AAMI: When it comes to EMR integration, getting there is half the fun

CHARLOTTE, N.C.—The impetus was toward patient safety—with special emphasis on reducing errors in drug prescriptions—when Children’s National Medical Center moved to integrate its medical devices with its EMR a few years ago. The hospital’s director of biomedical engineering, Jeff Hooper, MS, shared lessons learned from the project in a June 3 session at the 2012 annual conference of AAMI, the Association for the Advancement of Medical Instrumentation.

Hooper explained that, after the hospital identified the need for an EMR in 2004, it rolled out the implementation in three phases. Order entry would lead, followed by clinical documentation and then surgical and ambulatory systems. Once internal teams were formed and vendors selected, the organization turned its attention to integrating the relevant medical devices.

“The goal from the beginning was that phase two, clinical documentation, would include BMDI (bedside medical device interface),” explained Hooper, who noted that the EMR rollout coincided with the hospital’s move into a new facility from 2005 to 2009 (the story of which may be familiar to readers of Healthcare Technology Management).

With the big-picture goal established, “the stars all aligned,” said Hooper. Children’s National brought him aboard in 2005 to develop a new biomedical engineering (BE) department under the executive leadership of the CMIO.  

Standardization of equipment being a major part of the plan for both establishing the department and moving the hospital into its new home, project managers decided to replace all physiological monitoring devices. They awarded the install to Philips. 

They made a similar decision around alarm integration and, tellingly, appointed a member of Hooper’s department to manage this effort. This equipment-service specialist went on to earn a promotion to manage device integration across the enterprise. “Clinical Engineering was doing all equipment planning for the new hospital,” said Hooper.

The hospital chose Cerner as its EMR vendor and, not long into the implementation, hired a BMDI specialist to work as an intermediary between Cerner, Philips and the staff of Children’s National, said Hooper before rattling off the devices brought in under the standardization initiative—Philips Healthcare's MP 70 bedside physiologic monitors, Somanetics and Foresight cerebral monitors, and Draeger and Maquet ventilators.

Hooper displayed a graphic showing how Children’s National’s information architecture was centered by a database server dedicated to the intensive care and cardiac intensive care units (ICU/CICU) and connected to central stations in each unit that were fed real-time data by bedside devices through Philips VueLink modules. In turn, the ICU/CICU server fed a Cerner back-end setup that used a Cloverleaf interface engine to pass vital-signs readings and charting info to workstations and then on to the EMR.

Cerner provided a table of available vital sign fields, said Hooper, while the implementation team used a Health Level Seven (HL7) programmer’s guide to map the info and validate the nomenclature.

Hooper's group re-labeled monitors with unique identifying names, then individually tested each for accuracy. Nurses were trained. BE and IT staff were brought up to speed to provide ongoing support.

In fact, the latter remains a work in progress to this day, as the EMR vendor has since moved to a new architecture and as new devices have continued to stream into the facility.

Hooper highlighted several lessons he learned during the culture-changing project:

• Manage user expectations;
• Remember that EMR selection “drives everything”;
• Make sure your EMR vendor is an active partner of your device vendors; 
• Make site visits, phone calls—and buddies;
• Develop metrics to define the value of the integration;
• Test, test, test; and
• Keep a queue of developing to-do’s. (“Always have one step in front of you,” said Hooper.)

“What are you trying to build? It goes back to that question all the time,” Hooper concluded. “You have to understand what your organization’s objectives are and what it is they’re trying to build as a system in order to make good decisions on integration configurations.”

Also presenting at the session was Luis Melendez, an associate director specializing in biomedical engineering, medical device integration and informatics with Partners HealthCare in Boston. He pointed out that much EMR integration is being driven by the American Recovery and Reinvestment Act of 2009 (better known as the “Stimulus”).

“That’s really why IT is such a major player in this and why they have such a significant stake in how decisions are being made. They’re really the ones who are being funded for a lot of this,” Melendez reminded attendees. “And so they come to us [for the device piece] … and it’s important that BE has a seat at the table, helping make a lot of these strategic decisions. There are a lot of financial incentives, and there are penalties for hospitals that do not adopt this technology in and around meaningful use Stage 1 and Stage 2. That’s really an important driver as well.”

Melendez closed by showing a photo of two men near the steep summit of Mount McKinley, separated by 20 yards or so but connected by a rope. “I took this picture,” he said, then explained that one of the men is a member of Partners’ IT team and the other is a member of biomedical engineering. “If one of them were to take a spill down one side of that mountaintop,” he said—and then trailed off to let the audience draw its own conclusions about the criticality of a close, respectful and collaborative BE-IT connection.