EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Lessons Learned from EHR Integration of Medical Devices 

Lessons Learned from EHR Integration of Medical Devices  | EHR and Health IT Consulting |

Human lives depend on how well a healthcare organization manages its EHR integration of medical devices.

As the assigned project manager spearheading numerous large health system enterprise-wise medical device integration programs for over a decade, I’ve learned an essential lesson about EHR integration of medical devices.

Data captured from thousands of heart monitors, ventilators, balloon pumps, and other bedside devices must be perfectly managed, seamlessly integrated, and standardized to each patient’s electronic health record (EHR) and then made accessible to multiple providers. Once synced properly across the care continuum, connected medical devices play a critical role in the transfer of near real-time, reliable data to EHRs that improve both the safety and quality of patient care.

Otherwise, failing to do so can prove fatal.

Lessons borne out of experience

My role in bringing together clinicians, IT experts and device vendor representatives is to achieve that goal through flawless organization of precise integration methods and over-communication. Sharing information among these three teams is paramount to our success — that is, we’re managing vital data used by physicians and nurses as analytics in making life-changing medical decisions as quickly as possible.

Additionally, I have learned other valuable lessons about EHR integration of medical devices.

Start with a clean inventory list of biomedical devices and equipment planned for the device integration project. This list should comprise the number counts of all devices and supporting equipment including firmware versions and serial ports in addition to Ethernet gateway connections.

At the project’s onset evaluate and identify devices lacking the capability to integrate. Identify older firmware versions and research feasibility of cost to update as opposed to replacement.

Conduct walkthroughs on clinical rounds to determine data points for integration in order to identify network cabling and power needs. At that time, initiate engaging device vendors and setting clear deadlines and key parameters for the EHR integration.

Ensure middleware vendors partnering with the medical facilities supply all security-related product information upfront.

Invite middleware vendors to an onsite visit to determine exactly how much hardware is needed to ensure connectivity with other devices. Also include them in weekly or biweekly team update meetings. They are oftentimes overlooked.

Be adaptable and versatile to make quick adjustments while also striving to deliver impeccable results. Since workflows are not usually established upfront, responsibilities get shuffled around and integration details quickly become overwhelming.

Find creative ways to facilitate communication among the different team members. For example, assign color-coded status levels — green, yellow and red — to flag a change in project progression to speed up problem resolution. When senior management tackles red status issues as a group, expect people to pay attention!

Organization translates to project acceleration

Finally, organization of every integration detail is imperative. Associated device hardware, such as installing mounting hardware and new monitors in each patient room, must be managed. Biomedical managers, hospital IT groups, and clinical administrators must work concurrently to coordinate every step. In my experience, managing all of these different teams is by far the most challenging aspect of device integration.

Our healthcare ecosystem is slowly but surely modernizing, and we must leverage our technologies every possible way to maximize delivery of patient care to improve outcomes and the patient-provider experience. Ultimately, the success of any enterprise-wide EHR integration of medical devices is founded on strong communication and organization in addition to data management.

Technical Dr. Inc.s insight:
Contact Details : or 877-910-0004

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How does medical device integration alter EHR adoption, use?

How does medical device integration alter EHR adoption, use? | EHR and Health IT Consulting |
Delivering care of the highest quality requires clinicians to have the most pertinent information about the patient available to them. In acute care environments, this information comes from a variety of sources, not all of them readily accessible such as medical devices.
“Devices obviously generate critical information at the patient bedside. Historically, a very small subset of that information would ever find its way to the electronic medical record because they didn’t need to archive every breath a patient took, for instance,” says Andrew Malcolmson, Director of Integrated Patient Intelligence at Covidien.
“If you’re doing clinical decision-making and trying to understand patient conditions, especially in a dynamically evolving situation, and you’re not at the bedside to look at the device firsthand, you want to be able to see everything — every loop, trend, waveform, alarm, and parameter,” he explains. “That’s the type, richness of information that just isn’t not possible to house in the EMR. That’s just too much.”
Malcolmson and his team are the driving force behind the company’s Vital Sync software, which allows clinicians to access beside medical devices from their own devices — from desktops to smartphones. “There’s an unmet need to have that bedside device information available to them wherever and whenever they needed it,” he adds.
Not only does the ability to access monitoring devices from their other devices, especially those that are mobile, extend the range of clinicians within the clinic, but it also makes possible the coordination of a patient’s care well beyond the four walls of the institution.

“A physician who isn’t in the unit and who may not necessarily be in the hospital can take a look at what’s being measured and what the devices associated with a given patient are telling them to help collaborate on improved decision-making,” Malcolmson notes.
According to Malcolmson, this shift toward medical device integration and remote monitoring is just beginning to emerge but its potential to change the way care is coordinated and collaboration among the care team takes place is clear.
“The whole paradigm of having to go to the patient bedside to get comprehensive information is something that is changing,” he continues. “Obviously, we would never encourage nor expect clinicians to not want to go to the patient’s bedside because there’s a whole universe of additional information that you can get beyond that which is just on the devices monitoring that patient.”

Tapping this potentially, however, requires device manufacturers to face the same challenges their counterparts in EHR development are currently encountering when trying to get information to flow seamlessly between data sources — that is, interoperability.
“We’re primarily exporting information to the EMR. We have an HL7 engine that is designed to handle just about any type of data requirements,” explains Malcolmson. “We’re on the cusp of releasing an ADT interface as well, which will be coming out with our next release. That will be the first element of our system that actually pulls information back from the electronic medical record system as well.”
If the EHR is to be a comprehensive record of a patient’s care, then it must comprise information from various sources not just those that are captured by clinicians. As with health information exchange at a more macroscopic level, moving information from one source to the next requires that standards and rules of the road are obeyed by all players.

David Greene's curator insight, December 9, 2014 3:12 PM

There are some great interoperable choices on the market - these tools not only can provide clinical support, but also can reduce some of the IT implementation costs...!

Don’t drink the Kool-Aid: Tips for easing into medical technology if you're afraid of EMRs recently posed the following questions to its readers in a survey format: “Are more doctors buying electronic medical records than before? Or, has the Stimulus bill only brought out the tire kickers?“. The results of the survey are available here; while the survey wasn’t scientific and it didn’t have enough participants to draw wide scale conclusions, the results do imply a general feeling of positive momentum towards the purchase and implementation of EMRs.

As an experienced healthcare IT professional I am very happy to see that people are looking towards EMRs and automation to improve healthcare staff productivity. However, I’d like to urge a bit of caution and be sure that buyers don’t jump into the market for the wrong reason. My rule about automation and insertion of software in any workflow process is simple: if you can’t repeat it, don’t bother automating it.


How to choose the right software and technology

For most potential users of EMRs, EHRs, and other “complex” workflow automation tools you should ease into the technology. What that means is that before you install any new technology, ensure that first and foremost it does no harm. All technology takes time to implement and get significant improvements; what’s important is that while you’re working towards improvement you don’t harm your business in the process. Technology should first and foremost not make a practice, department, or hospital worse off than it was before the technology was introduced. Then, it should start improving or “healing”.

Second, focus on interoperability and best of breed. Our desired tendency is to go for “all inclusive” or “complete solutions” but healthcare is too complex for any single vendor or package to do everything. By focusing on best of breed and interoperability you can grow at your pace and choose solutions that you really need versus those that the vendors think you need.

Third, Ask the right questions of your vendors and staff when they’re selecting any new technology. Don’t worry about features, functions, and technology. Worry more about your business (which is healthcare and patient happiness) by asking questions like this:

  • Will my patient be more satisfied because I’m using the system?
  • Will the outcome of care be improved because I’m using the system?
  • Can I spend more time on my patient’s care versus documenting the encounter?
  • How many more patients per day will I be able to see because of the system?
  • Can I go home earlier because the system helps me finish my work faster?
  • How many fewer lawsuits will be filed because I used the system?

Fourth, make sure the technology fits with your desired outcomes (not tasks). Almost any software will improve some aspects of your business — but, the question is will the software improve the aspects you care the most about? When asking technical questions, start with some of these:

  • How can I easily transmit my patient’s medical records in a safe and secure manner without spending all day making copies?
  • How many more lawsuits will I win because I used the system?
  • How will the system be able to increase my patient population or help me market my services better?
  • How much faster can I get paid for my services after I’m using the system?
  • Can I get secure access to my data while I’m away from home or the office?

Fifth, be sure it can handle all the different kinds of data you have. Most vendors or technology providers focus you on what kinds of data they can manage. But, any reasonable office deals with all the following kinds of data and you need to make sure your selection can manage it:

  • Structured data (fully coded ICD, CPT, etc)
  • Semi-structured data (machine understandable but with keywords and such)
  • Unstructured data (natural language)
  • Images
  • Faxes
  • Audio
  • Video
  • Chat logs, e-mail logs
  • probably many others

Most software systems handle structured data quite well. In fact, EMRs are an excellent way to capture structured data but in my experience structured data makes up only a small fraction of healthcare data. Semi-structured data and completely unstructured data along with faxes make up a big portion of data and medical images make up an even larger portion of the healthcare data pie. Video and email, chat, and other upcoming technologies will be taking up larger portions of database space as well.

When you’re choosing a technology, be sure to look at the kind of data you’re capturing regularly and ensure that the vendor you choose and the deployment model you pick are geared towards the data you create rather than the kind of data the vendor can store. Again, almost all vendors are great at structured data but there are very few that are good a non-structured data, faxes, images, and similar information. When looking at “cloud providers” (online software) make sure that the larger data you capture can be fit through your network pipes.


An EMR isn’t necessarily the first way to automate

While most people who are new to healthcare IT or looking to jump in quickly always point to EMRs as the most important application, there are actually many different healthcare IT applications that make up the “industry” as a whole. When you’re dealing with healthcare IT, EMRs might be a good entry point for some folks but it’s actually more likely that EMRs aren’t your first place to start your automation journey. These are some other techniques I’ve used to kick off automation before jumping into full-fledged EMRs:

  • E-mail (beware of HIPAA, though) — internal office messaging and email is a great place to start. If you haven’t started your office automation journey here you should.
  • E-Prescribing — e-prescribing is a great place to start your automation journey because it’s a fast way to realize how much slower the digital process is in capturing clinical data. If e-prescribing alone makes you slower in your job, EMRs will likely affect you even more. If you’re productive with e-prescribing then EMRs in general will make you more productive too.
  • Office Online and Google Apps (scheduling, document sharing) — Google and Microsoft have some very nice online tools for managing contacts (your patients are contacts), scheduling (appointments), dirt simple document management, and getting everyone in the office “on the same page”. Before you jump into full-fledged EMRs see if these basic free tools can do the job for you.
  • Clinical groupware — this is a new category of software that allows you to collaborate with colleagues on your most time-consuming or most-needy patients and leave the remainder of them as-is. By automating what’s taking the most of your time you don’t worry about the majority of patients who aren’t.
  • Patient registry and CCR bulletin board — if you’re just looking for basic patient population management and not detailed office automation then patient registries and CCR databases are a great start. These don’t help with workflow but they do manage patient summaries.
  • Document imaging — scanning and storing your paper documents is something that affects everyone; all scanners come with some basic imaging software that you can use for free. Once you’re good at scanning and paper digitization you can move to “medical grade” document managements that can improve productivity even more.
  • Clinical content repository (CMS) — open source systems like Drupal and Joomla do a great job of content management and they can be adapted to do clinical content management.
  • Electronic lab reporting — if labs are taking up most of your time, you can automate that pretty easily with web-based lab reporting systems.
  • Electronic transcription — if clinical note taking is taking most of your time, you can automate that by using electronic transcribing.
  • Speech recognition — another “point solution” to helping with capturing clinical notes; you can get a system up and running for under $250.
Technical Dr. Inc.s insight:
Contact Details : or 877-910-0004

No comment yet.!

How to Adopt Unique Device Identifiers for Medical Devices |

How to Adopt Unique Device Identifiers for Medical Devices | | EHR and Health IT Consulting |
Unique device identifiers can improve tracking of medical devices for research and patient safety.
In response to new FDA requirements for all medical devices to have a unique device identifier (UDI) within the next few years, the Brookings Institute has helped to develop a roadmap for adopting and integrating UDI technology in order to improve patient safety and provide better data for research and analytics.  The roadmap includes a number of critical steps to help bring UDIs into provider systems, administrative transactions, and patient-directed tools.
“The benefits of UDI implementation across the health care system are significant and, while the path to full implementation is complex, there are relatively straightforward steps that can be done now to begin realizing many of them,” the document says.  “Recording UDIs at the point-of-care (POC) in electronic health records (EHRs) and in claims data could significantly enhance the nation’s ability to conduct medical device safety surveillance and manage recalls.”
“Other benefits include: efficient identification and communication of device safety concerns, active learning about the long-term quality and performance of devices, facilitation of premarket device approval/clearance and expanded indications for existing devices, data collection to support better value, increased reimbursement transparency, and more accurate and efficient supply chain processes.”
The recommendations include the following:
• Providers should incorporate UDIs into their EHR systems, and may consider adopting automatic identification and data capture (AIDC) technology to make the process more efficient.  Patient safety reporting should be automated.
• UDIs should be integrated across the entire healthcare ecosystem, including through the supply chain, clinical processes, and revenue cycle management to achieve the highest return on investment.
• UDIs should be incorporated into the criteria for Stage 3 meaningful use as well as the EHR certification criteria.
• The device identifier portion of the UDI should be included as a situational element at the claim detail level for high risk, implantable devices
• Patient advocacy groups, the FDA, and providers should work together to promote patient education on the subject of UDIs, and encourage patients to be aware of their devices and any potential recalls or issues related to their equipment
• UDIs should be integrated into personal health records to easily provide patients with appropriate device data.  Developers should collaborate with patient organizations to provide proper resources related to UDIs.
• Provider systems, payers, and other stakeholders should commission studies and pilots to highlight use cases for UDIs and demonstrate the benefits of integrating medical device data into the workflow.
The roadmap focuses primarily on the highest risk devices, which are typically implantable, but adds that all medical devices that impact a patient’s care, even transient equipment such as MRI machines, can significantly benefit from UDI labeling and tracking.  “The UDI system, which will be phased in over several years, represents a landmark step towards improving patient safety, modernizing device post-market surveillance, and facilitating device innovation,” the roadmap says. “These promised benefits will only be fully realized with the adoption and integration of UDIs into the health care delivery system.”

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