While the most meaningful information about a patient’s health comes out of interactions directly with clinicians, valuable data is also available through monitoring patients using a variety of medical devices. A challenge for healthcare organizations and providers is to incorporate the latter effectively into the EHR system and the patient’s electronic record so that the most reliable health information is available to the care team at the point of care. Given the number of manufacturers and diversity of their products, efforts to implement medical device integration (MDI) requires careful consideration and strategic coordination of project managers, health IT staff, and other pertinent personnel.
John C. Lincoln Health Network in Phoenix, Ariz., successfully completed its MDI project last year by working closely with its EHR and MDI vendors, Epic Systems and iSirona, respectively, to make integrating medical devices part of the system-wide overhaul of its health IT systems. Overseeing those projects was Robert Slepin, VP/CIO at John C. Lincoln. In this installment of the CIO Series, Slepin discusses best practices for MDI as well as the tangible benefits for clinicians when this kind of patient monitoring is implemented correctly.
When did you integrate your medical devices into your EHR?
We implemented Epic in 2012 across our Network. Most of our physician practices went live on Epic as well as both of our hospitals. After we assessed the requirements of the organization, we decided that medical device integration (MDI) was a core requirement for the first phase of the implementation. We chose to implement medical device integration with our big bang go-live for our two hospitals in August of 2012.
How was the MDI project managed alongside the EHR implementation?
We established an overall program and organizational structure for implementing the electronic medical record. Epic was a key partner for us in driving that program, but we also worked with a number of other vendors — including iSirona for MDI — in parallel project work streams for other applications which together with Epic comprised a comprehensive electronic medical record. For medical device integration, we assigned a dedicated project manager from John C. Lincoln, and we formed a project team that included an iSirona project manager and a combination of Epic staff and John C. Lincoln IT, biomedical engineering, and clinical staff to plan and execute that part of the work plan.
How did you come to choose which medical devices to integrate?
We surveyed the devices in our hospitals and decided not to integrate every single device, but we prioritized them. We identified a subset of devices that we thought would bring the greatest value in terms of return on investment. We looked at all the critical and intensive care units and the emergency departments and decided to include and scope all the patient monitors, balloon pumps, and ventilators in those areas, plus the anesthesia machines and patient monitors that are attached to them for the inpatient and outpatient operating suites throughout the organization. We cast a pretty wide net that included a wide variety of devices from a number of manufacturers. There were dozens of different kinds of equipment. Really the biggest challenge of the project was to manage the diversity of equipment. They’re not all plug and play with MDI.
What health IT infrastructure is necessary for supporting MDI?
In parallel with the EHR software implementation, we overhauled our technology infrastructure. We moved our production servers into a brand-new data center that’s tier-3 class, rock solid and highly redundant, so that it is always up and running. We installed new servers and replaced our entire data storage with a new system designed for high availability, high reliability. We also upgraded the data network: We put in a new wireless network and modernized many aspects of our wired network. In this particular case for connecting the MDI devices to our EMR, we chose to use wired versus wireless for the highest reliability. In theory, we could use wireless but we wanted the most reliable configuration possible. End to end, you need to design and build in high reliability so the information is always available.
What is the best piece of advice you have for other CIOs handling MDI?
Cultivate a really good relationship with your MDI vendor because they hold the key to the kingdom as far as software and device integration. You have to be able to trust and rely on your MDI vendor to have the device drivers either built in their library and available for reuse or be very crisply responsive to gathering your requirements for new devices to assess the technical implications and work with you in a timely manner on integration. The device process requires investment of time and resources for assessment, planning, development, testing, and deployment.
What are motivations for integrating medical devices?
The value of MDI is in optimizing the quality of care by increasing accuracy, timeliness, and access to biomedical data across the continuum of care — any authorized users at any time from any point in our organization can see that data in real time and the data can be leveraged for real-time clinical decision support. Having that kind of access is valuable for our clinicians.
Another big benefit is time savings for the anesthesiologists as well as nurses. That time can be plowed back in to attending and focusing on the patient, which is why we’re here in the first place. Having highly-trained physicians, nurses, and other clinicians reading data off of a monitor and then transcribing and rekeying it, or keying it directly into a PC via the keyboard– that is wasteful motion and time and it’s error prone. That’s not the best use of time for these clinicians. We would much rather see these folks spending time with patients, assessing information, making decisions, and providing care than being data-entry clerks.
