The Relationship Between IT and Biomeds | HTM Insider | Nader Hammoud of John Muir

Nov 24, 2021


Chyrill Sandrini, Nader Hammoud


Chyrill Sandrini  00:15

Welcome to HTM Insider. I’m Chyrill with MultiMedical systems. And today I’m really pleased to bring you Nader Hammoud of John Muir health. And I’m gonna give Nader a few minutes introduce himself, in case you haven’t met him before, and just so we know what his background is. Hello, how are you?


Nader Hammoud  00:35

Hi, thank you Chyrill for having me. My name is Nader Hammoud. I’m a biomedical engineer, I have three degrees in biomedical engineering. I have an MBA. I’ve been doing this since 2001. So that’s 20 years now. I started my career in Lebanon in the Middle East and moved to the United States in 2012. I’ve been doing the same thing managing biomedical engineering departments, and I was also consultant at the same time for equipping and designing hospitals. Today I am managing the biomedical engineering department all healthcare technology management, John Muir health. I am a co chair of the Education Committee with ACCE, American College of Clinical Engineers and member of the Technology Management Council TMC with AAMI. And at any opportunity, I can help this field. Always there. So, I’m happy to be with you here, Chyrill.


Chyrill Sandrini  01:45

Oh, yeah, happy to have you on. We’ve known each other quite a few years now. I can recall a CMA meeting back in Sacramento one time, when we first met. I taught you how to play blackjack?


Nader Hammoud  01:58

Yes, you did.


Chyrill Sandrini  02:02

Well, I’m excited to talk to you today about something I know that you’re extremely passionate about, is the difference between biomed healthcare technology management and IT and how they can work together or how they’re working differently. So let’s just start that off, right, like what is the difference between IT and a hospital? And biomedical engineers and that department?



Yeah, that’s that’s a great question. And this is a really interesting topic. And we we need to be aware of those differences and how to tackle it. Start by answering your question, what’s the difference it are educated and they learn through their education and through their training, all the aspects of it and how to follow the processes and how to perform tasks in a very process driven way. And they are very good at doing it. Biomed when what we get in our education, we study anatomy and physiology, we study electronics, we study electric electricity, in different forms, we study mechanics in different forms. So our whole all our focus and education is focused towards the human body and how to help the human body how to engineer things to help the human body. So the focus ever since the education piece is totally different. We are thinking of patients human body and how to help the human body and IT are focused on processes and provements. How to get to the next code, how to eliminate bugs, how to make sure it’s secured. Now you bring those two people put them in a healthcare organization. And they have to work together, you will see that they are extremely repelled from each other and it’s systematic everywhere in any organization, you go, you will find those two teams, they are not the closest that they should be, because IT is process driven. They have to follow their processes. biomed is extremely the opposite. They are not process driven. They are event driven. We follow when there is an event, we rush to address the event. We if there is a process, we might follow it. But it’s not our Bible. We will jump loops, we will avoid things we will trick systems to make sure to get to the final result, which is a safe device that’s available for treating a patient that might save his life. Right. This is our ultimate goal. From an IT perspective. They received the call. Their focus is to make sure that this device is cyber safe. And it’s running the latest patch and it has the latest updates. They cannot link that to the patient. Yeah, so


Chyrill Sandrini  04:56

what’s it gonna take to get out it’s same page? At your facility, what’s been your experience to get IT and biomed On the same page? How do you get in the same room and come to that end result being cyber safe and patient safe?



Yeah, you might be surprised by this simple answer. It’s communication. Because of the lack of because of the gap in understanding of the roles, biomed has always been focused on that patient side. And they always see it as the ones who has no clue what’s happening on site. And they do not understand the importance of what’s happening. And they do not understand why we’re doing, why we’re how we’re doing it. And the same thing on it, they see biomed as a disconnected department, they’re disorganized. They do not follow orders, they do not follow processes, they run things on their own. And they always cause issues to IT, because they always do things without proper planning and processes and following the proper flow. Because of that, there was a huge absence of communication between these two departments, they’re not even willing to communicate. So when any organization I walked into, including my current organization, when I started exploring that, let’s have a meeting, let’s discuss why, why do you want to talk from both sides? We don’t have anything to talk with them. All I need from them is when I call them to respond. And don’t tell me you have to wait two or three weeks, I want them immediate response and you go to IT, we need to meet with you on top, why do you need to meet with us, we don’t need to work with you. We are fine on our own, we don’t need you You’re You’re a mess, I don’t want to deal with you. So that gap and lack of communication created that repulsion. Once you start meeting and talking to these guys, and learn from them. And talking as healthcare technology specialist, specialist, professional. Start talking to them and learn from them learn why they do what they do, and how they do it, and share, share with them what you do and how you do it. And why you do it, you will be surprised that you’re all have the same goal, the same purpose, but you wouldn’t different way. And that can be a strength if you actually know how to play with it and drive it properly. So we need their processes and their organization. And they need our ability and availability next to the patient, they will be scared to approach a device next to a patient or do anything to a device attached to a patient. We’re not because this is our area. So working together and communication can start eliminating that and making it clear.


Chyrill Sandrini  07:49

So in your organization, I know it varies across the country. Who is IT reporting to? And who is biomed reporting to in your structure? And what do you see in the movement?



In our department and our organization here, now we report to operations. So we do not report to IT. I’ve worked in previous organizations that I reported to IT. And so there is no best answer there is no right way or wrong way, simply because regardless if you’re reporting to IT or not reporting to IT, the communication is still the key. I reported to IT and there was no communication and we still struggle in our relationship with IT. The key is that communication, that understanding that sharing knowledge between the two, and making sure that we all care for the same purpose, which is patient care, if you’re reporting to IT, you still need to have that same type of communication with the IT folks because they’re still disconnected from you. You’re not even though you’re at the higher level, maybe you’re one department, but at the operational level, you’re not, you’re separate, you’re still separate, it doesn’t make a difference. So it’s the same


Chyrill Sandrini  09:09

With your staff and IT staff. Do you see your team working cohesively with the IT team? Or is it really kept at a management level? Or how do you how are your guys get along with their guys? Is there any tension there?


Nader Hammoud  09:25

There was thankfully we were able to pass that I would contribute this to to the higher level thinking of some of the IT managers that I had, that I’ve worked with. They were able to understand where we’re coming from, and I was able to understand where they’re coming from. So to answer your question, it’s it has to be kind of a mesh. It has to be both management working together and the team’s work Working together has to be both. It cannot be just the management and the management now deploying their engineers and their engineers is waiting going back to their management, it has to be both. So both having the same focus, calling each other to meetings, if I’m dealing with something, and it has anything to do with it or touching the network, I will stop everything, I need it to be there, not because this is how it should be. But because this is the right thing to do. They’re the experts. And the same thing, we were able to evolve to that point that when it is working on anything, integrating changing the network on a device, anything that they’re doing, it involves it touches a medical device. They never cared about that before. But now they say stop. Did we involve biomed? That’s notify biomed. So then they will work with my engineers, management on both sides are aware. And we work together. So there is I would say there’s zero tension. And actually, we, we really appreciate that great relationship with them now, because they bring so much to the table that we were lacking.


Chyrill Sandrini  11:05

You come from a large facility, and I know you’ve worked in prior large facilities and organizations. How do you see this affecting like the smaller hospitals, the rural hospitals, that facilities is actually running their day to day operation? And they’re outsourcing biomed staff and maybe outsourcing it? Do you see more of a struggle there for those folks as far as everybody on the same page?



Definitely, I would say it’s different. So when when we say outsourcing, then you start talking about different perspective, different division, because the outsourcing companies, they don’t share the same passion and vision as the in house biomed or it. The outsourcing companies, they always have metrics, and they need to hit those metrics, because their contract is based on those metrics. I know that they will do their best, I’m not gonna speak bad of them. But they are obligated by their contract. As long as they’re fulfilling their contract that set for them, they don’t have to go above and beyond. So that’s going to be really hard for either parties, either teams to build a better relationship or to evolve that relationship when it’s being outsourced in either way. In Jamia, we did outsource our IT department to a huge organization OPTiM. But it wasn’t actually outsourcing, it was more kind of a new type of collaboration. But the good thing is the teams that we were working with, they’re still the same team. And they’re still their only focus is this organization. And they’re doing a great job. And we really appreciate that the added value. Now for the rural rural organizations, healthcare organizations, or smaller organizations. It varies on on the size and how, how, how deep, the leadership of the organization wants to invest in either IT or biomed, because I’ve seen organizations here and not in a rural area here in the Bay Area. It’s decent size hospital 150, 200 beds with one biomed. One single biomed. So they’ve they’ve opted to say that, okay, let’s do contracts. And all that you have to do is just manage those contracts, you cannot expect from that person to evolve that relationship with it and take it to the next level is just kind of contracts manager. So it depends on the organization, their vision, how they want to proceed. And at the same time, the same level, the involvement on both of both parties biomed in it in in the market and the society and Are they involved? Are they aware of what’s happening? Are they attending conferences? That’s a key point. Do they know what’s happening? Do they know Chyrill? Do they know someone else? Have they met them in conferences, have they listened to their concerns and what’s happening in the market so they can bring it back as a best practice and evolve their departments. So multiple aspects effect that it doesn’t feel in necessity depends on how small or big or rural, not rural? Totally different than if it’s outsourced, though.


Chyrill Sandrini  14:30

Right. I see that. So you brought up a good idea of conferences. Are your IT personnel there? John Muir? Are they attending the same conferences that you’re attending? Or do they have separate medical conferences that they attend?



I am not sure to be honest. I know like HIMSS this year at least. I didn’t see any from our IT departments going there. Maybe Because of COVID, and um, lots of people didn’t go, lots of my colleagues and other organizations, they didn’t go because of COVID. So I cannot throw that. Do they have other conferences? I would, I would guess so I hope so. I’m not sure I’m not an expert in their field. But from our side, I do my due diligence, and I make sure that I go and attend to bring that back that information. And I will share with these guys about what opportunities we have. And they’re open, because, you know, it’s it’s getting us to a better place.


Chyrill Sandrini  15:32

Right? It’s protecting your hospital and your patients, right? Yes, exactly. So where do you see the gray area, where’s the gray area, if you had to, like paint a picture, where would be that that middle zone that you cross over, or it’s just not not known yet.



So maybe 10, 15 years ago, I would say there was a gray area. Today, I don’t see any gray area, to be honest. And as I say, some people will not like it, especially on the healthcare technology side. When we see gray area, and the relationship between biomed it, it means someone is trying to avoid taking responsibility. It’s really simple. There shouldn’t be gray areas. And this is we were able to resolve this at John Muir, by very simple definition. Anything that has anything to do with the medical device, it’s the healthcare technologists responsibility. I don’t care whether it is connecting to the network, connecting to wireless, changing IPs, changing configuration, wherever it is, it’s a medical device, it’s the biomedical responsibility. Now who’s going to be performing that task? Most probably, it’s IT or networking, then it’s the biomed job to dispatch and request from it to perform that task. And then the biomed’s job is to ensure that everything was done, everything is working. This way, it’s simple. We our customers to it, they cannot do anything to the medical device, unless they receive a request from biomed. It’s not that Joe, somewhere in the in the upper floors, he wants to connect his ultrasound to the wireless, and he calls his friend in IT “Hey, can you come pick it up and connect it to the wireless and they come show up and connect it to the wireless.” And then it’s not sending and then they call biomed “The ultrasound is not sending? Why it’s not sending?” But it’s not plugged to the wall? Oh, yeah. But it’s sending wirelessly now we changed it to wireless… We cannot let this happen. Right? You need to change it to wireless, it’s a medical device, even if you reach out to his IT counterpart or colleague, the IT will say it’s a medical device, send the request to biomed, we receive the request, we identify, we need to do this not need to do this. And then we will dispatch the same guy. We need your help guys, we need to change this side. So gray area does not exist anymore. If you take your responsibility properly, if you are willing to hold that responsibility and say, This is my device, I’m responsible for everything that relates to it. And it Do you think they will, they will be worried or concerned or wouldn’t like that. It will be the joy, because now they have a single point of contact. Not any customer, not millions of people asking them questions and requesting different requests. Every time it’s a different request. Now it’s just channeled through biomed anything related to a medical device? It has to come from biomed period.


Chyrill Sandrini  18:37

Yeah, so do all your techs, do they have the ability to set that up? Or do you read it through one technician? Or maybe one admin or how does that work?


Nader Hammoud  18:48

What do you mean?


Chyrill Sandrini  18:49

So if you have technician, Joe, Amy and Frank, can Frank call it can Amy call it instead of that device? Or make those changes? Or events?


Nader Hammoud  19:00

Yeah, yeah. Any of the biomed we’re just like any other customer to it. How do you know? We have work orders and our CMMS system. And we submit actually a ticket and snow they have the ServiceNow platform. So we do submit a ticket. And we reach out to them saying we have a ticket and we need your help to to configure this. So this is how we work as simple as that.


Chyrill Sandrini  19:26

Very good. Very good. And do you guys collaborate on your reporting as far as cybersecurity, and you know, any concerns that come up? Do you guys work together? When that occurs?



We are in the process of evolving the cybersecurity world. We are not where we would like to be. We are definitely cooperating and coordinating. We have regular meetings with information security where we have open communication. If they receive something, they notify us if we receive something we notify them. We will very closely together, but we don’t have a robust solution for cybersecurity and at HIMSS we had a huge focus on cybersecurity. We’ve learned a lot. And even the biggest organizations in the nation, they’re still trying to figure this out. So we were able to get some best practices and what we can do the best to move forward. But it’s going to be a good, good adventure going forward.


Chyrill Sandrini  20:27

Yeah, I imagine so. And it’s changing all the time, right? Yes. It is evolving, evolving and new issues come up and even bringing in how do you handle loaners at your department? Is it involved and you’re bringing in loaner equipment?



No, no, it it’s purely in purchasing and biomed. And we’re looking also on improving that process. Because today we have some gaps and finding the devices and we’re looking for best practices to implement. But it has nothing to do with loaners. No.


Chyrill Sandrini  21:07

Yeah, I just wonder about the concern, you know, with patching it into the network. Do you guys if if it’s a device needs to be patched into the network, is that when it comes on board? New equipment? How does that work?



Yeah, so for loners usually we don’t connect loaners to the network, unless it was specifically brought in for the specific need. And the connection is a must, then it has to go through all the process of like a new device. So the new device, it passes through a process we call TRE with information security, regardless of anything that’s coming into the organization, it has to go through information security, even if we see a request that device, and we see it coming and we know it didn’t go through IT’s technical review evaluation, we will stop it and we will call them because we… as much as we ask them to be vigilant and involve us when someone requests something directly from them. But assuming the same on our side that any device, it has to be approved by IT. And we usually try to make our best that even if it’s not connected to the network today, but it has the capability of being connected, we want to make sure that it is aware. And there they clear it up. Sometimes that process can take time because approving devices to be connected to the network. It requires the technical expertise from the vendor side to give our IT folks the required specifications and the permissions that are needed. And then they have to evaluate that and give permissions based on that.


Chyrill Sandrini  22:58

And how are your end users involved? Are they aware of the collaboration between it and biomed? Who do they call when on the floor? If they have which they perceiving IT issue? How does that work out?


Nader Hammoud  23:14

So the first question is, they are not aware. And for a good reason be we don’t want them to be aware, we don’t want them to be worried and thinking how it’s happening. Is IT doing this, is biomed doing this for them, it should be a complete package deliver, then you’re good to go. Everything has been cleared. Now for service requests. Sometimes they ask me, they submit a request using ServiceNow to it for a biomed ticket. And then it would call biomed. And then we will take care of it. Because as I said at the beginning, we are event driven. So we wouldn’t call the end user and tell him, please submit a ticket. And then we will respond we will go take care of it. We will open a work order on our side and document our work. If the other way around happened, if they call biomed or submit a ticket to biomed and it’s an IT issue, we will reach out to IT and we will inform the end user that hey, this is an IT issue. We informed them if you would like to submit a ticket so you can follow up on that.


Chyrill Sandrini  24:18

Yeah, that’s that’s great, because that’s what happens. Right? That’s where a lot of the confusion lies within the hospital is when the end user has an issue. Right? Who do they call? So that’s great. Yeah,


Nader Hammoud  24:28

We tried to streamline this and definitely at 1 point, 4 or 5 years ago, if you’d call IT for a Biomed issue, they will say it’s not our job, hang up. And if you call biomed for IT, it’s just not our job hang up. But we discussed as we discuss and again, as we communicate together, we developed that relationship that we want to serve our customers. We don’t want to say go figure it out. I mean, a call was received by someone. Let’s take care of the customer. So we communicate internally. But just that,


Chyrill Sandrini  25:01

that’s great. That’s great to hear. I think that’s a message that can be really shared to our viewers and our listeners, is that just making that one call and then work amongst each other right? To figure out how to best serve the customer and the patient? Because I myself, you know, I’m not very IT driven as far as sometimes I get confused, would that be an IT issue on that pump? Or is that a biomed issue? Or my computer’s not connecting, right? Like, who do I call and, and they’re in the midst of patient care. So they need to be serviced and customer service. Right. So we’re coming to the end. And I really appreciate you being with us today. And I’m sure our viewers are going to get a lot of information. But right now like to give you an opportunity to give us your own words of wisdom around in a sentence or a couple words between biomed in IT. What are those words, you can hang your hat on?


Nader Hammoud  25:59

Oh, thank you so much. That was really nice and interesting. Words of wisdom, I’m not the wisest person, but from that, for that topic. Just the main point is communicate, you will be surprised how much you can get across and how much you can evolve. If biomed and IT communicate and evolve and develop that relationship between them. We have an ultimate goal both of us is the patient care. The lack of communication will make us doubt each other. Just communicate work together. And if there’s anything I can help with, I’m more than happy. Please feel free to share my contact information. Sure, I’ll just focus on the patient.


Chyrill Sandrini  26:56

Exactly. So I like that let’s finish that word with communication. And and I really appreciate your time today. And I’m sure I’ll see you again soon at a conference on the road somewhere.


Nader Hammoud  27:06

Thank you. Thank you. Nice seeing you!