Medical Device Integration
with an Ambulatory EMR
HIMSS 2010
Fred D. Rachman, MD
Conflict of Interest Disclosure
Fred D Rachman, MD
has no real or apparent
conflicts of interest to report.
Interconnecting Devices and the EMR
Why Connect Devices to an EMR?
Improved Workflow
Reduced Errors
• Eliminate manual and paper recording of
diagnostic testing
• Streamline efficiency & workflow
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Device
Data
Capture
Reduction in lost results
Reduction in transcription errors
Reduction in patient ID errors
Reduction in “missed opportunities”
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Improved Data Access
Improved Data Access
• Immediate enterprise-wide access to results data
• Capture of elements not previously available
• Improve documentation filing and reporting for regulatory/malpractice
Current State
• Devices developed in isolation
– Lack of adherence to cross-vendor standards
• Custom interfaces needed
• Scarcity of well-defined use cases
• Primary experience in Hospital settings
Challenges
• Getting data into the proper data fields is laborious
• Often many parameters exist for different types of
data
– Example: blood pressure data taken with
different body positions
• Disparate data sources with different clinical value
– Example: heart rate from an ECG and heart
rate from a pulse oximeter; often a clinician
needs to make the decision
Efforts to promote increasing interoperability of
Medical Devices with each other and with EMRs
• Consumer driven initiatives to promote medical device
interoperability
• Vendor efforts to promote ability of EMR to integrate with
Medical Devices
• Use cases to drive ROI
Medical Device Plug and Play Program
(MDPnP)
Promotes standards based interoperability of Medical
Devices to
• create error-resistant medical systems,
• support the widespread use of data obtained from
medical devices,
• improve clinical workflow to enhance patient safety and
reduce healthcare costs, and
• produce complete and accurate electronic health records
for clinical care and research
• enable the development of a medical grade network for
high-acuity health care
Founding HCOs: Massachusetts General Hospital Partners
HealthCare System, Inc. Kaiser Permanente Johns Hopkins
Medicine
Vendor Certification
Vendors that are certified have had their EHRs successfully
tested for connectivity to a set of commonly used
devices in the Ambulatory setting.
Objectives:
1) To establish superior functionality and service
standards for device connectivity
2) To improve the customer experience when installing
and operating a connected device with software from a
certified EHR partner
Minimum requirements to receive
Certification
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2006 and/or 2007 CCHIT certification
At least 300 installed customer sites
Independently verified completion of connectivity testing
Commitment to implementation and technical
support coordination with device manufacturer to
improve implementation and service for connected
devices
Certified Devices
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Spot Vital signs equipment
Vital Signs monitor
PC Based resting and stress ECG
PC Based Spirometer
Future devices
• Digital Otoscope
• Digital Stethoscope
• Rapid vision screening device
Use cases
• Drive ROI on both Vendor and Consumer sides
• Largely focused in Hospital Settings
Have focused largely on patient safety on cost
• Need for use cases in the ambulatory setting
Advantages of HIT data
Ability to aggregate and correlate data for evaluation of
impact of medical devices and services in terms of other
process and outcome measures
• Efficiencies
• Reductions in errors
• Reductions in needed referrals and tests
• Outcomes and quality measures
Medical Device Integration Project
Collaboration between a Medical Device manufacturer and
an ambulatory Health Care organization to:
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Establish measures for quality and efficiency gains
Collect baseline data
Integrate selected devices with Electronic Health Record
Demonstrate gains.
Promote new uses for integrated devices in the
ambulatory care setting.
History and Mission of Community Health
Centers
• first funded by the Federal Government as part of the
War on Poverty in the mid-1960s.
• designed to provide accessible, affordable personal
health care services for people living in medically
underserved communities
• Mission encompasses quality, access, and
responsiveness to particular needs of the community
served.
• Typical services include primary care (Including
Pediatrics, Internal Medicine, OB/GYN, and Family
Practice), dental, behavioral health, nutrition, case
management and health education.
Facts about Community Health Centers
• Nearly 1,100 health center grant recipients operate more
than 7,000 community-based clinics
• One of every 19 people living in the U.S. now relies on a
HRSA-funded clinic for primary care.
• HRSA-supported health centers treated more than 16
million people in 2008.
• Nearly forty percent of patients treated have no health
insurance and one-third are children
Alliance of Community Health Services
Overview
• HRSA funded Health Center Controlled Network
founded by 4 Federally funded Health Centers
located on the Near North Side of Chicago
• Aim is to provide infrastructure through which
Centers can share services at higher quality and
lower cost.
• Emphasis on shared Health information
technology platform
• Implementation and support of a common,
centrally hosted EHR with integrated decision
support and performance measures
• The Alliance supports a centrally hosted EHRS
shared by 24 Health Centers in 8 States.
Health Centers at the Forefront of Quality
and Health Information Technology
• Comprehensive model of comprehensive primary care
predating Medical Home concept
• Long history of formal chronic disease management,
evidence based practice and reporting on national
measures.
• Federal investment Health Center Controlled Network
model to support adoption of HIT has resulted in
examples of advanced use and resembles REC strategy
of ONC
• Focus on quality while respecting limitations in resources
have led Health Centers to explore strategies to promote
efficiciency
Common Medical Equipment Used in Health
Centers
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Eye, Ear, Nose & Throat
Stethoscopes
Blood Pressure Management
Cardiopulmonary
Thermometry
Monitoring
Women’s Health
Radiology
• Endoscopy
Drivers for Medical Device Integration in the
Ambulatory Setting.
• Improve efficiency of patient flow
• Reduce errors
• Capture information to facilitate new opportunities for
care delivery
• Capture observations to enable clinical decision support
• Facilitate aspects of Meaningful Use
Categories of Benefits from Device
Integration.
• More efficient capture of information, with reduction in
error
– eg, integrated Vital Sign Device
• Capture of data elements not easily captured previously
for decision support
– eg, EKG, QT intervals used for decision support
around medications
• Ability to share data for new patterns of service delivery
– eg, digital stethoscope, used for remote consultation,
comparison of observations over time
Electronic Vitals Connectivity
Electronic vital signs data is integrated
directly into the EHR vitals template
with one-click data collection and
transfer
• Parameters
NIBP, Thermometry, SpO2, Heart
Rate
• Connected (integrated)
Data transfer via IR RS-232, USB,
and/or RS-232 cables
Connecting Cardiopulmonary Devices
• Provide bi-directional exchange of information between the
EHR system and cardiopulmonary device software
Cardiology Workstation Solution
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Retrieve records with keystroke and on the screen edit
Access information remotely
Fax or e-mail reports directly
Connect to EHR to streamline diagnostic testing workflow
Digital Otoscope and Stethoscope
Digital otoscope and stethoscopes make it possible to
capture visual and sound images as files for
incorporation into the EMR.
These files can be reviewed by different clinical providers,
or can be reviewed by the same provider to compare
observations over time.
Visual files can also be shared with patients.
Measures
Vital
Signs
Improved Accuracy completeness
of data capture
Improved workflow efficiency
Opportunity for improved quality
patient service
Improved data Capture for
clinical decision support
New Data Capture for clinical
decision support/ patient service
EKG
Digital
Otoscope
Spirometer
Challenges Encountered
Technical challenges in establishing interface
Design of appropriate data collection forms in EMR.
Changes in workflow required
Preliminary Findings
• High level of staff and patient satisfaction
• Improved efficiency of recording data
• Overall improvement in accuracy and reduction of errors,
however potential for new types of errors may be
introduced.
How Medical Device Integration Fits with
Meaningful Use
• Promotes quality and safety
• Provides structured data for performance measurement
and clinical decision support
• Health information exchange capacity
• Telemedicine
• Can support patient engagement
Promises and Challenges of the Future
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Wireless Connectivity and Mobility
Expanded devices
Telemedicine and home based services capabilities.
Increased automation of clinical decision support
New challenges with wireless mobile devices and remote
data collection:
– associating devices to a verified patient identifier
– theft
Questions
and
Discussion