By Ken Olbrish, MSBE
While healthcare has undergone a dramatic transformation for the better via the integration of medical devices with information systems, the unforeseen consequence of marrying these technologies is similar to the marriage between the healthcare facility and the vendor providing these solutions. In many cases, these relationships have been fruitful for both parties; however, in other cases, they have led to prolonged difficulties for the facility since extraction is no longer a matter of simply switching to another product.
Historically, if a healthcare facility had significant issues with a particular device, it could select another device from another vendor as a replacement moving forward. Oftentimes, contracts were in place that allowed for such transitions with minimal financial impact to the facility.
And unless the device was expensive and not easily removed, such as with an MRI, or there were no long-term purchase commitments to the vendor, the facility could move on from a bad experience in a relatively short amount of time. Maybe there was some financial impact and the need to retrain staff—but a way out of the relationship existed.
Now, so much time and money is invested in integrating medical devices and information systems that it’s increasingly difficult for a facility to walk away. Entire workflows are developed around systems over long periods of time, and these workflows may vary significantly from system to system.
Just look at today’s smart pump technology. Traditionally, facilities wishing to standardize on a particular infusion pump could switch to a different device model from a different vendor if the currently pump didn’t meet expectations.
Not so anymore. Today’s smart pumps are part of a complex network—tied to pharmacy systems to interact with drug libraries. Not only are they often integrated into the facility’s electronic health record (EHR) to transfer clinical data to the patient’s medical records, they also rely heavily on the facility’s Wi-Fi infrastructure to exchange data in real time.
Moreover, a vendor application most likely manages the pumps. And there are potentially other integrations involving barcode systems, asset tracking, and real-time locating systems.
Key Logistical Concerns
Not surprisingly, building such complex interfaces within the system takes significant vendor resources in terms of installation and configuration. And facilities must also make significant investments of their own.
Along with ensuring that the clinical engineering department works with IT to design and scale the Wi-Fi infrastructure to support the volume of pumps, IT personnel must also collaborate with the vendor to build Health Level Seven interfaces to both the facility’s EHR and the pharmacy systems.
What’s more, the hospital’s pharmacy staff must build out the drug libraries and rules—and the nursing staff must work with the vendor to design a workflow for using the pumps in a clinical setting, in addition to coordinating all training initiatives for bringing the pumps into day-to-day clinical use. And, finally, the asset management staff must tag the equipment and add it to their inventory-tracking systems.
This doesn’t even incorporate all the time needed to build test environments and test out these complex interfaces. Nor does it take into account how much time dozens of individuals within the facility spend to plan these tasks and coordinate a rollout of the new devices without impacting patient care. After all, hours and hours of facility and vendor resource time is spent to bring all of this together over a long period of time.
Now, imagine what would happen if this complex deployment of technology—one that should benefit patients—goes live and isn’t successful or what the facility expected. What if the interfaces don’t properly deliver data or the system is very complex and the nursing staff won’t use it as a result? And what if people discover this early on?
Even then, no quick solution exists. Even if officials say they’re abandoning the technology in favor of a different system, the facility would’ve still wasted significant time and money to get to that point. After all, the facility would face major setbacks in terms of rolling out a technology to benefit patients since it would have to go through the entire process again, thereby adding months—if not years—to it.
Making the situation even worse, the facility may try to work with the vendor to resolve the issues and, in doing so, may inadvertently delay the deployment of a successful technology even further—especially if a solution cannot be found.
And what if significant issues arise after the technology had been installed for a year or two, due to unforeseen issues associated with device reliability? Or what if the facility changes its IT infrastructure or information systems over the life of the technology, making the device no longer operational and vendor unable to support it?
Clearly, the cost of choosing the wrong technology is higher than ever before. And, many times, it leads to a facility sticking with a technology that has significant issues or limitations or doesn’t meet staff needs since no avenue for getting out of a bad selection exists for many years.
So, what does this mean? As systems become increasingly integrated, not only is the evaluation and selection of a technology important—but perhaps even more important is the evaluation and selection of a vendor partner that can successfully deliver that technology to meet the facility’s needs. And the vendor partner should not only meet those needs initially, but for the life of the technology as well.
To some degree, facilities have always tried to assess the likelihood that a potential vendor partnership will be beneficial. But, at times, that relationship has been given much lower priority than physician or staff preference for devices or equipment cost. That’s not to say that these factors have lost their importance, but it’s also critical to recognize that vendor relationship is at least as important as these more traditional selection factors.
At the end of the day, if a system cannot be integrated and makes workflow more difficult for physicians or staff—and if it ends up costing significantly more than other solutions due to implementation delays or the need for additional staffing to complete the implementation—then these initial preferences disappear quickly.
Thus, when evaluating technology, it is essential to not only look at traditional factors, such as ease of use and serviceability, but also scrutinize the vendor providing that technology to ensure that they can fulfill their promises.
For instance, can the vendor deliver the integration they promote and provide you with examples of it? Can they build a solution that meets the unique workflow solutions of the facility? Can the vendor act as a long-term partner and not only support the initial implementation, but stand by the facility as its infrastructure and integrated systems evolve?
While a vendor may offer the best technology at the lowest cost, if that vendor is difficult to work with, unresponsive to the facility’s needs, has not shown a commitment to partnering with the facility, or demonstrates inflexibility, then in today’s healthcare world of integrated systems the vendor relationship may ultimately override the technology decision. Otherwise, the facility may find itself in a very unhappy, long-term relationship.
Ken Olbrish, MSBE, is senior product manager at Arthrex California Technology in Santa Barbara and a member of 24×7’s editorial board.