As healthcare providers feel the imperative to deliver higher-quality care, improve the health of populations and reduce costs – the so-called "Triple Aim" – a small but growing number of hospitals are looking to integrate data from medical devices into electronic health records.
"Smart" medical devices are creating a flood of data that can help in all three areas, but could also overwhelm some organizations as they try to wrangle all that new information. Those that have begun to address interoperability between devices and EHRs are also seeing roles change.
In a July report from Orem, Utah-based health IT research firm KLAS Enterprises, 55 percent of healthcare provider representatives interviewed said integration with EHRs was a "key factor" in future purposes of intravenous infusion pumps, and another 23 percent called it at least somewhat important. Only 10 percent indicated that it was not important to them.
Notably, KLAS asked survey respondents what level of benefit smart pump integration with EHRs would have on their hospitals, on a scale of one to nine. In the realm of patient safety, the average was an eye-catching 8.4. "They all felt that the patient safety gains were significant," report author Coray Tate says.
However, few have actually gone through with connecting infusion pumps to EHRs. Tate says only nine organizations nationwide were "live" with such integration at the time the report came out; one more has come online since then. Another 54 healthcare organizations are reported to be under contract for pump-EHR integration, and 18 of those plan on going live by next summer.
"This is very much just getting out of the gate," Tate says. It is "more dynamic and complicated" than just feeding data from a device into an information system, he explaines. "The process change is as significant, if not more so, than the technology itself."
David Siva, senior director of medical information systems and technology at Daughters of Charity Health System, a six-hospital organization based in Los Altos Hills, Calif., foresaw 10 years ago what connected medical devices could do and how they can better fit into clinical workflows. "We had the vision that it was going to happen," Siva says.
The six hospitals have about 20,000 medical devices among them, Siva says. Since mid-2012, the organization has been working to integrate 16,000 bedside monitors, pieces of telemetry equipment, infusion pumps and other devices with the QuadraMed inpatient EHR, prioritizing based on how much value clinicians stand to realize.
Siva and his team have been looking at how to get data both in and out of various equipment with the help of a medical device integration engine from Panama City, Fla.-based software company iSirona. The technology takes a standard, nonconnected medical device and makes it wireless , sending data to patient records once a minute. "The resolution of available data is much higher [than with manual collection]," Siva says.
It has the added benefit of showing trends over time, according to Siva. "You can retake measurements if they aren't clinically viable," he says.
Gary Barnes, chief information officer of Medical Center Health System in Odessa, Texas, presented a scenario involving patients in a postoperative recovery area. A technician taking temperatures one patient at a time might need four hours to cover the whole unit and then manually enter the readings in each patient's record. The patient's temperature might spike during that time, but the physician might be working with old data and not notice the change. With automatic population of the EHR, doctors can get immediate warnings of potential issues.
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.
Medical technology and IT departments have synchronized various processes as well. For example, syringe pumps have software to support bar-coded medication administration, which requires the administering nurse to scan bar codes on each dosage and on the patient's wristband to make sure it is the right prescription."The technology has already come together, and now I'm bringing in the people and the processes," explains Siva, who reports directly to the CIO.
"The medical devices are getting smarter," Siva says. "We have to get smarter about how we use them."