This is the second post as part of an ongoing series that discusses the market trends that are affecting the evolution of medical device connectivity (MDC) technology. I received some good comments from my previous post – please consider sharing your thoughts, ideas, and experiences.
The second trend I’d like to discuss is the shift towards patient safety as one of the key market drivers for connectivity. It is probably not news to anyone that patient safety has become one of the key drivers for many healthcare IT initiatives. But what is the relationship between patient safety and MDC? Ever since the often referenced IOM report, To Err is Human: Building A Safer Health System, hospitals and vendors alike have increased their focus on driving towards significant reductions in medical errors. The industry as a whole has made great strides, but still lots of work remains.
With device connectivity, my experience has been that for at least the past 15+ years, the key driver has been making the nurse more efficient by eliminating the manual transcription of device data into the patient’s chart. One of the related benefits is a more come complete and legible patient record. However, one could argue that the more legible patient record could be achieved if the vital signs from medical devices were simply typed into the charting application manually (something that many hospitals are actually doing today). So I believe that the nursing efficiency argument holds as the primary driver – but that is starting to be challenged by the focus on patient safety as it relates to connectivity.
Up to now, bedside patient monitors have been the priority medical device driver for connectivity. Multi-parameter patient monitors produce approximately three quarters of the total number of device parameters that need to be charted on a periodic basis. Other devices that make up the remaining one quarter of the data set includes ventilators, anesthesia machines (of course in the OR environment), standalone pulse oximeters, IV pumps, standalone cardiac output devices, and even beds (weight, angle of inclination, rail positions, etc.) However with the increased drive for patient safety in recent years, we are starting to see hospitals discuss requirements for smart IV pumps to be interfaced as a priority over other devices.
One of the reasons for this shift is likely due to the high number of visible errors involved with high profile infused drugs such as Heparin. Simply put, hospitals are focusing more on those devices that are directly related to patient safety and errors and IV pumps are often in the mix. Hospitals have been migrating to smart IV pump technology. One key market indicator is the rapid growth of smart pumps being purchased – now over 60% of US hospitals have made the switch to smart pumps. For details – refer to this link.
Even though smart pumps are proliferating, challenges remain when it comes to the integration of smart pump data to the EMR and smart pump alarms to alarm management and notification systems. In reality, there are very few instances of IV pump connectivity to EMR or alarm systems. Not only is there the issue related to patient ID and association (for detailed discussion see this link). There are also the issues related to the unique nature of the data produced by an IV pump. But it is a bit ironic that just as patient safety is driving the adoption of smart pumps, the need to ensure safety is one of the factors holding back the end to end integration to the EMR. Vendors have been very cautious on all sides when determining how to integrate pump data. The stakes are high if the integration does not work 100% – patient safety is at risk.
What really needs to be charted into the EMR from an IV pump is the total volume infused (TVI), the infusion rate, and the drug dose. The problem is that EMR vendors have been working on how to accept automated data from pumps – but some EMR’s are not there yet.
One complexity is related to the fact that the EMR cannot just import the data values directly from the pump devices. The EMR needs to perform a calculation of volume infused taking into account what has already been infused over the last charting intervals. Also, don’t forget that most patients are infused by more than pump device at a time, especially in the ICU.
Another important challenge is related to bi-directional communication with an IV pump. Data must be able to flow seamlessly from the IV pump to the EMR for documentation purposes. But to really reduce administration errors and impact patient safety at the bedside, automating the programming of the pump is required. The order for the infused medication or fluid needs to be transmitted to the right pump at the bedside – and this requires a capability to communicate bi-directionally with the pump device. The workflow challenge for the nurse at the bedside is ensuring you have the right patient, the right pump, and that the order matches the patient before it gets to the pump.
I believe that the focus on patient safety will continue to drive vendors towards providing connectivity solutions that solve these types of complex problems. IV pump connectivity and integration are the next big frontier in MDC. What do you think? Whether you are a care provider or a vendor – agree or disagree. Do you think I missed anything?