What with all the effort required to get everything plugged together and talking, it is easy to forget that medical device connectivity is really about workflow automation. In other words, providing everything "connects" and works, the question of how it works becomes critical. The October 2008 issue of 24x7 has a story by yours truly on workflow along with some suggestions on how to deal with workflow.

The complexity and costs of implementing a medical device system that uses specialized peripheral devices, applications and systems integration with third party applications can add considerably to the cost and time required to install and implement such systems. This seriously impacts one of the most common tools providers have for evaluating vendor's products.

The on-site evaluation is becoming a weak link in the conventional equipment evaluation process when complex systems are under consideration. An on-site evaluation can certainly reveal how effective the medical device itself may be in a specific clinical environment. This evaluation tool breaks down with purchases that require additional peripherals like personal data assistants or computers on wheels, application software installations, and, especially, systems integration with other hospital information systems. All of these components—that extend beyond the actual medical device—come at considerable expense and time required for systems integration. The result is frequently an on-site pilot that represents only a small fraction of the total system under consideration, leaving the buyer in the dark as to how the complete solution would perform in their environment.

The consideration of workflow associated with medical device systems is presently not receiving a lot of focus in many hospitals. The IT department looks at workflow for their conventional HIT applications. And nursing is focused on policy and procedures associated with caregiving - including IT and medical devices - but this rarely gets down to a detailed assessment of workflow. All of this provides an opportunity for clinical engineering to add value:

In response to the growing impact workflow is having on the ultimate acceptance of equipment purchases, many hospital biomedical/clinical engineering departments have an opportunity to step in and leverage their clinical focus to better account for workflow in vendor selections. An appreciation of the value of workflow is growing. Hospitals are increasingly interested in improving workflow through process reengineering methodologies like Lean and Six Sigma.

The story goes on to propose use cases as a tool to capture, assess and manage workflow at the point of care.  Industry utilization of use cases is growing as vendors and health care providers both look for tools to define requirements and ensure that resulting solutions result in workflows that are improvements over previous manual processes. As we all know, medical device connectivity can easily result in workflow that is a step backwards as far as end user productivity and workflow is concerned.

The main portion of the story describes the components of a use case, and how to create them.

As medical device, connectivity and software vendors zero in on the point of care, workflow will be an increasingly important issues. A complicating factor is the tension between vendor's preferred strategy of proprietary end to end solutions, and clinicians (increasingly impatient) need for patient centric solutions. Use cases will be an important tool for both vendors and providers to assess workflow at the increasingly interconnected point of care.