As a project manager working with hospitals on a daily basis, it can sometimes feel like I’m on an episode of “MythBusters.” Consistently, I work with hospital executives, nurses, clinicians and IT staff that have been told “one-size-fits-all” when it comes to various technology implementations. And, in my experience, it typically doesn’t take long before the truth is exposed.
For hospitals entertaining a technology implementation like medical device connectivity, there is not a one size fits all approach. Each hospital facility is unique and the a la carte and mix and match options for integration are numerous. Spending ample time with a collaborative team made up of the CMIO or CNO, biomed, nurses, IT and clinicians to define an enterprise device connectivity strategy prior to selecting a solution, is essential.
A critical step in this process is defining the devices and workflow of each hospital unit to determine the best solution to maximize the results of medical device connectivity. For intensive care units, typical devices to integrate include patient care monitors, ventilators, monitoring devices, beds and dialysis machines. Connections with these devices can be accomplished through a serial connection or via the device gateway. Evaluating the types of devices in each location and how they connect will determine the hardware or software needed to integrate in those locations.
For example, a unit with a patient monitored gateway that only occasionally uses ventilators may choose to connect the devices to the EHR via the gateway and use a mobile piece of hardware on the ventilator that can wirelessly send the data points to the EHR. In contrast, a unit that has only serial monitors and ventilators may choose to use a non-mobile piece of hardware in each room to achieve connectivity. Some devices may send vitals directly to the EHR without a gateway, or with an attached third party device. Evaluating these differences will help determine the best way to connect.
The type of monitoring needed for a location can be broken down into two categories, continuous versus spot-check. The workflow of each is specific to the locations and roles of the clinicians, and will directly affect where the clinician’s work is done – at the device or in the EHR. EHRs achieve connectivity with room-based location association, device specific association or patient-centric association. The EHR’s capability will have a direct effect on defining the strategy.
In a room-based association with continuous monitoring such as an ICU, the nurse will interact with connectivity primarily within the EHR where they will review and validate vital signs. In a patient-based association with spot check monitoring such as a Med/Surg floor, the nurse tech will typically send verified vital signs from the device at the bedside without even logging into the EHR. This means vital signs are available immediately upon completion and readily available for clinical decision support. In the OR, the anesthesiologist can review the continuous monitoring while it is flowing into the EHR – therefore these vitals are sent as validated to the EHR.
Of course, the hardest part for determining the scope of connectivity is the future. Are the decisions we make today growth oriented or will more hardware need to be purchased? Imagine the ability to take collected data and compare, contrast and analyze it from multiple sources and then deliver it back to caregivers in a meaningful way. The near future may hold the ability to manage device connectivity for each patient across the spectrum of care, including data integration along with alarm and alerting support.
Accomplishing this begins with seeing past the “one-size-fits-all” myth, and developing an enterprise strategy for medical device connectivity that is unique to the individual hospital facility, based on a thorough review of locations, devices, workflow and EHR capabilities.
Michelle Grate is project manager, Capsule Tech, Inc.
