Why Consistency is Key – HTM Insider | Ben Scoggin, Duke Health Technology Solutions
May 26, 2021
Chyrill Sandrini, Ben Scoggin
Chyrill Sandrini 00:14
Welcome to HTM Insider. I’m your host Chyrill with MultiMedical Systems. And we’re really excited to talk about right to repair again today. We have Ben Scoggin of Duke University. And I would like to give Ben an opportunity to introduce himself and tell us how long he’s been in the HTM industry.
Ben Scoggin 00:33
Yeah, yeah. Hey, how are you? Yeah, so I’ve folks that know me, have heard me say this before. But I’ve, I’m, I’m 33 years old. And I feel like I’ve been in the industry for about 34 years. My dad was a clinical engineering original you one of the folks that were in it in the late 70s, early 80s. And I grew up around this stuff. I’ve been doing this professionally since 2011.
Chyrill Sandrini 01:06
Well, let’s start, let’s get down to it. Right repair means a lot of things, a lot of people, and a lot of different industries. But what does it mean to you, Ben?
Ben Scoggin 01:18
It just really means that a consumer or the owner of a product has the right to perform their own repairs, or to choose a delegate to perform the repair or just to have an option outside of whatever is offered only by the manufacturer. And there’s nuances and all that, depending on the industry, but that really is just the bottom line.
Chyrill Sandrini 01:53
So it’s kind of interesting, since your dad has been, you know, in clinical engineering for a long time, and you’ve progressed since a young age. So it’s kind of interesting to get your opinion on when did that change? When did ownership versus right to repair and the OEM, you know, taking a stance on, they’re the only ones that can do it? Where did you see that shift happen?
Ben Scoggin 02:15
Yeah, so this is, this is an interesting story because, for me, it actually started. It started when I was right out of high school, and I worked on heavy equipment. And I was a field service tech for a distributor for an international, just heavy equipment company. And one of my jobs, one of the primary things that I did was just troubleshoot stuff. And then you go to a huge, massive commercial lumberyard or you go to a port, or place where these container loaders are. And they’ve got these, they’ve got crews of very skilled, incredibly technical people working on their equipment. And yet, me as a, you know, 18-year-old 19-year old that went to a manufacturer school for three months, they would call me and I would get out my laptop, I would hook it up to a data port, I would pull a bunch of codes, I would look the codes up in my book, and I would say, here’s the part you need to replace. Here’s my invoice. Have a nice day. It didn’t ever really strike me what I was involved in, and what I was doing until, you know, four or five years later, I was I had gone to school, get an associate’s degree became a Biomed tech. And I went, I got a laser certification of certified laser repair tech and I was working on a laser. Long story short, I put this supply this power supply in when I’m testing the laser, I’m not getting the power output that I need. So I called the manufacturer I said, Hey, you guys sold me a faulty board, I’m not getting the power output. And they said, Well, you got to calibrate it. And I said, Okay, well, what’s the procedure, and they said, You can’t do it only, you know, you’ve got to have, you know, the laptop and the special cord. And all of a sudden, I thought back to the faces of those hundreds of people that stood there and watched me troubleshoot their, you know, their crane, their container. And I thought I don’t think they appreciated me at all. I think they probably felt like I feel right now. And I think prior to that I was like most people just you assume that the right to repair is kind of innate, you assume that it’s just there, you don’t think it’s not a cause you see people lining up for, you know, other than those of us that are privy and that are impacted. It’s not something you’re acutely aware of as a general consumer. So that’s kind of my path to understanding what was going on here.
Chyrill Sandrini 04:44
Well, you know, if we look at it from now, we’ve been through COVID where it has caused issues with technicians being restricted to travel. Absolutely, you know, parts availability, equipment availability, how is it impacted you and your team in your day-to-day operations and patient care and patient safety?
Ben Scoggin 05:08
Yeah. So it certainly has. So, there are two parts, two parts of this. And I’ll answer the direct question first. Me and my team. The very next thing that there was a shortage of after toilet paper was field service engineers coming on site. It was it was crazy. It didn’t matter what it was. I mean, if it was a patient lift or a linear accelerator. You could we were getting told that we’re sorry, our organizations not allowing us to travel right now the organization is not allowing us in the hospitals right now. It was such a disconnect from reality. And, you know, we had to get creative a couple of times with staffing to make sure that we had coverage. You know, and our part of North Carolina was a part that struggled quite a bit, you know, and we’re, we’re a large, reputable hospital, and we ended up with a lot of really sick folks. And you, but my people were here, you know, we were coming in, and we were putting on scrubs, and putting on our masks and social distancing. And we were still responding to service calls, we were still doing what we could. And when we needed that, that next layer of support, it wasn’t available. Right. And it was, so it was disheartening. It was frustrating. And, and honestly, it was infuriating in a lot of cases, because I’m looking at, you know, we’re up here, we’re all trying to figure it out. We’re you’re watching providers try to figure out how they’re going to respond to a code, because it’s the first one that’s happened in one of these rooms, and right, it was just it was, it was tough. And the supply as far as like the supply chain piece to that, that’s at least more forgivable because you understood the reality of if, you know, just in time manufacturing and things like that there’s not just warehouses full of, you know, gaskets for my anesthesia machines, you know that that does exist to some extent, but it’s not months and months and months of work for everybody. And so at least that, like that was a burden. And that was troubling. And we and you work your way through it. But the people that tell us otherwise, that we’re not allowed to access service mode, and we’re not allowed to turn off this PM light, we’re not allowed to X, Y, and Z. When those folks are not coming on site. It just, it was a completely different situation.
Chyrill Sandrini 07:49
Yeah, I, I’ve heard that a lot that it’s been a frustrating time. Did you see me relax in those like maybe service keys or help, via Zoom or something that they’re trying to help you? Or was it just shut off, or you just cut off from that too bad? It’s broke, it’s broke. We’ll get there when we get there.
Ben Scoggin 08:08
So we definitely had some I want vendor name drop, I will say that I’m planning on it another 35 or 40 years in this industry. And I have a very short list of people that anytime I’m ever asked, I want to say they do not have your patients and in mind and let’s move on. So there are a couple that just it. We’re so sorry, this is unfortunate. Good luck, we’ll see you. You know, when was he when herd immunity hits. And obviously, it didn’t get that bad. But there were some that worked with us, you know, some that may be extended some, gave additional licenses, some that may be shared expert agreement, type of contracts were expiring and you have to re-up but we weren’t able to attend the school. They went ahead and extended. We did see a lot of that. So I’m very appreciative to those vendors that remembered that what they’re doing is providing solutions for patient care and very, very frustrated by some others.
Chyrill Sandrini 09:22
You know, I’ve talked to a couple of people before you and on this podcast. You know, Benson Wang, Perry Kerwin had a couple of things they brought up is, you know, manufacturers are saying it’s the IP rights, intellectual property. That’s why they’re not giving it up. So if I gave you a choice of the top three things, why do you think a manufacturer doesn’t want to play ball necessarily, especially in this need, would it be IP to you? Would it be money, what are some things that you can come up with?
Ben Scoggin 09:57
I’ll start with the popular one; 1 is the service is very profitable for, for vendors, whether ISOs, OEMs, all that kind of stuff, if it wasn’t, they would do something else with their time and their resources, right. So if you’ve got publicly traded companies and all these things, they’re not just, they’re not providing service just out of the goodness of their heart, they’re, they’re doing it to all kinds of reasons, you know, establish loyalty, build that kind of long term relationship, you know, selling sockets, when it comes time for this thing to be replaced. You remember how great this lady or this guy was that came in and took care of you. But the margin, especially like preventive maintenance, the margins are usually pretty beneficial for the vendors. And, of course, there’s except there’s somebody screaming right now saying, Yeah, we’re only at, you know, 2% sure, but that’s, that ain’t the standard. That’s not what the medical device service industry is like, what $20 billion, or something a year. I mean, it’s, it’s, it’s serious money grows eight to 10% every year. But the second piece, that folks aren’t willing always to admit to their there is risk for the vendor, letting us, letting people outside of their organization service things, especially when they’re held so accountable by like the FDA. If there’s a sentinel event with a device, that that’s a big deal, if, if there are multiple Sentinel events with the device, it’s it, we’re reading about it, and you know, 24 seven, and they’re removing that thing, it’s, it’s, it’s a problem, and it costs it, these manufacturers spend, depending on what you read 20, 30, 40 million bucks to get something through, like the FDA process, and then and they just don’t want people monkeying around with it. Now, the caveat to that is, that ain’t what we do, we’re really good at fixing this stuff. You know, and, and I know, the techs that are doing these things are incredible. And they’re very good.
Chyrill Sandrini 12:24
And they’re very focused on patient care, very focused on patient care, passionate, dedicated, people in the HTM industry, it’s amazing.
Ben Scoggin 12:34
My dad used to tell me, if I wanted to be a hero, I should be a firefighter. And I always thought that was pretty good. So you definitely don’t get into this for the money, or the prestige or the recognition, you know, it really is the folks that do it and do it well. It really does feel like a calling. But the piece that I do want to address and may take talk about this a little later, too, though, but as an industry, we have to do a better job of representing ourselves. And we have to do a better job of representing ourselves outside of our organizations and outside of our symposiums. And when, when it when a manufacturer sends their, you know, Government Relations professionals to go meet and wine and dine. The people that are making these decisions and making it right, and these laws and these things. They spend less time talking about how awesome they are and more time talking about how we’re scary, you know, you should be concerned Look at this, you know, look at this work order. Look at this scenario, look at this, look at this situation, this litigation, this. And almost always the evidence of those situations is documentation. As silly as it is, that’s one of the things that we’ve got to do better, and the technicians and the management. And, you know, I really appreciate, you know, Matt and some of those folks that are doing an initiative right now towards just standardizing the language. Because we don’t if you had if you were running an HTM program, and I’m running an HTM program, and we’re across the train tracks from each other. We can’t even really compare our own data.
Chyrill Sandrini 14:37
Ben Scoggin 14:38
And so it’s and I would bet pretty good money that both of us are doing an incredible job of keeping equipment up keeping things compliant, probably the Joint Commission, or DNV, or whoever was thrilled with their last survey, and yet we can’t compare with each other how things are going.
Chyrill Sandrini 14:57
Yeah, you’re right. You’re absolutely correct. Have you noticed any of these really affecting patient care? Do you feel like had you been able to repair it, or given authorization, or the key? Or maybe parts, that you would have had better patient care in your facility?
Ben Scoggin 15:19
Absolutely. Um, again, I said it earlier, I’m only 33 years old, and can literally give you not anecdotal personal stories of multiple times that I’ve been impacted, not even as a clinical engineering or HTM professional, but just as a, as a patient or a patient’s loved one. You know, I’ve taken a day off work to take someone to an appointment and found out that morning, it needs to be rescheduled. And, and because I am in the know, I’ll say, don’t you guys have an HTM department? Yeah, but this system that we use, requires the OEM and when I look at what it is, and like, Oh, yeah, I know. I know. Exactly. But that is, and you’re right. So yeah, I mean, any patient care? it. It’s not like getting a haircut or whatever. And if, if I’m sorry, we can’t do it this Wednesday. Let’s do it next Thursday. You don’t know what your eighth day is feeling like? What if that eighth day is an extension of finding out if your breast cancers come back? Or what if it’s an extension of you know, you’re supposed to have something done tomorrow now, it’s next Tuesday. And that stuff’s happening all the time. And I promise you, it’s happening as a direct result of the folks that are there every day clocking in not having the autonomy, to be able to go take care of whatever the device is, and not just that, but even just the cost, the cost of patient care. You know, we know that in, especially in the United States, our cost, that our cost to health outcome ratio is not good. I’m dealing with a service contract earlier today with an 18% cost of service ratio, and annually so that the device cost x, and every year I have to spend 18% of that for maintenance. And that’s not including, you know, consumables and just like the rest of the cost. Yeah, I’ve got to pay for that. But guess what my budget is underpinned to another budget that is underpinned to another budget that is paid for by billing people for our services, maybe in the bill that and it’s billed to the payer, okay. Well, Medicare and Medicaid, you know, when those costs go up, then the funding goes up. It’s also BlueCross, BlueShield, Cigna, Aetna, those people when those costs go up, it all goes up. People get hung up on kind of Medicare, Medicaid, and that’s a big part of it. And, but that’s like, you know, depending on where you are in the country, that’s like half of it. There’s a whole other half that it there’s a cost problem, too. So
Chyrill Sandrini 18:14
I feel for our rural hospitals, right. I mean, your buying power and, you know, working with, you know, Perry Kerwin, you guys have a lot more negotiations that you can bring to the table. Right? I see in real hospitals, so many, so many small hospitals had to shut down during COVID. They were they’re run by facility directors, who may call a third party in to handle their PMS, or they’re trying to do it themselves. And they just have service contracts. Now no one’s coming out. The little guy, right. So people depend on these rural hospitals across the nation. And they’re taking care of a lot of people that we don’t realize it’s not just the big universities.
Ben Scoggin 19:03
Yeah, absolutely. That’s, and I’m glad you bring that up. Because I was thinking through that, as I was kind of thinking through us talking this afternoon. And honestly, the place I’m at now was probably among the best places to be to deal with all this. And we still we had a ton of challenges is way harder than it should have been. But I really have thought a lot about even my friends that are at larger places, but they work for ISOs. You know, I’ve got a lot of friends in the industry that had no bargaining at all. I’ve got friends, people that I love dearly, and think the world has that have just been removed from the ability to really make an impact.
Chyrill Sandrini 19:55
So it seems to me that there’s a lot of money being thrown on the ocean. Inside, and I understand that there are things that they need to protect, we discussed those. But overall, the organization of the HTM industry has been difficult at best, right? Your BMETs are not the ones that are going out to talk to their legislators. Right. So it’s now become a political issue in California. It was just introduced, you know, what tends to zero. So in favor of the right to repair. Politically, how do you see it? Is it a bipartisan issue? Do you feel that in your territory in North Carolina, that you’re being heard? What are your thoughts?
Ben Scoggin 20:39
Yeah, you know, politics have gotten so strange anyway, it’s like, there need there needs to be like a manual to understand which topic needs to be avoided in which crowds and things like that, it’s, it’s wild, that even something like the right to repair can be so polarizing, just based on which person brings it, you know, forward into a legislator, I think you hit the nail on the head, one of the big issues is that folks like you and I have a lot more thoughts but a lot less money to be able to go out and influence this stuff. We’re approaching it ideologically. And I’m not sure that right now, ideology wins in politics. And I think it’s more about either being able to find, at least at this level, you know, it’s more about being able to fund the decision or buy a decision. Or it’s just if it’s not one of the really cool things to be doing right now. People just don’t seem to care. And I think, you know, you brought up like California and California is one of the places that explicitly mention medical equipment, you know, that as, as one of the things that should be able to be repairable outside, and I think the last I looked, it’s there’s, you know, 25, 30, something like that states that have brought forth legislation and,
Chyrill Sandrini 22:24
yeah, there’s 31 to be exact, right?
Ben Scoggin 22:27
Okay, that’s close enough. That’s a so 31 and, and most of them, either just either, they say, like, non-automotive or whatever. And many of them say, like, excluding medical and excluding agriculture, and you like it’s like, what? Okay, so why is automotive, agriculture…? What did what does the automotive industry, the agriculture industry, and the medical device industry have in common? They’ve got more lobbyists? Yeah. And, and again, they’re also heavily regulated industries. But is that like a chicken or the egg type of situation?
Chyrill Sandrini 23:11
Well, how can you inspire our HTM industry out there to get more involved? What do you tell your team?
Ben Scoggin 23:22
The first thing I usually tell my team is to go get your PMs done. No, just kidding. Yeah, actually, I’m not. But we have to represent ourselves really well. Every chance we get sometimes that changes. A patient got hurt, and they’re doing, you know, they picked up a good TV lawyer and they’re trying to get some money, and they want to know, every device that was on this patient, and now they’re coming and they subpoenaed all the service records for that for those devices. Just make sure their service records are really good. Yeah. Like and, and, and, and I tell my team this all the time, and I mean it sincerely. All you need to do is in writing, explain what you did. Because I know you I know, we did a good job. And I know you did what you needed to do. And it’s not about, you know, being it’s not a creative writing exercise or anything like that. It’s just making sure when, if this is printed in a magazine, everyone that reads it would say wow, you know, Ben did a really good job on that work order, or I don’t know anything about pm and anesthesia machine, but look, look at that test equipment to use look at those part numbers. Look at the test that he performed. He verified you know, at the end of all that then he verified it was operating properly and he returned it to service and he talked to Rachel you know, or whatever. And, and, and It’s It’s simple.
Chyrill Sandrini 25:02
If you don’t document it, it didn’t happen.
Ben Scoggin 25:04
Exactly. And I think that I think that it’s got to start there. It doesn’t. We have to add every moment. Every time we’re subpoenaed. Every time there’s a tracer. Every time the FDA comes in and wants to see what you did with the recall, every time anything like that happens, we should be just in some relatively consistent way across organizations, we should be able to show what we did. That way when, when we’re standing, you know, when Binseng and Matt Veritate and when these folks are standing in front of the people making the decisions and saying, well, we are worthy of this, we’re capable. They’re not saying Yeah, but did you? Did you see this work order? And and and that feels like an oversimplification, but it’s true. So I think, I think we let the smart folks I love Binseng and I love all those people, I really do. And let’s make sure that we’re doing, we’re representing ourselves in a way that it makes what they’re doing even easier.
Chyrill Sandrini 26:06
That’s a great point, then that really is. So I’ve enjoyed our talk today. And I’m going to ask you one last question. All right. All right. So we’re closing everything in this series with what is your wow word, your word of wisdom, when it comes to the right to repair, he might use a couple of words, but give us something to think about. From just you.
Ben Scoggin 26:29
We do the big things. So well, we have to focus on excellence and consistency in the small things that we’re doing. I think if we can handle that, well, I believe that we are handed the right to repair on a silver platter and we’re able to move forward as an industry. And we can still compete with each other at RFPs. And we can still compete on KPIs and performance metrics and all this stuff. But we’re doing that in a way. That is who has the most excellent and not, not trying to prove that the other person’s not worthy.
Chyrill Sandrini 27:12
I like those words, excellence, and consistency. Pleasure having you today. I hope I get to North Carolina to visit you in person someday soon.
Ben Scoggin 27:22
Yeah, please do. I know a couple of good barbecue spots and I’d be happy to spend some time with you.
Chyrill Sandrini 27:30
That’d be great, Ben. Well, thanks again. And thank you for tuning in to HTM insider brought to you by MultiMedical Systems.
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