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First published in National Academy of Engineering Perspectives, May 27, 2022, date of re-publication in GlobalCE Journal, June 1, 2022

Copyright and Credit belong to National Academy of Sciences (all rights reserved).

The Growing Role of Clinical Engineering: 
Merging Technology at the Point of Care

By Thomas Judd1 and Yadin David2  

1 International Federation for Medical and Biological Engineering’s Clinical Engineering Division, USA 

2 Biomedical Engineering Consultants LLC, USA

Keywords – healthcare, technology, clinical engineering, patient care, health systems, global collaboration, nursing, policy

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

Fiza Shaukat is a native of Pakistan living in the United 
States. As a biomedical engineer, she was eager to improve 
her country’s medical devices and digital health strate-
gies. She approached us in 2018 seeking expertise in 
clinical engineering, which focuses on the point-of-care 
intersection between the use of health technology and 
the expertise needed for optimal support and resource 
management.

Pakistan, like many countries, has faced myriad sys-
temic challenges, which were amplified by the covid-19 
pandemic; these challenges include a fragmented delivery 
system and a lack of interoperability between medical 
devices, electronic health records, and other recent 
health technologies. We worked with Fiza on a health 
technology asset management method. Later, during the 
pandemic, we pointed her and her in-country colleague 

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Judd, David : The Growing Role of Clinical Engineering: Merging Technology at the Point of Care

Tazeen Bukhari to the covid-19 inventory tool, offered by 
the World Health Organization (WHO), to assess national 
gaps in the availability of medical devices and oxygen; the 
information was used to inform the Pakistani Ministry of 
Health’s plan for confronting the pandemic.

Meanwhile, Fiza faced the premature loss of her 
grandmother due to cardiac complications—she had not 
received care in a timely manner because patient data 
and test results could not be shared quickly between 
providers. Fiza took initiative so that her loss would not 
be repeated for other families. She brought a technical 
solution to the point of care, using clinical engineering 
and emerging health information technologies.1

As clinical engineers (CEs), we have encountered 
variations of Fiza’s story in several countries. Clinical 
engineers support and advance patient care outcomes 
by applying engineering, life sciences, and managerial 
skills to optimize healthcare technology during its life 
cycle deployments. They are sought for their systems 
thinking expertise, to conduct an independent validation 
of healthcare products, identify support requirements, 
and ensure that medical device users’ needs are met and 
that products are accessible and ready for patients. They 
assess and manage the use of health technologies, which 
WHO defines as “the application of organized knowledge 
and skills in the form of (medical) devices, medicines, 
vaccines, procedures, and systems developed to solve a 
health problem and improve quality of care and/or life,” 
including both traditional medical devices and emerging 
digital health tools.2

To illustrate the range of CE contributions, we offer 
two examples.3 The first is in device innovation. In re-
mote desert-like regions of Western and South Australia 
treatment for trauma victims requires long-distance and 
space-limited transportation. The patients are often in 
shock and require a blood/fluid transfusion. But these 
fluids are kept at a very low temperature, and rapid infu-
sion of cold fluids can worsen a patient’s condition or even 
induce hypothermia. Two clinical engineers developed a 
fluid/blood warmer that does not require electrical power 
but uses the latent heat principle to warm intravenous 
fluids at accident sites, overcoming the lack of suitable 
portable fluid warmers that are not dependent on main 
electrical or battery power.

The second example involves risk reduction and safety 
of medical devices at the point of care. A clinical engineer 
and his team in Mexico’s National Center of Health Tech-
nology Excellence investigated national management of 
medical equipment in public hospitals. They concluded 
that, among the country’s 32 states, health technology 
management was effectively coordinated by trained CE 
practitioners.4

Clinical engineers are trained to identify challenges and 
opportunities to improve healthcare delivery through the 
adoption of effective and safe technological solutions. For 
example, “alarm fatigue” can be eliminated in ICUs with 
smart medical device alarms that triage the urgency of 
attention needed, distinguishing life-threatening events 
from those less urgent. And remote care for patients 
isolated due to infection concerns can reduce the time 
and cumbersome logistics involved for care providers to 
monitor and tend to their patients.

Clinical engineers recognize the need for both systems 
expertise in healthcare partnerships and the development 
and implementation of national policies to reduce frag-
mentation and inefficiencies in healthcare delivery.5 The 
case for such expertise and partnerships has been made 
in classic consensus reports of the National Academy of 
Medicine—To Err Is Human: Building a Safer Health System 
(2000), Crossing the Quality Chasm: A New Health System 
for the 21st Century (2001)—and in a joint publication 
with the NAE, Building a Better Delivery System: A New 
Engineering/Health Care Partnership (2005). The latter 
report notably described “opportunities and challenges 
to using systems engineering, information technologies, 
and other tools to advance a twenty-first century system 
capable of delivering safe, effective, timely, patient-centered, 
efficient, equitable health care” (p. vii).

We are encouraged to see recent evidence of engineer-
ing partnership improving healthcare delivery, in the May 
2021 NAE Perspective, ERs Rise to the Covid-19 Challenge: 
Teamwork between Engineers and Healthcare Providers 
Cuts ER Waiting Time, and in a Johns Hopkins University 
January 2020 article, Enter the Surgineer. But the vision, 
alas, is yet to be fully realized.

Since 2020 the US healthcare delivery sector has lost 
over 300,000 workers,6 exacerbating a staffing shortage 

https://pubmed.ncbi.nlm.nih.gov/25077248/
https://pubmed.ncbi.nlm.nih.gov/25057539/
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https://www.bme.jhu.edu/news-events/news/enter-the-surgineer/#:~:text=%E2%80%9CIt%20is%20to%20'bury%20the,member%20of%20the%20clinical%20workforce.


31 J Global Clinical Engineering Vol.5 Issue 1: 2022

Judd, David : The Growing Role of Clinical Engineering: Merging Technology at the Point of Care

that existed before the pandemic. Nurses are among the 
most impacted group.7

A new approach that includes shared interprofessional 
training can help alleviate the situation by training clinical 
engineers for engagement at the point of care. We envision 
broader systems responsibilities for all care delivery team 
members, to overcome the segmented and increasingly 
specialized healthcare workforce and thus ensure higher 
quality and safety through a new collaborative approach.

THE INTERSECTION OF TECHNOLOGY AND 
HEALTHCARE DELIVERY

Clinical engineers have the expertise to facilitate a 
systems approach to health, where technological tools 
are needed to measure health system inputs and outputs. 
Tools for monitoring and reporting clinical parameters 
and laboratory results enhance the identification of early 
trends in large populations and can support better health 
and wellness.

The use of health technologies must be strategically 
guided, with coordination of local, national, and interna-
tional resources, optimal resource management, policies 
that guide technology-related outcomes,8 and plans for 
life cycle stages. To that end, a healthcare model is needed 
that integrates the delivery of care to improve both care 
outcomes and patient experience.9 Such integration re-
quires adequate knowledge of the technology life cycle, 
from innovation to application; academic programs that 
keep up with changes to point-of-care technologies; and 
participation in technological innovations such as robot-
ics, artificial intelligence, and implantables.

Clinical engineers have a foundational role in this 
integration, with their unique knowledge related to the 
management of health technology systems and validation 
at the point of care. In coordination with clinicians and 
other stakeholders, CEs are demonstrating the benefits 
of their inclusion as equal members of the healthcare 
delivery team, particularly during the global pandemic, 
at both the point of care and population health levels.10 

GLOBAL NEED

As the sales of global medical products are predicted 
to reach $658 billion by 2028,11 it is clear that, for optimal 

return on investment and sustainability, the implementa-
tion of such products should be managed and supported 
by trained professionals such as clinical engineers.

During the first 2 years of the covid-19 pandemic, 
WHO’s World Health Assembly focused on the need for 
intensive care ventilators (2020) and medical oxygen 
(2021).12 WHO has specifically recognized clinical engineers 
for optimally managing assets such as medical devices, 
personal protective equipment, oxygen, and digital health 
tools, particularly in low-resource settings.13 

Two CE organizations, the International Federation of 
Medical and Biological Engineering Chemical Engineering 
Division (IFMBE CED) and the Global Clinical Engineering 
Alliance (GCEA), grew tremendously during the pandemic 
with a surge in the need for their members’ expertise. 
In partnership with WHO, these organizations are now 
connected to colleagues in nearly 200 countries, sharing 
best practices and solutions to complex challenges.

The next step is to build the right systems capabilities 
for improving global healthcare delivery.

A CALL FOR ACTION

For clinical engineering to transition from localized 
point of care to population health, certain systems com-
petencies must be in place:
1. Education of the workforce to create greater collabo-

ration and resiliency. Collaborative interdisciplinary 
educational training14 will ensure the systems skills 
needed to maximize the benefits of health technolo-
gies. With demonstrated competencies and interna-
tionally coordinated professional credentialing, CEs 
will be prepared to be equal partners with the other 
members of a healthcare team, participating in new 
clinical roles and workflows to free physicians and 
nurses for direct patient care.

2. National health technology policy to address prior-
ity national challenges. Pandemic-related impacts 
necessitated rapid implementation of national health 
technology policy in many countries.15 This and ex-
periences with other disasters (e.g., floods, wildfires, 
earthquakes, power outages) clearly show the need for 
international coordination of new national guidelines 
to sustain access to, availability of, and the transfer of 

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Judd, David : The Growing Role of Clinical Engineering: Merging Technology at the Point of Care

critical healthcare technology tools. Clinical engineers 
can play an important role in informing and imple-
menting such policy.

3. National and international alliances and partnerships 
to share expertise and lessons learned. Such alliances 
will coordinate meetings of healthcare stakeholders 
(e.g., clinicians, administrators, and ministry of health 
personnel with clinical engineers) to examine areas 
of concern where CEs can make a difference. For ex-
ample, the Global Clinical Engineering Alliance has 
offered webinars, a virtual international congress, 
and a global CE summit to identify and rank common 
global challenges. Such alliances can help those in 
the health sector, industry, academia, and NGOs drive 
cost-effective and high-quality innovations in health-
care delivery, and manage the performance of the 
technology used at both point of care and in regional 
and global populations.

As healthcare delivery systems around the world in-
creasingly depend on technology for access to the best 
care, the expertise of clinical engineers in the use and 
management of this technology is critical for achieving 
best outcomes. For both point-of-care and population 
health, a systems approach can improve the delivery of 
health services through education, workforce collaboration, 
policy development, and partnerships. Clinical engineers 
are indispensable partners in achieving this mission. Just 
as Fiza was driven to overcome challenges, the approach 
described here shows a pathway to achieve the outcomes 
we all need.

REFERENCES

1. See “Women Shaping the Health Tech World 2021” 
(https://www.youtube.com/watch?v=DHV5hNqNeI4).  

2. WHO Compendium of Innovative Health Technologies 
for Low-Resource Settings 2021: Covid-19 and Other 
Health Priorities. Geneva. p. vii.

3. For further evidence of the scope of CE contributions, 
see Clinical engineering success stories and patient 
outcomes based on evidence from 125 countries 
(chapter 3, Clinical Engineering Handbook, 2nd ed., 
2020, Academic Press).

4. Ayala R, Orencio E. 2019. Identification of health tech-
nology management departments in Mexico’s state 
health services. Global Clinical Engineering Journal 
1(2):17–21. In their article CEs are referred to as 
biomedical engineers.

5. Many CE success stories are reported in our 2020 
article, “Evidence-based impact by clinical engineers 
on global patients’ outcomes” (Health & Technology 
10(2):517–35).

6. US Bureau of Labor Statistics. 2022. The Employment 
Situation – April 2022.

7. Kreimer S. 2022. Nursing shortage looms large and 
projected to intensify in next 18 months: Report. Fierce 
Healthcare, Apr 5.

8. For an introductory resource on Development of 
Appropriate Health Technology–Related Policies 
and Legislation, see IFMBE CED 2020 Webinar on 
Healthcare Policy.

9. Such impacts are demonstrated in the projects recog-
nized by the Healthcare Information and Management 
Systems Society (HIMSS) Davies Awards.

10. See the presentation by Claudio Meirovich on “Covid 
Case Studies” (track F3) at the IFMBE CED-GCEA Oc-
tober 2021 Global Virtual Congress.

11. Fortune Business Insights. 2021. Medical Devices 
Market…2021-2028.

12. WHO Priority medical devices list for the COVID-19 
response and associated technical specifications

13. WHO. 2017. Human Resources for Medical Devices. 
Geneva. See pp. 24 (table 1) and 40.

14. Institute of Medicine. 2015. Measuring the Impact of 
Interprofessional Education on Collaborative Practice 
and Patient Outcomes. Washington: National Acad-
emies Press.

15. Sharma J, Bunders J. 2020. A model for priority setting 
in health technology innovation policy. Global Clinical 
Engineering Journal 2(3):24–34.

http://www.globalcea.org/
https://ced.ifmbe.org/covid19/gurupcategs/16-covid19/view.htmlHYPERLINK%20%22https:/www.globalcea.org/webinars%22
https://www.globalcea.org/icehtmc
https://www.youtube.com/watch?v=DHV5hNqNeI4
https://www.who.int/publications/i/item/9789240032507
https://www.who.int/publications/i/item/9789240032507
https://www.who.int/publications/i/item/9789240032507
https://www.sciencedirect.com/science/article/pii/B9780128134672000031
https://www.sciencedirect.com/science/article/pii/B9780128134672000031
https://www.globalce.org/index.php/GlobalCE/article/view/51/22
https://www.globalce.org/index.php/GlobalCE/article/view/51/22
https://www.globalce.org/index.php/GlobalCE/article/view/51/22
https://www.bls.gov/news.release/pdf/empsit.pdf
https://www.bls.gov/news.release/pdf/empsit.pdf
https://www.fiercehealthcare.com/providers/nursing-shortage-looms-large-and-projected-intensify-next-year-and-half-report
https://www.fiercehealthcare.com/providers/nursing-shortage-looms-large-and-projected-intensify-next-year-and-half-report
https://ced.ifmbe.org/ce-leadership-competencies-webinars/guruPrograms/14-ce-leadership-competencies-webinars/51-policy-legislation.html
https://ced.ifmbe.org/ce-leadership-competencies-webinars/guruPrograms/14-ce-leadership-competencies-webinars/51-policy-legislation.html
https://www.himss.org/resources-all?f%5B0%5D=resource_center_resources%3A29766
https://www.globalcea.org/icehtmc2021-materials-2?hsLang=en
https://www.globalcea.org/icehtmc2021-materials-2?hsLang=en
https://www.fortunebusinessinsights.com/industry-reports/medical-devices-market-100085
https://www.fortunebusinessinsights.com/industry-reports/medical-devices-market-100085
https://www.who.int/publications/i/item/WHO-2019-nCoV-MedDev-TS-O2T.V2
https://www.who.int/publications/i/item/WHO-2019-nCoV-MedDev-TS-O2T.V2
https://www.who.int/publications/i/item/9789241565479
https://doi.org/10.17226/21726
https://doi.org/10.17226/21726
https://doi.org/10.17226/21726

