|In an effort to corral the industry’s considerable collective wisdom, AAMI, ACCE, and HIMSS formed the CE-IT Community.|
A system failure in today’s modern medical facility can go from “mission critical” to “life critical” in a heartbeat. Reflecting a gradual paradigm shift, IT managers who once focused on business must now take patients into account. Inevitably, partnering with clinical/biomedical engineers has become a large part of this new patient-focused approach.
While the merging of technology and patient care has been happening for a long time, much of it, says Stephen L. Grimes, FACCE, FHIMSS, FAIMBE, vice president for Technology in Medicine Inc, Holliston, Mass, has gone unnoticed. “A lot of these processes have been developed in isolation, without giving thought to integration,” he says. “Individual hospital departments began bringing in their own devices and networking them within their departments, eventually trying to integrate them into the infrastructure of the hospital’s IT. Since there was no plan, a lot of the safeguards for managing these technologies were not there.”
In an effort to bolster these safeguards and corral the industry’s considerable collective wisdom, the Association for the Advancement of Medical Instrumentation (AAMI, www.aami.org), the American College of Clinical Engineering (ACCE, www.accenet.org), and the Healthcare Information and Management Systems Society (HIMSS, www.himss.org) formed an alliance. The resulting CE-IT (clinical engineering-IT) Community is now collaborating to better understand the many issues surrounding the continued integration of clinical/biomedical engineering and IT.
The stakes are high. Lost productivity hurts the bottom line, and system glitches can jeopardize patient care. Biomeds are all too familiar with the tough cases arising in recent years. Grimes illustrates the point with a true story about a malfunctioning server that supported multiple pediatric cath labs, along with all the diagnostic ultrasound systems.
The system went down and Grimes’ team looked at the problem from several angles, concluding that it might have been a hard drive failure on the server. When that proved incorrect, he escalated his troubleshooting by replacing controllers, back units, motherboards, and software. “Whatever we did, we could not solve it,” Grimes says. “Meanwhile, the system was down, and it was costing several hundred thousand dollars in lost productivity. Ultimately, someone read through an event log from the server. It showed that someone—at the time the system went down—had changed an IP address on the server. When that happened, the devices that were sending images, or being asked to retrieve images, had no way of contacting the server. It was done by someone in IT, and he or she did not follow the change management process.”
The people who were trying to resolve the problem were totally unaware of this critical change. Among other things, CE-IT hopes to address these important communication failures through a focused education process. “People are not aware of these vulnerabilities, these single points of failure,” Grimes says. “Changing an IP address is a single point of failure, because it took this critical server out of the loop.”
Keeping track of seemingly small changes and adjusting to other large-scale changes are challenges that CE-IT seeks to address in the coming years. Despite a natural resistance to change in many industries, Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, vice president of informatics for the Chicago-based HIMSS, believes the time is right for stakeholders to tackle these problems before they truly get out of hand. “IT staff and clinical engineers have worked in silos for some time,” Sensmeier says. “I think the pain points are strong enough to break down walls, because they really see the need to work together and get to the next level of success.”
Developing real solutions and attaining success is often about pruning what amounts to a massive amount of opinions and methods. Recognizing this, leaders at AAMI, ACCE, and HIMSS hope to avoid duplicating efforts already in progress. Harnessing the expertise from all three major conferences is one way to make this a reality. To this end, Sensmeier says that the HIMSS conference this April in Chicago will feature an all-day symposium with plenty of dialogue concerning CE-IT goals. Additional educational sessions and Webinars will only expand these efforts. Eventually, CE-IT will beef up its Web site (www.ceitcollaboration.org) and feature white papers, surveys, and planned events.
GEARS IN MOTION
To get the ball rolling, CE-IT organizers formed five separate work groups made up entirely of volunteers from the three organizations. For now, those five work groups are charged to deal with: 1) integration of systems/devices in multivendor environments; 2) emerging technologies; 3) CE-IT collaboration; 4) IT infrastructure and wireless systems implementation; and 5) security/risk management. Both Sensmeier and Grimes acknowledge that CE-IT’s work will not be easy, and it will take time to coordinate and reach a consensus. However, they are confident the work can and should be done. In existence for the better part of a year, the work groups have only recently completed their first round of meetings, and the deliverables of those groups have yet to be fully defined.
Part of the challenge stems from high interest in and the overall need for CE-IT. Grimes says that CE-IT officials and organizers are committed to hearing a wide range of opinions from diverse backgrounds. Then and only then, he says, can the fledgling alliance produce the “very practical paradigm guidelines” that everyone wants to see.
According to Steve Campbell, AAMI’s vice president of communications, marketing, and health care technology management, 2008 was a chance to lay the groundwork and develop a structure. “We surveyed our members to identify their specific needs, and recruited volunteers to work on specific projects,” Campbell says. “In the fall of 2008, we also achieved our first success—release of the fourth edition of IT Horizons, a special publication produced by the CE-IT Community and distributed to more than 10,000 of our members.”
By using volunteers from all three organizations, organizers hope to avoid the individualized approaches of the past, which could go a long way toward improving the quality of the eventual guidelines and the speed in which they are produced. “There has truly been an independent approach in the past,” Sensmeier says. “Each of our organizations have been doing activities and had initiatives to help resolve the lack of integration across the specialties. With this new community, it gives us a chance to leverage our resources and work together more closely to help the industry see what is possible for true integration across biomedical, clinical engineering, and IT.”
Inevitably, any future CE-IT guidelines will likely include calls for more formal relationships between departments. “A few years ago, it was probably just a small percentage of the biomed and clinical engineering folks who reported to the same people as IT,” Grimes says. “In fact, biomed used to report largely to facilities engineering. That has gone from a few percent 5 years ago to the neighborhood of 20% now with a common reporting relationship. It makes sense, but people are still wrestling with the details.”
As IT continued to impact health care and society in recent years, officials at AAMI, ACCE, and HIMSS responded with programs, publications, and targeted resources. The crucial difference now is unity. “Now that the three organizations are working together on IT projects, it has reduced the duplication of efforts by the three groups and provided a platform for CE and IT to work together to solve many of the issues that biomeds and IT are facing,” Campbell says. “Through the CE-IT Community, we are maximizing our resources and brainpower to benefit the entire biomed community.”
BEST OF BOTH WORLDS
IT comes primarily from a business background, while people on the biomedical/clinical engineering side typically look at technology from a patient care standpoint. While it is true that divergent groups with different histories can sometimes differ, CE-IT officials hope to reconcile the culture clash and ultimately take the best practices from both clinical engineering and IT experts.
“On the IT side, they think in terms of mission-critical systems that could take down the business operations,” Grimes says. “As we begin to move into this converged work space, the IT group is having to be aware that some of the systems and technologies that are getting attached to their infrastructure are life critical, not just mission critical. If there is a failure, it can have a direct impact on the diagnosis and treatment of the patient.”
Response time is one area where the two groups have differed in the past. IT can take hours or even days to respond, but biomed professionals are used to responding immediately. However, when it comes to establishing rules, Grimes says that IT usually does a better job. “Biomed tends to operate more in the Wild West type of atmosphere. We go out and get it done, whatever it takes,” Grimes says. “IT has best practices in place, and there is a lot in there that the biomed community would benefit from. IT folks need to have a better understanding of patient implications. The biomeds must appreciate that since they are dealing with systems, and not discreet devices to a significant degree, you can’t go making changes without understanding the implications. You must notify everybody that is potentially going to be affected, and give them an opportunity to sign off.”
One point of agreement is that both biomeds and IT staff members know that increasing complexity can also lead to widespread meltdown. So-called smart devices are recording more and more data that nurses must eventually record and get out of the systems. While the new devices offer many advantages, they can also lead to mistakes.
Last year, the new CE-IT Community, a partnership between the Association for the Advancement of Medical Instrumentation (AAMI), the American College of Clinical Engineering (ACCE), and the Healthcare Information and Management Systems Society (HIMSS), e-mailed a survey to each of their members to determine their members’ top concerns. The online survey yielded informative results that the organization will use to help guide the direction of this newly formed alliance.
According to the survey, an overwhelming number of respondents want the CE-IT Community to develop and share best practices. They also want regular information so they can stay on top of new standards and regulations and new technologies.
In addition, respondents had specific ideas about what they would like more guidance on, such as the integration of systems/devices in multivendor environments and recommendations and guidance on implementing new technologies, including wireless systems.
Working groups have already been formed to address these needs in detail. These groups also present an opportunity for clinical engineers and biomedical equipment technicians to voice their ideas and help ensure the success of the collaboration and the progress of the industry. Anyone interested in joining a working group can find out more on the CE-IT Web site at www.ceitcollaboration.org, or contact Steve Campbell, AAMI’s vice president of communications, marketing, and health care technology management, at .
“Ideally, if you were in a patient’s room and all of the devices that were connected to the patient were also connected to the information system and being captured—that would be the best scenario,” Sensmeier says. “If a nurse today is recording the pulse oximetry result, he or she is probably doing that reading, recording it, and then re-entering it into the nursing documentation system. So if those systems were integrated, there would not have to be that extra step, and the chance of error with the data entry would be reduced. There would be a time savings and greater patient safety achieved by the naturally integrated process.”
Other smart devices in the mix include intravenous pumps that regulate drip rate, record fluid volume, and even document blood oxygen levels. With that new intelligence comes another layer of complexity that must be effectively managed. “We want to make sure those systems continue to work together as opposed to setting off a chain of events that trigger alarms or negative reactions in the patient,” Sensmeier says. “It can be a somewhat chaotic environment, but we can use all of this to truly improve our care delivery.”
ENGINE OF CHANGE
A 1965 Mustang and a 2009 Lexus both have tires, but the differences under the hood are numerous. Today’s auto mechanic must be well versed in computer diagnostics, a fact that medical equipment professionals have dealt with for many years now. With further technological advancement inevitable, existing technology (aka legacy systems) must be ripe for future connectivity, and CE-IT is eager to address this concern.
Since full equipment replacements are often not feasible, the holy grail of integration once again comes to the forefront. “We want to be sure that there is a migration path as we acquire these new technologies, and we want to be sure that these are not dead end technologies,” Grimes says. “If you are replacing infusion pumps, you want to look at whether they have wireless capability, which would offer the connectivity. Even if you are not going to start out that way, you want the ability to upgrade for a reasonable fee.”
One of the many reasons for CE-IT’s existence is that clinical engineering has not significantly evolved to address many of today’s challenges. In fact, in the eyes of industry veteran Grimes, today’s model resembles the one from 30 years ago. Drawing a comparison with the recent economic malaise, Grimes points out that one component of the financial meltdown was an inability to keep up with technology, a situation no one wants to see in the CE-IT world. “Things got so complex with the financial instruments that it got way beyond the regulators’ ability to deal with them,” Grimes says. “And we’re seeing the same kind of thing take place in the health care industry. The technologies we are dealing with are often getting beyond the capabilities of existing resources. Part of what we are trying to do with these CE-IT work groups is to educate people as to what the issues and challenges are, then quickly develop that infrastructure to effectively address them.”
Ultimately, a sound set of principles will help all parties avoid severe problems before they start. In health, as in medical equipment, the best solution is often prevention and proper maintenance. “CE-IT will help to identify the problems and provide education about the need for putting processes and systems in place,” Grimes says. “Get the technologies in that will be sufficiently robust and redundant so you won’t have the problems in the first place.”
Greg Thompson is a contributing writer for 24×7. For more information, contact .