Officially, Erin Sparnon, engineering manager for Health Devices at ECRI Institute, heads up a team of engineers to monitor and discuss medical technology. But off the record, she has diversified her professional efforts through involvement in a half-dozen side projects and committees.
Last year, she moonlighted as a certification tester, reading HL7-based messages that followed the Integrating the Healthcare Enterprise (IHE) profiles. She consulted with ECRI member hospitals about their clinical goals for integration, participated in an FDA panel on the use of standards to improve health IT safety, and helped create a research agenda protocol for the ECRI Patient Safety Organization, a private-sector partnership for health IT safety. “Luckily, there are 25 hours in my day,” she jokes.
Over the last several years, Sparnon has also built a national reputation as an infusion pump safety expert. She recently won the ACCE-HIMSS Excellence in Clinical Engineering and Information Technology Synergies Award, largely for her efforts involving hospital infusion pump and EHR integration. We spoke with her about the challenges of meshing these systems, how she’s working to reduce implementation barriers, and how clinical engineers and IT experts can work together.
24×7: How did you end up at ECRI Institute?
Sparnon: It was both curiosity and luck, because I graduated in the middle of a recession. ECRI was a lot more interesting than waiting until the hiring freeze subsided. It was quite lucky that I started here, but then I stayed for a while because I got caught up in ECRI’s mission of improving patient care. That was 13 years ago. I also got the chance to be a national expert on infusion pumps at 25, and that was a lot more interesting than what my other undergraduate friends were doing at the time.
24×7: Describe your activities at ECRI.
Sparnon: I lead a team of engineers that test and evaluate medical equipment. We try to find the key technical differences in the medical devices, write about them, and consult with our member hospitals to help them make purchasing decisions. The main part of my job is producing content for the Health Devices website. But with my other hat, I’m our in-house expert on three main topics: infusion pumps, medical device integration, and EHR and health IT safety. What that really means is I get to go play with our other departments and member hospitals.
24×7: How have you worked to address the key challenges of infusion pump-EHR integration?
Sparnon: I’ve been working with many, many different committees and trying to help coordinate them and draw parallels between them. I was working with the Integrating the Healthcare Enterprise (IHE) Patient Care Device domain on some of their early work about what should flow between an EHR and infusion pump server, and in what format it should be. I worked with the Association for the Advancement of Medical Instrumentation’s Healthcare Technology Safety Institute focus group on infusion pumps, which focuses on how to reduce infusion pump errors in general—everything from getting the right medication, to setting up the plumbing correctly, to using technology to help reduce errors. I’ve been working with a patient safety task force that’s sponsored by HIMSS that was looking at how they can help their member hospitals recognize and address health IT errors. I’m also on the HIMSS Quality, Cost and Safety Committee.
24×7: What are the problems and dangers associated with infusion pump-EHR integration?
Sparnon: In an integrated system, your infusion pump server is tied to your enterprise information system. Keep in mind, there are maybe a dozen hospitals doing this. When it works, you can use a medication order to feed information into your infusion pump and make sure that the pump is delivering what the doctor ordered. Of course, if that information isn’t correct, then you’re no longer giving the patient what the doctor ordered. When you’re sending an order to the pump, the information has to get there accurately, it has to get there securely, and it has to get to the right place. If any of those three aren’t fulfilled—if it’s not accurate, if it’s not secure, or if it doesn’t go to the right place—then your documentation could be either missing or wrong, the nurse could have to enter the data, or the patient could receive the wrong dose.
The most common error you see in an integrated system is when the data just doesn’t get to where it’s going. Maybe there’s a medication name that’s too long, so it gets spit back from the pump server and never gets to the infusion pump. Maybe information is trying to flow from the infusion pump server to the EHR, but it’s not in quite the right format so the EHR can’t accept it. If the information doesn’t show up, then the nurse is going to have to manually program the information, and you could have some errors there.
24×7: If integrated systems can cut down on errors, why haven’t more hospitals adopted them?
Sparnon: It’s very, very expensive and not particularly quick or easy to implement. There are three approaches to medical device integration in general. One is that you build your own interface, and then you have to take on all the work and liability. Two, you could hire a third-party integrator, and they will essentially build the interface for you and take on the responsibility of getting the two systems to talk to each other. Or three, try buying an integration solution from your enterprise vendor. All of these are quite expensive. Hospitals have so many other financial and IT demands that they don’t necessarily have the time and budget.
24×7: How have you been working to reduce those time and cost barriers?
Sparnon: I’ve been collecting user information and user experience, and publishing purchasing, planning, and implementation guidance, so that hospitals know what they’re getting into and how to best work with their vendors. I’m working with IHE and trying to promote the use of their standardized messaging. When we get more EHR vendors to accept that standardized messaging, that should reduce cost.
Everybody wants to work toward a plug-and-play approach. We’re not close. But the use of standardized messaging can help at least make sure the two systems are speaking the same language. The guidance I’ve been writing can help hospitals think through whether they’ve established a good clinical use case for integration—have they figured out exactly what they want to know, where the data ought to go, and why? As more hospitals gain experience with integration, we should be able to reduce some of the upfront build costs.
24×7: What other integrated devices are becoming more common?
Sparnon: Physiological monitoring systems are a good target for medical device integration. A lot of hospitals are looking to integrate vital signs monitors, and some are looking at integrating things like ventilators.
24×7: Are infusion pumps the most likely to be related to patient safety issues?
Sparnon: I think any of them could. With any device that’s feeding data into the EHR, if that data is not correct, then caregivers can be making decisions based on wrong data. That type of risk is really the same no matter what kind of medical device you’re talking about.
24×7: Where do you see the room for more overlap between clinical engineering and IT?
Sparnon: More and more devices have software, networking, or security features that are really going to require clinical engineering and IT to work together, first of all just to establish ownership. It might be that clinical engineering has ownership of certain aspects of the medical device, and IT might have ownership of others. Perhaps for a particular device, clinical engineering takes ownership of the whole device, its networking, and its software, but then they’re going to have to have the IT expertise to do so. Regardless of where the two departments are starting from, they’re really going to have to work together in the future just to keep up with the medical devices coming into the facility.
24×7: Do you see a clear lack of boundaries right now?
Sparnon: I think that there’s a lot of goodwill and good intentions. I’ve seen some nice documents coming out of the CE-IT community. That’s a group cosponsored by the American College of Clinical Engineering and HIMSS that puts out advice about working together. The situation varies widely among hospitals. We’ve seen everything from hospitals where clinical engineering and IT both report through the same chain, to facilities where it’s not entirely obvious if the two departments have ever met.
24×7: What steps can readers take to establish ownership?
24×7: Do you think IT departments currently lack context to understand those sorts of issues?
Sparnon: Depending on their training and experience, IT staff may already have a deep appreciation for clinical context—but if not, your readers can be a valuable resource for this knowledge.
Jenny Lower is associate editor of 24×7 magazine. Contact her at [email protected].