Clinical Engineering Division
IFMBE

Chairman's Report 1997 - 2000

Executive Summary

Following the IFMBE World Congress in Nice, France, in 1997, the Clinical Engineering Division of IFMBE embarked on a new journey promotion and the strengthening of clinical engineering.

This was reflected by the composition of the new board of the Clinical Engineering Division, which included at least one member from each continent. As part of the advocacy initiative, the Clinical Engineering Division, through its members, supported a number of regional and national clinical engineering conferences and workshops. Numerous clinical engineering conferences and workshops, notably the CORAL meeting in Mazatlan, Mexico (November 1998), the workshop in South Africa (November 1999) and the Caribbean Conference on Clinical Engineering in Havana, Cuba, in April 1999 bear testimony to this increased emphasis on regional activities.

Further collaboration with regional organisations closely linked to clinical engineering such as the AFTH (African Federation for Technology in Healthcare), CORAL and the ACCE (American College of Clinical Engineering) has resulted in the hosting of numerous workshops focused on the advancement of skills for clinical engineers and healthcare technology managers. More than 450 clinical engineers, hospital administrators and managers and other decision-makers have participated in these workshops globally.

Increased corporation with multinational and bilateral organisations over the last few years has also increased the visibility of the clinical engineering profession. The World Health Organisation (WHO) and the Pan American Health Organisation (PAHO) have in particular promoted and supported the objectives of the Clinical Engineering Division. This co-operation and involvement by members of the Clinical Engineering Division at meetings organised by the WHO have significantly contributed in highlighting CED objectives and the plight of many of its members. At regional level, clinical engineering aspects have been incorporated in the draft framework for healthcare technology policy development. This framework guides governments in the African and Mediterranean region in preparing national healthcare technology policy.

The CED was also involved in the finalisation of a number of guidelines and documents in the field of healthcare technology management. The most significant contributions include the Medical Equipment Donation Guidelines, the Framework for Healthcare Technology Policy Development, the Implementation of Policy Guidelines and the Country Situation Analysis. These publications will be published under the WHO logo in order to provide and increase accessibility, especially in developing countries.

The Division also had to address a number of very important internal and administrative issues. The sustainability and continuity of the Division has been severely tested during the last three years. Financial constraints, informal relationships to member societies and individuals and the lack of incentives and benefits for members have raised a number of key questions. The informal arrangements associated with the establishment of the CED board have further highlighted the difficulties associated with managing such a global activity. The intensification and support of external activities by the Division therefore clearly need to be evaluated and readressed to ensure the continued existence of the CED within its current structures of IFMBE.

It is obvious that the CED will not be in the position to support and promote global clinical engineering activities at such an intensified and sustainable pace as during the last three years. The Division therefore has to welcome the establishment of regional clinical engineering divisions within the IFMBE-CED framework. The proposed establishment of the European and Caribbean chapters for clinical engineering, the African Federation for Technology in Healthcare, CORAL (for Latin and Central America) and a number of clinical engineering associations in North America with regional membership will therefore be the only viable alternative in promoting the clinical engineering profession globally.

It is thus opportune that with Chicago 2000 the Clinical Engineering Division will have the opportunity to bring together all of the regional chapters and to ensure that International Corporation and cross-regional clinical engineering activities are established, promoted and co-ordinated.

The Role of Clinical Engineering in the 21st Century

Global economic, political and social changes, as well as increased and changing disease burdens, have generated widespread efforts to reform and adapt healthcare systems with a view to improve their efficiency, equity and effectiveness. Serious economic constraints have led health authorities, world-wide, to be increasingly concerned with defining policies and strategies to contain the growing cost of care while preserving health system social imperatives of equity and solidarity. At the same time, healthcare systems in all countries, rich and poor, are becoming more and more technology dependent, and as healthcare technology evolves, so does its impact on patient outcomes, hospital operations, financial efficiency, and overall performance of health services and systems.

Technology plays a paradoxical role in healthcare systems. It is frequently cited as the most significant contributor to unacceptable cost increases while, at the same time, it equips healthcare providers with indispensable tools to perform their functions more effectively and efficiently. The promise of new technologies is becoming increasingly familiar to populations. And rising public expectations for better health services, combined with growing market and professional pressures for introducing the latest technological advances into practice, have commonly led to the perception that the quality of care is directly linked to the sophistication of technologies used in providing such care. In many instances, however, the high expenditure related to the introduction of costly and complex new technologies is not sufficiently justified by the overall improvement in benefits achieved, in terms of access, quality and health outcomes. Moreover, expansion of healthcare infrastructure and the proliferation of technologies have far outpaced the capacity of many countries to effectively absorb, adequately support and fully utilise these technologies, thus creating serious imbalances in health services provision.

Within this paradigm, healthcare technology, and in particular related management strategies, have repeatedly come under the spotlight as healthcare providers seek to identify cost-effective methods for providing equitable and quality healthcare. It is commonly accepted that only rationally planned healthcare technology interventions, based on sound needs assessment and provision of support throughout its life cycle, can maximise the benefits of technology, contain costs, and improve health outcomes. Otherwise, technology can become a long-lasting burden on scarce health sector resources. Realising these goals is a major challenge to healthcare decision-makers and other health professionals in many countries. The task is compounded by the lack of appropriate management tools and expertise for optimising the deployment of healthcare technology and facilities that house it, and for matching national needs and capacity with available technology options.

In response to this urgent need of the World Health Organization (WHO) Member States, WHO and numerous other organisations have embarked on a mission to readdress the need for rational planning and management of healthcare technologies. Part of this new global strategy is the development of an entirely new category of healthcare technology professionals, which will carry the burden of addressing the above-mentioned challenges.

Since clinical engineers traditionally had the sole mandate in the field of medical equipment maintenance, commissioning, planning and procurement, it was envisaged that clinical engineers would meet this new global healthcare technology management challenge. Unfortunately, this challenge was not met and clinical engineering globally remained largely inactive and unresponsive to the health needs and associated developments in the field of healthcare technology and healthcare technology management.

A major contributing factor to this unresponsiveness has been the rigid definition of clinical engineering as shown in the article by Barkalow. Clinical engineers were traditionally defined, placed in monolithic structures and were tasked with introvert activities with very little developmental prospects. The profession thus never developed beyond its traditional area of influence and with the major global changes of health and technological development, mentioned above, lost its "central role" and now faces a serious battle for survival. It would be opportune at this stage to paraphrase David Harrington

Is the profession dying? No, but it is on the critical list. Will the profession live? It could, if the profession is willing to fight for its life, and become proactive....

This proactive approach will have to be developed, nurtured and implemented if we want the clinical engineering profession to survive in the 21st century as an independent profession. Lip service and further unresponsiveness (see Clinical Engineering Update, No. 26, July 27, 1997) will be fatal for our profession.

It is our opinion that IFMBE is ideally placed to become the stallward for these proactive ideas and it will have to actively get involved to identify and develop the 21st century "clinical engineer". If it fails this challenge, clinical engineers will remain fragmented, as they are at present, and will subsequently be absorbed into a yet undefined profession which will manage healthcare technologies in the 21st century.

The Regionalisation of Clinical Engineering Activities

The issue of regionalisation of clinical engineering activities has again been highlighted by recent requests and attempts to establish a European Chapter for Clinical Engineering. Although, the establishment of parallel structures and federations clearly could influence the status of IFMBE (Clinical Engineering Division(, the recently established regional chapters have proven to be rather beneficial to the development of the profession.

Currently, the CED has a loose structure which lacks both a financial and technical infrastructure and other resources to really address the complex and huge task of strengthening and promoting clinical engineering activities on a global scale. In particular, the geographic and technological differences each of the member states experience adds to the complexity of supporting the clinical engineering profession from a central structure, such as the CED. It is our opinion, based on substantial input from the regions, that the CED needs to restructure and carefully refocus its approach to ensure maximum impact in the field of clinical engineering.

The African region established the African Federation for Technology in Healthcare (AFTH) in 1994 in response to the need identified by African states to establish a federation which would represent both the African continent but also would represent and address healthcare technology management, applicable in the region. This Federation was established under the auspices of the WHO and in close corporation with IFMBE, and indeed has been instrumental in the development of the healthcare technology management (which includes clinical engineering) in the region. Numerous member states have been assisted through the AFTH in the establishment of healthcare technology management programs and indeed have used the AFTH rather successfully in strengthening healthcare technology management by ensuring sustainable and applicable solutions for the region.

The Americas also have been very active in the promotion of clinical engineering activities. In particular, two organisations, the American College of Clinical Engineering (ACCE) and CORAL have been instrumental in the development of the clinical engineering profession by hosting conferences, workshops and training seminars. With the support of both PAHO and private sector initiatives, these activities have been organised on a continuous basis.

Numerous publications, newsletters and technical documentation have been drafted under the umbrella of PAHO addressing a variety of clinical engineering topics.

A number of conferences and seminars were held in the European region, although many of these occurred outside the auspices of IFMBE.

Clinical Engineering Board

During the 1997 World Congress, a new Clinical Engineering Board was 'elected'. Although the board was geographically representative many members were unable to participate in the activities of the CE board. This clearly had an effect on the cohesiveness of the Division and its activities.

The CED budget was also significantly reduced in 1994 and this further had an effect on CED activities. The inability to hold board meetings has been identified as the critical shortcoming in the proper management and co-ordination of clinical engineering activities.

Unfortunately, many of these shortcomings are merely symptoms of a less than perfect "CED Constitution". The present electoral process is possibly at the core of these problems. Presently, candidates have to be nominated by their national clinical engineering societies to be eligible for election. The CED board has little or no influence in the nomination of candidates and therefore has to accept all nominations offered. In the majority of cases, the candidates are unknown to both the CED board and the clinical engineering profession in general. In addition, past experience has indicated that candidates seldom have the financial, time and/or administrative support to manage the portfolio, which is entrusted unto them.

The voting process complicates the issue even further. Nominated clinical engineering candidates are voted into office during the IFMBE General Assembly by non-clinical engineering professionals, questioning the electoral process. This issue is of particular concern and needs to be addressed urgently.

Nevertheless, as will be reported, a small core group of the CED has actively supported a number of activities during the last three years.

CED board 1997-2000

Clinical Engineering Conferences

A number of Clinical Engineering conferences were organised during 1997-2000. The conferences listed below were of typical scientific nature with peer review papers and sessions being the focus.

* Official CED IFMBE representation and/or conference

Advanced Clinical Engineering Workshops (ACCEs)

In addition to the scientific conferences, a number of Advanced Clinical Engineering Workshops were organised by the ACCE in collaboration with WHO and other regional organisations and federations affiliated to IFMBE.

Past Workshops

• Mexico, Mexico, November 1998
• Hartford, Connecticut, USA, June 1999
• Moscow, Russia, September 1999
• Cape Town, South Africa, November 1999
• Santo Domingo, Dominican Republic, March 2000

Future Workshops

• Chicago, Illinois, USA, July 2000
• Vilnius, Lithuania, September 2000
• Panama City, Panama, October 2000 (approximate date)
• Lima, Peru, March 2001 (approximate date)
• Nepal, April 2001
• Caracas, Venezuela, Autumn 2001 (approximate date)
• Central Asian: Kazakhstan, Kirgizstan, Mongolia, Tadzhikistan, Turkmenistan, Uzbekistan (TBD)
• Moldova (TBD)
• India (TBD)
• Ukraine (TBD)
• Russia (TBD)
• Armenia (TBD)
• Jamaica (TBD)

An Advanced Clinical Engineering Workshop (21-23 July 2000) was held in Chicago before the World Congress on Medical Physics and Biomedical Engineering. The topics covered will be on the Acquisition of Medical Equipment:

World Congress

Following initial conference planning meetings, the CED board approached the ACCE in October 1999 and requested the organisation to plan, co-ordinate and host the scientific Clinical Engineering Conference for Chicago 2000.

Presently, we have a full three-day programme with more than 60 scientific papers. This is the largest meeting of the CED, although the issue of registration fees (especially for developing country delegates) has been a contentious issue yet to be resolved.

Clinical Engineering Directory

The Clinical Engineering Directory has been updated and now lists more than 1800 current clinical engineers and healthcare technology managers. The database has been developed in South Africa and the electronic version of the database is available on CD.

Cost associated with the distribution of the CD still has to be resolved and delays in the production of the database has unfortunately hindered the Division in providing the database to delegates of the WC2000 Conference.

The beta release of the software will, however, be available.

Technical Documentation

The following technical documentation has been drafted (* denotes completed) in collaboration with IFMBE members.

• Healthcare Technology Regional Strategy Template*
• Healthcare Technology Policy Framework *
• Healthcare Technology Policy Formulation and Implementation *
• Country Situation Analysis for Healthcare Technology Management*
• Healthcare Equipment Acquisition:
  • Healthcare Equipment Procurement *
  • Healthcare Equipment Donations*
• Essential Healthcare Technology Package*
• Healthcare Facilities Audit
• Development of Medical Devices Regulatory System
• Establishment and Operation of Healthcare Technical Service
• Human Resources Development for Healthcare Technology Management
• Approaches to Healthcare Facilities Planning

INFRATECH

The INFRATECH Internet discussion group was created in January 1999 by WHO, is hosted by PAHO and co-ordinated by ACCE.

The purposes of INFRATECH are to:

• provide a global forum for exchange of information and experience on various critical issues of common concern related to healthcare infrastructure and technology management;
• create a knowledge base for use by countries and development agencies in future projects;
• provide an information database concerning upcoming events, publications, and educational programmes and materials;
• provide advice on various specific problems experienced by members.

The membership group is currently composed of about 90 experts from some 40 countries.

To subscribe, send an email to listserv@listserv.paho.org, giving your full name and stating that you wish to subscribe.

After you subscribe, send messages to infratech@paho.org, and they will reach all members.

International Collaboration and Funding

Finally, it is my pleasure to express my appreciation to numerous organisations, federations and individuals that have supported IFMBE-CED during the last three years. In particular, I would like to express my appreciation on behalf of IFMBE-CED to WHO, which has supported and funded most of the ACCE Advanced Clinical Engineering Workshops by both supporting the international faculty and participating delegates.

In addition, they have funded all of my visits as chairman of IFMBE-CED to visit CED member states and to promote the clinical engineering profession (Estonia, Russia, Sri Lanka, Egypt, Cuba, Mexico, the United States of America, Germany, Sweden, Zimbabwe and Namibia). It goes without saying that many of the above-mentioned activities would not have been possible without their support.

Summary of Activities