PEER-REVIEW PAPER

Your Hospital Needs a Chief Technology Officer

Brandi Spencer and Nick Cram, MS, CBET, CHSP

A Chief Technology Officer oversees both the Clinical or Biomedical Engineering and Information Technology
departments in a hospital. He or she is charged with the integration of all systems for a more efficient hospital. The
introduction of this leader will bring efficiency and power to the hospital, simultaneously increasing both customer
and employee satisfaction.

So, you think your hospital is efficient? You are fairly certain ing and integrating the hospital’s information database,
it runs at a near-optimal speed? If you lack a Chief allowing better focus for the facility.4 It is therefore under-
Technology Officer (CTO) in your facility, there is substan- standable that a CTO must be flexible and knowledgeable in
tial room for improvement. If you plan to survive the next a myriad of specialties to supervise the broad departments.
decade, you should start accepting applications now. A CTO will generally have the education of a clinical
The technology boom in the past century was phe- engineer, most of whom get a Bachelor of Science in
nomenal. It surpassed everyone’s greatest expectations. Of Biomedical Engineering with a focus on Clinical Engineering
course, with any advancement comes the accompanying or an equivalent degree. Typically, he or she will then
need for internal change. Currently, there are few CTOs in pursue a Master of Engineering in Biomedical Engineering
hospitals; this new trend is emerging alongside the increased or another applicable degree, possibly in business. This
availability of the Internet and medical devices that have the background is extensive, including many varying disci-
ability to be networked. As high-speed Internet access enters plines: bioengineering, electrical engineering, management,
the homes of over 20,000 Americans daily, many patients are networking, and other core classes.3–5
seeking the same convenience while they recover from their It is, needless to say, important to fully comprehend
injuries and illnesses.1 the operation of any profession before managing an entire
This request and many others have prompted the need department. Beyond formal education, a CTO should also
for network guidance and stability. With medical devices have proper field experience. This is usually a collection of
becoming progressively more complicated in their interfac- internships, cooperative positions, and on-the-job training.
ing, CTOs are needed to be more involved in the hospital’s On average, managers and supervisors in the Clinical
daily routines. Engineering Department have about 18.6 years of experi-
ence in a healthcare facility, putting them at an optimal
position for a career as a hospital CTO.6
What Is a CTO?
The overall well-roundedness enables the CTO to have
According to Christian and Timbers, ‘‘[A CTO] must a complete understanding of those he or she will manage
understand the technology requirements for their compa- and mentor. From biomedical engineering technicians and
nies today and five years down the road.’’2 clinical engineers to computer or network technicians, the
A CTO is responsible for the integration of both the CTO will be the direct contact for many varying personal-
Clinical Engineering (CE) and Information Technology (IT) ities; therefore, interpersonal communication by the CTO
departments. This might at first seem like an odd pair to should adapt readily to accommodate for their different
combine, but from their similar tasks, it becomes increas- styles and backgrounds. This and many other character traits
ingly evident it was a match that was indeed meant to be. are important for any managerial position and should be
The CE department maintains and purchases medical weighted heavily upon the position.
equipment, while also overseeing its proper usage.3 Indivi- The general purpose of a CTO is not clearly defined.
duals in the IT department are accountable for network- This is mainly due to job variability and the level of demand.
138 Journal of Clinical Engineering  July/September 2004
Someone willing to handle the job must be prepared to work apparatus or a microwave for the break room, it will
hard, be understandable, and be readily adaptable. require routine maintenance. To prevent forgotten repairs,
Computerized Maintenance Management Systems are
employed. They deliver reminders when each piece of
Eased Transition Into New Technology
equipment is due for its preventive maintenance. It also
One difficult task for a CTO is directing the acquisition of can track any corrective maintenance that has been
new medical equipment and then having it smoothly performed on a device that has been damaged or has
integrated into the network without causing unwanted, malfunctioned.7 This information is important for docu-
harmful interference. mentation purposes for some certification and recognition
For example, while the decision for the particular (see Compliance with Future and Current Standards), plus
brand of equipment is important and can be a sizeable aids in deciding the life-span of the hospital’s devices.
investment for any company, the numbers can vary from When it becomes less expensive to purchase new
item to item; the integration phase, however, requires a equipment than to maintain what is currently present, a
great deal of time and research into all present equipment message will be sent to alert the operator of the system.
and future endeavors regardless of how small the purchase In an effort to modernize the facility, integrating the
may seem. scheduler should be considered. When a nurse, janitor, or
After an audit, prepared by either the CE or IT other staff member notices a damaged device or a broken
department, has presented a need for new or updated component, he or she can send a message that will notify
technology, it is up to the CTO to oversee the process of the CTO, who will in turn send the message to the CE or
acquisition. First, funding must be delegated through either IT department directly (whichever is applicable). This will
the Chief Executive Officer (CEO) or Chief Financial save some paperwork but, more importantly, will speed
Officer (CFO). Then, the department in question is re- the repair process so that the equipment is ready for
sponsible for researching vendor candidates and sending implementation as soon as possible.
them requests for purchase. The CTO will then reside
on the committee reviewing the returned estimates and
product descriptions. If the product is a significant price Economical
in the company’s perspective, a medical technology Certainly, the big question on your mind is probably: How
assessment will then complete the investigation into the much is this going to cost me? Well, how much are you
company and its device; there will be a formal presentation willing to spend in order to save? CTOs, on average, make
of the products either in the hospital or at the potential about $60,000 per year (it should be noted that, since there
company’s site. The CTO and committee members will are relatively few CTOs, these data are based on the
then have a final review of employee and vendor sug- earnings of a Clinical Engineering Manager or Supervisor).5
gestions, and an acquisition will take place. Naturally, this number is flexible, but they have an
After all purchases have been made and all contracts education that merits far more.
finalized, pertinent employees must have proper training. The package is an incredible bargain for what you are
This ensures the device will be used as was intended and presently paying. For instance, how cost-effective was your
that few errors will be made during its operation. Often, device purchase list last year? Was it too frugal? Maybe it
the device manufacturers will handle this aspect of the was too frivolous? Device purchases accounted for over
acquirement; however, there are certain occasions when $9 billion between 1997 and 2001, 11% of total hospital
the CTO must handle the lecture and training or delegate expenditures.8 While physicians may want the best
this responsibility to his or her departments. If the new possible device or test for their patient, it is wiser not to
equipment is a medical device that has no need for make purchases based solely on novelty. This is especially
network integration, the training can be handled solely by true when working in such a large sum of money.
the CE department. If the purchase is more related to According to J. G. Irwin et al, there is a strong, positive
software interfacing and networking, the IT group may correlation between adding new medical technology and
control the situation. When the new addition is a fiscal performance; however, the purchase must ‘‘have
combination, requiring the combined knowledge of many high value, be high in imitability, and have high rareness.’’
areas, obviously the CTO will have the CE and IT While many new, high-tech inventions sound great on
departments work side by side. The multiple perspectives paper, they may be squares trying to fit into round holes.
will eliminate confusion over procedures and lost time for The CTO is able to predetermine certain requirements
unnecessary, repeated training. for pragmatic purchases. While making decisions, it is
Finally, after purchasing and delegation of authority important to ponder the opposition’s device leverage and
has occurred, technology maintenance and management the need to entice new patients and physicians.9 Isolating
begins cyclically. To effectively uphold the integrity of the only those products that will enhance strong departments
equipment in the entire facility, whether it is a radiology or strengthen more vulnerable areas of the facility will limit
Journal of Clinical Engineering  July/September 2004 139
whim purchases, simultaneously saving money and raising processes and offer appropriate responses; while the
the standard for healthcare. hospital changes with the times, so should the knowledge
With one person leading the two departments re- of its inhabitants. When the decision to ask for accredita-
sponsible for nearly every large technological purchase in tion is made, there should be a ‘‘committee head’’ in
the hospital, excessive spending would quickly diminish. charge of the preparations and the continuing education of
everyone. Once again, the prime candidate would be the
CTO, whose knowledge of the hospital is extensive, from
Compliance With Current and Future Standards
devices and reports to staff members and procedures.
While it is important to be concerned about monetary The Health Insurance and Portability and Accountabil-
issues, there is the ever-looming issue of compliance. Every ity Act of 1996 (HIPAA) is one of the newest additions to
device must be up to code, every second of maintenance the list of regulations for healthcare providers. It includes
must be documented, and every incident must be recorded many stipulations for the protection of customer informa-
and handled appropriately. There are so many organiza- tion. At its most basic level, the law says that any medical
tions and laws to satisfy, the task is seemingly endless and data cannot be paired with personally identifiable informa-
nearly impossible. However, everyone continues to crave tion, such as names, social security numbers, birth dates,
recognition and funding. Thanks to your new CTO, the zip codes, etc. Doing the reverse could cause the offender a
process becomes smooth and simple. fine of up to $250,000 and up to 10 years imprisonment.
The Safe Medical Devices Act of 1990 (SMDA), revised While a name on the back wall in the nurses’ station may
in 1992, mandates that the Food and Drug Administration seem trivial, it may provide clues to patient information,
(FDA) will be notified in the event of a patient or employee thereby compromising patient confidentiality.13,14
serious illness, serious injury, or death that was caused by a How does this relate to a CTO? The status of the
medical device or its misuse and that this notice must take transfer of patient health information electronically is one
place within 10 days of the incident. Furthermore, a report of the core elements of the law. Since special care should
must be made semi-annually to the FDA including each be taken when transferring sensitive data, the CTO must
report sent to them in the previous 6 months.10,11 work with the IT department to create the highest level of
This intense amount of paperwork required under the security possible. Password protection and data encryption
SMDA requires the willing participation by every depart- are a must, while common sense is necessary. If a nurse is
ment in the facility. With 100% contribution, hours of left logged in to the system and the monitor of the screen is
laborious tracking and documenting still remain so as not temporarily unprotected, any passer-by that manages to
to overlook a reportable event. If each individual area is glimpse the screen violates HIPAA, not to mention the trust
held responsible for this reporting, havoc due to forgotten of your patients.
reports may soon arise. However, if each department is While standards seem tedious and annoying, their
only responsible for reporting weekly (or immediately in purpose is to keep the standards of medicine high and
the event of an incident) to a central person, it becomes admirable. A CTO will expedite these issues, creating a
more routine. Because the person in control of the devices pristine facility that is readily compliant at all times.
is the CTO, it clearly follows that he or she should handle
such matters (or at least their appropriate delegation). With
the CTO being the direct link between the FDA and the Intradepartmental Efficiency
hospital, fewer errors will occur and prompt reporting will According to data presented in 1999, ‘‘the eighth leading
become the norm. cause of death in America was preventable medical error.
The Joint Commission on Accreditation of Healthcare In fact, forty-four thousand to ninety-eight thousand deaths
Organizations, according to their website, is ‘‘setting the from preventable medical error occur annually. Patient
standard for quality in healthcare.’’ For a hospital to be injury costs hospitals between seventeen and twenty-nine
recognized as and maintain its status of ‘‘Accredited,’’ it billion dollars annually.’’15 These astonishing numbers are
must pass on-site evaluation surveys every 3 years with the inexcusable. A healthcare facility is one where a sick or
possibility of unannounced visits in the interval. With this injured person will go to be healed, to feel better.
label, organizations are viewed more respectably by What all healthcare providers and their affiliates should
physicians and their community; accreditation also reflects ponder is ‘‘Why?’’ Why did they die? Why were they
well when handling some legal matters, including state caused further pain? Why are the numbers only increasing?
licensing, Medicare, and other litigation.12 Why not decrease overall human error? This is the
Although this is not necessarily a requirement, the simplest solution to the horrendous statistics. From an
benefits received convey its importance. This is, again, a engineering perspective, it is easy to see how the
difficult process that claims the obedience of the entire technology can be intimidating or even frightening.
facility. When queried by the Commission’s surveyors, all However, to eliminate human error with medical devices
hospital staff should have full comprehension of hospital will definitely begin to change the statistics. One vital
140 Journal of Clinical Engineering  July/September 2004
approach is to have training sessions for all employees who (LAN). This ‘‘more responsive and less expensive’’ system
handle medical devices scheduled on a predetermined placed them at a distinct advantage over other facilities with
cycle. This way, there will be better familiarization and ease mainframe information systems. This added flexibility
of use associated with the equipment. When new devices caused them to save an estimated $1 to 3 million in just 2
are introduced, it would be prudent to have sessions more years.16
often for at least the first year of its usage. These steps will Why does this matter? It did, indeed, 16 years ago. Since
make sure that nurses will not mistakenly believe that one that acquisition, Moses Cone has grown to include a
button means ‘‘On,’’ and another knob signifies ‘‘Off,’’ Women’s Hospital, a Health Services Division, a merger
while both of them control very different processes. Thus, with Wesley Long Community Hospital, and the Annie Penn
smaller human error means your facility is not a major Hospital. Today, Moses Cone Health System is ‘‘a recognized
contributor to the problem. leader in cardiology, neuroscience, trauma, and rehabilita-
While helping society, this also greatly helps your tion.’’16 Of course, this success cannot be contributed solely
hospital. For instance, when a nurse is ordered to check a to their LAN, but it cannot be determined a coincidence.
patient’s vital signs, he or she will know immediately how Having a CTO network the entire hospital to include not
to use each tool in the room. Before, what merely appeared only Internet services, but also medical devices, schedules,
as foreign gadgets lacking accessibility, are now easily used and alert systems could rapidly propel any business ahead
to find any necessary calculable data. Intradepartmental of their competitors.
efficiency then is allowed to soar. With more time available, By including medical devices in any networking plan,
nurses will be able to spend more time with patients at the CTO has decreased the overall time spent searching
their bedside and not staring at their charts, although these for equipment and issues with device interactions. While
charts will undoubtedly be more accurate and precise. wireless Internet may sound harmonic to any CEO, it is
Since the nurse will still need to leave his or her important to fully investigate any endeavor. While the CEO
patient’s bedside to care for other patients and tend to may know what is popular, he or she may not know what is
common duties, it is important that the patient have the safe and will not be quite as thrilled when their expensive
ability to contact a nurse at any moment. To reduce waiting equipment begins to malfunction, resulting in possible
time for the patient, the CTO could work with each patient injury or death.
hospital department to incorporate automated messaging Any potential CTO should have this knowledge. Hours
devices. When a patient requires assistance, the button to of research should be placed into these willing hands, and
call the nurse can actually call the nurse. A pager integrated the CEO’s hands will always be tied with other, more
into the hospital’s network can conveniently (and quite pressing matters.
inexpensively) serve this purpose, while wireless tele- To lessen down-time, a CTO may implement coordinat-
phones that are designed not to interfere with the medical ed, individualized task schedulers. Each staff member would
equipment would be an added embellishment to the be allotted space on the network where they should record
communication system. daily tasks and duties as they arise and are completed.
Now, instead of beeping the nurse’s station, explaining Progress reports and possibly interoffice challenges with
the situation, and seemingly waiting forever for the nurse prizes involved for the most improved area will raise morale
to arrive (if the nurse ever receives the notice), the patient and devotion; raise and promotion decisions would then
can instantly receive a direct response from him or her. have more meaning and evidence.
This saves other staff members time to complete their Having hospital-wide digital planners that automatically
assignments, as well. Instead of being a middleman, plenty include important dates and times from managers and
of time for paperwork, sick patients, and errand-running supervisors will also eliminate missed meetings, seminars,
now exists. and other important events (or at least any superfluous
Overall, in lieu of the present scurrying from bed to excuses, such as ‘‘I didn’t get that memo!’’). While the
bed, desk to desk, employees would be more efficient at employee could include personal reminders, surgical
their jobs, while making the experience for their patients procedures, patient rounds, and shift changes would all be
more endurable, possibly enjoyable. With gratitude in the automatically inserted.
end delivered to the CTO, who does not like their pillow In turn, the top-down management structure will be
fluffed every now and then? reinforced. Each employee will have their schedule as a
direct link to their overseer and vice versa, alongside their
personal communication system. By having an omniscient
Enhanced Interdepartmental Communication
manager, employees are less likely to attempt cutting
Even in the 1980s, hospitals were already aware of the corners. All work is more apt to be on time and correct.
benefits of using Internet technology to increase productiv- The scheduling also makes sure surgeries and other
ity and employee satisfaction. In 1987, Moses H. Cone costly procedures occur more regularly and properly. While
Memorial hospital switched to a Local Area Network costing the hospital money, delayed procedures also reflect
Journal of Clinical Engineering  July/September 2004 141
poorly upon its reputation as a dominant healthcare provider. detrimental hospital events, involved adverse drug inter-
To prevent such thoughts, each event could be given a actions. This creates a notable loss of revenue through
generous estimated time (far above the average amount). In patient injuries and malpractice suits. As a preventive sys-
this way, quicker surgeries with extra time allow doctors to tem, patient data entry into a central database would serve
have flexibility and availability should an emergency arise. to save lives and decrease unnecessarily lengthy hospital
Reduced confusion and better preparedness present an stays, saving an average of over $2 billion yearly.18
impression of smooth operation for everyone. Data from connected devices would also have the ability
to be stored directly on the patient’s electronic chart.
Instead of having a nurse check the patient’s vital signs every
Electronic Patient Tracking
5 minutes, the software could be programmed to record the
Two hospitals in Boston, Massachusetts, have stepped up data at the exact second requested. The nurse would now
to the challenge of becoming electronic; they are Brigham only need to check to make sure the equipment continues to
and Women’s and Massachusetts General. Their current function and if the patient needs the television channel
endeavors include electronic medical records, electronic changed.
order entry, digital radiology, and telemedicine. Undoubtedly, the patient will have worse demands than
The two hospitals have found many benefits from their just the television. Since the Internet has engulfed Ameri-
efforts. Electronic medical records have reduced bulky cans, many require access to sustain customers, keep in
paper records, entering their information into one single touch with family and friends, or simply to relax in such a
database. Electronic order entry has sharply cut medication high-stress environment. There are a few solutions to this
errors by 55% since doctors now order prescriptions and dilemma, the most obvious being Ethernet and wireless
tests through the system. Film loss and storage have also systems. However, data encryption is a key factor in their
been nearly eliminated due to digital radiology, plus the availability. The necessary cipher strength is 128 bit. It has
added ease of access for doctors. Finally, telemedicine not yet been successfully cracked by hackers.19 Fortunately
enables the facilities to treat patients who are not near for hospitals, this means the Internet is indeed in a usable
Boston, saving money for patients and gaining money for state for medical purposes, especially casual browsing by
hospitals due to an increased coverage area.17 This prime patients.
example of electronic patient tracking can be applied to With a CTO combining the forces of the CE and IT
any healthcare system. departments, networking the devices, data, and events is
After patients enter the operating room, they can no simple and makes the jobs of the hospital employees less
longer speak for themselves. It is left to charts and close dramatic and more patient-oriented.
friends and relatives, when available, to provide necessary
information. To prevent disasters due to misread handwrit-
Resistance to Change
ing or misheard dictation, data could be entered into a
centralized electronic database. This information could be Unfortunately, not everyone is willing to evolve. While the
conveniently accessed from anywhere in the hospital. concept may seem embryonic, having a CTO is an overdue
Allergies to medicines, chronic illnesses, or previous pro- affair. Refusing to welcome a CTO will have continuing
cedures would be listed to answer any inquiries by doctors negative effects; loss of money, loss of integrity, and pos-
and could account for a largely reduced accident rate. sibly, the loss of life.
These data could be shared with multiple hospitals as The more a negative event presents itself without
the patient deems necessary. For instance, if a minor breaks immediate consequences, it is gradually accepted. Although
his arm while visiting his grandmother in Dallas, but he is the current state of your hospital is likely stable, the more
originally from Maine, it would be simple to electronically America turns from people to machines, the less it is
deliver his x-rays and medicines directly to his hometown. possible to remain predictable without having an associa-
The child’s legal guardian needs to only sign a waiver, and tion between your IT and CE departments. The only way to
the transfer is completed. This will also work within the avoid these crises is to endure technological abandonment;
hospital; if a patient was transferred from the emergency the hospital no longer will be a front line competitor.
room to the intensive care unit, their information would not
have to be wheeled alongside him or her. Since everything is
Conclusions
in one place, there is no need to dig for missing papers or lost
orders. This allows the doctors and nurses to focus more on Society is growing. Knowledge is expanding. Technology
the patient’s needs versus the next department’s needs. is flourishing. A CTO is imperative for the integration of
The computer could also check new information each clinical or biomedical and IT departments. With the
update for explicit errors or various interactions. The divisions isolated, equipment failure and life loss could be
Harvard Medical Practice Study found that the largest group abundant. Although funding for this position may not seem
presented, which accounted for approximately 19.4% of imperative, it is only one person, and this one person will
142 Journal of Clinical Engineering  July/September 2004
do the job of two departments. The price paid for your new 13. Pub. L. 104-191. Health Insurance Portability and Accountability Act of
CTO will have a high return of investment and will prove 1996 (HIPAA).
to aid in your overall success. 14. Fricke R. Medical design under the HIPAA Privacy Rule. [Peer-Review
Does your hospital need a CTO? Would you drive Paper] J Clin Eng. January/March 2003;28:49-55.
across the country without a map? Without the proper 15. Vicente KJ. From patients to politicians: a cognitive engineering view
guide, it is easy to get lost along the way. It is true that a of patient safety. [Patient Safety] Qual Saf Health Care. December
2002;11:302-304.
wrong turn can be easily corrected, but there is still a loss
of gas and time, not to mention the added frustration. The 16. Pompili T. Hospital’s networking scheme cuts costs, increases
flexibility: medical LAN. [Section II: Connectivity] PC Week.
easiest way to raise the standard of healthcare in your November 24, 1987;4:47.
facility is simple: have a CTO who will oversee your major
17. Unknown. The electronic hospital [online]. Business Week Online.
investments and continually provide you with more The McGraw Hill Companies. 11 December 2000 [cited 5 April
improved technology. 2003]. Available at: http://www.businessweek.com/2000/00_50/
b3711080.htm.
18. Lin L, Vicente K, Doyle JD. Patient safety, potential adverse drug
events, and medical device design: a human factors engineering
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Journal of Clinical Engineering  July/September 2004 143