Device Integration: Getting Point-of-Care Data Where Its Needed
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The problem is that many of these devices—such as vital sign monitors, infusion pumps—use vendor-specific protocols, and aren’t designed to share information. A clinician may be able to access bedside device data, but specialists or nurses elsewhere may have no way of seeing it, unless it’s manually recorded in the patient record. Despite efforts to develop standards for these devices, there is no standard format for point-of-care device information exchange.
EHR and EMR vendors support direct integration of device data into an electronic record system, easing enterprisewide connectivity as hospitals build on connections they have already. Such device integration efforts have been going on for more than a decade at WellSpan, a health system serving the greater Adams-York County region in Pennsylvania, according to R. Hal Baker, MD, FACP, the organization’s vice president and CIO.
WellSpan includes two hospitals and a multi-specialty medical group that includes 30 primary care practices. Together, the hospitals account for 614 beds and more than 1 million office visits per year. The goal of integrating devices was originally part of “a desire to get more efficient, although not necessarily paper-free,” says Baker.
WellSpan uses Cerner’s CareAware architecture in its inpatient EHR, which enables data to be input directly from supported devices into the patient health record. The healthcare system is currently in the third year of a five-year agreement with Cerner to integrate more devices, starting with nursing records, moving to ventilators and monitors in the facilities’ intensive care units. Getting IV pumps connected to the EHR is WellSpan’s next move, says Baker.
Cerner writes the interface program that allows the CareAware technology to convert the monitor/device output into a data field in the EHR. “Most vendors have a device-specific output. Cerner’s system makes bringing it into the Cerner record easier, but [it’s] not quite yet ‘plug and play’,” Baker says.
Because information moves from devices directly to the record, this returns time to caregivers, who can spend more time with patients, he says. “It’s very unusual to walk around the floors a few days after go-live, and have nurses tell you how much they like it.”
“It’s a big win for clinicians because it gets them out of the middle of having to enter everything into the record by hand,” he adds.
Serial connection
Another integration option combines hardware/software to deliver information. This technique, used by vendors including CliniComp and Capsule Systems, transmits device data to a concentrator or repository, which converts the data to a network packet and forwards it to a server. Data are converted to a useable format, such as a flavor of HL7, and forwarded to the facility’s health information system.
At Baptist Health South Florida, a five-hospital health system and the largest not-for-profit health care organization in the region, the effort to integrate devices began in 2002 as part of the healthcare system’s effort to get away from paper records, says Melissa Barthold, MSN, RN-BC, CPHIMS, FHIMSS, Corporate Manager, Nursing Informatics at the health system.
Baptist Health South Florida has implemented CliniComp’s Essentris clinical documentation system for their perinatal departments in three of the five hospitals, says Barthold.
The CliniComp system collects data from bedside devices in all perinatal units, including neonatal intensive care units (NICUs), and sends it to the documentation module via two routes. A data acquisition system (DAS) connects serially to bedside fetal monitors, ventilators, and non-networked physiological and cardiac monitors, and stores data from these devices. Data from centrally networked devices can also be collected and stored by the DAS. Essentris software then converts the data into usable information. Data buffering capabilities allow each DAS to continuously receive data and store it into local memory for a minimum of 24 hours.
“As long as a device can send the data out, the Essentris system can interface to that device through the DAS. No matter where they go in the system, in Essentris, they can acquire the data from multiple sources,” says Barthold.
“If everything is plugged in, it pretty much works,” says Barthold. She has the numbers to prove it. After the integration implementation, average time for nurses to input vital signs in intensive care units dropped from 4 minutes to 20 seconds, she says. The average time required by respiratory therapists to document ventilator settings in ICUs dropped from 5 minutes to 3 minutes with implementation of the biomedical device integration system, Barthold adds.
More than 1,000 nurses now use the system, she says. “We planned it only for nursing, but others liked it so much they want to document there, too,” she says.
A go-between
Device integration is ongoing at Children’s Mercy Hospital, an academic pediatric-only medical center that includes 317 inpatient beds in two hospitals, plus urgent care facilities. Approximately five years after the medical center began its partnership with Cerner to implement healthcare solutions, “we’re not completely integrated, but getting closer every day,” says Morgan Waller, RN, BSN, clinical systems analyst, IS critical care representative and lead for the inpatient biomedical device integration project for the Kansas City, Mo.-based facility.
Capsule Systems’ DataCaptor provides device connectivity via a monitoring gateway for the vital sign monitors, and through terminal servers, which are serially connected to Ethernet concentrators, for the portable devices, according to Waller.
The gateway and the terminal servers “report, if you will, to the DataCaptor server,” Waller says. Within the server, the transactions are identified numerically and delivered via HL7 to Children’s Mercy Hospital’s Cerner EHR (called “PHRED,” the Pediatric Health Record Electronic Database). They are then translated into recognizable data and presented to the appropriate fields of the EHR, Waller says. Currently, about 38 fields are interfaced, she says.
“Capsule provides that go-between for the patient and our electronic health record,” she adds.
Currently, the Siemens Servo I ventilators and GE Solar 8000i vital sign monitors are interfaced into the hospitals’ electronic health record for the PICU and ICN units, which comprise 27 and 64 beds, respectively, says Waller. The respiratory therapists went live with Capsule in November, and because the department was already live with the Cerner iView direct charting application, the process was relatively painless, she says.
Children’s Mercy plans to integrate its Somanetics cerebral oximeters and aspect bispectral index monitors, followed by integrating the anesthesia machines in all 20 ORs, as well as two cath labs and radiology suites, later in the year, says Waller. In addition, “ER and Sedation will be looking at integration for their Solar 8000i monitors,” she says.
In the five years since Children’s Mercy decided to go paperless with Cerner, “we’ve gone live with many applications,” and biomedical device integration is a natural portion of the process, Waller says. “It’s a huge win for end users, it simplifies their workflow. It’s time-saving, immediate, accurate. …Transcription errors are virtually eliminated.”
In the more distant future, Children’s Mercy Hospital plans to integrate additional respiratory support devices and “IV pump integration is certainly on our timeline as well,” Waller says.
Implementing BMDI has been easy, because most of the basic features do not require much effort on the part of the end user: “If they already know how to use their app for charting, this is a snap,” Waller says.
One-time data capture
The University of Alabama Medical Center includes two inpatient hospitals with 908 beds and 213 beds, respectively, and employs about 1,100 staff physicians. The system accommodates about 55,000 ER visits annually. UAB began to deploy Cerner clinical systems in 2002 as part of its EHR initiative, says Joan Hicks, CIO of the hospital system.
For device integration, UAB opted for Cerner’s CareAware MDBus (medical device bus) integration solution. “One of the reasons we chose Cerner is because of their standard database. We want to capture [data] once and reuse it throughout all of our clinical systems,” says Hicks.
In January 2006, UAB went live with a BMDI pilot unit using CareAware. Today, devices including ventilators and vital sign monitors are integrated into the EMR. Physiological monitoring data from several ICUs also is integrated into the medical record. In addition, UAB was a Cerner development partner for integrating data from fetal monitors to the EMR. That integration—the first of its kind in the nation, according to Hicks—went live in December.
“Most of the systems are stand-alone, but … it’s extremely important that [patient data] stays with the record,” Hicks says.
The next phase for UAB is to enable regular nursing units to have vital information automatically captured into the record at bedside. “That will definitely be … a nursing staff pleaser for them not having to [manually] enter those vital signs on the regular unit,” Hicks says.