If there is a Sentinel Event and you do a root cause investigation, you may start by looking at what time something occurred. But if you look at an infusion pump, it might give you a completely different time than the heart monitor. Why? Because there is no central device that synchronizes time for devices. This is one of the examples of the lack of interoperability between devices and the potential problems it can cause hospitals.
“If you want to learn from big data, at the very least, they [devices] should share the same time,” says Joseph Smith, MD, chief medical and science officer for West Health Institute.
The word interoperability has been bandied about the healthcare world for several years. It is usually associated with electronic health records (EHRs) and their frustrating inability to talk to one another if they aren’t made by the same vendor, or often made by the same vendor in the same decade. But there is another problem of interoperability that is worrying frontline staff: the ability for medical devices to talk to one another.
A survey of nurses conducted by Harris Poll for the West Health Institute found that just about every one of the nearly 500 respondents thought that medical devices should be able to talk to each other and to the electronic health record, and just about every one of them worked with these devices on a daily basis. Half of them had witnessed a medical error related to a device and its lack of interoperability with another device or the health record.
Almost half said they felt that a medical error was likely due to the necessity to hand transcribe data that these devices should be able to report to one another automatically. If these devices did talk to each other, most of the respondents — 96% — thought healthcare could be safer.
As it stands, three-fourths of respondents felt that a lot of devices ended up creating work for them that takes them away from patient care. The nurses answer alarms, troubleshoot technical issues, transcribe data, and teach patients and family members about the devices, they reported — all things that take them away from other, more important tasks.
An example of the potential safety improvement, says Smith, might be an infusion device and an oxygen monitor. If the infusion pump, dispensing an opioid, was set wrong or the patient somehow decompensated, the oxygen monitor would note a decline in blood oxygenation, sound an alarm, and alert the nurse. Would it not be better, though, if the two were paired and the oxygen monitor could alert the infusion pump, and the infusion would suspend operation pending a nurse or physician arriving on scene?
Another example of the potential of interoperability, Smith says, is if you need to change the programming of one device because of something observed by another. For instance, if the blood pressure of a patient is very high, and the medications aren’t doing what they should, then you would want the rate of medication delivery to increase. “It is closing the feedback loop,” he says. “We want these devices to make sure things are happening the way they should be.”
In the near term, the best hospitals can do is ensure that equipment is uniform so that staff does not have to learn new interfaces. “That does tend to drive us to a single vendor, and reward a business model that does not share,” he says. “I do not like this.”
There are some manufacturers who are integrating across product lines. Another option is middleware vendors, who create software to hang off the back of the devices to make sure they talk to each other or send data seamlessly to the EHR.
He also wants to see more user-centered design for devices. “Right now, we have to pick our EHRs from ONC-certified lines, rather than picking something that is easy for us to use or that meets our needs. Let’s not go that route with devices. Let’s make sure that manufacturers start creating the devices that provide what we need.”
The problem is solvable — we did it with the Internet, he says, which can talk to any device we own. But healthcare lags. “We have to get 21st century information flow,” he says.
The Center for Medical Interoperability, associated with the West Health Institute, is working on the topic, with some 500 hospitals involved in it at the board level. “We can’t be burdening bedside care and clinicians like this. We have to amass our buying power and sentiment to let vendors know that we will only buy what talks to each other.”
That is the long-term approach. For now, the more complicated medical world means it is more dangerous. The best a hospital can do is to keep its finger on the pulse of what is going on within its own doors. Ask frontline staff what problems they have, the workarounds they are having to create, and what worries them most.
Sometimes, a hospital is big enough that its own IT staff can help with some solutions. Other times, he says, vendors may be willing to help.
More information on the Center for Medical Interoperability is available at http://www.medicalinteroperability.org. A conference video on the topic can be viewed at http://www.westhealth.org/igniteinterop. And the entire nurse survey can be found at http://www.westhealth.org/sites/default/files/Nurses-Survey-Issue-Brief.pdf.
For more information, please contact Joseph Smith, MD, Chief Medical and Science Officer, West Health Institute, San Diego, CA. Telephone: (858) 535-7000.
