Author: Bridget Moorman

Update: Integration/interfacing of Medical Devices to an Electronic Health Record

Overview of Medical Device Integration Task I provided an overview of integrating medical device systems and information into an EHR in a paper I wrote in 2008. The figure below provides a graphical representation of the overview. The system architecture for medical device integration consists of a medical device which is attached to a network, and then a series of aggregators and ‘interface brokers’ for the medical device data to flow to the EHR.  Also shown in the figure is a process and system to affiliate the patient information with the specific medical device data (“patient ID binding”).  Generally, the process to implement medical device integration into an EHR consists of identifying a medical device, its networking capability, transforming that networking capability if needed, aggregating the data output from the medical device, and then mapping the data to the EHR or other consumer of the data from the sensors or setting of the medical device. It can be very difficult and time-consuming to implement a medical device integration system as there are many different vendors of medical devices with different sensors and networking capabilities. Many times a medical device does not have the ability to send data or will require a networking transformation to integrate into the system and the EHR.  In addition, depending on the medical device integration vendor, there may not be a ‘driver’ which converts the...

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Usability Heuristic Test of Mobile Fitness Application

I just finished a master’s in healthcare informatics and through that process learned quite a few things.  I am planning a series of blog posts (three or four) that highlight several of the papers I wrote that might be of interest to readers of this blog.  The subjects will cover usability of a popular mobile fitness application, an update on what is happening in the medical device integration space, and an attempt at building a medical device integration knowledge base. My healthcare background as a clinical engineer in the last 26 years has been mainly in operations or industry. ...

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DocBox Introduces New Open Clinical Decision Support Platform

While reading a couple of articles in the healthcare IT industry, several statements stood out as they highlighted some of the issues with EHRs, the data they collect, and how useful that data is to clinicians.  In a recent Healthcare IT news article Dr Anders of Medicomp stated with regard to his desire to follow a diabetic patient that, "I have to click on six different places to see if the patient's renal condition is getting better or worse."  In another article, InterMountain announced that they were working with Clinical Architecture to develop a “clinigraphic technology, which leverages ontologies...

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FHIR in Action – How Well Does It Work?

 Two years ago, I was at eHealth week in Athens, Greece, and stumbled upon several other Americans who represented the Office of the National Coordinator (ONC) touting Fast Healthcare Interoperability Resources (FHIR) as a standard that would help move healthcare interoperability forward more quickly than what we have seen over the last few decades. FHIR has been developed by the HL7 standards organization and among some of its features is based upon RESTful techniques and the Pareto idea of addressing 80% of the most common clinical use cases. At that time (2014), I started a dialogue with some of...

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From Pilot to Policy: Lessons from e-Health Deployed at Scale

As mentioned in previous posts, the United4Health project was intended to test the deployment at scale of mobile health solutions and to integrate those telehealth services as part of the standard of care. Participants took this to heart and used the project to help tackle larger issues of policy, funding, technology, resources and overall workflow. The following interview explores some of these larger issues, specifically:  the need to realign payment models, challenges around the adoption of communications and data standards, the role of test and certification bodies like Continua, overcoming systems integration challenges, patient generated data, and how sensors need...

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Case Study: Sensor Selection for Remote Monitoring

In a previous blog post, I highlighted general principles for implementing and scaling systems to support remote monitoring of chronic conditions, namely congestive heart failure (CHF), Diabetes Mellitus (Type II Diabetes) and chronic obstructive pulmonary disease (COPD).  In this blog post I will focus on COPD as a case study for the development, implementation and scaling of a remote monitoring system. Definition of COPD The World Health Organization (WHO) defines COPD as a “...lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible [...] diagnosis is confirmed by a simple...

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Major EU Remote Monitoring Pilot Results

This post looks at some lessons learned from remote monitoring projects in Europe.  This and subsequent posts are based on my last eight years of supporting these projects combined with some thoughts from my implementation experience of technology systems in many different scenarios over the last thirty years.   I hope that some of it will be of value to the readers wherever they are in the healthcare industry delivery chain. Overview I’m finishing up support  of two long-term projects based in Europe that are focused on using remote monitoring technologies and integrated platforms to support chronic disease management.  One of the...

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Challenges Using Patient Generated Data for Patient Care

When I do presentations on the use of standards, I invariably have a slide which defines interoperability as "the ability of a system or a product to work with other systems or products without special effort on the part of the customer." My second slide then defines syntactic and semantic interoperability. Syntactic interoperability occurs when there are two or more systems capable of communicating and exchanging data and this is usually attainable with the use of physical standards, data standards, and messaging structures. Semantic interoperability is defined as the ability to automatically interpret the information exchanged meaningfully and accurately...

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Connectivity Standards Adoption Over Time

I was listening today to the CE-IT Webinar on CE and HIT from the 2014 AAMI conference in Philadelphia. Much of the session reviewed what has happened over the last five years and it got me thinking about my experiences and what I’ve seen over the last ten years in medical device connectivity and remote monitoring. It’s been an interesting ride and yet I realize there are a few basic ideas that have resonated over the years. These basic ideas are: Specifying those requirements that are unique to my situation are where I have the most control in acquisition;...

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mHealth – How Much Does it Cost and is it Clinically Effective?

I wrote in the beginning of 2012 that perhaps that year was the year for mHealth to ‘breakout. ‘  I cited several proclamations and organizational activities to support that claim. mHealth and the use of remote monitoring as an integrated healthcare offering is still not as prevalent as one would think it would be two years later.  Even in the Telemedicine & E-Health LinkedIn Group, one sees angst at the low adoption rate of the use of telehealth solutions.   Inevitably, when I speak with my colleagues and other people involved in healthcare, economic and clinical effectiveness questions prevail.  Two specific conversations I had with clinicians stand out.  In one, the cardiologist had not seen enough evidence that the quality of care and cost would justify a large addition or change to the existing healthcare offerings.  In another, the clinician reminded me that with chronic diseases, one is attempting to get patients to change their behavior, which is very difficult, regardless of any technology involved. With the above in mind, I’d like to offer the following results from the Renewing Health (RH) project in Europe, a randomized control trial which endeavored to compare the use of remote monitoring technologies and workflows with traditional workflows in the management of chronic disease in both economic and clinical terms.  While the final results of the whole study are due out this summer, Veneto, Italy,...

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