Electronic Health Records

Integrating medical devices into the EMR, data repository

Electronic medical records (EMRs) are quickly becoming the standard solution to improve efficiency and reduce healthcare costs in the United States. The EHR Incentive Programs reward hospitals for the meaningful use of EMR technologies that improve patient care. The tracking and benchmarking of patient data enables clinical teams to collaborate on patient health within an organization — and improve on the workflows that capture this key data.

For efficiency and safety improvements, facilities are moving away from manual charting and transcribing data — put simply, manual procedures mean the possibility of too many mistakes, too much time, and too much aggravation. Medical device integration (MDI) enables the automatic transfer of data from medical devices into electronic records which translates to timely and reliable data.

For any facility pursuing an MDI solution, the goal is to get the most bang for the buck in terms of workflow impact for all hospital users and IT staff. The right information from the right devices in the correct format must be automatically integrated into the patient’s EMR safely and accurately. Facilitating this means a hospital must make many decisions, not only about selecting the right equipment and data to integrate but also about choosing the right MDI solution to support its goals. Vendor neutral MDI solutions can connect a variety of devices to different hospital information systems, allowing for change and growth of a hospital’s technology. Its advanced software translates data across all vendors for acceptance by the EMR. Device integration provides broad flexibility in the data delivered to the EMR based on the specific needs of the hospital.

Assessing device capability for integration

To begin the process of determining data points for integration, a clinical walkthrough should be done to evaluate which devices are ideal candidates for the process. Some hospitals house older technology that does not have the capability to integrate; in that case, look at which equipment will have maximum impact with MDI. Monitors, for example, are used in some fashion by almost everyone who cares for patients. For charting and tracking, these are essential players, as are ventilators. Some hospitals now have the ability to integrate with Smart Beds capable of providing data parameters such as patient weight, the degree angle of the bed position and the bed side rail status — all of which have broad impact on hospital operations as it pertains to overall patient safety. In the operating room (OR), large volumes of data from several different devices must be tracked continuously, making anesthesia carts and other OR technologies ideal MDI targets.

Determining data parameters, measurements

Once devices are chosen for integration, the data parameters from each device must be set. What data points does the clinical team need and want in the electronic medical record from each device?  This is an important question that requires detailed research and analysis by nurses, physicians and other caregivers (e.g., respiratory therapists in the case of ventilator integration). A medical device may have 200 parameters, while the team may only consider 30 to 40 to be necessary for clinical decision making. Device data can be pared down for electronic documentation designated by the hospital’s protocols.  MDI vendors should provide consultation for hospitals to offer support not only in the solution choice for MDI but also in setting the key parameters for EMR integration.

Unit of measure has historically been a challenging issue for EMR integration. What may be recorded as a unit of time or percentage by a nurse may be recorded differently by a technologist in another area of the hospital or a device default setting. A monitor may display temperature in Celsius while it has been determined that the record will be a Fahrenheit measurement. Data measurement must be standardized in the EMR and a scalable MDI solution will seamlessly convert this on the backend for a complete and accurate record.

Choosing best data sources from similar devices

In other cases, multiple devices may capture the same or similar patient monitoring signs, (e.g., pulse oximetry) or the measurement of the saturated percentage of oxygen in the blood (i.e., SpO2). These would include a finger cuff, monitor and ventilator. Clinical teams must determine the particular device whose value(s) should be represented in the patient’s record.

Alternatively, they may decide to chart multiple values and find a way to distinguish among the sources. Capturing heart rate or documenting specifics of body placement of IV lines would prompt similar discussions to ensure a successful EMR integration. Teams would also analyze various data points to determine which are continuous and which are aperiodic. Non-invasive blood pressure, for example, is an aperiodic parameter type and the value would normally be sent automatically to the EMR every 60 seconds. However, the team may prefer saving it only hourly unless the values or measurement time has changed. Should data points be noted with the actual time of measurement, real-time or the time shown on the device? With direct data integration, teams must make these crucial decisions proactively to maximize the usefulness of patient data.

Establishing a common naming system

A significant data challenge during integration is the naming convention. Oftentimes, nurses and physicians refer to hospital rooms, beds, devices and even entire units by entirely different names than how they are labeled in records officially.  Also, there can be redundancy in bed, floor, or device identification numbers throughout hospitals, or more typically, hospital organizations or networks with multiple sites or buildings. An agreeable format must be found to ensure MDI data integrity.

Thanks to advanced medical device integration solutions, device data will flow automatically to the EMR.  But to ensure workflow success, IT personnel and clinical staff must collaboratively make strategic decisions about how devices are integrated and how the data is recorded.

Rob Jennings is the Director of Implementation Services for Capsule Tech, Inc., based in Andover, Mass., and Paris, France.

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