Medical Device Integration Snowballs
When SSM Health Care, with 17 hospitals across Wisconsin, Illinois, Oklahoma and Missouri, began integrating EHRs in 2008, clinical engineering (CE) played a big role in the planning and implementation.
"CE wanted to be involved in the [EHR] planning and implementation," says Heidi Horn, MA, vice president of CE services. It doesn't hurt, she points out, that the system CIO has overall responsibility for the successful implementation and also oversees CE. "If we hear of meetings in which we think we should be involved, we ask to participate. It doesn't take long for people to understand we bring a lot of knowledge on device integration to the table, and they make sure CE is there the next time."
Healthcare technology management (HTM) and IT departments need to work together to implement EHRs, Horn says. While not absolutely necessary, she says "it will only help if IT and HTM report to the same boss."
The implementation and clinical adoption of an integrated EHR has enabled the realization of several benefits, she says. That includes the reduction and, in many cases, elimination of medical errors, significant reduction in transcription expense, compliance with meaningful use Stage 1 and improved turn-around times between a physician placing an order and fulfillment of that order.
Today, the relationship between HTM and IT at SSM "is good and improving every day, as we work hand-in-hand on more and more projects," Horn says. Of the 15 HTM departments reporting to her, those where the IT and HTM departments meet regularly to review projects have a good relationship and IT is more likely to respond to needs. "Like everything, building relationships and trust is key to improving cooperation between teams."
Integration can occur on a smaller scale. For example, Stillwater Regional Hospital in Stillwater, Okla., first integrated finger stick blood sugar testing and glucose monitoring devices, says Chris Roark, CIO. "Now, we're seeing a snowball effect."
Witnessing the success of that integration, the facility went on to link ICU patient vital signs directly to the EHR. Since the ICU nursing staff must take patient vital signs every 15 minutes, they were spending a lot of time transferring those data to flow sheets and into the computer. "We were looking for a way to grab those data and quickly input that information while eliminating transcribing errors," says Kathy Hawkins, RN and IT analyst.
"The cost of nursing care is one of the biggest costs for a hospital," says Roark. The facility earned a huge return on the investment resulting from the integration, he says, particularly when it comes to increased efficiency for nurses. "We want the focus to be on the patient rather than on manual documentation."
The integration went so smoothly that Stillwater has been integrating many more department systems with its EMR, including the emergency department, same-day surgery and endoscopy.
IT and clinical departments must work hand-in-hand with biomedical engineering for successful integration, says Roark. "In the past, devices were siloed and didn't have any network beyond their own proprietary network." Advances in integration interfaces as well as the devices themselves are starting to change that.
Some facilities are rebuilding with this kind of integration in mind. Wise Regional Medical Center in Decatur, Texas, began building its new facility in 2005. Pam Martin, RN, ICU director, dreamed of integrated monitor and charting systems. She interviewed several monitoring companies to learn whether they could interface and says it took some time before that could be accomplished.
The wait was well worth it, she says. ICU nurses went from spending 25 percent of their time charting to 15 percent, which "is a great deal in a 12-hour shift. That's about two hours freed up that can be spent on patient care." Plus, physicians can access those vital signs anytime, anywhere as well.
Whether by device, department or for a complete hospital, integrating medical devices with EMRs is worth the effort.
"CE wanted to be involved in the [EHR] planning and implementation," says Heidi Horn, MA, vice president of CE services. It doesn't hurt, she points out, that the system CIO has overall responsibility for the successful implementation and also oversees CE. "If we hear of meetings in which we think we should be involved, we ask to participate. It doesn't take long for people to understand we bring a lot of knowledge on device integration to the table, and they make sure CE is there the next time."
Healthcare technology management (HTM) and IT departments need to work together to implement EHRs, Horn says. While not absolutely necessary, she says "it will only help if IT and HTM report to the same boss."
The implementation and clinical adoption of an integrated EHR has enabled the realization of several benefits, she says. That includes the reduction and, in many cases, elimination of medical errors, significant reduction in transcription expense, compliance with meaningful use Stage 1 and improved turn-around times between a physician placing an order and fulfillment of that order.
Today, the relationship between HTM and IT at SSM "is good and improving every day, as we work hand-in-hand on more and more projects," Horn says. Of the 15 HTM departments reporting to her, those where the IT and HTM departments meet regularly to review projects have a good relationship and IT is more likely to respond to needs. "Like everything, building relationships and trust is key to improving cooperation between teams."
Integration can occur on a smaller scale. For example, Stillwater Regional Hospital in Stillwater, Okla., first integrated finger stick blood sugar testing and glucose monitoring devices, says Chris Roark, CIO. "Now, we're seeing a snowball effect."
Witnessing the success of that integration, the facility went on to link ICU patient vital signs directly to the EHR. Since the ICU nursing staff must take patient vital signs every 15 minutes, they were spending a lot of time transferring those data to flow sheets and into the computer. "We were looking for a way to grab those data and quickly input that information while eliminating transcribing errors," says Kathy Hawkins, RN and IT analyst.
"The cost of nursing care is one of the biggest costs for a hospital," says Roark. The facility earned a huge return on the investment resulting from the integration, he says, particularly when it comes to increased efficiency for nurses. "We want the focus to be on the patient rather than on manual documentation."
The integration went so smoothly that Stillwater has been integrating many more department systems with its EMR, including the emergency department, same-day surgery and endoscopy.
IT and clinical departments must work hand-in-hand with biomedical engineering for successful integration, says Roark. "In the past, devices were siloed and didn't have any network beyond their own proprietary network." Advances in integration interfaces as well as the devices themselves are starting to change that.
Some facilities are rebuilding with this kind of integration in mind. Wise Regional Medical Center in Decatur, Texas, began building its new facility in 2005. Pam Martin, RN, ICU director, dreamed of integrated monitor and charting systems. She interviewed several monitoring companies to learn whether they could interface and says it took some time before that could be accomplished.
The wait was well worth it, she says. ICU nurses went from spending 25 percent of their time charting to 15 percent, which "is a great deal in a 12-hour shift. That's about two hours freed up that can be spent on patient care." Plus, physicians can access those vital signs anytime, anywhere as well.
Whether by device, department or for a complete hospital, integrating medical devices with EMRs is worth the effort.
| New standards will make medical device connectivity standard |
| Integration between patient monitoring systems and EHRs is "very much in the early stages," says Barbara Majchrowski, MHSc, PEng, senior project engineer, Health Devices Group at The ECRI Institute. Results are hard to come by at this point because most facilities are still in the process of setting up the integration. Some facilities plan to replace their older patient monitoring systems, as they become obsolete, with new systems already designed to integrate with an EMR. It's not that simple though, says Majchrowski. Medical devices typically have a longer lifecycle than IT systems. "Some legacy devices did not have the idea that they were going to connect to a documentation system but that doesn't mean you cannot connect legacy devices to an EMR." Both newer and older devices will probably require a third-party integrator to facilitate different, non-standardized data exchanges into an EMR. She hopes new devices comply to industry standards soon. However, "you can have a standard but still have a million ways to formulate a message," Majchrowski says. The industry must agree on how to send a message across. Integrating the Healthcare Enterprise is working on a common language for patient monitors, ventilators and infusion pumps, for example. The collaboration between clinical engineering and IT "has been in the works for at least 10 years, but as with everything, the train slowly gets out of the gate and then picks up speed," she says. As recently as five years ago, she says, it was hard to know who to contact in IT and biomed staff didn't know how to reach out. "Now they are at the same table and all have a voice." Integrated systems call for IT and clinical engineering departments to work closely together and understand both worlds, she says. Problem-solving is the biggest opportunity for improvement. " An intricate, multi-layered system is so complex that it is a challenge to delineate where a source failure is. It's much more difficult to troubleshoot." In the next couple of years, Majchrowski predicts, medical device connectivity will become standard. "Policies and procedures will evolve and mature as we gain more experience with these projects. We will see the efficiencies gained by having data available for critical clinical decision support and efficiencies in workflow that we so desire for our clinicians." Despite the hurdles, "it will be worth it in the end." |
| Lessons learned at SSM Health Care |
| Heidi Horn, MA, vice president of clinical engineering services for SSM Health Care, based in St. Louis, shares the following "lessons learned" from her experience integrating medical devices and EHRs: 1. Start planning at least 18 months in advance, so you can budget for replacement devices and middleware, if needed. 2. Do not assume that just because you are not being asked to participate in the planning meetings that you shouldn't be there. 3. Get the healthcare technology management (HTM) staff trained prior to go-live on the EHR workflow and how to triage whether the issue is a device issue, a data engine issue, an EHR issue or a network issue. 4. Set up processes before go-live to prevent the "Ping Pong Effect"—what occurs when a service call is placed to the incorrect department. The customer is told to call another department and then another, with no one coordinating to resolve the issue. 5. Different devices have different clinical workflows for the nurses. Make sure to understand those differences and take those into account in the purchasing process. 6. Do not purchase touchscreen EHR workstations for the anesthesia machines. The doctors do not like them and will demand a keyboard and mouse for data entry. 7. When mounting the workstation in a surgery area, remember the anesthesiologists often like to sit during surgeries. Place the monitor so it can be seen from a sitting position and the doctor does not have to turn around. 8. Do not take the vendor's word that the workstation is medical grade. Test for electrical leakage prior to purchasing a large quantity. 9. Do not take the vendor's word that the clinical device you want to purchase is compatible with your EHR or does not require middleware. |
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.