Building Standards for the HTM Industry | Heidi Horn, HTM Consulting

Jan 18, 2024


Wed, Jan 10, 2024 11:23AM • 32:26


htm, standards, industry, organizations, cmms, agree, equipment, heidi, oems, people, work, standardize, cms, best practices, regulations, maintenance, joint commission, point, sense, standardization


Chyrill Sandrini, Heidi Horn

Chyrill Sandrini  00:13

Welcome back to HTM Insider. I’m Chyrill at MultiMedical Systems, your host. And we’re back again with another topic that I think needs some attention. I’m so excited to have Heidi on today with Heidi Horn has been in the industry for quite a long time. And she’s also working with AAMI. And we’re going to kind of explore standardizations in the HTM industry. So Heidi, thank you for coming on. And why don’t you introduce yourself and kind of your background to our guest?

Heidi Horn  00:43

Oh, thank you for having me. Sure. Well, it’s been an honor to be joining the show. And I really get a kick out of talking to you and all our HTM friends out there. So yeah, as you mentioned, this is a hot topic, and we’ll get to it. But just a quick background for those of you I have not met, and hopefully we’ll meet soon. My name is Heidi Horn, and I’m the president of Heidi Horn HTM Consulting, which is a consulting company I started back in May. And prior to that, though, I do have over you know, I keep saying over 20 years, but I hate to admit it’s now 25 plus years of experience in the HTM world, I ran my a fairly large htm organization for a large health system and 22 hospitals about 120 technicians reporting up to me and did that for, you know, like I said, I was in there for decades, working with that area. Over the past four years prior to becoming, joining or starting my own firm, I actually worked for a company called Nuvolo, which is a CMMS provider. And that’s where I think and we’ll talk a little bit about this, I’m sure where the it really became clear to me working with all the dozens and dozens of clients across the United States, how unique and different all HTM organizations are, and how they all see themselves as having best practices. And everybody thinks that their way is the best way. But it really does create a lot of quite frankly, extra work and not, you know, unfortunately, not everybody’s, quote, best practice is a best practice. So, so we’ll talk about that. But yeah, so that’s my background, I’m also you mentioned, I’m on the AAMI board. I’ve been with AAMI since 2005, actually, and I’m on the Treasurer of the Executive Committee of the AAMI board. And so that’s a wonderful organization. And I have utmost respect for all those folks there. And one of the things you know, that Amy does is it provides standards and guidelines and everything else. And so again, it was through that work with Amy that I really started to appreciate the need and what standards brings to organizations.

Chyrill Sandrini  03:04

Now I know there’s a lot being talked about, out there social media and other periodicals, standardization and exactly what are we going to talk about today. So those are different?

Heidi Horn  03:17

I guess the area that most interests me, I’m looking for the low hanging fruit. And I know some people want like, let’s standardize on how we do every, you know, pm or this, that or the other, we’re not talking about that that’s not, to me, that’s a little bit more complicated, quite frankly, because all repairs and all maintenance needs are a little bit different. And so to come up with a standardized practice for how to approach something like that is going to take, you know, I’m not saying it wouldn’t be possible, but it would require a lot more work. What I’m really interested in are those areas, and we might not even realize it, that that we are all doing things differently, that don’t make a whole lot of sense. For example, you know, again, being with in the CMMS world, I realized that everybody had different work order codes, you know, some people call it Corrective maintenance, some people call it repair, some people call it this any other, but even within those, they would have different type of things and different failure codes. And so everybody’s using different data points there, you know, again, the response codes, all those just the codes themselves. Everyone’s calling it something different. They’re tracking the data differently. And those are the things that make no sense to me whatsoever. Because again, you know, those are things that we can standardize on and if you think about the amount of time it takes to configure a CMMS to be specific to your department’s unique needs, that’s extra costs. It’s extra time, and I will tell you, it’s very, very hard for these all CMMS companies to support them. Because again, when you’re calling and you say I have a problem, because my repair codes aren’t working, or whatever it might be, you’re completely different than everybody else. So that’s just one example. Things like, you know, again, Joint Commission is, and CMS, DNV, they’re all very, very vague in their regulations. However, how so how we interpret those as an as an industry also are very different and variable and things like it. I just wrote this down, because I wanted to make sure I got the wording correctly, there’s. So CMS says you have to provide PMs, on devices that are new equipment with a sufficient amount of maintenance history, that’s exact words. So new equipment was sufficient amount. So but what is sufficient? You know, what, what does that mean? Some people say, Well, if I’ve had it a week, it’s sufficient. If I’ve had it two years, it’s sufficient. Again, everybody is interpreting that differently. And so how their policies or procedures play out and how they are, you know, operating is very, very different. So those are just some examples of things that I think are what I call low hanging fruit, that we should be able to agree on. Case in point, yeah, this just drives me nuts sometimes. Is it planned maintenance, preventive maintenance, or preventative maintenance, and, and you see it all over the place. Like, can we just agree that this is what we call it? And, and be in be, you know, you know, consistent on it? So those are… What so what we talked about standards, you know, and even our name, HTM? Are we HTM? Are we Clinical Engineering, are we, you know, Biomed? So we can’t even agree on that. So it’s just, it’s, I think we’ve come to a point in time, where having being unique and different, it was used to be part of our DNA, we had this get her done attitude, and you don’t really worry about the procedures, you know, necessarily the policies all the time you go get it done, you fix the equipment as fast as you can. But those days, quite frankly, of not having any of those standard dyes best practices, really identifying what the best practices are in agreeing to them and practicing them are, are over because we now need, you know, we need data to compare ourselves to each other, we need to be able to show that we’re doing a good job we need even if you can’t if you if you don’t. If you can’t compare yourself to other organizations, how can you say you’re the best of the best? Or how can you even say you’re doing an adequate job? How can you tell your C suite you’re doing pretty good job, you can’t because you can’t compare it. So anyway, you can see I’m very passionate about this. 

Chyrill Sandrini  07:55

I love it, though. I love it. So how are you at the me, let’s just say AAMI is working on this initiative to gather these people. And there’s a lot of people to gather. Yeah, and how are you going to standardize that, across the board with so many, I’m gonna say, whether it’s an ISO, to a large in house program? How are you going to get all those meetings of the minds to happen to see who has the best terminology and enforce it?

Heidi Horn  08:26

Right? Well, it takes it takes people and so that is the big thing right now is AAMI has, I’ll use on the sterilization side of AAMI, they have some wonderful standards and these OEMs have come sterilization that OEMs have come together and agreed on you know, these are the best sterilization practices, these are the best things to do. And it makes a lot of sense for them, you know, and so that, again, they can ensure that the sterilization equipment they’re building matches up with what those best practices are. And they’re agreeing on that. Where we’ve always struggled in HTM, though, is the coming together part and, and so what you know, this is kind of first thing that we’re, you know, when I say we, AAMI but also other you know, other organizations ACCE and others, you know have kind of come to the point where I think we agree as an industry we need to start looking at this a little bit more. So the first step is really just to make people aware, I think when you say standards, everyone out there thinks oh my goodness one it’s Those are rules we don’t like rules that we have to follow. And and those rules will be more costly and they will slow us down. And if done properly. That’s actually the opposite will occur. If you if you create and identify best practices and turn them into standards, then you’re no you’re not reading renting the wheel every time you’re not going out and saying, okay, you know what, what are what? They’ve come up with this AEM thing? Now I gotta manage it. How do I What do I do with that? What are the steps I have to take it is, you know, we’ve we’ve come up with AAMI has put up some guidebooks on AEM. But I will tell you and I know this just talking to people in the industry, not many people are following it to the letter, they’re still trying to reinvent the wheel. So they’re creating more work, more variation, and ultimately more opportunities to, you know, fail and create errors. So when you asked, you know what, how do you do that, and you get people to aware, but we are going to need people to participate. And that’s been the struggle all along, is getting people to participate in those standards committees. Because they take a long time. I mean, there’s there’s no doubt about it is it is, you know, I worked., when I was with the Technology Management Council, I did share the Technology Management Council a few years ago with AAMI, and we created this plan maintenance definitions guide. And that was just a guidebook a very short 12 page, I believe guidebook that took us months to get through. So you when you’re creating standards, it can take a long time. But that’s not to say just because it’s hard, you shouldn’t do it. And ultimately, if you can get people to participate and be part of the process. And again, buy into you know, identify those best practices, the end product will be everybody saving more time, doing things better raising the bar, you know, the whole industry will improve with that. So

Chyrill Sandrini  11:42

I think that it would make everyone speaking the same language. Right. And, you know, we know that we’re lacking in biomed in this industry. And I think that would level the playing field for new people coming in, to understand the language and the codes are across the board. I mean, it makes sense to me. 

Heidi Horn  12:04

It does and for healthcare in general actually does tend to be very, you know, we’re all unique and different, you know, they view themselves we are, we’re a children’s hospital, we’re in a rural hospital, we’re a urban center, whatever it might be, everybody looks at that they’re unique and different. And in some cases, they are but the vast majority of what they do is the same, there’s working with the same equipment. And it’s supposed to be doing the same thing. And they’re supposed to maintain it, you know, in a certain way, following the same regulations. And so that was trying to wrap your head around those things that where we are the same and can be the same or should be the same. And not get as hung up on those things that maybe we should continue to be unique and different on because there are going to be those variations that you you have to you know, because {…} not everything is the same in healthcare. So I think if we can focus on those areas that we are, have those opportunities there, we can really drive and move forward. This industry, I really did as far as you know, the safe and reliability, reliable use and the equipment.

Chyrill Sandrini  13:24

And I would think that you’d want the OEMs somehow integrated into this process. Wouldn’t you?

Heidi Horn  13:31

OEMs, ISOs, Everyone. So that’s another Okay, so yeah, I mean, you know, we always refer to htm as it’s the in house organization. But OEMs have htm organizations, they have a service arm, they have service technicians that provide service on medical equipment. Those are that’s HTF. So it’s the same thing. So we are all you know, I think when we stop kind of saying they’re different from us, and they’re different from us, and they’re different from us. And again, look at there are differences, no doubt about it, but we’re all again, working on the same equipment. We all have safety, reliability, cost savings, regulatory compliance, top of mind, then you know, that we can find some common ground and there’s Yes, so yes, they have to be involved. They should be involved. I associate involved. Anyone who maintains equipment and should be involved. I should say, everyone, yes, we need some select. We need a obviously a representative from all those areas.

Chyrill Sandrini  14:44

Yeah, I could see that you would, what would be like a date that you’re looking at? Is there a year projected?

Heidi Horn  14:51

Oh, no, no, no. I mean, honestly, that so there have been you know, years of there’s been differences. standards that have been created around medical equipment maintenance, by Amy. But I think everybody will agree that they’re, they’re pretty loose still, you know, in vague. And there’s still some opportunities for improvement. And so, so it’s not like this, we’re just starting this. I mean, the this has been a journey. But I think what has happened up until recent years, there has been a major pushback from the ACM folks to even think about or consider more standards and more standardization. Vainly because we we don’t have, you know, we haven’t had the ability to really to get into a room and start talking about it as a representative group. And then even when that group agrees, you know, then you kind of push it out to the industry, and industries like that, not gonna do it not gonna do it. So you know, then that’s when you started having, okay, you create good standards that are based on real world. So that’s important, you know, they have to be real world, in the organizations have to have the ability to implement them, and those implementing them will create a safer, better, more cost effective environment. And if that’s the case, then we would hope that CMS, Joint Commission DNV, then can adopt them as their own standards. And so rather than having CMS to the tail wagging the dog thing, I think has happened in the past CMS, and then Joint Commission has come out and said, Well, you need to do this, you need to do that. And there, I’ll be very honest, and I’ll say this now, because I’m not part of a health system. And I won’t know more about them showing up at my door yelling at me. But they’re, they’re very vague and they, I think, in some cases, were obviously not written by anybody who has ever maintained equipment. And, you know, I mean, it’s, it’s terrible to say, but they’re not based in real world, how things are done, you know, in a, in a hospital setting. And so what happens, you know, I’ll use the 100% PM completion thing, which, again, is another sore point for me. But it’s like, the, it’s impossible to be to complete 100% of all your PMS on time, every single time. It’s impossible, because you have equipment that gets lost, you have equipment that is in use, you know, you have equipment that is waiting for a part from a vendor, all these different reasons. And so, excuse me, making 100% Completion, a regulation forces, the ordinate forces, HTM organizations, essentially to lie, because they’re not completing them. What they’re doing is that they’re closing the work order out. But that is not complete.

Chyrill Sandrini  18:03

That that’s a great point. Heidi, that’s a great point. Yeah. What do you think that the HTM industry is going to say about the cost that would be incurred by each organization to make those changes? I feel like that might be something that might be brought up.

Heidi Horn  18:22

Yes. So again, the costs, you know, I couldn’t even begin to say what they might be. But they will, you know, they will, if if there’s a standardized processes that are pushed out, like anything like, again, like, the whenever there’s new regulations, you know, the the hospitals have to run around in the OEMs. And the ISOs have to figure out, Okay, how are we going to adhere to these, and there are costs involved with changing their policies and procedures to adhere to the new regulations and new requirements. That’s what this would in fill. But ultimately, the hope is that there will actually be cost savings, because you’re not spending so much time independently of each other trying to figure out how now to, you know, adhere to these, these changes. It’ll be it’d be a collective standard, essentially,

Chyrill Sandrini  19:20

Especially with a different CMMS programs, if everyone made the same changes, it wouldn’t be an individual change, it would be a system change, if everybody went to it at the same time, I think that would be beneficial, right? And like everybody was on Nuvolo as their CMMS program all made the changes at the same time, then it maybe it’d be a collective cost than a individual cost,

Heidi Horn  19:44

Right. So you’ll okay we’ll use the CMMS example, which is a good example. I would put it if if all ACM organizations could agree that these are going to be their work or these are our you know, we’re going to use Corrective Maintenance Pan Maintenance. Support Services, you know, I’m just kind of rattling some off my initial inspection, all those, whatever they might be, what are the whatever AAMI guidebooks as they should be, then in these are gonna be all our failure codes that all CMMS companies can then configure their CMMS to the that is the out of the box configuration for everything. As an end, again, it’s it makes it that much easier. If you think about how much time you have to spend cleaning up the data to go into, you know, a new CMMS everything would be ready to go ready, you know, from that perspective, so. So those are so ultimately the hope would be that is going to save you time, and money, and effort. Because again, everything else will be set up accordingly. And you can make those changes, if that makes sense.

Chyrill Sandrini  20:55

Yeah, 100%, I really liked the thought that PM is defined. Right? That’s a simple one, that should be a good one to start with. I would think.

Heidi Horn  21:05

Start with exactly. And then we have, you know, so many different cases of that in the industry, that people are doing things differently. You know, when do you call it? Well, if you’ve looking for a device, let’s say, for its PM, and you can’t find it, how many times should we look for it before we decide it’s no longer in the building? Again, every organization does it very, very differently. So I’m decide, we’re gonna keep looking for it. Every six months, we’re gonna go out and look for this device. And if you multiply that by the hundreds, hundreds of devices that they have, they can’t find that is a lot of time. Or some might say, we’re just going to look for it once and then we’re closing it out as the device is retired. But there’s, again, this whole variation in there. And who’s right, who’s wrong? And what’s the best way? I don’t I find it hard to believe that that is driven so much by the type of organization it is, you know, I’m saying that should we should we all agree on that, you know, you look for it twice, you can find it, you assume that the device is retired and mark it as such? Those are, that’s a simple one.

Chyrill Sandrini  22:17

That’s a simple one. And you know, I came across something last week that invoked this conversation about operational verification checks, and logical safeties. Right, there was four different opinions. Oh, yeah. Oh, yeah. Right. And I’m like, can we just pick one? Right? Like, we’re just trying to get the job done? And, and do you want it to be electrical safety checked? And, you know, do an operational verification? Do you want one or the other? It took several people to get involved in the conversation to figure that out. And that should be standardized.

Heidi Horn  22:54

Right? And there’s no reason why it shouldn’t be. And again, it’s, it’s because the, the industry has been left. You know, and it’s done a good job so far, but everybody’s operating, you know, in their own little bubble, and then they decide, well, the way I’m doing it is the best way to do it. Because I’m doing it that way. So but that obviously cannot be the case, everybody can’t be the best way to do it. So what what ultimately, you know, you looking at is what makes the most sense to ensure the safety and reliability of that equipment, at the lowest cost and least amount of effort. And, you know, that’s a very simple way of putting it but you know, you never want to hinder the safety and reliability of equipment. But if you’re going too far, and you’re spending too much time doing unnecessary work, in some ways, one could say you’re actually taking away from the time that people could be spending doing life saving type of work, you know, so you’re spent, you’re wasting your time doing things where you should be spending and doing other things over here that actually impact

Chyrill Sandrini  24:13

And that’s a cost savings. Right? You know, another thing I think might be great to see standardized at some point is inventories. I see a lot of inventories. They’re just… the amount of unnecessary information, necessary information, things that are completely missing. You have to ask for even an inventory when was the last PM, right? In several different ways. So I could see that would be beneficial and standardizing you know how everyone has their inventory listed but it goes back to CMMS programs. That’s where it comes from.

Heidi Horn  24:51

Right but again, if there’s if there’s standards Oh, I was I think I was explaining before it’s like it’s the tail wagging the dog or the dog wagging the tail. If we as HTM professionals can develop those standards based on, you know, real world experience and data and analytics and everything else that you know, and doing this in a way that makes a lot of sense. And then have, you know, the regulatory agencies, the CMS, the DNVs, the Joint Commission, adopt those as standards, rather than vice versa, you know, rather than them pushing it down, and us adopting something that was not really, you know, based in real world, then I think it makes a lot more sense. And something that will be more practical for all HTMers. And the same goes with the CMMS piece is if, if the HTM professionals are driving the standards, versus the CMMS companies, you know, because they can tell you most CMMS companies, you know, not all but most don’t have a lot of people in there who know HTM, they have engineers, and they have, architects and, and so those folks don’t know the industry. And so they’re creating software, based on their limited knowledge of how it actually works in again, in the real world.

Chyrill Sandrini  26:17

So, is there a committee yet? Is there a place where people might that might be leaders in this industry, can get ahold of you? Or to AAMI to volunteer their time? 

Heidi Horn  26:28

Yeah. So, at this point, the answer is no. And so AAMI, you know, being like any organization and all of us, we have, you know, limited resources and limited amount of, you know, folks that can work on these things. However, I think the first step is, you know, we’re trying to get the word out and get people that understand, and at least get acclimated to the concept of, because it is a foreign concept, I think, for most HTM organizations, and again, I’m talking about the OEMs, the ISOs, any in-house organizations to appreciate, but then, you know, we at AAMI, then will, you know, start collecting interests, like which, which, because because we can’t do it all at the same time, you know, you have to, you have to prioritize and pick and choose. So which standards should we be working on, to make the most sense, and then, you know, we start putting those into a, you know, a plan, creating a plan for them, and then creating committees, and looking for volunteers. So, you know, this is really at the point where we’re wanting to get people excited about volunteering and thinking about it, and understanding how extremely important it is, and how much this work, you know, will mean to the industry as a whole. And then there will definitely be things coming up from Amy in the future about it. And you know, what, how people can get involved and, and you know, it might not be just be on a committee, it might just be providing feedback to particular standards, or draft standards or things like that. So there’s, there’s a lot of work that needs to be done. And so excited about that.

Chyrill Sandrini  28:06

So if there’s somebody who is as passionate about standardization as you are, can they send you an email and reach out to you?

Heidi Horn  28:15

Yeah, I think that would be a good way to start. And I don’t want to, you know, I definitely want to make sure that people do reach out so you can reach me on my email, which is pretty easy. It’s So, yeah, you can, you can find me pretty easily and that way, and then we’ll start collecting some names. And like I said, this is going to be a multi year process. So this isn’t going to come out right away. First step is just to make sure that as you mentioned before, you couldn’t get everybody to agree even that there is a need to agree. And so I think we need to first we hear your first step except you have a problem, we have a problem. And so then get everybody’s like, Okay, we gotta we went, we got a problem. So this is how we’re going to work our way through it to as an industry start, you know, working on low hanging fruit of things that we can start agreeing on, which there are many things.

Chyrill Sandrini  29:16

I think it’s a great idea and I believe standardization will benefit everyone in time saving cost savings, and just making the industry more standard in general. So all the new people that we’re attracting to the industry, it’s not well over here we call this and over there you call it that and you do it like this here but not like this there. And I think standards are good for the industry in general. So I got ask, we always close every episode with the WOW, your words of wisdom, we like we’d like to hear from you Heidi and just to leave the listeners and viewers with something. It’s been a great Episode and I want to give you a little time just to close it out for us. Okay,

Heidi Horn  30:05

well, um, so I don’t know how words of wisdom but, you know, we do pride ourselves in HTM about how you know, and quite frankly, we know our we’re all aging in it. You know it’s a it’s a it’s an aging industry and I think that’s the average age is like 55 plus right now. However, you know, I will just remind everybody, we’re not dogs and we can learn new tricks. And so my I guess, words of wisdom for the HTM industry is that, you know, always be curious, always want to learn new things, always want to make sure that you’re educating yourselves on the latest and best and greatest in the industry. And standardization and standards is one of those new tricks that I think we can learn. And so that would be my words of wisdom is don’t be a dog.

Chyrill Sandrini  31:10

Us older dogs can learn new tricks. Right? I learned Excel. So if I got Excel, exactly. Okay. Heidi. It’s been great having you on today and we appreciate your time, we know you’re busy to come on and share a little bit about standardizations with the HTM community and where it might be headed. I think it’s gonna be really intriguing for our viewers and listeners to tune in and see where the industry might be going.

Heidi Horn  31:40

Well, I look forward to talking to everybody and anybody who is interested in, in getting on, you know, finding out about how you’ve been involved and will certainly keep everybody up to date on that. And thank you again Chyrill for having me on your show. It’s been fun.

Chyrill Sandrini  31:56

Thank you Heidi now, you know you can find htm insider any place you listen to your podcast. You can also listen through Tech Nation. And when you log on and listen there if you need the CE credits, you get one CE for listening to this podcast today. Thank you for following htm insider and you all have a great day.