Certified Healthcare Technology Manager CHTM

Certified Healthcare Technology Manager CHTM Flashcards: 392 cards

392 free Certified Healthcare Technology Manager flashcards from the course's cheat sheet and glossary. Tap a card to flip it. Mark the ones you know and they drop out of the deck; the rest keep coming back.

Acronyms 72

AABB: Association for the Advancement of Blood and Biotherapies. The body that accredits blood banks and transfusion services.
AAMI: Association for the Advancement of Medical Instrumentation. The standards body for medical equipment and the sponsor of the HTM credentials.
ACI: AAMI Credentials Institute. The body inside AAMI that writes and administers the certification exams.
ADA: Americans with Disabilities Act. The civil rights law that bars disability discrimination and requires reasonable accommodation.
AEM: Alternative equipment maintenance. A program that adjusts maintenance intervals and activities away from the manufacturer's recommendations, based on risk.
AHA: American Hospital Association. The hospital trade association that publishes the useful-life schedule for hospital assets.
AP: Accounts payable. What the organization owes its vendors and has not yet paid.
AR: Accounts receivable. What the organization is owed by others and has not yet collected.
BMET: Biomedical equipment technician. The technician who inspects, maintains, and repairs patient care equipment.
CABT: Certified Associate in Biomedical Technology. The entry-level ACI credential for people beginning a career in medical equipment service.
CAP: College of American Pathologists. The body that accredits clinical laboratories against detailed discipline-specific checklists.
CAPA: Corrective and preventive action. The paired fix: correct this cause, and prevent the same cause from acting elsewhere.
CBET: Certified Biomedical Equipment Technician. The ACI credential for technicians who service general patient care equipment.
CCE: Certified Clinical Engineer. The clinical engineering credential, awarded outside the technician certification family.
CDRH: Center for Devices and Radiological Health. The FDA center responsible for medical devices and radiation-emitting products.
CEU: Continuing education unit. One hour of qualifying educational or professional activity, counted toward recertification.
CFO: Chief financial officer. The executive who owns the hospital's finances, budgets, and capital decisions.
CHTM: Certified Healthcare Technology Manager. The ACI credential for HTM supervisors and managers: 100 questions, 2 hours, offered in May and November.
CLES: Certified Laboratory Equipment Specialist. The specialist credential for people who service clinical laboratory instruments.
CLIA: Clinical Laboratory Improvement Amendments. The federal program through which CMS regulates clinical laboratory testing on humans.
CMMS: Computerized maintenance management system. The database that holds the equipment inventory, work orders, costs, and service history.
CMS: Centers for Medicare and Medicaid Services. The federal agency that pays for most hospital care and sets the conditions of participation.
CoP: Condition of participation. A federal requirement a hospital must meet to be paid by Medicare and Medicaid.
COSR: Cost of service ratio. Annual service cost divided by acquisition cost, as a percent; the field's main cost benchmark.
CRES: Certified Radiology Equipment Specialist. The specialist credential for people who service imaging and radiologic equipment.
DNV: DNV Healthcare. An accrediting organization for hospitals whose program joins a quality management system to the CMS rules.
DoD: Department of Defense. The federal department whose biomedical equipment training program is a recognized eligibility pathway.
ECG: Electrocardiograph. The device that records the heart's electrical activity, used here only as an inventory example.
ECRI: ECRI Institute. An independent nonprofit that tests medical devices and publishes hazard and recall alerts.
EEOC: Equal Employment Opportunity Commission. The agency that enforces the federal bans on employment discrimination.
EHR: Electronic health record. The patient record shared across organizations, as opposed to the record inside one of them.
EMR: Electronic medical record. The patient record held inside one organization.
EOC: Environment of care. The accreditation program covering the physical environment, including medical equipment.
EOL: End of life. The date a manufacturer stops supporting a model, which is not the date the device stops working.
FCC: Federal Communications Commission. The agency that licenses and manages the radio spectrum, including the medical telemetry bands.
FDA: Food and Drug Administration. The agency that regulates medical devices, from market clearance through reporting and recalls.
FMEA: Failure mode and effects analysis. A forward-looking method: list how each step of a process can fail, then act on the worst.
FMLA: Family and Medical Leave Act. The law giving eligible employees unpaid, job-protected leave for family and medical reasons.
FTE: Full-time equivalent. One full-time position, roughly 2,080 paid hours a year; partial coverage is expressed in tenths.
GAAP: Generally accepted accounting principles. The standards, conventions, and rules accountants follow when recording and presenting financial statements.
HFAP: Healthcare Facilities Accreditation Program. A hospital accreditation program that has held federal authority to accredit hospitals.
HIPAA: Health Insurance Portability and Accountability Act. The law that protects the privacy and the security of identifiable health information.
HITECH: Health Information Technology for Economic and Clinical Health Act. The law that extended the HIPAA rules with breach notification and stronger enforcement.
HTM: Healthcare technology management. The profession and the department that manages a hospital's medical equipment across its whole life.
HVAC: Heating, ventilation, and air conditioning. The building system that holds temperature and humidity inside the limits equipment needs.
IEC: International Electrotechnical Commission. The international standards body behind the medical electrical equipment and network risk standards.
IT: Information technology. The group that owns the network, servers, and enterprise systems the devices depend on.
KPI: Key performance indicator. A measure a department reports to show whether it is performing.
MAUDE: Manufacturer and User Facility Device Experience. The FDA's public database of medical device adverse event reports.
MDR: Medical device reporting. The federal requirement that user facilities, manufacturers, and importers report device-related adverse events.
MDS2: Manufacturer disclosure statement for medical device security. The standard form on which a manufacturer discloses a device's security capabilities.
MEMP: Medical equipment management plan. The organization-wide written plan for how medical equipment is maintained and monitored.
MTTR: Mean time to repair. The average hands-on time to complete a repair.
NFPA: National Fire Protection Association. The nonprofit that publishes consensus codes which become law only where a state adopts them.
NIST: National Institute of Standards and Technology. The federal institute that keeps the national measurement standards test equipment is traced to.
NLRA: National Labor Relations Act. The law protecting employees' rights to organize, bargain collectively, and act together on working conditions.
NRC: Nuclear Regulatory Commission. The agency that licenses and inspects the use of radioactive materials, including nuclear medicine.
OSHA: Occupational Safety and Health Administration. The labor agency requiring employers to provide a safe and healthful workplace.
PACS: Picture archiving and communication system. The system that stores and moves medical images along with the patient identifiers attached to them.
PHI: Protected health information. Any identifiable health information, including what sits on a medical device's storage.
PM: Preventive maintenance. Scheduled work on the parts of a device that wear, done before they cause a failure.
PPE: Personal protective equipment. The gloves, eye and hearing protection, and other gear a hazard assessment requires.
RCA: Root cause analysis. A backward-looking method: work from the event to the cause underneath it, then fix that.
ROI: Return on investment. The gain from an investment minus its cost, divided by the cost, as a percent.
RPN: Risk priority number. Severity times occurrence times detection, the number that ranks failure modes in an FMEA.
SMDA: Safe Medical Devices Act of 1990. The law that made adverse event reporting mandatory for hospitals and other device user facilities.
SOP: Standard operating procedure. A written departmental procedure that says how a recurring task is actually done.
TCO: Total cost of ownership. Everything a device costs across its life, not the price on the quote.
TJC: The Joint Commission. The most common hospital accreditor in the United States.
UMDNS: Universal Medical Device Nomenclature System. A free device naming standard, widely used to keep an equipment inventory consistent.
UPS: Uninterruptible power supply. A battery-backed supply that carries a device through a power interruption.
WMTS: Wireless Medical Telemetry Service. Protected radio spectrum reserved for patient telemetry, coordinated under FCC rules.

The exam itself 24

Certifying body: The AAMI Credentials Institute (ACI), the credentialing arm of AAMI
Credential: Certified Healthcare Technology Manager (CHTM), for HTM supervisors and managers
Questions: 100 multiple-choice questions
Time and rules: 2 hours, closed book; an on-screen calculator and an on-screen notepad are the only tools
Delivery: Computer-based at Kryterion test centers
Testing windows: Twice a year: May 1 to 15 and November 1 to 15
Domain 1: Financial Management, 20% of the exam
Domain 2: Risk Management, 16% of the exam
Domain 3: Operations Management, 40% of the exam
Domain 4: Education and Training, 11% of the exam
Domain 5: Human Resources, 13% of the exam
Scoring method: A criterion-referenced cut score set by the modified Angoff method; the cut score is not published
Results: Reported as pass or fail, with no numeric score
Fee: $490 member, $565 non-member; retake $440 member, $515 non-member
Retake rules: Wait 60 days between attempts; at most three attempts in two years, then a one-year wait
Recertification: At least 30 continuing education units (CEUs) in a three-year cycle, with fees paid by December 31 of the year the credential expires. One CEU is one hour of qualifying activity
Other ACI credentials: CABT for associates entering the field, CBET for technicians, CRES for imaging specialists; the CHTM is the management credential. A CABT alone does not satisfy an eligibility pathway
How the questions read: They ask for the FIRST step, the BEST recommendation, the MOST appropriate report, committee, or document, and now and then the LEAST appropriate action
1. Current technician or engineer credential: A current CCE, CBET, CRES, or CLES plus at least three years of work as an HTM supervisor or manager in the last five
2. Military training: The Department of Defense (DoD) BMET training program plus three years of military or civilian HTM supervisor or manager experience in the last five
3. Associate degree: An associate degree in biomedical technology, a related healthcare discipline, information technology, or business plus three years as an HTM supervisor or manager in the last five
4. Bachelor's degree or higher: A bachelor's degree or higher in biomedical technology, engineering, a related healthcare discipline, information technology, or business plus two years as an HTM manager in the last five
5. Experience alone: Seven years in the HTM field with three years of management experience in the last five
Attestation rule: A pathway without the supervisor or manager title needs confirmation of management duties by self-attestation or third-party attestation

Financial management 40

Operating budget: Next year's spending on labor, parts, contracts, outside service, calibration, tools and minor equipment, office supplies, travel, memberships, education, and shop meetings
Capital budget: Requests above the hospital's dollar threshold for items with a long useful life: a system, test equipment, a shop expansion. It competes with every other capital request in the hospital
Who approves what: The manager builds both. The operating budget is approved up the manager's own chain with finance; the capital budget is approved by the capital or technology committee and senior leadership, because capital money is rationed across the whole hospital
When budgets are built: Three to six months before the fiscal year starts
Fiscal year: The hospital's twelve-month accounting year. It often does not match the calendar year, so know which one a request is aimed at
Cost center: The numbered account a department's costs post to. Every work order, part, and contract payment should trace to one
Chart of accounts: The hospital's list of cost centers and subaccounts. The HTM budget is reported in those subaccount numbers, not in categories HTM invents
Distributed budgeting: HTM holds only shop costs: labor, calibration, training, supplies. Contracts, parts, and outside labor stay with whichever clinical cost center owns the device, which leaves nobody able to see total maintenance cost or hold a vendor to terms
Consolidated budgeting: Every equipment dollar is moved under the HTM cost center, then allocated back to the clinical cost centers from CMMS reports. This is the better model, because the department that pays can withhold payment until service reports arrive
The irregular-cost trap: A large cost that recurs on a long interval, such as an eighteen-month part, must be budgeted on its interval. Last year's spend may not contain it at all
Purchase order cost: Raising one purchase order carries roughly $100 of hospital overhead, so many small orders waste more than the lower part price ever saves
Fiscal agreement: Consolidation only works with a written understanding among HTM, the clinical departments, and the chief financial officer on priorities and on how a repair that exceeds the budget still gets done
Technician and supervisor wages: Salaries, the payroll line
Overtime and on-call pay: Salaries. Track it as its own line: rising overtime is the first sign of understaffing
Repair parts bought by HTM: Maintenance and repairs
Service contracts and vendor labor: Purchased maintenance and repair
Shop consumables and small supplies: Office supplies or medical and surgical inventory, by what the item is
Test equipment calibration: Maintenance and repairs, or a calibration line if the hospital has one
Training tuition, travel, and lodging: Travel and education. Training is an expense because it cannot be depreciated
A replacement monitoring system: Capital, not operating. It is depreciated over its useful life rather than expensed this year
Budget variance: Variance = actual minus budget. $112,000 actual against a $100,000 budget is a $12,000 variance
Variance percent: Variance / budget x 100. $12,000 / $100,000 x 100 = 12%. Accounting usually wants a written explanation once a month lands 5% or 10% off its budget
Favorable or unfavorable: An expense that comes in under budget is favorable; over budget is unfavorable. Over-expenditure is what gets the attention
ROI percent: ROI = (gain minus cost) / cost x 100. A $25,000 school that avoids $90,000 of contract cost: (90,000 minus 25,000) / 25,000 x 100 = 260%
Payback period: Payback = cost / annual savings. A $100,000 project returning $20,000 a year pays back in five years. Shorter is better
Total cost of ownership: TCO = purchase plus installation plus service plus parts plus training plus disposal, across the life of the device. Compare TCO, never the sticker price
Straight-line depreciation: (Cost minus salvage value) / useful life, per year. A $1,000,000 system over ten years with no salvage depreciates $100,000 a year
Book value: Book value = cost minus accumulated depreciation. After three years that system books at $700,000, and that number says nothing about remaining useful life or resale value
Cost of service ratio: COSR = annual service cost / acquisition cost x 100. $5,000 a year on a $125,000 system is 4%
Reading a COSR: Across a hospital, 4% to 25% is the normal band. Manufacturer service typically runs 10% to 25%; full in-house service can reach 4% to 6%
COSR on a quoted contract: Divide the contract's annual price by the device's purchase price, then compare it with the department's COSR. A $180,000 contract on a $1,000,000 system is 18% against a department running 6%: three times the cost
Balance sheet: A snapshot on one day: assets, liabilities, and owner's equity. Assets equal liabilities plus equity
Income statement: Also called the profit and loss statement. It covers a period of a month, quarter, or year: revenue minus expenses equals net income
Cash flow statement: Cash in and cash out over a period, split into operating, investing, and financing. Reported profit is not money in the bank
GAAP: Generally accepted accounting principles: the standards, conventions, and rules accountants follow when recording transactions and preparing statements
Accounts payable: AP is what the hospital owes its vendors. Unpaid service invoices and parts orders sit here
Accounts receivable: AR is what the hospital is owed. Revenue from servicing outside clinics sits here until it is collected
Accrual versus cash basis: Accrual records an expense when it is incurred; cash basis records it when the payment clears. Hospitals budget on accrual, so a part ordered in June is June's expense
Capital versus expense: A capital item is depreciated over its useful life; an expense lands entirely in this year's budget
Who to know by name: The chief financial officer and the cost accountant for your cost center. The CFO decides how large irregular costs are carried in the budget

Procurement, contracts, and the lifecycle 30

How is useful life set: Manufacturer guidance, the AHA useful-life schedule for hospital assets, the department's own failure trends, parts availability, and the declared end of support
What the AHA schedule is: An industry average life expectancy by asset type, widely used to set depreciation. It is an average, not a verdict on the device in front of you
What end of life means: The manufacturer has decided to stop supporting the model. It does not mean the device is unsafe, unrepairable, or finished
Is support guaranteed: No. No law requires a manufacturer to supply parts or support for any number of years after it declares EOL
What triggers replacement: Support withdrawn, parts no longer available, failure rates climbing, calibration that will not hold, technology overtaken by something safer or more capable, or an annual maintenance cost that has outgrown the device's value
How replacement is forecast: Rising annual cost per device in the CMMS plus the manufacturer's EOL notices, read years ahead, because replacement runs into millions
Scope: Exactly which devices, systems, modules, and accessories are covered, by serial or asset number, and during what hours
Cost: The annual price, what it buys against the alternatives priced over the same years, and the COSR it works out to on this device
Compliance: Whether the vendor's people are qualified and will supply training and competency records, whether their work will be documented in the CMMS, and whether their intervals meet the plan and the accreditor
Response time: Time to a phone response and time to on-site arrival, stated separately, with what happens when they are missed
Uptime guarantee: The promised availability, how it is measured, and the remedy when it is not met
Parts: Whether parts are included, whether glassware and major assemblies are included, and whether they are new, refurbished, or exchange
Loaners: Whether a loaner or backup unit is provided, how fast, and at whose cost
Training: Seats, level, location, and whether service literature and passwords come with them
Exclusions: The list that decides your real cost: batteries, accessories, probes, abuse, after-hours maintenance, software, travel
Termination: How the hospital gets out, how much notice is required, and what penalty applies
Renewal and escalation: Whether it renews automatically and how much the price may rise each year
Indemnity and liability: Who answers for injury, data loss, and damage caused during service
Entire-agreement clause: The signed contract is the whole deal, and a term can run as long as ten years. Nothing said in a meeting or an email survives it
Where the leverage is: Before signing, and before the capital purchase closes. After the sale the hospital has none
Purchase: Capital money, depreciated over the useful life. The hospital owns the asset and all of its downstream cost
Lease: Operating money spread over the term. Read who maintains it, who insures it, and what happens at the end
Fair market value: What a willing buyer would pay today. It is not book value and not replacement cost, and policy should say who determines it
Trade-in: Convenient, and usually the lowest value the hospital can get. Price the open market before accepting it
Resale: Used-equipment companies and broker sites will bid. After the labor to list, negotiate, and load, it is often close to break-even
Donation: A charity may deploy the device abroad. Policy must say who selects the charity and who may donate instead of sell
Environmental disposal: Batteries, mercury, sealed sources, refrigerants, and electronics follow environmental rules, not the loading dock
Data wiping before disposal: Any device that stored patient information is wiped or has its media destroyed before it leaves. Selling or donating a device holding PHI is a HIPAA violation, and often only HTM knows the data is there
Documentation: A disposal record naming the asset, the method, the date, the wipe, and the signature closes the asset out of the inventory and the ledger
Order of preference: Redistribute inside the organization or to a simulation center, then sell, then donate, then recycle. Disposing of an asset still being depreciated takes a hit for the remaining book value, so finance agrees first

Risk management 50

Patient safety risk: A device that shocks, burns, delivers the wrong dose, or reads out of calibration and leads to a misdiagnosis
Operations risk: Downtime on the only device of its kind; a procedure canceled; a surgeon who takes cases to another hospital
Financial risk: Unplanned repairs that blow the budget, a contract signed without review, regulatory fines, the cost of a lawsuit
Emergency preparedness risk: A utility failure, a network outage, or a disaster that leaves clinicians without working equipment and no documented workaround
Regulatory risk: A survey finding on maintenance records, an unreported adverse event, equipment in an alternative program that is not eligible for it
How risk and cost trade: Risk and cost move in opposite directions. Almost any risk can be driven near zero if the hospital pays enough, and cost comes down only by accepting more risk. The hospital's risk management department decides how much is acceptable
Equipment function: What the device does: life support, therapeutic, diagnostic, analytical, or support. Life support scores highest
Physical risk: The harm a failure could cause: death, injury, a wrong diagnosis, or an inconvenience
Likelihood of failure: How often this model actually fails, from the hospital's own history or credible outside data
Maintenance requirement: How much scheduled work the device truly needs: filters, batteries, calibration, moving parts, or almost nothing
Incident history: The number, frequency, and nature of past failures and service requests on identical or very similar equipment
How the score is used: The inputs combine into one number. High scores get full scheduled maintenance at the manufacturer's interval; low scores get a longer interval or less work
Run to failure: A low-risk, inexpensive device whose failure harms nobody may be repaired or replaced only when it fails, under a documented alternative equipment maintenance program
Root cause analysis: Define the event, gather the facts, ask why until the causes stop being symptoms (the five whys), map contributing causes on a fishbone, agree corrective actions with owners and dates, then verify the fix held
What RCA is for: Events that already happened. It works backward from the nearest cause to the root, which is often the organization rather than the person at the bedside
FMEA: Pick the process, list every step, list how each step can fail, score severity, occurrence, and detection, multiply them into a risk priority number, act on the highest, then rescore. Use it on failures that have not happened yet
Risk priority number: RPN = severity x occurrence x detection. Severity 8 x occurrence 3 x detection 5 = 120. Rank the list and work from the top
Incident investigation: Secure the device, its accessories, and its disposables where they are; preserve settings and switch positions; photograph everything; interview the witnesses; pull error logs; document names, dates, and sequence; then report
What not to do: Do not clean, repair, re-calibrate, update, or return the device to service, and do not let the trash be emptied: lot numbers of disposables live in it
Where the report goes: The complete report goes to the risk manager, which is what makes it work product. Discuss its contents with no one else. A near miss is investigated the same way
Safe Medical Devices Act of 1990 (SMDA): Made adverse-event reporting mandatory for device user facilities: hospitals, ambulatory surgical facilities, nursing homes, and outpatient diagnostic and treatment facilities
Death: Report to the FDA and to the manufacturer no later than 10 work days after becoming aware. Where the manufacturer cannot be identified, the report goes to the agency alone
Serious injury: Report to the manufacturer no later than 10 work days, or to the agency instead when the manufacturer cannot be identified. Copying the agency on every suspected serious injury is recommended practice
Serious injury, defined: Life-threatening, or causing permanent impairment of a body function or permanent damage to a body structure, or requiring medical or surgical intervention to prevent that permanent harm
Annual user facility report: Submitted to the FDA on Form FDA 3419 by January 1 of each year, identifying the facility and the reports it filed
MDR event files: A user facility must keep written reporting procedures and must retain the event file for 2 years from the date of the event, available to an FDA investigator
How reports are filed: Mandatory reports go in on Form FDA 3500A through MedWatch. Form FDA 3500 is the voluntary form for clinicians and the public
MAUDE: The public database of device reports. Search it before buying and during an investigation to see whether others have reported the same failure
Sentinel event: A patient safety event that reaches a patient and results in death, permanent harm, or severe temporary harm. It triggers a full root cause analysis and an action plan, and accrediting bodies publish alerts on the patterns they see
Recall classification: The FDA assigns a recall the numeral I, II, or III to show the relative degree of health hazard the violative product presents
Class I recall: The worst case: there is a reasonable probability that using or being exposed to the product will cause serious harm to health, or death. Act on it immediately
Class II recall: Using or being exposed to the product may cause health consequences that are temporary or medically reversible, or the chance of serious harm is remote
Class III recall: Using or being exposed to the product is not likely to harm health at all, but it still breaks a requirement and must be corrected
Recall workflow: Receive the notice, locate every affected asset in the CMMS by model and serial range, quarantine or correct, notify the users and the committee, document each unit, verify the vendor's correction, then close the recall with a record
Hazard and safety advisories: Manufacturer notices, ECRI alerts, and FDA safety communications. Someone must own the inbox, log each notice, and record the action taken even when the action is none
PACS: Stores and moves images with patient identifiers. Treat the archive as patient data, not as a file server
EMR and EHR: The record inside one organization and the record shared across organizations. Networked devices feed them directly or through middleware
HITECH: Extended the HIPAA rules: breach notification, direct obligations on business associates, and stronger enforcement
Integrity: Data that arrives at the record unchanged and attached to the right patient. A wrong-patient vital sign is a safety event, not a clerical error
Backups: Scheduled, verified, stored away from the system they protect, and restored in a test before you need them in anger
Access control: Unique named accounts, least privilege, multi-factor authentication where it is supported, and shared service passwords retired
Encryption: Protect data at rest on the device and in transit across the network, by the manufacturer's supported method
Patching and updates: Only on the manufacturer's validated schedule. An unvalidated patch can take a cleared device out of its cleared configuration
Hardening: Turn off unused ports and services, change default credentials, and remove software the clinical function does not need
Segmentation: Put devices that cannot be patched on their own network segment with tight rules, and document who approves exceptions
Antivirus: Only where the manufacturer allows it, and only with the exclusions they specify
MDS2: The manufacturer disclosure statement for medical device security. Require it before purchase; it is the inventory of what the device can and cannot protect
Operating system life expectancy: Ask how long the embedded operating system will be supported. A device with a long clinical life running an operating system whose support ends far sooner is a known future problem, not a surprise
Wireless Medical Telemetry Service: Protected spectrum for patient telemetry, licensed and coordinated under FCC rules. Someone must register the hospital's WMTS use and keep other transmitters out of the band
Why the FCC matters: It licenses and manages the radio spectrum. An unmanaged transmitter in a telemetry band means dropped waveforms on monitored patients

Service operations and metrics 56

Request: Captured once, with the device asset number, location, caller, and the problem in the caller's words
Triage: Ranked by clinical impact, not by order of arrival. A life-support device beats a convenience item every time
Assignment: To a technician with the competency and the parts, with the clinical user told who is coming and when
Repair: The work itself, with time and parts recorded as they happen rather than from memory at the end of the week
Verification: Performance and safety checks that prove the device meets specification before it goes back to the patient
Closure: Problem code, cause, action, parts, labor hours, and the condition on return, all in the CMMS
Customer feedback: Tell the user what was wrong and what was done, then measure satisfaction on a survey you do not change year to year, so the numbers compare
What a complete record holds: Asset number, date and time in and out, who did the work, the reported problem, what was found, what was done, parts used with cost, labor hours, test results, and the return-to-service decision
Problem codes that matter: Use error and cannot duplicate. Both are real work and neither is an equipment failure. Trend them or you will mistake a training problem for a reliability problem
Outside vendors: Every visit by a vendor or manufacturer is logged in the CMMS too. Make check-in and a service report within 24 hours a condition of payment
Asset inventory: Every medical device in the building, whether the hospital bought it, leases it, rents it, has it on loan, or borrowed it, and regardless of who maintains it
Standard nomenclature: One agreed name per device type, manufacturer, and model, so like items can be compared. UMDNS from ECRI is the common free standard
Granularity rule: Inventory anything carrying a serial number, because serial ranges are what recalls name. Give one shared number to the cheap, numerous, low-consequence items nobody would track one by one
Original cost: Price paid for every asset. Without it no cost of service ratio can be calculated and no cost can be fairly allocated to a cost center
Work orders: Every scheduled and unscheduled job, open and closed, with hours and parts against the asset
Service history: The full life of the asset, including work done by vendors, so trends and repeat problems are visible
Parts: What is on the shelf, what it cost, what it fits, and what is on order
Recalls and advisories: Which notice hit which asset, what was done, and when it closed
End of life and support dates: So replacement planning starts years before the device stops being serviceable
Preventive maintenance (What it means): Scheduled work on parts that wear: filters, fans, lubrication, batteries, and components with a known life
Performance verification (What it means): Confirming the device still meets specification. If it does, nothing is changed
Safety testing (What it means): Measuring leakage current, ground resistance, and where applicable isolation, with a safety analyzer
Scheduled maintenance (What it means): The umbrella term: any mix of safety testing, performance verification, and preventive maintenance done on a schedule
How PM is scheduled (What it means): By month. Each asset lands in one of the twelve months of the year, and the year is balanced around a short February, summer vacations, and the holidays
The flexibility window (What it means): The Joint Commission allows 30 days either side of the scheduled date for annual scheduled maintenance, which is what makes the plan workable
PM completion rate (What it means): Completed / due x 100. Monitor it daily, not at month end, because at month end it is too late to fix
The compliance report (What it means): Completion rate by month and by department, the list of misses, the reason for each, and the date each was completed
Documenting a missed PM (What it means): Name the asset, why it was missed, where the device was, what the clinical risk was, and when it was finished. A missed PM with a documented reason is a finding you can answer
What a surveyor asks for (What it means): The inventory, the plan, the completion rate, the misses and their explanations, the critical equipment list, which assets sit in an alternative program, and the evidence behind putting them there
PM completion rate (How it is read): Completed / due x 100. The number a surveyor asks for first and the one administration understands
Repeat repairs (How it is read): Repairs that come back within 30 days of the first one. A falling count means the fixes are holding; a rising one points at a bad device, a bad part, or a technician who needs training
Mean time to repair (How it is read): MTTR is the average hands-on repair time. It measures the technician and the parts supply
Total time to repair (How it is read): The clock the clinician feels: from the call to return to service, including waiting for parts, vendors, and access. Always longer than MTTR, and the one to report
Uptime (How it is read): The share of time a device was available for use. Report it on critical devices, where downtime cancels cases
Customer satisfaction (How it is read): A periodic survey of contactability, response speed, completion, technical competence, communication, and overall effectiveness, kept unchanged so results compare across years
Cost of service ratio (How it is read): COSR by hospital, department, modality, equipment type, and manufacturer. The drill-down is where the savings are found
Labor hours per device (How it is read): Total documented hours divided by assets supported. Useful inside one hospital and dangerous as a comparison between hospitals
Overtime (How it is read): Hours and dollars. Sustained overtime is a staffing request waiting to be written
Backlog (How it is read): Open work orders and overdue scheduled maintenance, with age. A growing backlog is the earliest honest warning
Which KPIs leadership sees (How it is read): A short monthly set: completion rate, backlog, total time to repair, satisfaction, and cost. Pick the KPI set once and keep reporting the same one
Devices per technician: Historically one technician per roughly 1,200 to 2,000 inventoried items. It ignores complexity, contracts, and how the inventory was counted
Hours per device: Build the workload from the bottom up: scheduled hours per model times quantity, plus historical unscheduled hours, plus travel
Workload by risk: Life-support and critical devices need more hours per unit than support equipment. Weight the count, do not just take it
Full-time equivalent: One FTE is one full-time position of roughly 2,080 paid hours a year. Express partial coverage in tenths
A worked case: A system leaves warranty. The quoted contract is $60,000 a year; a junior technician costs less than that. The new position absorbs 0.4 FTE of the system and returns 0.6 FTE to the maintenance schedule
Scheduling: Cover the hours clinicians work, not the hours the shop prefers. A second shift beats overtime when the volume is steady
On-call: A written rotation, a defined response time, documented pay, and a rule about who may be called and for what
What an AEM program is: A program that changes how often maintenance, inspection, and testing happen and what they include, away from the manufacturer's recommendations, on the strength of a risk assessment by qualified personnel
What CMS allows: The change itself, where no other federal or state law and no condition of participation requires the manufacturer's schedule
What may NOT be included: Imaging and radiologic equipment, whether diagnostic or therapeutic; medical laser devices; and new equipment without enough maintenance history to support a risk-based decision
New equipment: Maintained to the manufacturer's recommendations until there is enough history, from the hospital, its contractor, or nationally recognized sources, to support a change
Who may make the decision: Qualified personnel, hospital employees or contractors. The hospital must be able to show how it assures that contractors use qualified people
Evidence required: The equipment's function and the consequences of failure, how serious the likely harm is, likelihood of failure, maintenance requirements, availability of alternative or backup devices, and documented incident history of identical or very similar equipment
Documentation: Written policies and procedures, the risk methodology, the evidence held per equipment type, and the activities and frequencies chosen
Adherence: A hospital must follow the alternative activities and frequencies it set, strictly. An AEM program is not permission to improvise
Identification: Equipment in the program must be readily identifiable as such, and so must critical equipment. Surveyors focus on the critical equipment inside the program

Policy, regulators, and accreditation 35

Scope: Which equipment and which locations the plan covers, and who maintains what between HTM, clinical staff, contractors, and manufacturers
Inventory criteria: What gets an asset number, what is grouped, what is excluded, and how leased, rented, loaned, and patient-owned equipment is handled
Risk and maintenance strategies: How risk is scored, which strategies exist, and how each equipment type is assigned to one
Scheduled maintenance and inspection: Intervals, procedures, who performs them, and the flexibility window the plan uses
Incident response: How a device involved in an event is secured, investigated, reported, and released
Recalls and advisories: Who receives notices, how affected assets are found, and how actions are documented and closed
Emergency procedures: Clinical downtime procedures, utility failures, and how staff get a replacement device
Training: Who trains HTM staff, who trains operators, and how competency is assessed and recorded
Performance monitoring: The metrics the plan reports, to whom, and how often
Annual evaluation: A yearly review of the plan's scope, objectives, performance, and effectiveness, with the findings reported to the committee
Compliance statement: The plan must stand up against federal, state, and local requirements, be specific enough to show how each equipment type is maintained, and reference the organization's other policies rather than repeat them
Environment of care committee (EOC): Equipment inventory and completion rates, incidents and recalls, the annual plan evaluation, and utility and construction impacts
Patient safety: Device-related events and near misses, use error trends, alarm issues, and the actions taken
Risk management: Incident investigation reports, device holds, exposure from pending claims, and reportable events
Performance improvement: Metrics with targets and trends, improvement projects, and the results of corrective actions
Radiation safety: Imaging and therapy equipment performance, service records, survey results, and the radiation-producing device inventory
Infection control: Device cleaning and disinfection between patients and before service, water systems, sterilizers, and loaner handling
How to report to any of them: A short written report with the number, the trend, what caused it, what is being done, and what you need from the committee
CMS: The Centers for Medicare and Medicaid Services pays for most hospital care and sets the conditions of participation a hospital must meet to be paid
Conditions of participation: The federal requirements behind hospital surveys. Several CoPs reach equipment maintenance and documentation directly
Deemed status: CMS lets approved accrediting organizations survey on its behalf, so a hospital accredited by one of them is deemed to meet the conditions
The Joint Commission (TJC): The most common hospital accreditor, with standards for the equipment management plan, maintenance intervals, and competency assessment
DNV: An accrediting organization for hospitals whose program integrates a quality management system with the CMS requirements
AABB: Accredits blood banks and transfusion services, with equipment testing requirements often stricter than the manufacturer's
CAP and CLIA: CAP accredits laboratories against detailed checklists; CLIA is the federal program through which CMS regulates clinical laboratory testing
FDA: Regulates medical devices: clearance for market, manufacturing and performance, medical device reporting, and recalls
CDRH: The FDA center responsible for devices and radiation-emitting products, including mandatory performance standards and recall authority
FCC: Licenses and manages the radio spectrum, including the Wireless Medical Telemetry Service bands hospitals use for patient telemetry
NRC: Licenses and inspects the use of radioactive materials, including nuclear medicine, and enforces its requirements
OSHA: Requires the employer to keep the workplace safe and healthful, with hazard communication, PPE, lockout, and electrical safety rules
HIPAA: Protects the privacy and security of identifiable health information, by rules on privacy and on administrative, physical, and technical safeguards. It reaches every device that stores or sends patient data
State agencies: The state health department and licensing bodies, plus the state's adopted building, fire, and electrical codes. State rules can be stricter than federal ones
NFPA: Publishes consensus codes that become law only where a state adopts them. NFPA 99 is the health care facilities code and NFPA 70 is the electrical code
IEC: International standards used throughout the field, including the 60601 series for medical electrical equipment and the 80001 series for risk management of networks carrying devices
ECRI: An independent nonprofit that tests devices, publishes hazard and recall alerts, and maintains the nomenclature many inventories use

Projects, capital planning, and stakeholders 28

The request itself: What is being bought, how many, for whom, and when it is needed, in the hospital's capital request format
Clinical need: The clinical problem the device solves, stated by the department that will use it, with the consequence of not funding it
Feasibility: Whether the hospital can actually run and service it: staff, skills, parts, and vendor presence
Space: Footprint, clearances, doorways and elevator access, and the room it displaces
Site preparation: Construction, shielding, floor loading, ventilation, water, gases, drains, and who pays for them
Power: Load, receptacle type, emergency versus normal branch, and whether the device needs conditioned power or a UPS
Network: Addresses, ports, segment, bandwidth, interfaces to the record, and the agreement with IT in writing
Total cost of ownership: Purchase plus installation plus service plus parts plus training plus disposal over the life, not the quoted price
Service strategy: In-house, contract, or time and materials, priced for the life of the device, with the training and test equipment each option needs
Standardization: Whether this matches models already owned, and what a new model adds in training, parts, and procedures
Cybersecurity: The MDS2, the operating system and how long it is supported, the patching method, authentication, and encryption
The recommendation: One clear recommendation with the options compared against it, so the committee decides rather than deliberates
Charter: The scope, the objective, the sponsor, the budget, the deadline, and what is explicitly out of scope
Plan: Tasks, owners, dependencies, and the decisions that must be made before work starts
Schedule: Dates with the long-lead items identified: construction, shielding, network drops, and delivery windows
Budget: Capital and operating lines, with site preparation and training named rather than assumed
Stakeholders: Everyone who must be consulted or informed, named, with what each needs and when
Risks: What could delay or break the project, how likely it is, and the mitigation, reviewed as the project moves
Communication: Who reports what to whom on what day, agreed at the start so nobody learns about a change from the hallway
Acceptance testing: The incoming inspection and performance test the device must pass before the hospital accepts delivery and pays
Sustainment plan: Asset in the inventory, schedule assigned, parts stocked, service strategy live, training delivered, and support contacts recorded
Close-out: Final cost against budget, lessons learned, the old asset retired in the inventory, and the sponsor told it is done
Acquisition: Bring the cost history, failure data, and support-withdrawal notices, then compare total cost of ownership, serviceability, standardization, security, and clinical fit, filtering out marketing claims
Contracting: Negotiate price, training, manuals, parts discounts, response times, and exclusions while there is still leverage
Installation: Coordinate site preparation, power, network, delivery, and the pre-acceptance inspection, then inspect, test, tag, record cost and ownership, and assign the maintenance schedule
Training: Deliver operator and service training before clinical use, record competency, and keep the materials where staff can find them
Sustainment: Scheduled and unscheduled maintenance, parts, recalls, upgrades, patching, and cost tracking, with cost per year and failure rate watched so the replacement is seen coming years out
Disposal: Wipe the data, remove it from the inventory, settle the book value, and document the method

Education and training 23

Cost (The question it answers): What the training costs in tuition, travel, lodging, and the weeks of productivity lost while the technician is away
Return on investment (The question it answers): What the hospital avoids in contract, vendor labor, and downtime once the technician is trained, accumulated across four, five, and six years
Operations (The question it answers): Which backlog, response time, or completion problem this training actually fixes
Technical requirements (The question it answers): What the equipment demands: proprietary software, calibration, service keys, or a certificate to open it legally
Competency (The question it answers): Which assessed gaps exist today, by person and by equipment type
Customer requirements (The question it answers): What the clinical departments have asked for, and what they will stop calling the vendor for once staff are trained
Resources (The question it answers): Whether the test equipment, tools, manuals, and parts access exist to use the training once it is delivered
Asset inventory (The question it answers): How many of the model the hospital owns, where they are, and whether the count justifies a trained technician at all
Cost (What it should do after training): Vendor labor, contract spend, and parts cost for that equipment type should fall
Failure rates (What it should do after training): Repeat repairs on the trained equipment should drop, because the fix is now the right fix
Total time to repair (What it should do after training): The clinician's clock should shorten, because the first responder can finish the job
Staff competencies (What it should do after training): Documented assessments move from gap to competent, recorded per person and per model
Skill set (What it should do after training): More models covered in-house, with at least two people competent on every critical one
User satisfaction (What it should do after training): Survey scores for technical competence and responsiveness should rise in the departments involved
Technical and model-specific: Service-level training on one model. Start with the maker of the device, then price independent trainers, who are often cheaper and sometimes teach more
Manufacturer-provided, negotiated: Negotiate training into the purchase: seats, level, location, travel, and lodging, delivered inside the warranty period or the warranty extended until it is. After the sale there is no leverage left
Safety: Electrical safety, lockout, radiation and laser areas, hazard communication, lifting, and infection control for device handling
Soft skills: Customer service, written communication, conflict handling, and how to explain a technical answer to a clinician
Regulatory and code compliance: What the accreditor and the conditions of participation require, how records are kept, and what a surveyor asks
Internal policy: The department's own SOPs, the CMMS, documentation standards, escalation, and on-call rules
Orientation: A new technician gets a mentor, the SOP manual, the MEMP, supervised work, and a documented sign-off before working alone
Certification: Tie steps in the career ladder to a credential and pay for achieving it. Trained, certified staff stay with employers who value them
Competency assessment: Required by the accreditor. Test, self-assessment spot-checked by the manager, observed scheduled maintenance, or review of repeat repairs, documented either way

Human resources and labor law 34

Job description: Duties, required education and experience, certification expectations, physical requirements, and the pay grade. Keep a full ladder of levels and steps: nobody can be promoted into a job that does not exist, and even a two-person department needs at least eight
Selection: Screening against the written description, the same interview questions for every candidate, reference and credential verification, and a documented reason for the choice
Orientation: A mentor, the SOP manual, the MEMP, the CMMS, safety training, and supervised work with a documented sign-off before solo assignments
Evaluation: The annual review, which should contain nothing the employee is hearing for the first time. Feedback is the manager's job all year
Development plan: What the employee wants to be able to do next, the training that gets them there, and the date it is reviewed
Retention: The direct manager is the biggest single factor in whether staff stay. Interesting work, involvement, feedback, training, and respect hold people
Why turnover hurts: Recruiting and training a replacement is estimated to exceed 1.5 times annual salary, before counting the clinical cost of equipment nobody can repair
Performance improvement plan: Specific deficiencies, specific expectations, specific dates, the support offered, and a clear statement that it is an opportunity rather than an automatic exit
Termination: The last step of a documented path, done with the human resources department present and with every prior conversation already on paper
Compensation: Know the local and national market for each grade, and get a real survey done rather than relying on self-reported numbers
Organizational values: Tie department goals to the hospital's stated priorities, so the request speaks the language the budget is written in
Engagement: Bring staff into goal setting. A plan the shop helped write gets implemented; a plan dropped on the shop gets resisted
Goals: Department goals covering financial performance, scheduled maintenance completion, customer satisfaction, response time, repeat repairs, and use errors, shared with everyone
Coaching: Continuous and specific, in the moment, with the behavior named and the better alternative shown
Mentoring: Pair a new technician with an experienced one, with time protected for it rather than assumed
Recognition: Financial incentives are hard to get in a hospital. Recognition and a real say in the department's direction often matter more to technicians
What managers get wrong: Managers rank salary, bonuses, vacation, retirement, and perks first. Employees rank interesting work, involvement in decisions, feedback, training, and respect first, with the money items last
Conflict: Address it early, with the people involved, on the facts, and document what was agreed
Documenting improvement opportunities: Write it down when it happens, in neutral language, with dates and specifics, so the record exists before you need it
Recommendations to human resources: Bring human resources in before you act, not after. They own the process, the consistency, and the legal exposure
Staffing levels: One technician per roughly 1,200 to 2,000 inventoried items as a first pass, refined by inventory value, equipment complexity, risk mix, number of sites, and travel
Cost of a biomed: Salary / 2,080 hours plus benefits plus supervision and unproductive time. Under $100,000 a year is under $50 an hour, about $72 an hour fully loaded, which is below any vendor rate and below most contract labor
Incentives: Pay differentials for certification, on-call, shift, and specialty skills, where the hospital's compensation policy allows
Overtime and on-call pay: Budgeted, tracked as its own line, and governed by a written rotation. Sustained overtime is cheaper to fix with a position than to keep paying
Pay equity: Whatever criteria the employer applies when it sets wages must be free of any influence from sex or race, and comparable work inside the department should be paid comparably. Review it regularly
Certification as a differentiator: Make certification a requirement at defined steps in the ladder and reward it. It is proof of competence and a retention tool, not a resignation risk
ADA: The Americans with Disabilities Act prohibits discrimination against people with disabilities and requires reasonable accommodation. A disability is a physical or mental impairment that substantially limits a major life activity, a record of one, or being regarded as having one
EEOC: The Equal Employment Opportunity Commission enforces the federal bans on discrimination by race, color, religion, sex including pregnancy, gender identity, and sexual orientation, national origin, age of 40 or older, disability, and genetic information
EEOC coverage: The rules reach most employers of 15 or more people, and 20 or more in age discrimination cases. Retaliation against someone who complains or takes part in an investigation is itself illegal
FMLA: The Family and Medical Leave Act gives eligible employees 12 workweeks of unpaid, job-protected leave in a 12-month period for a birth, an adoption or foster placement, a serious health condition of the employee or a spouse, child, or parent, or a qualifying military exigency, with group health coverage continued
FMLA military caregiver leave: Up to 26 workweeks in a single 12-month period to care for a covered servicemember with a serious injury or illness
NLRA: The National Labor Relations Act protects employees' rights to organize, to bargain collectively, and to engage in concerted activity about terms and conditions of employment, whether or not a union is present
OSHA: The employer owes every worker a workplace that is safe and healthful. For HTM that means hazard assessment, PPE, electrical safety, lockout and tagout, hazard communication, and the right to report hazards without retaliation
Hearings and investigations: Human resources present, the facts gathered the same way every time, comparable cases treated comparably, and contemporaneous documentation. The same rule applied the same way to every employee is what keeps the hospital out of court

Questions people ask

How many Certified Healthcare Technology Manager CHTM flashcards are there?

392: 72 Acronyms, 24 The exam itself, 40 Financial management, 30 Procurement, contracts, and the lifecycle, 50 Risk management, 56 Service operations and metrics, 35 Policy, regulators, and accreditation, 28 Projects, capital planning, and stakeholders, 23 Education and training, 34 Human resources and labor law. They come from the course's cheat sheet and glossary, so what you drill is what the lessons teach.

Do I need an account?

No. The cards you mark as known are remembered in this browser only. Sign in to the course for progress that follows you between devices.