For a trial, the 402-bed Medical Center Hospital bought five "smart" blood-pressure cuffs that automatically send data to the inpatient EHR. They proved to be instantly popular. "Others started wanting them," reports Barnes.
Barnes said he was able to persuade the hospital's chief executive to replace every conventional cuff in the hospital with wireless blood-pressure cuffs from medical device supplier Welch-Allyn Inc. in fiscal year 2014, which began Oct. 1. The vendor will be working in tandem with the IT staff to integrate the new devices into clinical information systems in the coming months.
The hospital replaced all of its heart monitors in the last several years, automating data collection in the process, and is now looking beyond traditional clinical settings. "We're just evaluating home monitoring now," Barnes says.
Mike Garzone, an executive with CTG Health Solutions, the health care management consulting division of Dallas-based Computer Task Group, says some are starting to pull data from consumer-focused gadgets like the Fitbit personal activity tracker. "Devices like that are going to be enablers when we talk about home health," Garzone says. "You want to keep [patients] out of the emergency room."
In fact, the Annals of Thoracic Surgery recently published a Mayo Clinic study about a trial that demonstrated how Fitbit could predict postsurgical recovery time by recording how far people walk each day after an operation.
The availability of so much more data presents a whole new set of challenges in itself. At Medical Center Health System, for example, ambulatory and home-health records go into a different EHR than inpatient information, but the issues go beyond the technical realm.
"Technology is not the solution, it's the tool," says Meryl Bloomrosen, vice president for thought leadership, practice excellence and public policy of the American Health Information Management Association, a Chicago-based organization representing health information management professionals.
"I believe we need to be paying attention to the data," Bloomrosen says.
She has seen many inconsistencies in data coming from medical devices into EHRs because of the many different standards out there, including some proprietary ones. "These standards are not equivalent. We're not harmonizing them yet," Bloomrosen says.
"Data and information governance should be technology-neutral," she says. Proper data management includes not just raw data, but also technical expertise and connectivity to the cloud, Bloomrosen adds.
This might necessitate a rethinking of traditional roles. While hospital CIOs historically just manage information technology, Medical Center Health System put Barnes in charge of clinical and biomedical engineering – programming and management of medical devices – nearly five years ago.
Clinical engineering also recently gained authority over purchases and maintenance of all medical devices in the hospital rather than having individual physicians or departments make the final decision. "It has made a tremendous improvement in our workflows," Barnes says.
As CIO, Barnes is in the loop on all technology purchases, understands what data will come out of each device and knows how to integrate that information into the EHR, according to Barnes. "We're really creating an enterprise view of what data is needed and who needs that data," he says.
At Daughters of Charity, Siva has reorganized some areas in preparation for device integration. He now oversees image management as well as a medical device integration team. The California hospital system has outsourced medical device repairs and maintenance, though Siva is responsible for acquisition of devices and related software. He is directly involved in the organization's clinical informatics strategy, which helps extract meaning from data.