Panama City's iSirona is Helping Hospitals Deal with Big Data
October 30, 2013
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,"
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
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
"I believe we need to be paying attention to the data,"
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,
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
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
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."
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