I had a true “aha” moment while sitting in the audience during Tim Gee’s presentation, “Everything is Connected at the Point of Care”, at the New Jersey and Delaware Valley Chapters of HIMSS Fall Conference last week. This was one of the first conferences I attended where I knew many of the attendees personally as I live in the area and have known these IT professionals and clinicians for many years. I watched the reaction of many of them during the presentation and chatted with several after the session. My conclusion? Nurses get it. Clinical engineers (though few and far between at the conference) get it.  Many IT professionals still do not.

What don’t they get? That there is a growing impact or even a true threat to patient health and safety from the rapid yet disconnected implementation of medical and information technology at the point of care. (More information cited by Tim can be found in the attached presentation or here, here, and here). To many of the IT professionals, connectivity is about plumbing. It is not. Medical device connectivity is all about workflow in the service of patient safety and the clinician.

I think it’s safe to say that every hospital represented at the conference is dealing with the following issues.

1. Implementing sophisticated medical devices with embedded computing capabilities, including point of care diagnostic devices, patient monitors, telemetry packs, “smart” IV pumps, ventilators and spot vital signs devices
2. Managing an array of communications modalities at the bedside including nurse call, overhead pages, PDAs, barcode readers, computers on wheels, pagers and wireless phones
3. Nurses who must address an array of bedside tasks, not the least of which is hands-on patient care, but also documentation, alarm management, patient assessments and medication administration

The complexity and disparity of systems (people, process and technology) surrounding the point-of-care  can lead to noise, confusion, and an interrupt-driven environment with consequences such as alarm fatigue, failure to rescue, delays in care, and work flow poorly aligned with how clinicians really do their jobs.

If the vigorous bobbing of heads by the nurses seated in front of me was any indication, we are not managing this well.  What’s missing? I suggest it is the lack of strategic analysis to wrap our arms around this growing interrelated, multi-vendor ‘system-of-systems’.  Yes, each individual medical or information technology decision is assessed, but what about the big picture? Evaluating individual point-of-care applications in a vacuum can result in waste and complexity as previous phases are replaced or modified to support unanticipated impacts from subsequent phases.  We need  to apply the same rigor to evaluating needs, performing risk & budget assessments and taking the necessary steps to measure the impact of adding new component to the ‘system-of-systems’ that we do when replacing applications in our HIS systems.

It’s time for IT professionals to get into the game. They need to understand the interrelatedness of the complex clinical systems they are building piece by piece over time. They must actively contribute to the processes to select, implement & support all components of point of care technology – particularly as they “ride” on the hospital’s IT network.

An excellent reference for IT professionals is the publication, “Medical Technology for the IT Professional,” offered by ECRI Institute, a nonprofit organization dedicated to bringing the discipline of applied scientific research to discovering which medical procedures, devices, and drugs are best to improve patient care. Here’s what ECRI suggests every IT professional should know to assist their hospital to develop an effective ‘system of systems’.

1. Understand the criticality of their work on patient care and recognize that diverse stakeholders must come together to select, implement & support point of care technology
   • Clinical groups (nursing, radiology)
   • Support groups (clinical engineering, biomed & IT)
   • Administrative groups (risk management, contracts/purchasing)
   • Technology vendors & manufacturers
2. Understand the technology at point of care
   • Physiological monitors
   • Infusion technology
   • Asset tracking systems
   • Clinical laboratory
   • OR integration & surgical video systems
   • Anesthesia information systems
   • Telemedicine
   • Imaging systems
3. Know how to
   • Integrate systems & devices in a multi-vendor environment
   • Develop an IT infrastructure to adequately support medical technology and devices
   • Implement reliable wireless systems
   • Comply with standards and regulations
   • Mitigate IT security issues
   • Ensure patient safety and reduce risks
4. Be familiar with IT’s role with regard to compliance
   • Regulations governing medical devices
   • System security and accessibility
   • Hazard and recall management
   • Problem reporting and incident investigation
   • Service and support
   • Standards-related initiatives
   • Environmental concerns

Let’s get going…

Everything Is Connected at the Point of Care by Tim Gee_DV-NJ HIMSS.pdf (3.89 mb)