How Medical Device Connectivity Can Improve Outcomes in the SICU
In this article I will walk through typical decision-making processes within the surgical intensive care unit (SICU) related to respiratory weaning in order to highlight the key requirements associated with that area and to illustrate the importance of medical device connectivity in acute care environments as a necessary adjunct and enabler for complete documentation and clinical decision making at the bedside.
Acquiring Medical Device Data is Key to Clinical Decision Making
Medical device connectivity in the ICU is essential to supporting a complete clinical decision support framework. While electronic medical records in and of themselves offer enormous workflow benefits, the documentation and charting systems are only as good as the data they convey.
Due diligence by care providers can be augmented by automated and validated data collection, achieved through a seamless form of medical device connectivity and interoperability that is supported both inside and outside the enterprise, and follows the patient from the home to the hospital. Yet, as we know, human beings are complex systems of systems.
Decision making in the healthcare enterprise is often made on the basis of multiple parameters and in the context of the patient presentation, setting, and specific conditions relating to the reason for hospitalization and procedures. The data used in clinical decision- making originates from many sources: devices in and around the patient, laboratory and blood tests, films, and ancillary information available both prior to and during the encounter. How often should data be collected? The assessment of clinical needs change depending on the acuity of the patient and conditions present at the point of care.
Medical Device Open Source Frameworks
The Big Picture
Medical device interoperability and standardization is a hot topic, and with the efforts surrounding adoption of the 11073 standard, IHE and patient care device frameworks, and the drive towards implementing electronic medical records, the field has become essential to the future of the healthcare industry. Yet, as we look to realign medical devices and their communication mechanisms away from proprietary intercommunication and towards standards-based communication, we should think “outside the box” to other fields, technologies and technical disciplines for inspiration and guidance on best practices. Perhaps an obvious one that comes to mind is the USB 2.0 standard. The simple idea being proffered is the ability to plug a medical device into a computing platform and have it recognized and joined automatically to the operating system. While we are a long way from this vision as a universal standard, there is ample evidence to demonstrate its feasibility in the existing Windows and MAC OS architectures today.
Driver Bundling
Key to the seamless and universal use and acceptance of USB devices is the bundling of device drivers delivered as part of base operating systems. When a new device is developed, it could be adopted for incorporation within the base Windows and Mac operating system environments. However, even before that adoption, manufacturers of these drivers could consider bundling them as part of hardware delivery. The drivers could be installed at run time or prior to usage and, from there, no other special attention would be required: attaching a medical device to an accompanying computing platform would automatically result in that device “joining” with the base operating system. The challenge, of course, is how best to develop drivers that support consistent and common access to data. While the common Patient Care Device (PCD) framework fosters such an idea, it has yet to be realized as a universal standard.
One theme embodied by the IHE medical device connectivity demonstrations featured at HIMSS 09 (pdf) in Chicago was that of following a patient from admission through a critical care room, in which patient information was gathered at the bedside from and to the various medical devices present there, including infusion, bed, monitor, and mechanical ventilation. The ability to collect and integrate these data into a bedside electronic health record was accomplished in concert among the several medical device manufacturers through access to the communication frameworks peculiar to the many vendors participating in the demonstration. The bundling of device drivers and publishing of a common syntax required to communicate with the various devices could provide a starting point for enabling universal biomedical device communication.
