The convergence of biomedical devices and IT for the ED may lead to improved patient care.
Nowhere in healthcare is the dilemma of rising costs coupled with rising pressure to deliver quality care more pronounced than in the emergency department (ED).
The convergence of biomedical devices and IT for the ED may lead to improved patient care.
Nowhere in healthcare is the dilemma of rising costs coupled with rising pressure to deliver quality care more pronounced than in the emergency department (ED).
The 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) mandated care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. Subsequently, the annual number of ED visits increased 50 percent in the decade between 1993 and 2003. At the same time, the number of EDs decreased by 14 percent, leaving fewer EDs to serve a larger volume of patients, according to the American College of Emergency Physicians.
Results from the National Hospital Ambulatory Medical Care Survey show that with more than 110 million visits annually, the ED represents a significant portion of medical care in America. For hospitals, emergency care can be the most challenging type of care to manage — acute, continuous and short-lived. The average visit lasts only 3.3 hours. For the clinicians providing that care, even the slightest delay in retrieving valuable clinical data renders that data essentially useless for emergency care, and without data, mistakes happen.
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Obviously, emergency patients need treatment immediately — if clinicians cannot get the data quickly, they simply will not use it. Current discussions about the need for electronic medical records (EMR) center on their ability to give clinicians timely access to historical and evidence-based data. While such data is critical overall, in the ED, data collected real-time from monitoring devices can be even more important. Despite this importance, data from monitoring devices typically does not make its way into the EMR until the nursing staff transcribes it. This represents not only a waste of increasingly limited nursing time, but also a threat to patient safety and quality care due to transcription errors and lag time.
At hospitals where vitals might not be entered into the system for several hours, during which time no one can see the information, ED clinicians using even the most sophisticated EMR systems must make immediate decisions based on data that may be inaccurate or incomplete. However, ED clinicians using EMRs to direct patient care might have faster access to critical patient data with device-to-EMR connectivity. So, why isn’t this connectivity happening? The problem is one that plagues healthcare at all levels — incompatible data formats.
While some medical devices have the ability to transmit data in proprietary formats, many EMR system vendors choose not to create separate interfaces for the plethora of medical devices that monitor physiological parameters. Increasingly, the technological “middleman” is a specialized medical device integration (MDI) system that reads the data from the devices and forwards it on to the EMR system.
Though standardized data formats and interfaces would be ideal, until those standards exist, proprietary interfaces will continue to be the norm. However, the potential benefits that device-to-EMR connectivity could provide suggest that MDI may be a viable solution. For example:
At hospitals where vitals might not be entered into the system for several hours, during which time no one can see the information, ED clinicians using even the most sophisticated EMR systems must make immediate decisions based on data that may be inaccurate or incomplete.
Cost:According to “Addressing the Issues of Nursing Shortages and Patient Safety through Biomedical Device Integration,” a cost analysis study of a 150-bed facility conducted by business consultants MindGent, implementing MDI can save similar organizations up to 2,408 hours annually — equal to 20 FTEs — for a cost savings of as much as $970,338 per year.
Efficiency: A study by clinical systems engineers Tracy L. Rausch and Thomas M. Judd titled “The Development of an Interoperable Roadmap for Medical Devices,” projected savings of 50 percent of current support staff charting time and 20 percent of current practitioner charting time due to device-to-EMR automatic charting and analysis of vital signs.
Quality: The Rausch and Judd study also suggests that eliminating transcription and reading errors ensures that more accurate data is recorded to the EMR. In the ED, where patients see multiple clinicians, device-to-EMR integration eventually could create a “smart system” that would alert clinical staff of major changes in vitals from previous visits, or vitals outside the normal range.
The Future ED
Device integration may improve clinician productivity and quality of care, as well as reduce medical error rates. As our population ages, EDs will get even busier, which is why device integration may be most beneficial. For the ED, convergence of biomedical devices and the EMR may be a vital requirement for vital care.
Bridging the ED to EMR Gap: Case History
Regardless of hospital size or location, all EDs face a similar dilemma — providing continuous and immediate critical care when there is no access to real-time, accurate patient data.
Northern Dutchess Hospital, a Health Quest affiliate, is a 68-bed acute care, not-for-profit, community hospital in Rhinebeck, N.Y. It provides a comprehensive range of emergency, medical and surgical services to more than 153,000 people across the mid-Hudson Valley — primarily in northern Dutchess, southern Columbia and parts of Ulster counties.
Northern Dutchess’ ED clinical staff wanted patient data immediately. Traditionally, it took vital signs either manually, or by monitor, and then transcribed them to a laptop or paper for eventual entry into the department’s EMR system.
The hospital realized that the safest, fastest and most efficient way to get vital sign data into the EMR was also the most direct method — feeding it directly from the various bedside/portable medical devices that were collecting the data.
To accomplish this, Dutchess installed an integrated vital signs monitoring solution from Emergisoft that included CapsuleTech’s DataCaptor Connectivity Suite. The solution automatically collects patient vital signs from the Phillips Intellivue monitors and delivers it into the EMR. The resulting discrete data elements are readily available to ED clinicians during the charting process in a graphical and intuitive user interface.
This solution also creates a gateway connection to the central nursing station that feeds HL7 messages to the EMR, enabling ED nurses to spend far less time manually entering vital signs data into the EMR and more time on patient care.
FEBRUARY 2008
