Clinical Systems Engineering
By: Ray Zambuto, Stephen Grimes
In 2005, the Institute of Medicine (IOM) book Building a Better Delivery System: A New Engineering/ Healthcare System,1 made the case that a partnership between healthcare and engineering could lead to significant improvements in the healthcare delivery system, essentially by recognizing that it is, in fact, a system of interlocked systems, each with its own work flows, resources, overhead, and product. Some of these systems deliver care directly, such as emergency room queuing. Others are more behind the scenes, such as cycling of IV pumps or maintaining operating room (OR) sterile packs.
The IOM book, which was jointly drafted with the National Academy of Engineering, cites the need to apply systems engineering principles to the improvement of these systems. This is significant in that it gives recognition by the clinical community to the fact that solutions to complex problems in the healthcare environment sometimes derive from other disciplines.
More recently, Richard Schrenker reported in IT Horizons that as clinical engineering (CE) and information technology (IT) have converged, they have exposed not only the complexity of the healthcare IT system as a system of systems, but have also demonstrated that the clinical engineer is positioned by training and experience to meet the need for systems engineering in the technological side of healthcare. He makes the argument that there are broader areas of healthcare where clinical engineering can similarly function; however, the very success of clinical engineering in the clinical information arena has tended to create a “blind spot,” both in the profession and in the eyes of healthcare leadership regarding the broader application of clinical engineering in addressing the broader issues of healthcare delivery.
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