Town hall: Interoperability won’t make alarms any quieter
In the wake of widespread media coverage of alarm fatigue in 2011, when the Boston Globe and other outlets linked the problem to hundreds of deaths, healthcare consumers added one more item to their list of worries over hospitalization. The question now: Who owns the predicament?
Four experts addressed that and related concerns Sept. 17 in an online town hall meeting organized by the CE-IT Community, a collaboration of hospital-based clinical engineers and their IT colleagues. The virtual event drew close to 200 participants, many of whom transmitted questions during the 90-minute session.
The session considered the alarm problem in light of increasing device interoperability, by which one device’s alarm may affect the performance of one or more connected devices—for better or worse.
“Who sets the standard?” asked session moderator Elliot B. Sloane, PhD, founder and president of the Philadelphia-based Center for Healthcare Information Research and Policy. “How do we get this field to go from a field that feels a little queasy to a field that is at a standard of care that we can all agree is good enough? Where is the good enough, and who makes it happen?”
Alan Lipschultz, MS, a Philly-based healthcare technology consultant who previously spent close to 40 years in hospital-based clinical engineering, said he believes each provider institution is responsible for tailoring a response to suit its unique environment.
Sloane pressed for clarification. “So are we back to design-engineering and building our own systems from scratch?” he asked, a note of incredulity in his voice. “You put it in a lathe and you make it, and you put in a person and it’s done?”
“No, but it’s still each individual institution that’s making a decision about their system—hardware, software and processes—to make this all work as an overall system,” replied Lipschultz. “And they’re going to be the ones choosing the vendors. They shouldn’t be building it themselves, but they’re still choosing their partners to put the system together.”
“We have standards in areas like aviation to keep airplanes from running into each other, and we have standards in manufacturing to keep dangerous chemicals from being mixed with each other,” Sloane pointed out. “Is this an area that we as a community are going to need to formally address, or will it be addressed organically at each hospital with [a basic networking standard] and forensic assistance?”
Barbara Majchrowski, MHSc, a senior project engineer with ECRI Institute, observed that the glare of the media’s lights might not be such a bad thing as hospitals work through the challenges.
“I’m delighted to see that the industry has taken [the attention] and tried to run with it, because there are no easy solutions,” she said. “You do choose your partners and—depending on those partners, depending on your culture, depending on the patient population—you create management strategies that fit your needs. And what works for one hospital may not work for another.”
Electronic health realities
Another topic that seemed to scare up a batch of write-in questions from attendees: the role of the EHR in solving—or exacerbating—the alarm crisis.
Paraphrasing the questions, Sloane asked the panel: “In your ideal world, should the EHR be a data-logging system ideally, and not add any intelligence or interpretation? Is that practical? Is that what we as engineers think is a good solution?”
Here a vendor voice chimed in. Given the massive number of false alarms reported in various studies, “a lot of data may not show a lot of value if the raw alarms are fed into the EHR,” said Ken Fuchs, MBA, senior principal architect for enterprise systems at Mindray North America, a monitor manufacturer headquartered in Mahwah, N.J. “I don’t know of institutions that are considering dumping that data in; there would certainly have to be more checks and balances to ask the clinicians to verify the alarms before they go into the system. That’s a possibility, but then you’re talking about the labor costs associated with that. I think we’re a bit far away from putting that data into the EHR.”
In the closing comments period, Majchrowski put the problem into perspective by offering numbers from ECRI Institute research. “If you’re looking at just physiological monitoring alarms, depending on the type of patient population and the type of care unit you’re in, it is not atypical to have 250 alarms per bed per day,” she said. “And then if you add on alarms in nurse call and infusion pumps, you can easily reach 800 alarms per bed per day. You’re looking at roughly 2.7 million alarms per year just in [one] unit. Now multiply that across your hospital, and this is something that does matter. It has a huge and direct impact on patient care.”
“There’s a lot of front-end development and innovations—smart alarms and so on—that need to validate actionable alarms before we get into sending these to the networks, systems and EMRs,” added J. Tobey Clark, MS, director of instrumentation and technical services at the University of Vermont. “That definitely is an area we need to focus on before we start integrating the alarms and develop the interoperability.”
Fixes on the fly
Other experts have cited certain advantages to alarm interoperability—among them the ability of a monitor to cut off drug delivery from an infusion pump in the event of, say, cardiac arrest. Clark may or may not have had those observations in mind when he extolled the benefits of “the integration of multiple alerts, which the caregiver needs to be aware of.”
“It’s an important area,” said Clark. “I wish the standards were a little more developed. There are differences in nomenclature, for example, between [various sets of] standards. And that language barrier needs to be clarified.”
Sloane commented: “It would be nice if this were all engineered before we got to interoperability, but the cow is already long out of the barn and we’re sort of fixing this while the airplane is in flight, like so many other things that we’ve done.”
He concluded by lauding the Association for the Advancement of Medical Instrumentation (AAMI) for addressing alarm issues with the FDA and within the CE-IT Community, whose member organizations are AAMI, Healthcare Information and Management Systems Society and the American College of Clinical Engineering.
AAMI and the FDA will convene a summit on device interoperability and integration in early October.
The virtual town hall was the 10th in a series organized by the CE-IT Community, whose website maintains slides and recordings of past sessions.
Four experts addressed that and related concerns Sept. 17 in an online town hall meeting organized by the CE-IT Community, a collaboration of hospital-based clinical engineers and their IT colleagues. The virtual event drew close to 200 participants, many of whom transmitted questions during the 90-minute session.
The session considered the alarm problem in light of increasing device interoperability, by which one device’s alarm may affect the performance of one or more connected devices—for better or worse.
“Who sets the standard?” asked session moderator Elliot B. Sloane, PhD, founder and president of the Philadelphia-based Center for Healthcare Information Research and Policy. “How do we get this field to go from a field that feels a little queasy to a field that is at a standard of care that we can all agree is good enough? Where is the good enough, and who makes it happen?”
Alan Lipschultz, MS, a Philly-based healthcare technology consultant who previously spent close to 40 years in hospital-based clinical engineering, said he believes each provider institution is responsible for tailoring a response to suit its unique environment.
Sloane pressed for clarification. “So are we back to design-engineering and building our own systems from scratch?” he asked, a note of incredulity in his voice. “You put it in a lathe and you make it, and you put in a person and it’s done?”
“No, but it’s still each individual institution that’s making a decision about their system—hardware, software and processes—to make this all work as an overall system,” replied Lipschultz. “And they’re going to be the ones choosing the vendors. They shouldn’t be building it themselves, but they’re still choosing their partners to put the system together.”
“We have standards in areas like aviation to keep airplanes from running into each other, and we have standards in manufacturing to keep dangerous chemicals from being mixed with each other,” Sloane pointed out. “Is this an area that we as a community are going to need to formally address, or will it be addressed organically at each hospital with [a basic networking standard] and forensic assistance?”
Barbara Majchrowski, MHSc, a senior project engineer with ECRI Institute, observed that the glare of the media’s lights might not be such a bad thing as hospitals work through the challenges.
“I’m delighted to see that the industry has taken [the attention] and tried to run with it, because there are no easy solutions,” she said. “You do choose your partners and—depending on those partners, depending on your culture, depending on the patient population—you create management strategies that fit your needs. And what works for one hospital may not work for another.”
Electronic health realities
Another topic that seemed to scare up a batch of write-in questions from attendees: the role of the EHR in solving—or exacerbating—the alarm crisis.
Paraphrasing the questions, Sloane asked the panel: “In your ideal world, should the EHR be a data-logging system ideally, and not add any intelligence or interpretation? Is that practical? Is that what we as engineers think is a good solution?”
Here a vendor voice chimed in. Given the massive number of false alarms reported in various studies, “a lot of data may not show a lot of value if the raw alarms are fed into the EHR,” said Ken Fuchs, MBA, senior principal architect for enterprise systems at Mindray North America, a monitor manufacturer headquartered in Mahwah, N.J. “I don’t know of institutions that are considering dumping that data in; there would certainly have to be more checks and balances to ask the clinicians to verify the alarms before they go into the system. That’s a possibility, but then you’re talking about the labor costs associated with that. I think we’re a bit far away from putting that data into the EHR.”
In the closing comments period, Majchrowski put the problem into perspective by offering numbers from ECRI Institute research. “If you’re looking at just physiological monitoring alarms, depending on the type of patient population and the type of care unit you’re in, it is not atypical to have 250 alarms per bed per day,” she said. “And then if you add on alarms in nurse call and infusion pumps, you can easily reach 800 alarms per bed per day. You’re looking at roughly 2.7 million alarms per year just in [one] unit. Now multiply that across your hospital, and this is something that does matter. It has a huge and direct impact on patient care.”
“There’s a lot of front-end development and innovations—smart alarms and so on—that need to validate actionable alarms before we get into sending these to the networks, systems and EMRs,” added J. Tobey Clark, MS, director of instrumentation and technical services at the University of Vermont. “That definitely is an area we need to focus on before we start integrating the alarms and develop the interoperability.”
Fixes on the fly
Other experts have cited certain advantages to alarm interoperability—among them the ability of a monitor to cut off drug delivery from an infusion pump in the event of, say, cardiac arrest. Clark may or may not have had those observations in mind when he extolled the benefits of “the integration of multiple alerts, which the caregiver needs to be aware of.”
“It’s an important area,” said Clark. “I wish the standards were a little more developed. There are differences in nomenclature, for example, between [various sets of] standards. And that language barrier needs to be clarified.”
Sloane commented: “It would be nice if this were all engineered before we got to interoperability, but the cow is already long out of the barn and we’re sort of fixing this while the airplane is in flight, like so many other things that we’ve done.”
He concluded by lauding the Association for the Advancement of Medical Instrumentation (AAMI) for addressing alarm issues with the FDA and within the CE-IT Community, whose member organizations are AAMI, Healthcare Information and Management Systems Society and the American College of Clinical Engineering.
AAMI and the FDA will convene a summit on device interoperability and integration in early October.
The virtual town hall was the 10th in a series organized by the CE-IT Community, whose website maintains slides and recordings of past sessions.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.