Presentation on theme: "Medical Device Integration with an Ambulatory EMR HIMSS 2010 Fred D. Rachman, MD."— Presentation transcript:
Medical Device Integration with an Ambulatory EMR HIMSS 2010 Fred D. Rachman, MD
Conflict of Interest Disclosure Fred D Rachman, MD has no real or apparent conflicts of interest to report.
Interconnecting Devices and the EMR
Why Connect Devices to an EMR? Reduced Errors Reduction in lost results Reduction in transcription errors Reduction in patient ID errors Reduction in missed opportunities Improved Data Access Reduced Errors Improved Workflow Device Data Capture Improved Workflow Eliminate manual and paper recording of diagnostic testing Streamline efficiency & workflow Improved Data Access Immediate enterprise-wide access to results data Capture of elements not previously available Improve documentation filing and reporting for regulatory/malpractice
Current State Devices developed in isolation –Lack of adherence to cross-vendor standards Custom interfaces needed Scarcity of well-defined use cases Primary experience in Hospital settings
Challenges Getting data into the proper data fields is laborious Often many parameters exist for different types of data –Example: blood pressure data taken with different body positions Disparate data sources with different clinical value –Example: heart rate from an ECG and heart rate from a pulse oximeter; often a clinician needs to make the decision
Efforts to promote increasing interoperability of Medical Devices with each other and with EMRs Consumer driven initiatives to promote medical device interoperability Vendor efforts to promote ability of EMR to integrate with Medical Devices Use cases to drive ROI
Medical Device Plug and Play Program (MDPnP) Promotes standards based interoperability of Medical Devices to create error-resistant medical systems, support the widespread use of data obtained from medical devices, improve clinical workflow to enhance patient safety and reduce healthcare costs, and produce complete and accurate electronic health records for clinical care and research enable the development of a medical grade network for high-acuity health care Founding HCOs: Massachusetts General Hospital Partners HealthCare System, Inc. Kaiser Permanente Johns Hopkins Medicine
Vendor Certification Vendors that are certified have had their EHRs successfully tested for connectivity to a set of commonly used devices in the Ambulatory setting. Objectives: 1) To establish superior functionality and service standards for device connectivity 2) To improve the customer experience when installing and operating a connected device with software from a certified EHR partner
Minimum requirements to receive Certification 2006 and/or 2007 CCHIT certification At least 300 installed customer sites Independently verified completion of connectivity testing Commitment to implementation and technical support coordination with device manufacturer to improve implementation and service for connected devices
Certified Devices Spot Vital signs equipment Vital Signs monitor PC Based resting and stress ECG PC Based Spirometer
Future devices Digital Otoscope Digital Stethoscope Rapid vision screening device
Use cases Drive ROI on both Vendor and Consumer sides Largely focused in Hospital Settings Have focused largely on patient safety on cost Need for use cases in the ambulatory setting
Advantages of HIT data Ability to aggregate and correlate data for evaluation of impact of medical devices and services in terms of other process and outcome measures Efficiencies Reductions in errors Reductions in needed referrals and tests Outcomes and quality measures
Medical Device Integration Project Collaboration between a Medical Device manufacturer and an ambulatory Health Care organization to: Establish measures for quality and efficiency gains Collect baseline data Integrate selected devices with Electronic Health Record Demonstrate gains. Promote new uses for integrated devices in the ambulatory care setting.
History and Mission of Community Health Centers first funded by the Federal Government as part of the War on Poverty in the mid-1960s. designed to provide accessible, affordable personal health care services for people living in medically underserved communities Mission encompasses quality, access, and responsiveness to particular needs of the community served. Typical services include primary care (Including Pediatrics, Internal Medicine, OB/GYN, and Family Practice), dental, behavioral health, nutrition, case management and health education.
Facts about Community Health Centers Nearly 1,100 health center grant recipients operate more than 7,000 community-based clinics One of every 19 people living in the U.S. now relies on a HRSA-funded clinic for primary care. HRSA-supported health centers treated more than 16 million people in 2008. Nearly forty percent of patients treated have no health insurance and one-third are children
Alliance of Community Health Services Overview HRSA funded Health Center Controlled Network founded by 4 Federally funded Health Centers located on the Near North Side of Chicago Aim is to provide infrastructure through which Centers can share services at higher quality and lower cost. Emphasis on shared Health information technology platform Implementation and support of a common, centrally hosted EHR with integrated decision support and performance measures The Alliance supports a centrally hosted EHRS shared by 24 Health Centers in 8 States.
Health Centers at the Forefront of Quality and Health Information Technology Comprehensive model of comprehensive primary care predating Medical Home concept Long history of formal chronic disease management, evidence based practice and reporting on national measures. Federal investment Health Center Controlled Network model to support adoption of HIT has resulted in examples of advanced use and resembles REC strategy of ONC Focus on quality while respecting limitations in resources have led Health Centers to explore strategies to promote efficiciency
Common Medical Equipment Used in Health Centers Eye, Ear, Nose & Throat Stethoscopes Blood Pressure Management Cardiopulmonary Thermometry Monitoring Womens Health Radiology Endoscopy
Drivers for Medical Device Integration in the Ambulatory Setting. Improve efficiency of patient flow Reduce errors Capture information to facilitate new opportunities for care delivery Capture observations to enable clinical decision support Facilitate aspects of Meaningful Use
Categories of Benefits from Device Integration. More efficient capture of information, with reduction in error –eg, integrated Vital Sign Device Capture of data elements not easily captured previously for decision support –eg, EKG, QT intervals used for decision support around medications Ability to share data for new patterns of service delivery –eg, digital stethoscope, used for remote consultation, comparison of observations over time
Electronic Vitals Connectivity Parameters NIBP, Thermometry, SpO2, Heart Rate Connected (integrated) Data transfer via IR RS-232, USB, and/or RS-232 cables Electronic vital signs data is integrated directly into the EHR vitals template with one-click data collection and transfer
Connecting Cardiopulmonary Devices Provide bi-directional exchange of information between the EHR system and cardiopulmonary device software
Cardiology Workstation Solution Retrieve records with keystroke and on the screen edit Access information remotely Fax or e-mail reports directly Connect to EHR to streamline diagnostic testing workflow
Digital Otoscope and Stethoscope Digital otoscope and stethoscopes make it possible to capture visual and sound images as files for incorporation into the EMR. These files can be reviewed by different clinical providers, or can be reviewed by the same provider to compare observations over time. Visual files can also be shared with patients.
Measures Vital Signs EKGDigital Otoscope Spirometer Improved Accuracy completeness of data capture Improved workflow efficiency Opportunity for improved quality patient service Improved data Capture for clinical decision support New Data Capture for clinical decision support/ patient service
Challenges Encountered Technical challenges in establishing interface Design of appropriate data collection forms in EMR. Changes in workflow required
Preliminary Findings High level of staff and patient satisfaction Improved efficiency of recording data Overall improvement in accuracy and reduction of errors, however potential for new types of errors may be introduced.
How Medical Device Integration Fits with Meaningful Use Promotes quality and safety Provides structured data for performance measurement and clinical decision support Health information exchange capacity Telemedicine Can support patient engagement
Promises and Challenges of the Future Wireless Connectivity and Mobility Expanded devices Telemedicine and home based services capabilities. Increased automation of clinical decision support New challenges with wireless mobile devices and remote data collection: –associating devices to a verified patient identifier –theft