Clinical engineering is a specialty within biomedical engineering responsible for using medical technology to optimize healthcare delivery.
Clinical engineers train and supervise biomedical equipment technicians (BMETs), working with governmental regulators on hospital inspections and audits, and serve as technological consultants for other hospital staff (i.e., Physicians, Administrators, IT). Clinical engineers also assist manufacturers in improving the design of medical equipment and maintain state-of-the-art hospital supply chains.
With training in both product design and point-of-use experience, clinical engineers bridge the gap between product developers and end-users.
The focus on practical implementations tends to keep clinical engineers oriented towards incremental redesigns, as opposed to revolutionary or cutting-edge ideas far-off of implementation for clinical use. However, there is an effort to expand this time horizon, over which clinical engineers can influence the trajectory of biomedical innovation.
Clinical engineering departments at large hospitals will sometimes hire not only biomedical engineers, but also industrial and systems engineers to address topics such as operations research, human factors, cost analysis, and safety.
History
The term clinical engineering was first used in a 1969 paper by Landoll and Caceres. Caceres, a cardiologist, is generally credited with coining the term.
The broader field of biomedical engineering also has a relatively recent history, with the first inter-society engineering meeting focused on engineering in medicine probably held in 1948.
However, the general notion of applying engineering to medicine can be traced back to centuries.
For example, Stephen Hales' work in the early 18th century, which led to the invention of the ventilator and the discovery of blood pressure, involved applying engineering techniques to medicine.
In the early 1970s, clinical engineering was thought to require many new professionals. Estimates of the time for the US ranged as high as 5,000 to 8,000 clinical engineers, or 1 per 250 hospital beds.
Credentialization
The International Certification Commission for Clinical Engineers (ICC) was formed under the sponsorship of the Association for the Advancement of Medical Instrumentation (AAMI) in the early 1970s to provide a formal certification process for clinical engineers.
A similar certification program was formed by academic institutions offering graduate degrees in clinical engineering as the American Board of Clinical Engineering (ABCE).
In 1979, the ABCE dissolved, and those certified under its program were accepted into the ICC certification program. By 1985, only 350 clinical engineers had become certified.
After a 1998 survey demonstrating no viable market for its certification program, the AAMI ceased accepting new applicants in July 1999.
The new, current clinical engineering certification (CCE) started in 2002 under the sponsorship of the American College of Clinical Engineering (ACCE) and is administered by the ACCE Healthcare Technology Foundation.
In 2004, the first year the certification process was underway, 112 individuals were granted certification based upon their previous ICC certification, and three individuals were awarded the new certification. By the time of the 2006-2007 AHTF Annual Report (c. June 30, 2007), 147 individuals had become HTF certified clinical engineers.
Definition and terminology
A clinical engineer was defined by the ACCE in 1991 as "a professional who supports and advances patient care by applying engineering and managerial skills to healthcare technology."
Clinical engineering is also recognized by the Biomedical Engineering Society, the major professional organization for biomedical engineering, as being a branch within the field of biomedical engineering.
There are at least two issues with the ACCE definition that often cause confusion.
First, it is unclear how "clinical engineer" is a subset of "biomedical engineer".
The terms are often used interchangeably: some hospitals refer to their relevant departments as "Clinical Engineering" departments, while others call them "Biomedical Engineering" departments. The technicians are almost universally referred to as "biomedical equipment technicians," regardless of the department they work under.