1. Clinical Engineering & Device Integration (CEDI) Highly Integrated Clinical Engineering for Highly Integrated Healthcare Jennifer L Jackson, MBA, CCE June 1, 2013 Clinical Engineering Symposium, presented by ACCE AAMI 2013, Long Beach, CA

2. Overview Of Cedars-Sinai 2  Established in 1902 and located in Los Angeles, California  947 licensed beds, Level I Trauma Center  Primary service area includes 3.3 million people  Community support groups representing more than 16,000 individuals On average, every day we serve:  233 Emergency Department Patients  76 Emergency Department  Inpatient Admissions  >735 Inpatients  18 OB Deliveries  120 Operative Procedures  44 CVIC/E.P. procedures  4 Level 1 Trauma Patients  25 Acute Rehab patients  >1400 Outpatients Visits and Procedures

3. Caring for Our Technology 3 14,784 + Computers on the network 34 Physical Locations 2,588 servers in our 40,000 sq. ft. data center 412 clinical applications 2,828 TB of Tier 1 and 2 storage 112 systems are real-time synchronized to each other 10,437,932 interface transactions a day 29,000 medical devices managed by Clinical Engineering CS-Link launched in August 2007 CS-Link CPMO launched in March 2012

4. The Clinical Engineering Department May 2013

5. In close collaboration with clinicians, administrators, and other technology groups, Clinical Engineering and Device Integration promotes quality patient care through the appropriate and safe use of medical device technology. Mission Statement Clinical Engineering and Anesthesiologists meeting to discuss the hardware mounting related to CS- Link Anesthesia Record implementation. Clinical Engineering and nursing working together to plan out unit closures for the nurse call replacement. We strive to be a center of excellence for innovative and robust solutions that promote leadership in delivering healthcare related services.

6. Who We Are Biomedical Equipment Technicians Image Guided Systems Technicians Clinical Systems Specialists Clinical Systems Engineers Project Specialists Administrative Staff

7. Who We Are Staff re-organized into 4 teams. Total new FTEs created: 3 Clinical Engineering 23 FTEs Sample technologies supported EKG carts and EKG archive physio monitoring device integration terminal servers fetal monitors defibrillators Integrated Device Systems 6 FTEs Sample technologies supported Airstrip Emergin OBIX Nurse Call/Call Light OR Clinical Engineering 8 FTEs Sample technologies supported Scope Mgmt Anesthesia Machines OR AV integration Image-guided systems Device Integration 6 FTEs Sample Projects Device CS-Link Integration Voalte implementation Alaris integration Nurse Call replacement One Project Management/Implementation Device Integration Three Support and Optimization Teams Clinical Engineering OR Clinical Engineering Integrated Device Systems

8. CSMC Clinical Engineering a brief history Clinical Engineering Departments from Lebanon and Sinai hospitals merge, still under Cardiology 1976 Clinical Engineering moves out from Cardiology Merges with Laboratory Service 1978 HP’s PDMS installed at CSMC Ventilators, Urimeters, and Blood Gas Analyzers are integrated Clinical Engineers do this work Late 1980’s PDMS replaced with CareVue HP 200LX ‘smart’ calculators can receive alerts from system Integration engineer moves to IT Early 1990’s New EHR vendor selected One requirement is to keep current device integration Aug 2007 Clinical Engineering and Device Integration Department is formed July 2011 OR Imaged Guided Systems team joins CEDI Feb 2012 Cardiology Applications Team joins CEDI Apr 2013 Device integration with new EHR goes live Clinical Engineering and Device Integration are separate departments under different VPs Oct 2010

9. Medical device integration fundamentals Three key features of any medical device  The type of device and the complexity of the measurements it produces, and  The data it measures and transmits externally,  The method by which it communicates to external systems. Examples  ‘Simple’ data measurement devices to more complex  stethoscope -> ICU monitor -> MRI  One or two parameters -> analysis and alarms -> remote control  Simple to complex connectivity technology  Point to point serial  Fixed IP network enabled  Secure wireless network compliant Source: Zaleski, JR. Integrating Device Data into the Electronic Medical Record. Publicis Publishing. Erlangen, Germany. 2009.

10. Medical Device Domain with ever increasing complexity Source: Zaleski, JR. Integrating Device Data into the Electronic Medical Record. Publicis Publishing. Erlangen, Germany. 2009.

11. Snapshot of CSMC Medical Device Connectivity Infusion Pumps 924 Infusion pump brains wirelessly communicate  Currently used to push datasets and download logs  2014, bidirectional interfaces go into production (test environment live August) Patient Monitoring ~255 telemetry patients’ data imported to EHR (288 max – will increase in 2015) 690 multi-parameter monitoring devices imported to EHR 120 terminal servers in critical care areas for connection to ventilators, urimeters  85 anesthesia machine ‘systems’ in production Nov 2013  Expands to ED and 60 med-surg beds in 2014-2015  Mobile vital signs collection live Sept 2013 Cardiology 35 EKG carts are wireless Orders/results for cath lab hemodynamic systems Orders/results for EKG archive to EHR live July 2013, incorporated with carts Alarms/Alerts Bed exit/Chair exit alarms – sent to smartphones Medical Device (“aux”) jack in each room Tele monitor based alarms managed through central monitoring, filtered

12. What Makes Us Different in the way we manage medical device systems Unique organizational structure  Independent department within IT  Work side-by-side with applications and technical teams Unique job roles  Image Guided Systems Technicians  Much more clinical than a ‘typical’ BMET, working side by side with surgeon during procedures to ensure the technology is properly aligned and functioning  Clinical Systems Specialists  Stronger IT skill set than a ‘typical’ BMET More of the technical lifecycle within one department  Building device records in the EHR  Testing and maintaining orders/results interfaces  Project management  Technical support  System optimization

13. Current Projects External Leading role  Bidirectional pump interface  Nurse Call replacement  Mobile Vital Signs rollout  EKG orders/results interfaces  Digital OR implementation  Voalte phone implementation  Voalte/Rover co-existence testing  Part of Rover trial  Central Monitoring Center renovation  Pediatric reporting from cardiology PACS  Advanced Health Sciences Pavilion equipment planning, including Training Center Strong supporting role  Anesthesia Record (anesthesia machine integration)  Fetal monitoring expansion  EHR expansion to PPOs (integrated medical device strategy)  SEA 50/Alarms NPSG Task Force

14. Current Projects Internal Equipment Management Committee  Reviewing and revising equipment management policies  Overseeing equipment audit Training plans/Career paths  Developed career paths for BMET, CSE, CSS, and DBA job families  Corresponding training plans Recruit/retain the best staff Total Cost of Ownership/Cost of Service  Bring all service contracts into CEDI  Identify opportunities for improvement Prepare for Robot Wars 2013!

15. Our formula for success: We work hard. We play hard. We’re flexible and curious. We know Elvis.

16. THANK YOU!