Leading medical engineering into new frontiers

The first gathering of the ‘EBME Expo Leaders Network’ brought together a select group of influential leaders from the healthcare technology (HealthTech) industry, at the Cinnamon Club, in Westminster, to drive innovation and to collaborate on achieving key objectives in the field of EBME. This Special Report outlines the key issues raised.

Opening the first session of the EBME Expo Leaders Network, EBME Expo Chair, Prof. John Sandham CEng explained that the aim of the group is to improve healthcare technology management and the impact of healthcare technology on patient care across private and public sector healthcare organisations. The afternoon encouraged a thought-provoking exchange of ideas on how the sector can navigate some of the key issues around: the increasing connectivity of HealthTech, the NHS drive towards more personalised care in patients' homes, and the need for increased investment in strategic management of HealthTech and the EBME workforce.

John Sandham pointed out that HealthTech has moved away from single devices, towards increasing complexity and connectivity: "When I started in this profession in the 1980s, I was fixing individual items on a bench. As technicians in the workshop, we would do the repairs to the equipment, then take it back. Over the years, the role has gradually changed… We have moved from individual, 'device-based management of equipment', to a 'systems-based management' process. Part of that is connectivity."

To address the evolving demands of the profession, EBME Expo will be introducing a Connectivity Stage, this year, underscoring the importance of addressing the challenges of integrating HealthTech into hospital networks to provide clinicians with a centralised and real-time view of patient data within the hospital and beyond.

John Sandham pointed out that Patient Administration Systems (PAS) are no longer separate from the technology, and this is a relatively new area for devices such as infusion pumps, for example. He highlighted the experience of Chase Farm, part of the Royal Free London NHS Foundation Trust, which has been assessed by HIMSS (the global Healthcare Information and Management Systems Society) as having achieved stage 6 in the Electronic Medical Record Adoption Model (EMRAM).1

"I went to visit Chase Farm Hospital two years ago and they have portable medical equipment reporting directly into the PAS. They have a direct live feed, so that a doctor on another ward can look at a patient's information — or even at home, via their mobile phone," he explained.

Other hospitals are yet to catch up with this level of connectivity and there is still much work to be done in this area, as John Sandham pointed out.

Alongside the drive for increasing interoperability, there is increasing use of artificial intelligence (AI) in healthcare technologies. John Sandham pointed out that "we need to ensure connectivity works first".

Some exciting developments were highlighted by the EBME Expo Leaders Network, including an AI solution that will enable medical devices to 'talk to EBME systems', in order to directly log the need for maintenance, when a fault arises, into the department's database. This will reduce admin time and the time that nurses spend in phoning up the EBME department to report issues when they arise. It will also allow EBME departments to respond much quicker and reduce downtime.

Training

Caroline Finlay, Joint Chief Operating Officer at MTS Health, commented that the workforce is one of the biggest issues facing the EBME sector, in terms of skills and capabilities — particularly around IT: "We cannot achieve what we need to achieve, without recognition that we need more training and development." She highlighted the need for a workforce champion at a high level to drive this agenda forward.

Iain Threlkeld, Vice President Engineering at the Institute of Physics and Engineering in Medicine (IPEM) and Head of Clinical Engineering, at the Rotherham NHS Foundation Trust, highlighted recent efforts to address this. He pointed out that departments across the Yorkshire region were previously training engineers in very different ways. Hence, a need was identified for a more 'standardised' approach, that also reflected the changing skill sets required by a modern EBME workforce.

"The old mentality in EBME was that you must have an HNC in electronics…However, we have been working in collaboration and speaking to NHS England to develop a standardised training programme with healthcare science qualifications, recognised by the National School of Healthcare Science. We approached providers to update their course content, to remove some of the things we don't feel is relevant anymore, and to bring in key subjects that reflect the changing demands of the role," Iain Threlkeld revealed. All hospitals in the Yorkshire region now have a standardised approach to training.

"We are all following the same programme, using the same training guides and learning materials, so engineers can move between hospitals in the region and their new employer will know they have been trained in the same way," he commented.

While a framework for training has now been put in place, it has not been matched by funding from NHS England to support the next generation of engineers required, which Iain Threlkeld described as "a concern".

Succession planning, in light of an ageing workforce, was also high on the agenda. One member of the Network revealed that they were being asked to present their workforce plan to the Executive Board for the next 10 years. They suggested that the next generation may want to work differently, with greater flexibility and a greater focus on the work/life balance.

It was also suggested that the new generation may tell employers when they want to work; they may choose to work one or two days a week and have their own business running alongside, for example. This may mean that we see an increase in remote working, with engineers working from home on connected medical devices. The profession may have to adapt to a changing employment landscape, making use of the available technology to support hybrid models of working.

Intelligent devices and connectivity

John Sandham added that this is where intelligence within the equipment will be particularly important — there will be increased visibility of device maintenance requirements, while service periods may also be extended. Manufacturers will have a key role to play, as medical device connectivity and AI enable new ways of working.

While software developments will help to transform EBME maintenance, increasing intelligence in medical devices will also help guide doctors on the state of the patient. John highlighted the development of intelligent systems for patient observations, such as Visensia. Based on multiple physiological readings, the technology can inform clinicians as to whether the patient's condition is improving or deteriorating. This physiological monitoring system is software that uses a standard Health Level 7 (HL7) interface for communicating to and from other data sources such as bedside monitors, central stations, telemetry kits and electronic patient records.⁴

"The research shows that the software is often more accurate and quicker at deciding whether the patient is getting better or worse (providing the readings are correct), than the doctor or the nurse. It means that the patient gets treated sooner, gets discharged faster, and that has the impact of lowering costs for the NHS," commented John Sandham.

Sonia Tedeku, from the HealthTech manufacturer, Mindray UK, further explained how software developments and connectivity are advancing patient care. The M-Connect IT solution, for example, elevates individual patient monitoring to create a universal central monitoring platform, offering increased visibility, streamlining workflow and improving clinical decision making. 

"Instead of viewing data on multiple devices all around the operating room, we can bring data from many interfaces and systems all onto one device's screen — essentially, to simplify things for clinicians.

"Connectivity is a really big focus for healthcare right now, and we are driving this across many devices — not just patient monitoring, but with ultrasound, anaesthesia and ventilation. We have a transport ventilator, for example, where you can move from one care area to another and all of the patients' data is tracked…The technology is advancing at pace — I cannot imagine what this will look like in a few years' time," she commented.

Ethics and engineering

Prof. Helen Meese, Founder and CEO of the Care Machine, and a past Chair of the Biomedical Engineering Division, IMechE, went on to raise the issue of ethics when introducing new technology — she commented that the IMechE has been highlighting the potential for a new role of "Patient-Enablement Engineers". There is a need to build on the well-proven techniques of rehabilitation and assistive technology engineering to create the patient care pathway at home, and this new role could be key to delivering this.

Patient-Enablement Engineers and Technicians would work exclusively in the space between acute care and social care with their clinical colleagues. They would not only require the full remit of engineering qualifications and skills, but in-depth clinical and social care knowledge, as well as management and customer service experience.²

"With all of this wonderful technology that we develop, we have to consider the engagement of the patient — right from its concept and development, through to its use. I think that's something that engineers need to be thinking about now," said Helen. "We have an opportunity to prepare the younger generation to ensure that they are ready to work alongside the patient in bringing this technology to the bedside — bringing it into people's homes. This is an aspect of ethics that we need to consider in this conversation," Helen Meese asserted.

Technology's impact on care delivery

The Network continued to talk about the wider impact of technology — including the hospital at home and telehealth. Tracking of medical devices in the community will need a strategic plan, supported by technological solutions. The Network discussed how maintenance and monitoring systems are being built into today's technologies, which will allow predictive maintenance of devices and allow the assets to "monitor themselves".

The group pointed out that the scale of technological change over the next decade will have a major impact on the way healthcare is delivered. We have already seen technology, in the form of social media, change our society dramatically, over the past decade, so we will need to be prepared and look ahead to see what is on the horizon — from AI, machine learning, and robotics, to personalised healthcare. The focus is likely to be on how to deliver healthcare at home, rather than patients having to go to their GP or the hospital, but it isn't going to be a single technology that is going to deliver this change; it will be a combination of multiple technologies.

One of the thought-leaders predicted that "everything on the planet will have a chip" and will become connected to the internet. Robots will be "sat at reception desks in hospitals", and they will have an increasing role in performing surgery. Due to advances in AI, surgical robots will become more intelligent and increasingly capable of making "decisions around which operation to perform" in order to improve patient survival and outcomes. Patients will have wearable devices to enable remote monitoring of their health — whether it is their vital signs or management of their disease.

Others commented that the human element in patient care will still be important from an ethical perspective — giving a clinician's perspective, Rob Brothwood, Chair of the EBME Expo Operating Theatres Conference, pointed out that patients experience high degrees of anxiety when undergoing surgery and anaesthesia.

"If we removed all the human element and just relied on machines, I'm not sure how I would feel about that. Certainly, machines are more accurate, they don't get tired, and there's no emotions in stressful situations. There is a role to play, therefore, but I think we should be slowing up on replacing actual skills of educated people," he commented.

Returning to the topic of the hospital at home, Aidan McIvor, Chief Clinical Engineer and Medical Device Safety Officer (MDSO) for Defence, pointed out that deploying equipment outside of the hospital setting is a major aspect of military operations.

"While the driving factor is going to be different with the NHS, the more devices you put out there, the more you will have to consider in terms of how to support them from a workforce perspective," he commented. He pointed out that as technology advances, engineers will need more IT skills — he wasn't confident that today's EBME workforce have the necessary training.

He highlighted some important considerations:

• What happens if there is a problem with the Wi-Fi connectivity in the patient's home? How will this affect the function of the medical technology and what needs to happen?
• Will the EBME workforce have the IT skills and knowledge to tackle this connectivity issue?
• As more devices are deployed outside of the hospital, will there be the workforce numbers to support this?
• How long is a piece of equipment going to be down with the patient connected to it and what is the potential patient impact?

He added that previously separate organisations will have to work together on achieving connectivity of these devices in patients' homes — collaboration will be key.

Joe Emmerson, Head of Clinical Engineering at Manchester University NHS Foundation Trust cautioned against initiating Hospital at Home projects without early involvement of clinical engineers, without adequate guidance, and without the required resources to support this model of care.

"We are not equipped to govern it. We don't have engineers that are readily available to send out to the community. There is no business continuity planning. What happens if that device fails? What about the device selection and the principles of managing devices?" he commented.

To "jump aboard a moving train" is going to be very difficult for the clinical engineering community, he pointed out. "Patients don't want to be in hospital. They want to be at home or treated in their local community. That is the way to treat patients, but we're not equipped," he asserted. Others in the Network highlighted that, in terms of policy, there are "lots of pockets of collaboration". John Sandham added that "the technology is there, but the people are not", while Helen Meese pointed out there is a need for a strategy from government around regulatory standards and guidance to ensure that the technology is "ready to go and available to the public". Such standards will help give patients the confidence that "it's the right thing to do".

Will technology exacerbate inequalities?

Equitable access to digital technologies for patients was another consideration raised by the panel. In areas of deprivation, energy bills and the cost of Wi-Fi connection are a real barrier to adoption of connected medical devices in the home. The reality is such that, due to fuel poverty, some people are having to minimise or even switch off their electricity.

When pushing for more internet-based medical devices to be installed in people's homes, patients are not being consulted about the costs involved and there has been a lack of discussion around who is going to pay for these services when the patient is unable. Therefore, we inadvertently risk excluding some sections of society — often these are the people with the most healthcare need.

Caroline Finlay added that a technology-based model of care at home was particularly challenging for elderly patients with complex needs — not least due to their unfamiliarity and discomfort with technology.

"Hospitals do not have the resources, the coordination or the capability to manage this care in patients' homes," she commented, pointing out that hospitals already face difficulties coordinating care for people that are going home to die. Therefore, is it realistic to expect hospitals to have the capacity to coordinate complex and ongoing health needs in patients' homes?

Procurement

Luella Trickett, a Director at the Association of British HealthTech Industries (ABHI), went on to highlight the challenges around HealthTech adoption and the current fiscal environment. She identified the fact that there are some key challenges around the lack of strategic procurement — all too often, there is a race to spend the 'end of financial year budget' and equipment is often replaced with like-for-like.

"When a piece of equipment is on its last legs, the knee-jerk reaction is to just replace it with the same thing. That isn't what we should be doing. We should be replacing it with what we need in the future and looking at things like enterprise solutions and connectivity, so we have equipment that talks to each other. We should be buying something that does something different, so we get a different outcome," she asserted.

Others in the Network agreed that there needs to be a shift to value-based procurement rather than opting for the cheapest possible solution. We need to look at the "bigger picture" when implementing technology. What is the most efficient solution? Which technology offers the best outcomes and the best patient experience? And which HealthTech could help the NHS achieve its strategic ambitions in the long-term?

Helen Meese also raised the issue that very few engineers work in procurement. If we are to persuade Trusts to make better decisions around technology, we will need to "have engineers holding the purse strings" in a more controlled way, she commented.

Raising the profile of EBME

Another hot topic during the discussion was the need to raise the profile of the EBME profession in healthcare. Each year, 15,000 people are harmed because of misuse of medical devices. EBME departments have a vital role in protecting patients and staff, by minimising the risks, but there needs to be greater investment in the workforce, equipment and training.

The Network pointed out that there are a wide variety of job titles covering the role and this lack of standardisation makes it difficult for individuals to be identified and visible within organisations — some hospitals prefer the term 'EBME', while others favour 'Clinical Engineering'; however, there are many more variations, as the Network pointed out. This lack of consistency and visibility makes it challenging to achieve influence at both a Government and Trust level. Having a standardised title across the UK is a first step in promoting a better understanding of the vital contribution that engineers provide in the delivery of safe and efficient patient care.

As the role has evolved, some Network members suggested that a better title may be needed to "encapsulate all that we do" — 'healthcare technology management' or 'clinical technology management' were some of the preferred descriptions suggested.

Caroline Finlay highlighted the need for a change in culture — to break down the current tendency for 'silo working' between departments in hospitals, and move towards more collaborative working across Trusts. Skills sets and resources could be shared, she suggested. "You don't have to be an expert in procurement at every single Trust. There needs to be a way of actually sharing that resource. I used to talk about 'regional clinical engineering facilities'. It's probably moved on from that, but I do think that there's a level of core expertise that could be spread between a number of different hospitals," she commented.

In her view, clinical engineering teams need to be less protective about their own areas and focus, instead, on "bringing expertise together".

John Sandham commented that one of the biggest issues across the NHS (and also in the private sector) is the fact that there is "not enough focus on strategic medical equipment management".

"With this in mind, we have been working for the last three years with IHEEM on the development of a programme for 'Authorised Engineers for Medical Devices'. If you don't know what an authorised engineer is, it's somebody who looks at the strategic governance of a specific area within an NHS Trust. They are not working for the NHS Trust but are independent. They have Authorising Engineers for a variety of healthcare related areas, but not for medical devices, so IHEEM is now in the process of approving this new role," John Sandham revealed.

The new AE (MD) role will aim to help drive improvement in services going forward, through expert oversight, audit and support.

Iain Threlkeld went on to explain the benefits of initiating a department audit — there are some key advantages of working with an expert on identifying areas for improvement: "Every department has things that they can do better, and an audit will allow you to push your director to give you the resources you need to make the recommended changes. It also enables departments to provide assurances to their senior management team that they know what they are doing."

However, John Sandham added that there is also a need for increased investment in HealthTech: "Toyota came into the car manufacturing scene in the 1950s and introduced new technology which made them more efficient and made them able to manufacture cars quicker and better than Ford — it took Ford 20 years to catch up; that's the benefit of technology.

"There is lots of good software and technology that will make patient care better, safer and more efficient, but the problem is that the NHS only invests around 3% of its annual budget in technology, whereas Toyota invests around 44%. So, if you really want to make technology work for you, you've got to put more money into technology, instead of trying to shrink the budget."

All too often, Trusts ask, where can you save us money? How can you make these old assets last longer? John Sandham warns that this is the wrong approach.

"They should be saying, what assets can we buy to make us more efficient?" he commented, adding that even when Trusts are given expert advice and direction, they are unable to take it forward because they "haven't got the money to spend on the assets." The current status quo is too short sighted, in his view.

While the need for investment in connectivity and technology was at the forefront of discussion, this inevitably prompted members of the EBME Expo Leaders Network to raise the issue of cybersecurity. They highlighted the risk posed by increasing dependency on information technology and connectivity, in "a world that is becoming more and more uncertain and unsafe." It was suggested that, if we are moving towards increasing connectivity, it should also be supported by "an enormous amount of investment in cybersecurity".

EBME: global perspectives

While the Network focused mainly on the challenges faced by the EBME sector in the UK's NHS, it was also reminded of parts of the globe where the situation is much more critical. According to the WHO between 50% and 70% of all medical devices in Sub-Saharan African hospitals and clinics are out of service at any one time, and this has a huge impact on the ability of these nations to provide effective healthcare. A significant cause of this is the chronic shortage of adequately trained biomedical engineers in many of these countries.

The Amalthea Trust is a non-profit organisation that helps to provide the support, practical experience and know-how necessary for professionals in low resource settings to self-maintain their own countries' medical devices, thus helping to improve healthcare delivery for millions of people.3

Martin Worster, Programme Director at the Amalthea Trust, cast a light on the immense challenges faced by the sector in low resource countries: "What people don't realise is that there were very few biomedical engineering training courses, let alone departments, in most Sub-Saharan African countries until around 10 years ago."

"Even now, you can go to the National Referral Hospital in Malago in Kampala (the capital of Uganda), and you will have a 1000-bed hospital with two engineers — only one of those may have biomedical engineering training. The other may be an electrician, and they may spend most of their time fixing the air con and the TV sets. This is the reality; it is so far away from everything we've been talking about around this table."

He pointed out that, despite the immense challenges, there are lots of interesting ways in which distributive technology is already being used in Africa — people are using mobile phone technology for patient monitoring, for example, because they are dealing with very low resource settings. However, the hospitals which have electronic equipment are constantly having to throw it out or replace it, due to power outages.

"All the power comes back on and blows the equipment. There's very little surge protection in any of the hospitals I have visited," Martin Worster commented. "A lot of what we're talking about, from my perspective, brings up the question of inequality and how the West is clearly moving far away in one direction and leaving large chunks of the human race behind."

Martin Worster further elaborated on some of the challenges around medical devices management in low resource countries and gave a reminder to the Network that it is easy to get caught up in the excitement of new technology.

"I've come across asset registers where information on all of the equipment is kept on a mobile phone — because it's not connected to the mains and therefore won't go down when there's a power surge. So, technology needs to be appropriate — and I think this also applies to us, here. The technology that we're talking about, first and foremost, needs to be appropriate to what we're trying to do.

"It's easy to run away with the technology itself, which is all very exciting. But we need to keep one eye on the patient, at all times, and keep thinking: is this actually appropriate to providing healthcare for all of our population, not just the people that can afford to access the new technology? This is not just about the increasing inequalities between Europe and other parts of the world — we have the potential for increasing inequalities within our own society as well. Technology may — unbeknown to us and against all our best wishes — make these inequalities worse," he asserted.

Commenting on the day's discussion, Prof. John Sandham, concluded: "I was proud to chair this inaugural meeting of the EBME Expo Leaders Network which laid bare the critical junctions we face in healthcare technology. We're not just talking about connecting devices; we're talking about connecting patient care, workforce development, and ethical considerations in a rapidly evolving digital landscape.

"From AI integration to global inequalities in access, the insights shared will be pivotal in shaping the future of healthcare and, ultimately, the quality of patient outcomes. The EBME Expo, and initiatives like this Leaders Network, are crucial platforms for driving these vital conversations and fostering the collaborative solutions our sector urgently needs. It's clear: investment in technology must be matched by investment in our people and a strategic vision for equitable, safe, and efficient healthcare delivery." 

The EBME Expo Leaders Network will now meet at regular intervals to discuss topical issues in the sector. Many of the issues discussed during the meeting will also be addressed during the EBME Expo Conference, taking place at the Coventry Building Society Arena, 25-26 June 2025. To Register, visit: https://ebme-expo.com/

Source: Louise Frampton, Editor, CSJ