Vision and Provision of Clinical Engineering Division - CED/ IFMBE

Review article Vision and Provision of Clinical Engineering Division - CED/ IFMBE Mario Medvedec 1* 1 Department of Nuclear Medicine and Radiation Protection, University Hospital Centre Zagreb, Zagreb, Croatia Abstract Clinical engineering is the branch of biomedical engineering dealing with all aspects of medical equipment and technologies used in hospitals and other clinical settings. Clinical Engineering Division is a special division of the International Federation for Medical and Biological Engineering (CED/IFMBE). The CED/IFMBE vision is to be a primary international thriving professional, scientific and educational forum for developing, establishing and promoting clinical engineering. The CED/IFMBE mission is to advance worldwide research, development, learning, knowledge, skills and competences on healthcare technology management, to promote global communication and networking, to advance and disseminate worldwide safety tools and effective decision-making processes within the healthcare technology management system, to define and promote quality standards and to encourage excellence in clinical engineering practices and processes worldwide, to stimulate innovation and efficient use of technology-related resources in healthcare worldwide, and to internationally represent and advocate the interests of clinical engineering profession and their global exchange. In recent years, the CED/IFMBE has been making efforts to provide revised division s charter, multilingual translations of the six volumes from the Ziken How to manage book series for healthcare technology, a comprehensive publication on human factors engineering, an open-access international journal of clinical engineering and healthcare technology assessment, its dedicated web-site and e-conferencing tool, an on-line directory of clinical engineering teaching units and professional associations, clinical engineering awards, international program for *Corresponding author: Mario Medvedec Department of Nuclear Medicine and Radiation Protection, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia Phone: +385 1 2388 664 e mail: mario.medvedec@kbc-zagreb.hr currently serving as elected member of the Clinical Engineering Division Board of the International Federation for Medical and Biological Engineering certification in clinical engineering, global center for healthcare technology managers on disaster preparedness training, as well as other benefits. The IFMBE is the only international professional organization that has the CED focusing specifically on all aspects of life cycle management of healthcare technologies. Taking into account the recent activities and the outcomes of its completed and running projects during the last two terms of the CED/IFMBE Board, the latter time seems to be probably one of the most fruitful periods in its history, to the benefit of clinical engineers and healthcare systems, but primarily for the benefit of all patients worldwide. Keywords: biomedical engineering, clinical engineering, International Federation for Medical and Biological Engineering, Clinical Engineering Division 2015 Folia Medica Facultatis Medicinae Universitatis Saraeviensis. All rights reserved. Introduction Biomedical engineering integrates physical, mathematical and life sciences with engineering principles and design concepts applicable in biology and medicine, for the purpose of improving health and quality of life. It creates knowledge from the molecular to system levels, develops and evaluates materials, methods, devices, technologies, information, etc. for the prevention, diagnosis, treatment and palliation of a disease, for optimal health care delivery and patient care and rehabilitation. Clinical engineering is the branch of biomedical engineering dealing with all aspects of medical equipment and technologies used in hospitals or other clinical settings [1,2]. History of the International Federation for Medical and Biological Engineering (IFMBE) dates back in 1959 when a group of medical engineers, physicists and doctors met in Paris and founded an organization entitled International Federation for Medical Electronics and Biological Engineering. In the mid-1960s, the name of that organization was shortened to Interna- 12

tional Federation for Medical and Biological Engineering. The IFMBE is primarily a federation of national and transnational organizations and has an estimated 140,000 members in more than 60 affiliated organizations representing their interests in biomedical engineering. High extrapolated membership number is also due to the fact that biomedical engineers are recently among the fastest growing professions, showing strong demands because an aging population is likely to need more medical care and because of increased public awareness of biomedical engineering advances and their benefits. The IFMBE and the International Organization for Medical Physicists (IOMP) are two constituent member organizations of a union called the International Union for Physical and Engineering Sciences in Medicine (IUPESM), thus further contributing to the advancement of physical and engineering sciences in medicine for the benefit and well being of humanity. The objectives of the IFMBE are scientific, technological, literary, and educational. Within the field of biomedical engineering IFMBE s aims are to encourage research and the application of knowledge, and to disseminate information and promote collaboration. As the IFMBE grew, its constituency and objectives changed, while clinical engineering became a viable sub-discipline with an increasing number of members busy in the health care sector. The IFMBE today represents those engaged in research and development, as well as in clinical engineering. The latter category of clinical engineering now amounts to approximately half of the total membership [1,3,4]. Since the IFMBE may establish special divisions within the fields of interests to facilitate the growth and development of a branch of the subject and holding of meetings and seminars on special topics, a part of the organizational structure of the IFMBE are currently two divisions: Clinical Engineering Division (CED/IFMBE) and Health Technology Assessment Division (HTAD/ IFMBE). Originally established as a working group in 1979, CED/IFMBE attained official division status in 1985. At the present time, CED/IFMBE Board consists of 7 elected members, 2 co-opted members and 7 collaborators [1,5]. The objective of this paper is to present activities and the achievements of the CED/IFMBE, particularly during the latest two 3-year terms of the CED/IFMBE Board (2009-2015). Role and activities of CED/IFMBE Vision The CED/IFMBE vision is to be a primary international thriving professional, scientific and educational forum for developing, establishing and promoting clinical engineering and clinical engineering profession, and for all those who undertake and use clinical engineering principles in healthcare, industry, academia, government, non-governmental organizations, consumer organizations, consultancies and other stakeholders, with the purpose of improving healthcare delivery through the advancement of safe and effective innovation, deployment and management of healthcare technology [1,6]. Mission The CED/IFMBE mission is to advance worldwide learning, knowledge, research, development and communication of healthcare technology management in the clinical engineering community and other professional communities, and its understanding by other stake holders; to promote global communication, networking and understanding of challenges related to healthcare technology management; to define and promote an international body of knowledge, skills and competences on which the profession of clinical engineering can be practiced in various clinical setting; to advance and disseminate worldwide safety tools and effective decision-making processes within the healthcare technology management system; to define and promote quality standards in clinical engineering practices worldwide; to stimulate innovation and efficient use of technology-related resources in healthcare worldwide; to internationally represent and advocate the interests of clinical engineering professionals and their global exchange; to encourage, through education and training, excellence in clinical engineering practices and processes, and professional exposure worldwide [1,6]. Objectives and tasks The objectives of the IFMBE specialized division shall be to stimulate research, creation, knowledge and application of new developments within a fields of medical and biological engineering; to develop and improve co-operation and exchange of information among interested and competent individuals working in different countries; to promote collaboration between specialists and subspecialists, including those belonging to other scientific societies and, in particular, to medical societies; to work on other objectives as approved by the IFMBE Administrative Council for each specialized division [1]. In addition to these general specialized division s objectives and in support of its vision and mission, the CED/ IFMBE is particularly focusing on a number of specific objectives and tasks in order to stimulate knowledge creation and sharing through research and application of new methodologies and practices within the field of clinical engineering; to support and improve co-operation and exchange of ideas, information and expertise 13

through meetings, publications and other services for clinical engineers working in different countries, aiming the development of competent clinical engineers and their interaction with experienced clinical engineering leaders; to survey globally for the current state of the clinical engineering profession, both for individuals and institutions, and make global clinical engineering directory; to create, adapt, promote and translate technical and professional guidelines and manuscripts for the activities within the clinical engineering field; to promote collaboration between individual clinical engineers, groups, institutions and clinical engineering societies; to support exchange visits with regional or national societies to engage them closer with the CED/IFMBE and its international benchmarking; to promote sharing of exchange and mentoring programs - student/faculty/practitioner; to examine and update training programs and workshops contents including special train the trainers programs and the usage of existing course models; to promote the CED/IFMBE mission by building strategic relationships with appropriate agencies, and interested public and private sector organizations; to facilitate continuing professional development and to promote improvements in the capacity and quality of healthcare delivery; to collaborate with global, regional, national and local organizations interested in health technology management to improve the science and increase the outcomes from health technology policy around the world; to examine and update global clinical engineering competencies, body of knowledge, certification programs, study curricula, benchmarking support services and clinical engineering recognitions and awards, as well as present capacity and future needs for manpower and competencies in clinical engineering; to develop dedicated website and other means of communication, including e conferencing, to ensure that the CED/IFMBE and its work and deliverables are archived, conveyed to and understood by its members and all healthcare technology stakeholders; to investigate the convergence of clinical engineering and information technology (IT) and its education, practice and leadership impact; to conduct periodical international meetings that address the interests and needs of members from all disciplines and backgrounds with an interest in healthcare technology and reflect the CED/IFMBE s international nature; to enhance the potential of the CED/IFMBE working groups to serve as a means of building consensus on issues involving CED/IFMBE, related to policy matters of importance to the public and private sectors and to facilitate interaction with the professionals practicing in any related area within the wide spectrum of IFMBE membership; to support the initiatives and the development of clinical engineering methodologies in those countries whose stakeholders request such support, including developing countries; to increase individual and organizational membership from all the above groups throughout the world to generate sponsorship and networking opportunities for clinical engineering field and its members; to develop and manage systems for the governance and administration of the CED/ IFMBE that are responsive, transparent, professional, and accountable to its members and, in particular, to create, adopt and revise the CED/IFMBE charter; to work with publishers to support the publication and diffusion of a peer-reviewed international journal on clinical engineering that meets the interests and needs of the CED/IFMBE scope [1,5,6]. In recent years, there have been three CED/IFMBE working groups dealing with Professional Practice and Education, Standards and Guidelines, and Strategic Development and Communications, respectively. These groups have been selectively focused on the topics, objectives and tasks just listed above [1,6]. Results and Discussion From a strategic point of view, one of the most significant achievements during the recent years has been, perhaps, the refreshing and rewriting of the CED/ IFMBE Charter. The new Charter further adds and strengthens the grounds for recognizing and securing more hands to help constantly and reliably working with(in) CED/IFMBE Board, thus fostering and empowering the potential of its constitutive individuals - chairman, vice-chairman, secretary, treasurer, elected, co-opted and collaborating members, as well as groups - committees and working groups. The basis for that are updated rules and requirements on their engagements during the terms of offices, and towards the smooth realization of the CED/IFMBE objectives, specific activities, governance and meetings [1]. Since educational and training materials in the developing world can prove difficult and expensive to access, CED/IFMBE has been collaborating with different institutions and individuals to make certain texts available in a few languages of the developing world. Six volumes from the Ziken International How to manage book series for healthcare technology (Guide 1: How to Organize a System of Healthcare Technology Management; Guide 2: How to Plan and Budget for your Healthcare Technology; Guide 3: How to Procure and Commission your Healthcare Technology; Guide 4: How to Operate your Healthcare Technology Effectively and Safely; Guide 5: How to Organize the Maintenance of your Healthcare Technology; Guide 6: How to Manage the Finances of your Healthcare Technology Management Teams) were translated into Spanish by the efforts of the Biomedical Engineering faculty and students at Tec de Monterrey Medical School in 14

Monterrey, Mexico. The translation project included about 1,750 standard author s pages in English. The volumes are currently available for free download from the CED Global, Clinical Engineering Division group among Yahoo!Groups at https://groups.yahoo. com/neo/groups/cedglobal/files/training%20resources/ (English) and at https://groups.yahoo.com/ neo/groups/cedglobal/files/training%20resources/ Ziken%20in%20Spanish/ (Spanish). A Chinese version of that book series has been recently completed, and discussions are under way for a French or Arabic translation [1,5,6]. Canadian group of authors have just completed writing a comprehensive publication on Human Factors Engineering and the volume is currently undergoing external review, all as an approved CED/IFMBE funded project. This publication will help clinical engineers and others in using human factor engineering tools at their facilities to deal with the application of information on physical and psychological characteristics to the design of devices and systems for human use, i.e. with the collection of data and principles about human characteristics, capabilities, and limitations, in relation to machines, machine systems, work methods, jobs and environments and taking into account the safety, comfort, and productiveness of human users and operators. Like the books from Ziken International Book Series and their translations, this volume will be available for free download on the CED website too. There is already interest to perform translations into other languages [1,5]. Initial steps have been accomplished for the establishment of the International Journal of Clinical Engineering and Healthcare Technology Assessment - IJCEH- TA (formation of the International Board of Associate Editors/Reviewers, creation of the Call for Papers and a flowchart of the peer-review process, definition of the reviewers topics of expertise and key-words), a collaboration between the two respective Divisions of the IF- MBE (CED and HTAD). The IJCEHTA is expected to start its publication with a first issue in 2015. This open-access IJCEHTA aims to encourage knowledge and experience exchange in Clinical Engineering and promote the role and the involvement of Biomedical Engineers in Health Technology Assessment. The main objective of the IJCEHTA is to cover state-of-the-art advancements in clinical engineering practice and health technology assessment with the main focus on medical devices. The scope of the IJCEHTA includes all aspects of the state-of-the-art advancements in clinical engineering practices, new standards and health technology assessment reports from the biomedical engineer point of view. The IJCEHTA will serve as a forum for the wide range of clinical and biomedical engineers, health policy makers and professionals interested in the economic, ethical, medical and public health implications of health technology. It covers the development, evaluation, diffusion and use of health technology, as well as its impact on healthcare technology management [1,5]. Securing donations from the largest healthcare provider system in the USA to establish and host initial web-space for the CED/IFMBE, the latter could be finally found at https://groups.yahoo.com/neo/groups/ CEDGlobal/. This accomplishment has allowed CED/ IFMBE products to be timely posted, shared and to begin engaging clinical engineering community around the world. It facilitated the sharing of items such as CED/IFMBE meeting agendas and minutes, pending projects, news, call for volunteers and other documents and information pertinent to this community. Currently, there are about 200 registered members of that group, with more than 750 postings to date. In addition, established on-line capabilities, such as Cisco WebEx Meetings allowed CED/IFMBE to conduct virtual meeting at the required and agreed periodicity. The very first such a meeting combining face-to-face and on-line communication was organized during the World Congress of Medical Physics and Biomedical Engineering in Munich, Germany, in 2009, while the current pace is monthly to quarterly organized virtual meetings. Currently, the new CED/IFMBE web-site is under development. The structure of the web-site is ready. This CED/IFMBE project budget was used to hire specialists, who developed the site based on suggestions made by that project leader who is an IT expert. The tools used for development allows different types of inclusion and exclusions without the need of an IT expert. A person responsible for the site, probably CED/IFMBE secretary in the near future, will help as moderator and add or retrieve material sent by clinical engineers worldwide. The next step will be to populate the site, which is a kind of a problem for CED/IFMBE members since it requires a lot of dedicated time. Thus, that will be done as a result of authorized collaboration with the external group of American experts. It is expected that by the end of 2015, the site will be fully functioning and in use for all activities related of the CED/IFMBE [1,5,6,7]. The possibility to find contact data of and to establish correspondence with colleagues in order to begin professional exchange, mandate the need to access to biomedical/clinical teaching units, associations and practitioners worldwide. Thus, the Directory of teaching units and professional associations has been updated and posted at http://who.ceb.unicamp.br/, as a result of the CED/IFMBE project supported by the World Health Organization (WHO). Further project completed in 2011 in collaboration with the WHO was the compilation of the glossary of medical devices terms, 15

that are specifically used in health technology management by clinical engineers [1,5]. Recent outcome of the CED/IFMBE project on Clinical Engineering Awards is the production of all the documentation necessary to start new awards program during the forthcoming IUPESM2015 World Congress of Medical Physics and Biomedical Engineering in Toronto, Canada. Award program would offer 3 awards: 1) the CED/IFMBE Award to individual who has distinguished him/her-self for outstanding international or regional contributions to the field of Clinical Engineering - to be given triennially, 2) the Clinical Engineering Teamwork Award to individual(s) who fostered and facilitated cooperation between healthcare technology managers to achieve outstanding impact on the clinical engineering field - to be given annually, and 3) the Best Clinical Engineering Article Award to individual(s) who published an outstanding clinical engineering article in the IFMBE Conferences Proceedings and Journals, demonstrating innovation and making a contribution to research, to achieve progress in Clinical Engineering - to be given annually. The Award Program documents that were developed are: Award Scoring Criteria to be used by the CED/IFMBE Award Committee to classify the selected candidates; Clinical Engineering Outstanding Teamwork Award Application Evaluation Form to be used by the CED/IFBME Award Committee to evaluate the proposals; Clinical Engineering Outstanding Teamwork Award Application to be used by the applicants or indications; Award letter to individuals to be sent to clinical engineering societies, making them aware of the award program;, and CED/IFMBE award rules and prizes. The function of the CED/IFMBE award committee has been also discussed and defined, as to divulge the awards and rules to the clinical engineering community, receive, evaluate and select the nominations requests, and send the selected nominations to the IFMBE Award Committee [1]. Guidelines for professional development and regulation, together with the role of the International Certification in Clinical Engineering have been studied within the corresponding important CED/IFMBE project. The intention of the project is to further understand the corresponding potentials for the global strategy, and finally to create the international umbrella program for certification, either to certify or to certify the certifiers, as a way to mark the achievements of clinical biomedical engineers who have fulfilled mutually agreed requirements in education and training. A global survey on national and international programs for certification in clinical engineering has been done and ongoing, special sessions and roundtables have been organized during scientific and professional meetings, thematic texts for books and guides are being written (ex. WHO book Human resources for medical devices and Elsevier book Clinical Systems Engineering), and the contacts/cooperation with the Healthcare Technology Certification Commission and the American College of Clinical Engineering (USA) on possible modalities of support for international certification programs in clinical engineering has been established and ongoing [1,6,8]. The CED/IFMBE project on Global Center for Healthcare Technology Managers on Disaster Preparedness Training deals with the need for a global center in case of disasters events of various types, causing loss of lives, property destruction and affecting populations all over the world. The outcome of this project is building the capacity of healthcare technology managers in hospitals around the world to be better prepared to continue the delivery of critical healthcare services during and after such disasters. In particular, this project has been designed to collect information and develop resources on how health technology management can be better prepared to face and function before, during and after disaster. Since the initiation of the project, an interdisciplinary thematic workshops and sessions have been organized during global meetings, contacts/collaboration were established with the IUPESM/Health Technology Task Group - HTTG, WHO and, in particular, Pan-American Health Organization -PAHO. Furthermore, the process of collecting content for populating an appropriate global website for information and resources on disaster preparedness for hospital-based technology managers has been initiated. Conclusion The IFMBE is the only international professional organization that has the CED focusing specifically on all aspects of life cycle management of healthcare technologies, while embracing all those who professionally practice in relation to clinical engineering field, whether in health care facilities, industry, academic institutions, government, business, voluntary sector, and so on. Taking into account the recent CED/IFMBE activities and the outcomes of its completed and running projects during the last two terms of the CED/IFM- BE Board, the latter time seems to be probably one of the most fruitful periods in its history, to the benefit of clinical engineers, other related professionals and healthcare systems, but primarily for the benefit of all patients worldwide. Declaration of interest The authors declare no conflict of interest for this study. 16

Acknowledgement The author is very grateful to all those internal and external individuals who have been contributing by any means to the activities and the achievements of the CED/IFMBE, as described in this paper. References [1] IFMBE at http://www.ifmbe.org [accessed 15 February 2015] [2] Biomedical Engineering at http://en.wikipedia.org/wiki/biomedical_engineering [accessed 15 February 2015] [3] IFMBE at http://en.wikipedia.org/wiki/international_federation _of_medical_and_biological_engineering [accessed 15 February 2015] [4] IUPESM at http://www.iupesm.org/ [accessed 15 February 2015] [5] IFMBE Clinical Engineering Division at http://responsive.24x7mag.com/2014/09/ifmbe-clinical-engineering-division/ [accessed 15 February 2015] [6] CED Global, Clinical Engineering Division! at https:// groups.yahoo.com/neo/groups/cedglobal/info [accessed 15 February 2015] [7] Kaiser Permanente at https://healthy.kaiserpermanente.org/ html/kaiser/index.shtm [accessed 15 February 2015] [8] American College of Clinical Engineering at http://accenet. org/pages/default.aspx [accessed 15 February 2015] 17