By David Tandet
In the campaign to increase the interoperability of medical devices and integrate them into hospital networks, infusion pumps are on the front lines. Pumps are growing ever smarter as manufacturers improve their interoperability within a healthcare system and as the pump industry increasingly adopts smart pump standards. [Photo: Medfusion 4000 Syringe Pump from Smiths Medical.]
Integrating the Healthcare Enterprise
Leading the way for interoperability standards is the Integrating the Healthcare Enterprise (IHE) Patient Care Device (PCD) Domain Technical Committee. Its most recent collaborative effort came January 27-31, 2014, in Chicago, where the IHE held its North American Connectathon. The goal of the Connectathon event was to test the interoperability of various manufacturers’ smart pumps repeatedly throughout the week-long event.
Jeff McGeath, VP of patient care device integration at Iatric Systems, Boxford, Mass, co-chairs the IHE-PCD committee. He says that the testing helped solidify a foundation of smart pump interoperability: “All vendors could come together and know that we’re speaking the same language of IHE Integrating Protocols.”
McGeath notes that “pump manufacturers are truly biosciences companies. They’re not truly in tune with the EHR space and the EMR systems and the integrations systems. They’ve got to make sure that they’ve got very strong FDA-approved medical devices that support certain outbound capabilities and certain inbound capabilities.” And that’s where IHE comes in.
Testing helped various manufacturers ensure the transfer of infusion data to IHE-compatible electronic medical record (EMR) systems from state-of-the-art-infusion devices. Such devices enable clinicians using EMR systems to automatically capture therapy data for patient records. Time is saved and patient safety is improved by reducing manual data entry errors. Alarm reporting capabilities increase patient safety.
Smiths Medical, Dublin, Ohio, is one of the attendee manufacturers that successfully tested new interoperability software and demonstrated functionality using IHE Integration Profiles for Device Enterprise Communication (DEC), Infusion Pump Event Communication (IPEC), and Alert Communication Management (ACM).
IHE helps pump manufacturers like Smiths Medical overcome a significant technical hurdle posed by the wide variety of EMR systems. “The biggest challenge manufacturers face,” says Donald Gregg, vice president for global product management, medication delivery, at Smiths Medical, “is the large number of EMR vendors to integrate. Which do you focus on first?” Most medical device manufacturers, vendors, and other providers really like IHE, Gregg says, because it helps solve that problem by offering a “standardized way to interface to EMR systems.”
The Closed Loop
“Smart pumps represent an enormously positive patient safety impact to healthcare,” McGeath notes. “There are also revenue implications.” Despite the existing technology and ongoing protocol standardization, however, “Few hospital are at present doing the entire closed loop of smart infusion pump integration,” McGeath says. (“Closed loop” refers to fully integrated smart pumps’ ability to support inbound interface as well as outbound data flow. The support of incoming data is called “point of care infusion verification,” or “smart pump programming.”)
Newer smart pumps that support inbound messaging can automatically program drug name, infusion rate, drug volume to be delivered, and concentration. With such devices, McGeath says, “Nurses no longer have to walk up to the pump, hang the medication on the ringer, and remember, ‘For this particular manufacturer, I have to hit the down arrow a certain number of times to this field, then hit the right arrow to reach this many milligrams medication, and so forth.’?”
With a smart pump, such instructions can be sent to the pump automatically rather than manually. This allows you, McGeath says, to make sure the five “rights” of infusion therapy are consistently observed and validated behind the scenes:
- right medication;
- right dose;
- right time;
- right route; and
- right patient.
This capability can be especially useful, McGeath adds, “in a contemporary healthcare setting that might call for additional agency nurses to be relied on to provide assistance in, for instance, a flu season in which fluctuating patient rates are normal. You can’t give an infant 10 times more than the correct level of heparin. That’s what a smart pump can support.”
Technology Coming Together
The first step toward overall integration of medical devices began with computerized physician order entry (CPOE) and electronic medical administration records (EMAR). Ventilators were next to be integrated. Infusion pumps were third in line because they are very difficult to integrate, requiring a significant amount of real-time and near real-time processing power.
“Most medical devices found in hospitals and alternative healthcare facilities are built on long-standing platforms. As a result, these devices don’t turn over as fast as most [other] devices found in the tech industry,” Gregg says. “Biomeds will look at the boards and ask, ‘Well, why can’t you just put in a smaller wireless card in an infusion pump and get that cleared by the FDA?’ The answer is it that takes a significant amount of effort when you engineer the device to separate the clinical functionality of the device from the wireless part of the device that sends out data to a third-party system.”
If Not Now, When
John Noblitt, MAEd, CBET, is program director at Caldwell Community College and Technical Institute in Hudson, North Carolina. He welcomes the advances being made in smart pump technology, but wonders how long complete integration will take.
“Technology in patient health care is improving,” Noblitt says. “But no matter where we go, there are going to be issues” that prevent rapid integration.
The benefits of integration are obvious. “A patient connected to a smart pump with a drug library that won’t allow a nurse to accidentally put in 1,000 mL when the patient requires 100 mL is a life-saving thing,” Noblitt says. He also points out the benefits of a pharmacist’s ability to make required changes in drug protocol through the computer system. The benefits are not limited to the obvious patient well-being that results. For instance, precious work hours can be saved when personnel are freed from manually updating the drug libraries of, say, 1,800 “dumb” pumps.
Noblitt also points out issues that can come up in a world that has yet to become fully integrated and interoperable. He gives the example of a small healthcare facility with perhaps 100 “conventional” pumps. A difficult situation could arise if all those pumps are needed, but four of them are a day beyond their programmed preventive maintenance date and will not turn on without PM servicing. That particular facility can’t simply go to a storage location to retrieve backup pumps—there are no others to be found.
But for some facilities, the budgets simply don’t exist that will permit the switch to smart pump technology. McGeath points out that there are revenue recovery aspects to smart pump integration. No titration event or any stop time—or, for that matter, any and every pump-related event—goes undocumented in the world of smart integration and interoperability, and return on investment can be readily shown. But in many cases, that’s not enough. It is simply a question of affording what for them remains “a leap.”
Significant strides have been made in the integration of medical devices fueled by CPOE and EMR systems, and McGeath believes the healthcare industry is on the verge of breaking through to adoption of closed-loop integration.
There will come a day when all patients will be able to take advantage of the “smartest” pump technology in a fully interoperable healthcare system. The only question for observers like John Noblitt is how quickly that day will come. 24×7
David Tandet is a contributor to 24×7. For more information, contact editorial director John Bethune at [email protected]