Clinical engineering

Clinical engineering is a speciality within HTM (Healthcare Technology Management) biomedical engineering responsible primarily for applying and implementing medical technology to optimize healthcare delivery. Roles of clinical engineers include training and supervising biomedical equipment technicians (BMETs), working with governmental regulators on hospital inspections/audits, and serving as technological consultants for other hospital staff (i.e. physicians, administrators, IT, etc.).Clinical engineers also advise medical device producers regarding prospective design improvements based on clinical experiences, as well as monitor the progression of the state-of-the-art in order to redirect hospital procurement patterns accordingly. Their inherent focus on practical implementation of technology has tended to keep them oriented more towards incremental-level redesigns and reconfigurations, as opposed to revolutionary R&D or cutting-edge ideas that would be many years from clinical adoptability; however, there is an effort to expand this time-horizon over which clinical engineers can influence the trajectory of biomedical innovation. In their various roles, they form a sort of 'bridge' between product originators and end-users, by combining the perspectives of being both close to the point-of-use, while also trained in product and process design. Clinical engineering departments at large hospitals will sometimes hire not just biomedical engineers, but also IT, industrial/systems engineers to help address operations research, human factors, cost analyses, safety, etc. While some trace its roots back to the 1940s, the actual term clinical engineering was first used in 1969. The first explicit published reference to the term appears in a paper published in 1969 by Landoll and Caceres. Cesar A. Caceres, a cardiologist, is generally credited with coining the term clinical engineering. Of course, the broader field of biomedical engineering has a relatively recent history as well. The first modern professional intersociety engineering meeting to be focused on the application of engineering in medicine was probably held in 1948, according to the Alliance for Engineering in Medicine and Biology. The general notion of the application of engineering to medicine can be traced back centuries; for example, Stephen Hales's work in the early 18th century which led to the invention of a ventilator and the discovery of blood pressure certainly involved the application of engineering techniques to medicine. The recent history of this sub-discipline is somewhat erratic. In the early 1970s, clinical engineering was thought to be a field that would require many new professionals. Estimates for the US ranged as high as 5,000 to 8,000 clinical engineers, or five to ten clinical engineers for every 250,000 of population, or one clinical engineer per 250 hospital beds. The history of its formal credentialization and accreditation procedures has also been somewhat unstable. The International Certification Commission for Clinical Engineers (ICC) was formed under the sponsorship of the Association for the Advancement of Medical Instrumentation (AAMI) in the early 1970s, to provide a formal certification process for clinical engineers. A similar certification program was formed by academic institutions offering graduate degrees in clinical engineering as the American Board of Clinical Engineering (ABCE). In 1979, the ABCE agreed to dissolve, and those certified under its program were accepted into the ICC certification program. By 1985, only 350 clinical engineers had become certified. Finally, in 1999, the AAMI after lengthy deliberation, and analysis of a 1998 survey demonstrating that there was not a viable market for its certification program decided to suspend that program, no longer accepting any new applicants as of July 1999. The new, current clinical engineering certification (CCE) program was started in 2002 under the sponsorship of the American College of Clinical Engineering (ACCE), and is administered by the ACCE Healthcare Technology Foundation. In 2004, the first year that the certification process was actually underway, 112 individuals were granted certification based upon their previous ICC certification, and three individuals were awarded the new certification. By the time of the publication of the 2006-2007 AHTF Annual Report (c. June 30, 2007), a total of 147 individuals were included in the ranks of HTF certified clinical engineers. In 2011, AAMI arranged a meeting to discuss a new name for clinical engineering and/or biomedical equipment technology. After careful debate, the vast majority decided on 'Healthcare Technology Management'. Due partly to common confusion about the line between clinical engineers (engineers) and BMETs (technicians), the word engineering was deemed limiting from the administrator's perspective and unworkable from the educator's perspective. (An ABET-accredited college could not name an associate degree program 'engineering'.) Also, the adjective clinical limited the scope to hospitals. It remains unresolved how widely or officially accepted this change is or will be, and how this will affect Clinical Engineering Certification (CCE) or the formal recognition of clinical engineering as a subset of biomedical engineering. For regulatory and licensure reasons true engineering specialities must be definable in a way that distinguishes them from technicians with whom they work.