by: John R. Zaleski, Ph.D., CPHIMS
More than half of U.S. hospitals and health systems are planning to purchase and implement a medical device integration (MDI) solution. This is quite a difference from, say, five years ago. There are a number of reasons motivating this. Partially, the maturing deployment of electronic health record systems; partially, the maturing of the complexity of integration that requires higher-frequency, higher accuracy, higher fidelity data, such as clinical decision support methods within electronic health record systems; partially, the motivation of Meaningful Use and needs for improvement in patient safety; partially the PP-ACA. Other specific motivations, such as the recognition that improved patient care management can be achieved through better, more accurate data. Furthermore, MDI is an essential element for achieving better patient safety.
Improvements in patient safety through better data. For example, communication of data that can be used for patient care management. The 2012 AAMI/FDA Medical Device Interoperability Summit identified “Seven Clarion Themes”. Foremost, interoperability impacts patient safety. The ECRI Institute identified interoperability within the Top 10 Health Technology Hazards for 2013. Based on a 2012 AAMI survey of HIT professionals in 1,900 U.S. hospitals, interoperability issues placed first & second on the AAMI list of Top 10 Medical Device Challenges. Specifically,
- Medical devices and systems on the IT network (cited by 72 percent of respondents);
- Integrating device data into electronic health records (EHRs) (cited by 65 percent of respondents)
Studies of the benefits of receiving patient care data into electronic health record systems as a mechanism for improving nurse-charting workflow have been reported by individual institutions in terms of time to chart. But, the West Health™ Institute, in a report published in 2013 (“The value of medical device interoperability: improving patient care with more than $30 billion in annual health care savings”), as per the title suggests, estimated that through their top-down and bottom-up modeling, an annual saving of $30 billion may be liberated by widespread adoption of functional interoperability for medical devices.
As a researcher with more than 20 years working with medical devices and as a product developer and inventor, the following trends and major milestones are, in my opinion, the recognition of the value of MDI, which occurred not too long after electronic health record systems became widespread, perhaps not quite 10 years ago; then, the motivating Federal guidelines surrounding Meaningful Use Stages 1 & 2; the PP-ACA also provided some motivation. But, beyond that, my opinion is that receipt of data into the electronic health record systems motivated new ideas about what to do with those data. This, in my opinion, is leading to “higher-level” use cases other than charting. For example, use of the data to assist in improved patient care management and clinical decision making. When I started in this field, I was a graduate student and needed to collect data on live patients whom I was studying to develop methods for weaning from post-operative mechanical ventilation. I was running a study on patients recovering from coronary artery bypass grafting surgery and was following “my” patients from surgery through to extubation from mechanical ventilation in surgical intensive care and general surgery. When I was conducting this study, it was years before the commercial electronic health record system was widely publicized. Furthermore, none of the medical devices with which I was working had any automated data collection capability that was exploited within the hospital system I was working. Hence, I had to write my own code and perform data collection on my own, right at the patient bedside. My purpose was in using the data to develop models of patient state; to better predict time-based changes in physiologic and respiratory parameters, and guided by patient demographics, intakes and outputs, and other information. Yet, what was really lacking was a way to collect this information using an automated, standardized approach. So, I got into the MDI field as it was a necessary utility to meet my ultimate needs: complete data for better clinical decision making.
John R. Zaleski, Ph.D., CPHIMS, is the author of Connected Medical Devices: Integrating Patient Care Data in Healthcare Systems (HIMSS Books, 2015).