ECRI webinar: Medical device connectivity still plagues providers
 |
Integrating devices facilitates the quick flow of accurate information, without burdening staff and exposing human error to data, but “plug and play” is still fairly far away, according to ECRI. Physiologic monitors, vital signs monitors, infusion pumps, ventilators, anesthesia units, dialysis machines, fetal monitors and defibrillators all fall under the potential scope of interoperability, but implementation costs, challenges and success depend on careful planning by the organization.
There are four basic solutions to integration: do it yourself, use device vendors, hire a consultant, or use a third-party integrator. For most hospitals, a do-it-yourself solution requires a strong IT department and knowledge base, but there are unpredictable costs associated with each solution, including licensing fees, developing custom interfaces and staff training costs.
Vital Signs Monitors
One of the top challenges associated with integrating vital-signs monitors is gaining the ability to identify the patient at the point of care, according to presenter Ramya Krishnan, project engineer, Health Devices Group, ECRI. Most monitors don’t allow entry of patient ID vital signs on the monitor, and data association with patient ID is critical for automated documentation. Another challenge is the ability to ensure the accuracy of the time stamp on the data, as clocks are often not synchronized. Time discrepancies could affect time-sensitive care decisions.
“Automated documentation of vital signs is still in its infancy and the connectivity solutions currently offered have some drawbacks,” she said. Among those drawbacks: loss of function during network downtime and workflow challenges.
Purchasing considerations need to include understanding how the system will fit into their existing workflow. Hospitals should also consider how a system might impact their overall EMR strategy, according to Krishnan.
Physiologic Monitoring Systems
Physiologic monitoring systems can consist of a bedside monitor, a telemetry unit, a central station and associated network components, according to presenter Barbara Majchrowski, senior project engineer, ECRI, and patient parameters are measured continuously, but there may be periodic measurements as well. Physiologic monitors have the potential to connect to numerous systems, she noted.
“So far, hospitals have reported that there have been minimal problems. But those that have existed can take some time to mitigate,” she said. “Hospitals can get very frustrated when vendors take a hands-off approach to how their system ‘plays with others.’”
Integrating these monitors can improve workflows for clinicians, as well as provide them with quick and accurate information to make judgments about a patient’s condition. Interoperability of physiologic monitors is still several years away for many hospitals, but are there benefits?
“Of course the answer is yes,” said Majchrowski. “Clinicians are sometimes disappointed by the inability of a technical solution to fit their workflow to an exact tee, but overall they seem satisfied with the advantages that connectivity brings. They know the early stage of connectivity can be challenging, but they also see the promise of what interoperability and connectivity can bring.”
Infusion Pumps
Infusion pump integration is just getting started, according to presenter Erin Sparnon, senior project officer, Health Devices Group, ECRI, but success, so far, falls into two camps: homegrown systems and enterprise vendor solutions. A third standards-based option is on the way, she noted.
The infrastructures of hospitals vary, and current CPOE and eMAR (electronic medication administration record) systems have trouble with infusion orders and documentation. Pumps report each button press and alert, and eMAR may expect a nurse to validate each data point and recurring alert, noted Sparnon. Another issue is associated with rounding and truncation of dose calculations. The system may cut off at decimal point on the reported dose of a drug administered through an infusion pump and, while possibly clinically insignificant, could affect accurate data reporting.
So far, Salt Lake City-based Intermountain Health has been successful with a homegrown software solution to integrate their infusion pumps, and Wellspan in York, Pa., was successful with the enterprise vendor approach, she said.