools for staying competitive in today’s clinical engineering landscape. Health systems that invest in these technologies will not only enhance their operations but also position themselves as industry leaders capable of attracting top talent.

About the author

Rob Moorey serves as president of clinical engineering for TRIMEDX. Moorey has been with TRIMEDX for over 10 years and has served as senior vice president of customer delivery and division vice president during that time. Questions and comments can be directed to editor@24x7mag.com.

By Keri Forsythe-Stephens

Editor’s note: The January/February 2024 print issue will feature exclusive salary charts and regional break-downs.

In a year defined by turbulence, including the culmination of the COVID-19 national emergency, the rise of AI technologies, and global economic uncertainty, 2023 also saw salary fluctuations in the healthcare technology management (HTM) field.

It wasn’t all gloom and doom in 24×7’s 2023 compensation and job satisfaction survey— nationwide, BMET 3s, radiology equipment specialists, managers, and directors/executives saw moderate salary growth in 2023, with wages surging $4,400, $3,500, $6,300, and $6,400, year-over-year, respectively. Unfortunately, their BMET 1, BMET 2, and clinical engineer peers didn’t fare as well in 2023, with their median national salaries sliding a respective $600, $3,800, and $6,000, year-over-year.

That’s not to say that all regions performed equally. The West North Central region saw marked improvements in 2023, with all major job titles except directors/executives witnessing exponential salary growth. Median salaries for West North Central-based BMET 1s surged $13,300, year-over-year, in 2023 while BMET 3s in the region also netted double-digit salary gains. The latter group’s sala- ries rose by $14,900 in 2023, increasing from $76,000 to $90,900, year- over-year. Managers in the West North Central region also thrived financially, with their median salaries finally breaking the six-figure threshold to reach $115,000. (This was up from $99,300 in 2022.)

The financial picture was vastly different in the Mountain West region. Unlike their West North Central peers, salaries shrunk in five of the seven main job titles—only BMET 3s and managers saw slight gains in 2023. Mountain West-based directors/executives experienced the steepest declines, with their salaries falling from $153,800 to $131,300, year- over-year. BMET 1s and BMET 2s in this region also had a rough year. Their salaries fell from $67,200 to $53,000 and $75,100 to $64,200, year- over-year, respectively, in 2023.

On the (Job) Hunt

Regional discrepancies aside, one trend that stood out in 2023’s survey was the number of respondents who are job hunting. Nearly one- third of those surveyed—29%—are looking for a position outside their organization, with 42% considering their chances of promotion within their current employer to be “below average.” Only 12% of survey respondents rated their opportunities for promotion as “excellent.”

“Trying to get a promotion is hard, especially if you are younger,” one respondent lamented. It’s a catch-22, the person wrote. “[Employers] won’t give you special equipment experience until you get the promotion, but to get the pro- motion, you need special equipment experi- ence in the first place. This incentivizes leaving the company and gaining specialized experience somewhere else.”

Specialized experience, maybe, but not necessarily further education. In 24×7’s 2023 compensation and job satisfaction survey, 17% of survey respondents revealed that they are currently pursuing further education—a major decline from the 35% of respondents who copped to pursuing it in 2022.

One possible reason? The 30-and-under set, who may be more inclined to pursue advanced education, accounted for just 13% of 24×7’s 2023 survey respondents. The most-represent- ed career stage was, by far, mid-level professionals. Nearly half of those surveyed—44%— ranged from 30 to 40, while 31% were older than 55. Trailing this age bracket were those approaching retirement, with nearly 17% of survey respondents over 60.

Not surprisingly, males accounted for most survey respondents—81%—with females comprising a modest 16%. (A subsequent 3% chose not to identify their gender.) It’s a slight increase from the 11% of female respondents represented in 2021’s survey, but down from the 22% recorded in 2022.

To some survey respondents, it’s simply not enough. “We need more women in this profession to help balance changing times,” one person wrote. Another commented: “I would like to get others in the field, especially my female colleagues.” After all, the latter respondent wrote, “it’s a fun field,” with a varied workload.

Varied, yes, but also heavy, according to many respondents in 24×7’s 2023 compensa- tion and job satisfaction survey. A hefty 43% of survey respondents deemed their workload as “heavy,” with a further 13% calling it “excessive.” Only 3% characterized it as “light” while 41% called it “moderate.”

Fortunately, not everyone balked at the hard work. Despite feeling overworked, a majority of those surveyed said they would still promote the profession to others. More than one-third of the survey respondents—35%, to be exact— said they were “very likely” to promote the HTM profession, with 29% saying they were “likely” to do so. A further 21% indicated that they were “somewhat likely” to endorse HTM while 13% said they were either “somewhat unlikely” or “very unlikely” to promote it.

Those who fell into the former category—very likely to promote HTM—praised similar aspects of the field. Some cited the ability to positively impact patient care while others celebrated the technical aspects of the job. “It’s satisfying to take something that is broken and make it work again,” one respondent wrote. Another commented: “I really enjoy walking up to something I’ve never seen before that’s not working and [ fixing it].”

Navigating Complex Dynamics

Not that success in the HTM field only mandates technical skills. Being a good biomed, one individual wrote, “requires good communication, people skills, and problem-solving abilities.” Managing communication breakdowns with clinicians can be just as challenging as handling faulty equipment, other respondents pointed out.

“The nurses at my location seem to think we have an endless supply of equipment,” one person griped. “They also will hide equipment for a ‘just-in-case’ scenario, even when we’ve explained that we need to check it over for the safety of the patient.”

Communicating effectively with IT teams—especially given the cyber concerns of networked medical devices—is also paramount, some survey respondents mentioned. A number of those surveyed shared positive experiences with IT (“Our biomed team is an active part of the cybersecurity process,” one individual wrote) while others felt shut out by them. “It’s a daily struggle,” on respondent wrote, with another quipping: “Over the years, I’ve seen how [the IT department] plays their cards too close to the vest and are not forthcoming about things. And they almost always defer issues as a ‘biomedical problem.’”

Another top grievance that respondents cited in 24×7’s 2023 compensation and job satisfaction survey? Feeling overlooked by their clinician colleagues. “No one at the hospital acknowledges biomeds’ hard work,” one person wrote. “We don’t even get cel- ebrated for National Biomed Week.”

Compounding the problem is the fact that many veterans are exiting the field. “Older biomeds are retiring, but management has no plans to replace them,” one survey respondent wrote. “Hospital management does not recognize the value of the experienced technician.”

That workplace may be an outlier, however. One survey respondent revealed that their employer is filling the talent gap by creating biomedical assistant roles that don’t require a degree or HTM background. “Through experience, the biomedical assistant can be promoted to a BMET title,” the respondent wrote. “Our director has also worked closely with our local community college to create a biomedical certificate program. With these changes, we’ve already seen an increase in HTM interest locally.”

And some survey respondents are even taking matters into their own hands. “We are introducing the HTM profession at the high- school level,” one individual commented. “We go to the schools to discuss our field and bring in high school students to see what we do for a day.”

Because despite the challenges—hefty workloads, regional salary discrepancies, and staffing issues—HTM is rewarding work, many survey respondents expressed. One respondent perhaps summed it up best: “Although the workload is stressful, the work is fulfilling,” the individual wrote. “Because of the technical nature of this field, it is also growing and changing. That constant change keeps the work exciting.” 

Keri Forsythe-Stephens is chief editor of 24×7 Magazine. Questions and comments can be directed to editor@24x7mag.com.

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Your reply is critical—without it, the research may not do an effective job of representing organizations and positions like yours. You can look forward to seeing the survey results in the January/February 2024 issue of 24×7 Magazine. As sincere thanks for your participation, you can enter a drawing for a chance to receive a $150 Amazon gift card at the end of the survey.

For reference, here is a link to last year’s HTM salary survey.

“It’s essential that acting members of the HTM industry take the 24×7 Salary Survey to ensure that they’re being paid adequately according to region and job title,” says 24×7 chief editor Keri Forsythe-Stephens. “The more participation in the HTM field, the more accurate our salary data. The financial health of the HTM industry depends on it.”

In addition to supporting 24×7‘s 2023 Salary Survey, AAMI is also supporting Health-ISAC, as they survey HTM professionals to better understand the major threats to medical devices, including threats to cybersecurity.   

Errol Weiss, chief security officer at Health-ISAC, states, “The survey results provide the community with insight into the top threats and cybersecurity concerns facing healthcare organizations globally—information that can be used to ensure cybersecurity and medical device security leaders are considering the right priorities in their security budgets.”

Responses to Health-ISAC’s Threat Survey will provide the backbone to a forthcoming report on various threats and cybersecurity risks that threaten medical devices. The Health Sector Threat Landscape Report is expected to be published in January 2024, with the survey closing on December 8.

By Rob Moorey

Growing medical equipment inventories and increasing technical complexity are demanding more than ever from the clinical engineering teams responsible for maintaining clinical assets. At the same time, a shrinking talent pool of biomedical equipment technicians (BMETs) could lead to large staffing shortages in the coming years.

The Association for the Advancement of Medical Instrumentation (AAMI) surveyed more than 1,400 healthcare technology management (HTM) professionals in 2022 and found 60% of respondents were over the age of 45 and more than 6% of respondents were past retirement age, statistics in line with 24×7‘s annual salary survey statistics.

By 2032, there will be a need for more than 75,000 BMETs according to the U.S. Bureau of Labor Statistics. AAMI also found work-life balance and workplace environment are the top three retention priorities for HTM professionals.

These findings highlight the urgent need for new medical equipment management strategies that empower technicians to lead successful, fulfilling careers. Innovative technology, strong governance practices, and knowledgeable support teams can optimize medical equipment performance while helping improve satisfaction, productivity, and mental health for the technicians.

Inventory Visibility and Quality Data

A crucial step in improving the lives of BMETs is establishing a comprehensive inventory of a health system’s equipment. Many hospitals don’t have an accurate account of what equipment they own or where it’s located. This leaves BMETs scrambling to find devices and parts, creating frustration, and taking them away from their core responsibilities.

A comprehensive clinical asset management system will eliminate this stressor and provide quality data for BMETs, such as where a device is located, how often a device is used, and when it will need to be serviced or replaced. Health systems with accurate data and analytics will be able to make better ordering and stocking decisions from trusted sources in advance, relieving the pressure on BMETs to source parts or equipment on their own.

Technical and Regulatory Support and Resources

Technology is evolving and progressing quickly, with devices and equipment becoming increasingly complex and software driven. BMETs are now forced to keep up with that rapid pace of development, learning new systems and processes all the time. Without a dedicated support team, BMETS can struggle to stay up to date. This puts BMETs, already juggling increased workloads, in a difficult position. If they are not aware of the latest troubleshooting technique or changes in the newest model, they may struggle to solve issues when they arise, potentially jeopardizing patient care and increasing equipment downtime and lost revenue. This burden can lead to BMET anxiety and burnout.

The regulatory landscape has also evolved significantly, with frequent changes over the past several years. BMETs are often expected to educate themselves through conferences, industry publications, and OEM resources, putting the responsibility on an individual who may not have regulatory or legislative expertise.

One of the most effective ways to create a better working environment for BMETs is to provide them with expert support and the latest resources to stay informed. Health systems should have a dedicated quality and regulatory team. This team of experts ensure health systems are in compliance and provide BMETs with necessary training.

Access to technical support teams who can address specific needs in real time is also extremely helpful for BMETs. If technicians run into a particularly challenging problem, having an expert team who can assess the problem and walk them through a solution is much more efficient than leaving the BMET to try and figure it out on their own.

Easy access to device manuals and equipment guides can save technicians valuable time and decrease frustration as well. A technician needs to be able to quickly look up the appropriate manual, without having to search for a physical copy. Compiling all the relevant and up-to-date manuals in an online database is one way to make technicians’ jobs easier.

Specialized Cybersecurity Teams

As more medical devices become connected to the internet, cybersecurity is yet another factor BMETs must consider when doing their jobs. In addition to traditional responsibilities, they now are key players in ensuring medical devices do not provide bad actors an entry point into a hospital’s network. According to 24×7’s 2022 compensation and job satisfaction survey, cybersecurity is the top issue that keeps HTM professionals up at night. The same survey found more than half of respondents said their workload is already “heavy” or “excessive.”

Health systems should work with a trusted cybersecurity partner who is constantly analyzing threats, monitoring devices, and taking a proactive approach to guard against cyberattacks. While BMETs should still work closely with IT teams to share expertise and help prevent intrusions, having an expert team focused on cyber threats will be much more effective and provide BMETs with a sense of relief.

Predictive Systems

Unexpected equipment breakdowns can lead to patient safety issues, significant equipment downtime, lost revenue, and unhappy clinicians and patients. These unforeseen breakdowns can also be a major source of stress, frustration, and dissatisfaction for BMETs. If a piece of equipment fails, a BMET may have to rush into the health system during off hours or postpone other responsibilities to address the urgent need. The BMET will also be under pressure to solve the problem quickly to get patient care back on track. If the BMET discovers they’ll need to order a new part for the equipment, it could take days to arrive—leading to a longer period of equipment downtime and upended patient scheduling.

To help avoid these stressful situations, a health system can leverage technology and expertise to predict equipment failures. A predictive work system can combine remote device monitoring, service expertise, and data science to identify and proactively respond to common preventable equipment problems before a failure occurs.

For example, a predictive work system can analyze conditions that indicate air bubbles are developing within a CT machine—even when the machine appears to be functioning normally to the radiologic technician. Air bubbles in CT machines are a well-known, but hard-to-predict problem that can lead to serious issues. Once the predictive work system detects a problem, it can send a work order to the BMETs with prescriptive repair actions, relevant parts, and service manual information.

The BMET can then alert the clinicians and quickly make the repair during a break between patients or another convenient time before the CT machine becomes unusable. This can avoid days of unplanned downtime and prevent serious damage to the machines. If a health system invests in this type of technology for its MRIs, CT machines, Cath Labs, and other equipment, it will improve patient experience and safety, increase BMET satisfaction, and avoid revenue loss in the long run.

Automated Test Equipment

Another way to make BMETs jobs more efficient is through automated testing equipment. Health systems should take advantage of technology that is transforming the way technicians can test and inspect equipment. For decades, BMETs have had to run a test, record the results manually, visually compare results to acceptable limits, and physically input the results into a work order system. This traditional method is time-consuming and filled with opportunity for human error.

Now, technicians can run tests via mobile apps. There is no need to write down or document the results, because they’re automatically fed into the system. With the potential to automate the process, this could eliminate human error, reduce documentation time, and validate that test results are within permissible limits. Hospitals should partner with a vendor that offers this type of automated system to save significant time and ensure data accuracy, giving technicians peace of mind they didn’t misread or miswrite a number, forget a test, or enter a piece of data incorrectly.

BMETs take pride in their workplace and their career. Providing BMETs with the stability, support, resources, and growth opportunities will help them perform their jobs well, while maintaining a healthy work-life balance. This will not only benefit the individual technicians, but health systems and the broader HTM industry.

Rob Moorey serves as president of clinical engineering for TRIMEDX. Questions and comments can be directed to editor@24x7mag.com.

24×7 Magazine: Wasting money is an ongoing aggravation for you. Can you elaborate on your top strategies to maintain cost savings?

Charles Berberette: Several factors are considered when looking at cost-savings opportunities.  These involve evaluating staffing, contract management, training, equipment management/selection, and parts procurement options. 

Staffing Optimization

With our biomedical workforce, it’s important to evaluate the equipment fleet, ensure the right staffing levels, and review technician-level loading. I also consider staff hours, another important factor. For example, I reduce workforce cost by placing a few technicians on second shift. This allows those technicians to go into busy areas and complete preventive maintenance, or PM, with ease. We can then reduce the time of repairs and staffing needs during the day as those technicians handle trouble calls and departmental needs because of the PM reductions for their daily tasks. 

Contract Management

Contract management is vital to any organization. I take the strengths and limitations of my hospital and leverage the contractual agreements to best suit the organization I serve. For a cost-effective program, I use the buying power of the organization.

For example, I manage a health system, and we have multiple hospitals and many outside clinics. To save money and contracting efforts, I’ve found that combining all my contracts into master service agreements with negotiated terms that best suit my organization has improved my turnaround times; reduced cost; and effectively allowed my procurement partners to focus on only one contract for the specific vendor instead of managing multiple, smaller contracts.

Training

Training is critical to any cost-savings initiatives. I look first at the return on investment, or ROI, on any training and evaluate how much equipment and its service history the training will cover. This will tell me if we have enough equipment to ensure my technicians can grow their skillsets effectively.   

As a former technician, I have experienced training on the only piece of equipment within the organization, one that did not often break down. Over time, I didn’t heavily apply that training, and it was harder for me to troubleshoot versus my training on equipment with a larger fleet that allowed me to practice the education received. 

I apply this approach to my team today to ensure that they are set up for success, which in turn, allows for an effective ROI for my organization. As I noted earlier, I also try to negotiate favorable rates or include training to allow for partnership agreements. I can then leverage our buying power into my training budget to reduce cost for my organization.

Equipment Management/Selection

Equipment management and capital acquisition are also great ways to save money for an organization. The biomedical team has helped our organization to reduce expenses because we look at fleet utilization to ensure that our assets are properly allocated and implemented.  

We use a combination of reporting tools, asset tracking systems, and our network utilization tools to determine frequency of use and cost of ownership for each piece of equipment in our fleet. Then, within our organization, we know which areas overutilize the equipment and where to move it. This reduces the need to over-purchase or underutilize our capital equipment and link management to equipment selection. 

Additionally, my organization also looks at standardization of our fleets to achieve the best options for capital cost. The importance of standardization goes well beyond the acquisition costs of equipment. Having standardized equipment allows for greater negotiation power for capital purchases. Training costs are reduced with a similar fleet for capital equipment. This allows the biomedical team to train less staff and grow their competencies, including clinical teams.  

For example, if a nurse or technician floats from one campus to another, they will already be familiar with the equipment and not require additional training to use the equipment as described in the instructions for use. Overall, proper equipment selection, along with fleet management, is a foundational driver to reduce overhead cost for our organization.

Parts Procurement

Parts procurement is an area where the biomedical department can drive cost efficiencies. It’s important to understand the equipment and the best way to service the devices. Some repairs should always use new parts from the original equipment manufacturer, while other repairs can use the secondary market to drive cost savings. I find it critical to look at service history, cost of new vs. second market parts when making that decision. 

I also find it valuable to partner with vendors that can supply data to help in the determination of the selection process. We leverage a managed service model in partnership with PartsSource, which provides cloud-based data analytics, best processes and logistical support, and an actionable combination that drives evidence-based decision making for parts and services procurement.

From 2019-2022, Jackson Health System saved $1 million annually on parts procurement. This consistent savings comes from data-driven procurement decisions, enabled by the platform. Having this information at my disposal has also driven improved efficiency outcomes for across my department. Ultimately, quality patient care is our primary goal at Jackson and within the clinical engineering department. Knowing we have access to quality parts through the PartsSource platform is vital to meeting clinical needs as well.

24×7: Can you explain how data-driven decision-making among the clinical engineering staff support cost savings at Jackson Health System? 

Berberette: By using data-driven decision making, the biomedical team has been able to reduce capital expenditures, training costs, contract pricing, and staff competencies. We also ensure the right parts at the right price to reduce the amount of money spent to maintain and operate our devices. 

24×7: Your staff manages more than 45,000 pieces of medical equipment throughout Jackson Health System. What are the primary cost efficiencies in place that keep that equipment operational?   

Berberette: Like I mentioned earlier, I look at five factors for cost efficiencies to keep those 45,000 pieces of equipment ready and maintained. They are staffing optimization, contract management, training, equipment management/selection, and parts procurement.

24×7: I know accountability is also important to you as the system director of clinical engineering at Jackson. How does accountability affect the bottom line when it comes to ensuring work orders are completed?  

Berberette: Accountability significantly impacts the bottom line for any biomedical department’s cost impact to an organization. If turnaround times are not within measurable and acceptable limits, then less equipment becomes available, which in turn impacts the ability to perform daily clinical operations.  

For example, if an x-ray is down for multiple days, this can cause increased use of other systems and the likelihood of additional system failures. This scenario also impacts patient flow, which can start to back up multiple departments. While it is vital to accreditation organizations like the Joint Commission to monitor [preventive maintenance] compliance, the day-to-day corrective repairs keep our systems operational for patient use. 

Our organization is tracking to a turnaround time of less than five days for all repairs. We track this through reporting tools tied directly to our computerized maintenance management system, or CMMS, so that any associate or leader in the organization can view information on our team’s performance in real time. This allows the organization to see how we are performing daily.

24×7: How does your alignment with your IT department, vendor partners, and clinical engineering staff help maintain financial stability and overall operational improvement? Why is that alignment important to success? 

Berberette: The entire biomedical program at Jackson Health System was built with the help of many internal departments and vendors and feedback from staff.  This applies to how we maintain financial stability as well.  We use our CMMS operated by my team, maintained by the IT infrastructure and tied in with our vendors purchasing arm to maintain the savings I referenced earlier. My staff monitors and inputs the data that drives all systems, and we rely on the data to make decisions on how to move forward.  

For example, we use a cybersecurity platform to ensure that all medical equipment is patched appropriately. Reduction in risk to a malware or virus in our medical equipment has the potential to save countless dollars. The reporting tools from our procurement vendors allow the organization to evaluate and better manage the types of parts for our repairs. 

By working with our service vendors, we can use predictive analytics on many of our systems to proactively complete tube changes on a schedule, rather than a break-fix model. This approach reduces expenses for the organization since we plan our downtime instead of dealing with a reactive event. Our IT department also works with us to help integrate our systems for a more-centralized area to view data each day.

Headlines about healthcare workforce shortages are nothing new. For at least a decade, the deficit has been deepening as both physicians and clinical staff approach retirement age. Between short-term burnout from the COVID-19 pandemic and a long-range pipeline deficit, health systems face a “historic workforce crisis” according to AHA. There are no easy answers. Meanwhile, another critical labor shortage plagues hospitals: cybersecurity workers.

According to Cybersecurity Ventures, the shortage within the IT/cybersecurity sector is nearly unmatched: Between 2013 and 2021, the number of unfilled cybersecurity positions increased from one million to 3.5 million. Finding workers with knowledge of Internet of Medical Things (IoMT) and connected medical devices is especially hard.

Identifying Healthcare-specific Cyber Challenges

Attractive Targets: According to the 2022 Cost of a Data Breach report, for the 12^th consecutive year, the healthcare sector suffered the most expensive data breach costs of any other industry. The average cost of a healthcare data breach rose to $10.1 million per incident between March 2021 and March 2022, up 41.6% from the previous period.

Attackers know healthcare organizations are more likely to quickly pay the ransom to get encrypted data back and protect patient safety; they cannot afford to let medical equipment go offline or malfunction, nor release personal health information.

Direct Threats to Patient Care: Electronic health record (EHR) downtime and emergency department (ED) diversions are common after a successful cyberattack, but increasingly such attacks are threatening direct patient care.

Last September the FBI issued a private industry notification to healthcare entities (following a 2020 ransomware alert), warning that unpatched and outdated medical devices often lack adequate security features, providing threat actors with opportunities to exploit vulnerabilities. Susceptible devices include “insulin pumps, cardiac defibrillators, mobile cardiac telemetry, pacemakers and intrathecal pain pumps,” which can be compromised “to give inaccurate readings, administer drug overdoses or otherwise endanger patient health.”

The FBI notification followed on the heels of similar warnings from CISA, the HHS, the FDA, and the Treasury Department.

Insecure by Design: The rise of ransomware attacks against healthcare organizations, record-setting breaches and the widespread vulnerabilities associated with medical devices are symptomatic of an underlying condition: many medical devices are insecure by design and challenging to protect.

Internet of Things (IoT), operational technology (OT), and IoMT are non-traditional device categories that share one common denominator: they are insecure by design. Vedere Labs, which is the cybersecurity research arm of Forescout Technologies, is known for its research into these devices, including supply chain vulnerabilities in underlying software components and the insecure-by-design practices of vendors for whom security may be an afterthought. It’s research findings include:

• Access:7 – Discovered seven supply chain vulnerabilities impacting medical and IoT devices that, if exploited, could enable hackers to remotely execute malicious code, access sensitive data or alter device configurations
• NUCLEUS:13 – Revealed 13 vulnerabilities affecting the Nucleus TCP/IP stack used in safety-critical devices such as anesthesia machines and patient monitors
• R4IoT – Used a hospital setting to demonstrate how proof-of-concept ransomware could exploit an IP surveillance camera to gain access and move laterally in an IT network and crash the HVAC system to disable fans and electricity on patient floors

Parallel Challenges with Other Critical Infrastructure Industries

Like OT systems that control critical infrastructure and manufacturing processes, medical devices traditionally weren’t connected to the internet or IT networks. They weren’t built with security in mind and frequently still require insecure legacy systems to operate. Adding controls later can be difficult. Today, these same medical devices have become hyper-connected to IT networks and cloud, where they’re often the weakest access point.

Added regulatory requirements make it hard for medical device manufacturers to publish patches without time-consuming FDA review cycles. Even when patches are made available, because medical devices are mission-critical, proprietary and often decades-old, they can be difficult to update.

Likewise, IT security tools were not designed for clinical networks, so most organizations lack visibility into these devices. Cybersecurity sits within the IT department. IoMT and medical devices are typically managed by biomedical or clinical engineers, whose primary concerns are quality assurance, inventory tracking, regulatory compliance and hardware maintenance. Their job is to ensure the right device is available to the clinician and patient when needed.

This false dichotomy is not unique: Critical infrastructure operators and manufacturers face similar challenges. OT engineers—the asset owners—are primarily concerned with productivity and uptime, not cyber risks. Again, their IT counterparts may have little visibility into OT device inventory and status. However, as OT, IT, IoT, and IoMT networks continue to converge, so must their oversight.

Further reading: 5 Elements of a Comprehensive Cybersecurity Strategy

The Riskiest Connected Devices in Healthcare

Recently Forescout’s Vedere Labs analyzed data from almost 19 million IT, OT, IoT, and IoMT devices in its cloud data lake to determine the riskiest connected devices commonly found on enterprise networks. Most of them are perennial favorites such as networking equipment, VoIP, IP cameras, and building programmable logic controllers (PLCs), with hypervisors and human-machine interfaces (HMIs) joining the list in 2022. These devices are frequently exposed on the internet, critical to business operations and typically have unpatched vulnerabilities that can be exploited.

As businesses, health systems are susceptible to these mainstream device risks. But they must also worry about insecure medical devices. As part of the analysis, Vedere Labs identified these five riskiest devices:

• DICOM workstations
• Nuclear medicine systems
• Imaging devices
• PACS
• Patient monitors

The first four are all used for medical imaging. These machines commonly run legacy IT operating systems and are designed to facilitate easy sharing of medical imaging data (and sensitive patient data), which is a high priority for patient care. The DICOM standard is commonly used for sharing files and wasn’t developed with security in mind. While it does permit the encryption of data in transit, such encryption isn’t activated in many hospitals. That means medical images are transmitted in clear text and can easily be intercepted and tampered with.

Patient monitors are also among the riskiest IoMT devices. They’re ubiquitous in patient care settings and often use using unencrypted protocols, allowing communications to easily be intercepted and tampered with. For example, a bad actor could prevent an alert triggered by a change in the patient’s vital signs from being received.

Healthcare Is Different… Except When It’s Not

The phrase “healthcare is different” is a common refrain among stakeholders, from administrators to providers to payors. Patients don’t make normal consumer choices, physicians aren’t just businesspeople, lives are on the line.

When it comes to cybersecurity, however, healthcare is a lot like every other industry, especially manufacturing. Because standard practices such as vulnerability scanning and patching are often not possible, preventive cyber hygiene is critical. That includes:

• Asset management: What is connecting to your network and where it is located, physically and logically? Visibility is the foundation—you can’t protect what you can’t see.
• Risk and compliance: Is the asset critical to the business? Is it vulnerable? Is it configured and operating as expected? You can’t remediate what you aren’t aware of.
• Network segmentation: What other asset types does the asset communicate with, over what ports and protocols? Context-aware segmentation policies can reduce the attack surface without disrupting desired communication flow.
• Network access control: Should communication be limited or blocked? Proactive controls can authorize access and assign users and devices to network segments or quarantine devices based on their security posture.
• Continuous monitoring and threat detection: Are any threat actors trying to exploit a network, and how can they be stopped? With thousands of alerts firing every hour, you need to harness data intelligence to isolate true detections from false positives.
• Incidence response: Can threats be contained with the available security tools? With the right tools you can write policies to orchestrate the right response, every time.

Security Automation or Bust

Even without the persistent cybersecurity skills shortage and healthcare-specific challenges, security automation is a must. There are too many device types, too many threat actors and too much data to sift through to rely on manual processes.

An automated security process can continuously share devices context across all security tools, orchestrate workflows across those tools and accelerate response actions, such as applying controls and enforcing compliance. That leaves security teams time to focus on what truly requires human intervention. At least for now, that’s more than enough.

About the author: Daniel Trivellato, VP of product & engineering at Forescout, is responsible for driving the Forescout IoT and OT device visibility and threat detection roadmap and teams, to deliver market leading solutions for customers. Trivellato joined Forescout in 2018 via the acquisition of the cyber security startup SecurityMatters, which he joined in 2012.