The Prime Minister has promised to ‘harness game-changing tech’ as part of the 10 Year Health Plan, but what role will EBME departments have in integrating and managing these technologies? As these technologies become increasingly connected, do EBME departments have the skills and knowledge they need to support the government’s ambitions? What will be the impact of technology on patient care and how can clinical engineers ensure they are prepared?
Furthermore, as the government seeks to move more care away from hospitals into the community, what challenges will there be from an EBME perspective? How can clinical engineers ensure the remote technology, required to implement the 10 Year Health Plan, will be safe, maintained and effectively connected? These were among the key issues discussed at the Thought Leadership Workshop, held at EBME Expo back in June 2025.
Chairing the Workshop was Iain Threlkeld, head of Clinical Engineering, at Rotherham NHS Foundation Trust. He pointed out that UK Trusts are increasingly looking at IT integration. Medical devices are now being linked into the patient record and need to be connected to a plethora of rapidly evolving digital tools and artificial intelligence. The role of the clinical engineer needs to keep pace with this fast-paced changing landscape and the challenges that this presents were explored during the Workshop.
Iain Threlkeld asked delegates to consider:
- What developments could be introduced to take advantage of increased connectivity to improve patient care?
- How will integration be managed by the existing workforce?
- What do we need to consider, to get ready for the next steps on the journey?
Integration and connectivity challenges
One delegate commented that patient monitoring technology used at their Trust has been integrated into EPIC software and links into the electronic patient record (EPR). However, one challenge, in particular, has been a lack of training around integration among clinical engineers. “It is not just the mechanical side that we are looking at,” they commented. “When we go to equipment, integration is part of the issue,” they continued. “The training needs to be ‘generic’ in terms of IT, rather than specific to an equipment manufacturer,” they explained.
Other delegates pointed out that ageing infrastructure (especially within smaller hospitals) is an issue: “The infrastructure is a big challenge… if clinical engineers had some involvement when infrastructure is put in place, we could help negate potential issues, in the future, when we put in new equipment that is more connectivity oriented,” one delegate asserted.
Infrastructure is going to require capital planning, but also “cascades into a lot of other departments which need insight and approval,” they observed.
Importance of monitoring
Other challenges included the fact that manufacturers of patient monitoring equipment, and other healthcare technologies, have their own proprietary networking systems.
“Clinical engineers are not trained in how to manoeuvre or operate these networking systems,” another delegate observed. They explained that this can lead to challenges when a fault occurs — such as monitors not communicating with a central monitor.
“You may find the connector, the internet cable, and all the IT are working fine, and the monitor shows there is a network, but there’s nothing displaying on the central monitoring system. So, you contact your local IT team who say ‘everything is fine’, but when you contact the manufacturer, they give you a whole new story… The clinical engineer needs to be trained on how to use these manufacturer networks and how to manoeuvre between them, so when there is a problem, they know where to go,” the delegate continued.
Who is responsible?
Iain Threlkeld went on to pose the question: “From a clinical engineering perspective, where do you feel that your job role stops? Is it at the wall outlets; is it the network cable? Are we just hardware or do you feel that we should be supporting the back engine of the networking and connectivity?”
“For me, I think we stop at the outside point,” one of the participants answered. “However, having an idea of the networking could help in the case of an emergency [such as anaesthesia monitors not displaying on the central monitor]. If you have an idea of the background in terms of the networking, you’ll be able to troubleshoot exactly what the problem is and explain and report it to the manufacturer or the ICT team,” they continued.
Another attendee commented that there needs to be a better working relationship and trust building between clinical engineers and IT teams: “I feel that our role stops at the wall, but we need to have a close relationship with our IT team, so that we can negotiate barriers relating to IT login systems, because this can end up being quite time consuming. If we have close contact, we can work with the networking team and make progress.”
Another delegate said: “When somebody has a problem with a piece of equipment, it doesn’t matter whether it’s a switch cable or the equipment itself, they want to be able to ring you and say ‘I’ve got problem, solve it’… All too often, the equipment user will ring EBME who will say: ‘sorry it’s not our problem, you’ve got to ring IT’. They then ring IT, who will say, ‘we can’t find anything wrong with it’.
“Often, IT will make some changes in the network, and they think it hasn’t had an impact on anything, but it has. Realistically we’ve got to be able to look at it and be able to identify the issue, so we’ve got to have some access.”
Need for training and closer collaboration on IT
The attendees also highlighted a need for engineers to not only be biomedically and electrically trained, but to also ‘learn the basics of networking’.
“We need to be able to look at the systems and say, ‘is data coming out or not?’, and ‘what do we need to do about it?’ There needs to be more learning from our side,” one attendee commented.
They highlighted the high stakes and urgency involved, when a patient’s life or diagnosis depends on the availability of the equipment. The IT department’s priorities were perceived to be different and delegates suggested that IT may not always understand or appreciate the urgency and impact on the patient, as they do not have the same background as EBME.
While training will be vital going forward, it also poses challenges, as departments are already short staffed — releasing individuals for 4-5 days of training can create added pressure on already over-stretched EBME teams.
It was noted that Eastwood Park are now offering relevant training sessions and one EBME lead reported that they are currently looking to ‘start the journey, for some junior technicians’, in order to tackle this knowledge gap and bring this skill set into their department’s mix.
One of the delegates also highlighted the value of a study day that was previously run by IPEM a number of years ago, which focused on clinical engineering and IT working together. They pointed out that this is something that would be very beneficial to run again, as it helped to ‘understand each other’s perspectives’.
Rather than training every EBME engineer in IT, it was suggested that Trusts could hire an IT specialist into the EBME department, to operate as the link between the IT department and clinical engineering. They would act as a ‘conduit between the two different skill sets’, possessing a shared vocabulary and understanding.
“Trusts that have already done this have written a job description that is different to the normal clinical EBME technician and have employed these people with huge success,” one of the EBME experts reported.
Other Trusts have achieved this on a smaller scale, where they have a trusted member of staff who has acquired some IT knowledge. By working closely with the IT department, they are able to gain the trust of their IT colleagues, allowing them to ‘do more than they otherwise would’. The panelists agreed that this would speed up fault diagnosis and repairs.
The EBME leads were in agreement that there are challenges around communication between IT and EBME departments, which need to be improved. One of the EBME leaders, who experienced issues with an offsite clinic, explained that this site was networked into a server, located back in the Trust: “I went to the site, to look at the equipment, and they said they’d had an issue with it connecting to the server, so somebody from IT came out and altered some of the network settings on the device. I said, ‘Hang on, a minute, we need to know if there’s been an issue with the device because it’s our service record’.”
The EBME lead pointed out that unintended risks can arise if IT alters the device settings, in such scenarios. Hence, they suggested that there needs to be more clearly defined parameters to fully understand exactly ‘at what point IT gets involved’.
Some EBME leads said their Trusts were already working collaboratively with IT and were finding this closer relationship and better integration very beneficial.
“We were very lucky that our IT manager put a business case together and we now have a person focused on cybersecurity,” another EBME leader reported.
While the relationship between IT and EBME was working well, at this particular Trust, they felt that more resources are needed to ensure device security: “We know what the risks are… Currently, it’s just myself, as Medical Device Safety Officer (MDSO), and a cybersecurity person working together looking at devices, but it’s not enough.
“Medical engineering needs to be working together with cybersecurity, so they have that expertise between them. It’ll give us something to go on until, in time, things are more defined on whose role it is and what training is appropriate… it’s all very new.”
They added that there is too much reliance on OEMs when it comes to network configurations, software updates and cybersecurity in general. All too often, engineering say, ‘that’s not our territory’ and this needs to change. EBME teams need to be able to challenge the OEMs and hold them to account.
Cross department communication
It was reported that one notable Trust in the North has procured an individual to specifically work with their medical engineering team to address such issues.
“I’m not saying that has to happen in every organisation, but as long as you’ve got someone in IT who is linking in and learning medical engineering, and you invite them to places like this, it will help them to develop an understanding, so there is a two-way shared learning,” one delegate pointed out.
Some IT departments are more willing to work with clinical engineering than others, the EBME leaders agreed. Consequently, some Trusts are much further ahead, and one healthcare provider was singled out as an exemplar (Sandwell) — where the Medical Engineering department now reports directly into the Director of IT and Digital. This means they ‘work incredibly closely together’.
“Obviously, they had a new hospital to deal with, so there was a lot of focus on the connectivity and infrastructure,” one of the EBME experts commented. “However, hospitals are increasingly bringing in new technologies with connectivity. Whether building a new hospital or refurbishing, you need to make sure that you have a voice and that you are talking with the project team. It’s about getting into that room and explaining. It’s a great idea to bring IT colleagues to an event like EBME Expo too, because there’s a big focus on the connectivity at this conference.”
Another issue highlighted was the fact that there is an increasing trend for IT people to work remotely. This creates challenges in getting the right people onsite to solve connectivity issues together. There are further issues around IT availability on night shifts. When a fault occurs on a vital connected device out of hours, this can present significant issues.
“The connectivity or device malfunction often doesn’t materialise until it is displayed on a monitor screen and triggers a message or an alarm to the user. Often, the user doesn’t know who to report it to. We need to create defined roles, on who has ownership for these connectivity issues, and if the user comes to us to deal with it, we need to be trained,” said another one of the delegates.
“However, I think there are some potential problems with us becoming trained for that sort of thing — as we will inherit more and more IT jobs. I’m a clinical technologist and I found myself on a night shift in a riser cupboard trying to plug things in — because I was sent on a really good course on medical devices connectivity.
“Although I’m a clinical technologist, I’ve got the training for quite a bit of IT stuff. So, because I’m qualified to do that, I found myself troubleshooting beyond the wall, beyond the port, back to the riser cupboard, logging into remote services to see why data is not coming through. I’ve taken on a lot more jobs than my usual, because of the response time,” she explained.
Real-time priorities
Iain Threlkeld asked them: “Have you had any resistance from IT, when taking on those roles?”
“No, because they’re not inclined to come in on the night shift,” she responded. “Although there’s an on-call person, sometimes they are hard to get hold of. If you’re in an emergency theatre and you’re not getting your data on your anaesthetic machine, it is preposterous to tell an anaesthetist to stop what they are doing, log a ticket for IT, and we’ll escalate it to someone who will come in ‘when they can’. They need a response straight away.
“So, that’s why clinical engineering has inherited these issues and why I was sent on a training course. But I think, if we have a defined role of someone that knows this is their job, they are going to get onto it; they’re going to sort this out. Then the anaesthetist can get the data, which is better for the patient and speeds up the whole process.”
Another EBME expert interjected: “The experience I’ve had is that IT won’t move without a budget code and they have a priority list. So, it’s about getting on this priority list as well. A really important point is that it’s about patient safety and I think patient safety is what gets you into the C-suite priorities.
“I believe it’s the role of head of clinical engineering to take these issues to their exec teams and make them understand, because often the director of IT is an exec member. Quite a few Trusts have very big digital agendas and it’s important to make sure that clinical engineering are part of that digital funding.
“The other issue I want to highlight is that we could be setting ourselves up for a little bit of a challenge in relation to the workforce, because the more skills you give clinical engineers around IT, the more likely they are to be poached by the IT industry. So that is a real risk as well. I’m not saying we shouldn’t do it, for that reason, but pay is going to be a challenge.”
One of the EBME experts went on to caution against another challenge — if EBME departments become absorbed by the ‘digital directorate’, there is a risk that they may become ‘overlooked’ due to the many other competing demands and priorities.
One of the delegates pointed out that, at their Trust, IT is overseen by the Chief Digital and Information Officer’s department (CDIO), then there is ‘CDIO (Med)’ — where the Clinical Safety Officer is located. They are responsible for connectivity, including patient tracking systems etc. “That’s our route in,” they explained.
Overall, the discussion highlighted the fact that there is no standardisation across Trusts, with a wide variety of approaches being implemented to tackle the increasing connectivity of medical devices.
In the absence of strategic oversight on a national scale, each Trust is tackling the issue of device connectivity and evolving responsibilities in different ways. Ultimately, IT training and collaboration will be key going forward.
Technology’s impact on patient care
The conversation moved on to ‘technology’s impact on patient care’ and Iain Threlkeld asked the delegates to consider the following:
- As we move towards providing care away from acute hospitals, what needs to happen to support patients with access to medical equipment in these environments?
- Is there a need for new roles to support this?
- What challenges do we see in moving towards remote care and how can we ensure we are ready to address these?
The government is keen to roll out ‘virtual wards’ with more care being delivered in the home environment. Iain Threlkeld highlighted a paper from the Institute of Mechanical Engineers, highlighting a need for the introduction of a ‘patient enablement engineer’. The report can be accessed at: https://tinyurl.com/5e7a8uxd.
Patient enablement engineers 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.
“There could be a challenge here — how do we get people into the home environment and support them?” He pointed out that with home dialysis, for example, there will be an increase in water bills. “Who is paying for the extra water to run this? We have some elderly patients who need a machine which talks to the internet and sends results to the hospital, but they don’t have WiFi and they can’t afford it, so who is going to pay for it? Who is setting this up? Potentially, there are a lot of challenges out there,” he commented.
Control and influence
One of the delegates responded: “We have a virtual ward, but the team are based on site. One of the issues that arises, when we send babies home on oxygen for example, is that it’s often provided by a third-party provider via the GP, which we have no control over,” he explained.
Further issues have been identified during telecare trials: “The GP may want to monitor the patient’s blood pressure, for example, and they will state that the data should come to the GP. The hospital may be providing the equipment, but now the GP is saying, ‘well, actually it’s my patient’. There is a whole political thing, in the background, and with social care. Is the hospital funding the device that is going out into the community? Is the GP funding it or is it coming out of the social care budget?” he commented.
“I think are we going to end up with a patchwork of different routes across the country, as different areas decide on a different pattern,” he continued. “We have lots of patients with COPD who we provide CPAP devices to, via the chest clinic in our hospital. Patients come in to see our nurses for their health check-up and, if their device is due for a service, we come into the clinic and check it over. That’s fine, as it is controlled by the hospital, but what routes will there be for other devices in patients’ homes? And, if we’re going to get private sector providers involved, how is that going to impact, as well?”
The panelists questioned how HealthTech in the community setting will be effectively managed and serviced, to ensure they are compliant. Loss of assets in the community presents issues and technical training for the users will also be required.
“I’m not sure that we are quite ready for it,” one EBME leader commented. “We definitely need some guidance from MHRA with regards to managing equipment in the community,” another suggested.
The delegates agreed that EBME leads need to push for a model for the effective management of medical technologies, before the virtual ward initiative expands much further. This will be preferable to allowing things to develop and then trying to manage chaotic and fragmented systems further down the line.
“We need to solve the problem before it becomes too big,” Iain Threlkeld summarised.
Considerations for the workforce
Maintaining medical devices in the community will have significant work force implications — the NHS will require mobile engineers to visit people’s homes and a lot of time will be spent on travelling. Therefore, the health service will need to recruit and train many more engineers.
It was suggested that the virtual hospital could learn a lot from the military, who have extensive experience of maintaining dispersed assets in the field. Pool kits are used on the battlefield, one of the delegates explained.
One Trust has implemented a system where a box (effectively a pool kit) is sent out to patients in the community, with a pulse oximeter, BP machine and a thermometer, for example. The technologies are linked via an iPad and instructions are supplied in multiple languages (appropriate for the region).
The set up is kept simple in order to cater to people who struggle with technology — they simply press a button, then results go off to the hospital via WiFi. When the patient is finished with the equipment, it goes back into the box. A courier collects it and a third-party gets the box ready for the next patient. The third-party company retains the pool kit in an off-site workshop.
Hospital care at home
Using this approach, the hospital can obtain vital signs information from the ‘virtual ward’, either prior to coming in for an operation, or to reduce the need to take up hospital beds post-operatively. The patients’ home environments also vary greatly which can present challenges with regards to medical technologies and the provision of therapies at home. For example, water quality and water pressures vary from house to house. The cleanliness of a patient’s house can also affect the management of equipment.
“A key consideration is whether the device has a filter,” another EBME expert pointed out. “The cleanliness of patients’ homes isn’t necessarily what your home would be and if they have a lot of dust and nicotine, etc, things can get clogged.”
The state of the patient’s home will dictate the frequency of the maintenance required. So, how can this be assessed and managed in the community? Who will undertake this environmental assessment? Would it be a clinical engineering team or the manufacturer? And how can we sensitively manage discussions with patients about the cleanliness of their homes?
“For visiting engineers, there’s quite an emotional challenge as well because they get to know the patient really well and then they pass away. They have to go to the home and take the equipment out and the family is still mourning. It’s a really difficult situation,” one delegate shared.
The resilience of equipment also needs to be considered. While hospitals have back-up generators, what happens when there is a power cut to a patient’s home? In the case of home dialysis, it is not time critical — the patient can simply wait until the power is back up. But the virtual ward will ultimately be limited in what it can deliver due to constraints around the home infrastructure.
As one delegate pointed out, “You can work around a potential power cut for renal, but if you’re going to put an ICU at home, somebody is going to have to monitor that. You’ve got to have connectivity. What if the internet drops out? What if the power drops out, and the ventilator stops working? We are going to have to draw a line at some point.
“The people around this room need to advise the Trust and say, ‘you can’t do that, even if it looks like a great idea on paper, because these are the practical considerations…’ We need to be the people that are listened to and have that respect, when we say ‘no’.”
“When it comes to technologies, let’s be honest, we haven’t got a crystal ball,” another delegate interjected. “We don’t know what’s coming in the next decade. I think a lot of it will be about managing people’s wellbeing through prevention and managing long-term conditions — it will be about keeping people out of hospitals because it’s nicer to be at home.
“I can imagine a situation where someone with a long-term condition wakes up, does their blood pressure, does their monitoring, does all their blood tests themselves and all of that gets transmitted through to some sort of central monitoring.”
The panel highlighted that if we are sending patient information across the network that also needs to be secure.
“I think the challenge is going to be knowing what you’ve got and where it is. I think that’s still a big challenge. It is easier in an acute setting to do tracking, but there are some GPS technologies emerging. The price is still too expensive and can cost more than the asset, however,” one EBME leader commented.
If the cost starts to come down, this may become more of an option in the future, they suggested. “We already have wearable technology coming through. It’s only a matter of time, I think,” another delegate commented.
Conclusion
In conclusion, the panel highlighted that many of the issues discussed were not simply ‘clinical engineering issues’ — they are ‘common issues’. There is a need to make all stakeholders understand that clinical engineering is about medical device management and patient safety. The lifecycle of medical devices management needs to addressed, as a whole, by working collaboratively. Ultimately, medical technology management must be everyone’s concern — as patient safety is the overriding priority for all.
Solving the issues highlighted in the Workshop will require a coordinated, multi-disciplinary approach. EBME experts need to have a strong voice and show effective leadership, if the government’s ambitious 10 Year Health Plan is to be delivered safely and cost-effectively.
There will be significant challenges ahead in moving care out of hospitals, and the EBME sector needs to highlight these at an early stage and advise on potential solutions — before the ‘proverbial horse has bolted’.
For further details on EBME Expo 2026 and future workshops, visit the event webiste at: https://ebme-expo.com
Acknowledgement
- This article was originally prepared for HEJ’s sister publication, Clinical Services Journal. We are grateful to CSJ’s Editor Louise Frampton for kindly permitting its inclusion in this month’s issue.