Medical Device Integrationwith 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?

Reduced Errors• Reduction in lost results• Reduction in transcription errors• Reduction in patient ID errors• Reduction in “missed

opportunities”

•

Improved Data Access

Reduced Errors

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Device Data Capture

Improved Workflow• Eliminate manual and paper

recording of diagnostic testing• Streamline efficiency & workflow

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 connectivity2) To improve the customer experience when installing and operating a connected device with software from a

certified EHR partner

Minimum requirements to receive Certification

• 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

• 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:

• 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

• 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

• Parameters NIBP, Thermometry, SpO2, Heart Rate

• Connected (integrated)Data transfer via IR RS-232, USB, and/or RS-232 cables

Electronic vital signs data is integrated directly into the EHR vitals template with one-click data collection and transfer

Connecting Cardiopulmonary Devices

• Provide bi-directional exchange of information between the EHR system and cardiopulmonary device software

Cardiology Workstation Solution

• 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

EKG Digital Otoscope

Spirometer

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

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

• 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