Editor’s Note: This is the second of a two-part interview. The first installment can be found here.
“We are a long way from universal interoperability of medical devices, where a device operates as easily and freely as plugging in a new USB-enabled device. Medical device drivers are still required, and these are highly individualized and proprietary,” says author and inventor John Zaleski, PhD, CPHIMS.
In this second installment of a two part interview, Zaleski, author of a new book entitled Connected Medical Devices: Integrating Patient Care Data in Healthcare Systems (HIMSS Books, 2015), explored what vendors, advocates, government agencies and healthcare associations are doing to standardize medical device communication, and how hospitals and health systems can create an environment where medical device integration can thirve.
HIMSS Books: From the vendor side, what do you think needs to be done to make these solutions more standardized, interoperable and user-friendly?
Zaleski: Medical device data communication for the purpose of obtaining those data for documentation, clinical decision support, or the like, do not universally follow a data communication standard. Of course, there are exceptions and there are a number of medical devices whose manufacturers have developed interfaces in accord with the HL7 standard, and some have gone farther and aligned output on frameworks, such as the IHE PCD TF. Yet, this is not enough. We are a long way from universal interoperability of medical devices, where a medical device operates as easily and freely as plugging in a new USB-enabled device to your Windows 7 or Windows 8 computer operates: medical device drivers are still required, and these are highly individualized and proprietary. Even in the situation of HL7-compliant output, there are many “flavors” of HL7 customization that mandate the need for tailoring. I believe one of the hopes surrounding FHIR is to ameliorate a great many of these issues. Yet, the basic challenge of ensuring data from the medical device “out-of-the-box” communicates according to some common standard, with the ability to align on common semantic data definitions, is a necessity that still represents a goal yet unmet. Again, I am speaking generally. There are some exceptions in the medical device space wherein some or all of these statements are met.
HIMSS Books: What are healthcare advocates and associations like HIMSS and the Association for the Advancement of Medical Instrumentation doing to advance MDI? What about government agencies, like the FDA?
Zaleski: I mentioned previously AAMI’s work with the FDA. There are other organizations, such as the Westhealth Institute, the American College of Clinical Engineering, and other healthcare associations, such as AMIA, that are elevating the discussion. ONCHIT has demonstrated its cognizance of MDI. The MDPnP program has been quite vocal over the years regarding the need for medical device interoperability (not simply communication, or integration) to support key clinical workflows that promote better patient safety.
HIMSS Books: Who was this book written for? How do you hope they will use it in a real-word hospital environment?
Zaleski: My goal was to write this book for the hospital enterprise that is about to embark on the process of an MDI rollout. I hope that the contents can educate those about to undertake the process. This book represents the third I have written relating to this topic. It was my hope to share some of my experiences having implemented MDI in live environments.
HIMSS Books: What sort of environment is ideal for MDI’s success? Meaning, what sort of technology, governance and processes should be in place before MDI is considered a logical next step for a hospital or health system?
Zaleski: The MDI project team must be identified that consists of the actors I identified earlier: clinical champion; clinical engineering; facilities; networking; information technology. The team should be educated to understand that undertaking an MDI rollout anew is, in my opinion, best begun by focusing on a single area of the hospital system (for example, surgical services), and then taking the lessons learned from there and expanding to other locations. There is a tremendous amount of “on-the-ground” knowledge that one gains from going through this process. Attempting to “boil the ocean” can result in overall delays and problems. It is better to take small bites of the apple.