It is widely understood that the American Recovery and Reinvestment Act (ARRA) will accelerate the development and adoption of electronic health records (EHRs). And, under the HITECH portion of ARRA, allocations of up to $48 billion in incentives have been made through the Centers for Medicare and Medicaid programs (CMS) “to assist providers in adopting EHRs.” For hospitals and health systems, this positions them to significantly benefit from the federal injection of capital to support their health information technology (HIT) infrastructure and initiatives. The road to receiving stimulus reimbursement is not straight and narrow, however, and hospitals need to be strategic when planning their approach.
The HIT Policy Committee has provided guidance on the five healthcare outcome priorities of meaningful use, which are to:
- Improve quality, safety, efficiency and reduce health disparities;
- Engage patients and families;
- Improve care coordination;
- Improve population and public health; and
- Ensure adequate privacy and security protections for personal health information.
While medical device integration is not specifically identified as a priority, it is one technology that can actually help hospitals achieve meaningful use in all three of the current phases. Specific phases include:
- Recording vital signs and charting changes;
- Using CPOE;
- Recording clinical documentation; and
- Medical device interoperability.
Recording vital signs and charting changes: 2011
Recording vital signs and charting changes (such as height, weight, blood pressure and body mass index) is a stated 2011 objective. While this can technically be accomplished by a clinician manually writing the values down and entering them into the EMR, manual documentation wastes valuable clinical time, is prone to errors and leads to large delays in those vitals making it into the record. Medical device integration automates this process by sending the data directly from the device to the information system, allowing hospitals to quickly and easily demonstrate that this objective is satisfied because those vitals can be easily tracked, logged and automated.
Using CPOE: 2011
Using CPOE (computerized provider order entry) is a stated 2011 objective. The actual use and adoption of CPOE does, however, have some challenges. One of those has to do with the vital signs data. When documentation isn’t automated, it means that physicians don’t always have access to the most recent data. To write a valid and accurate order they not only need all the data available, they also need it accurate and current. Medical device integration supports this because it enables the automatic transmission of vitals, directly from the device, in near real time.
Recording clinical documentation in the EHR: 2014
Recording clinical documentation in the EHR is a stated 2014 objective. While the final measure has yet to be defined in detail, it is expected that this objective goes beyond vital signs. So, again, technically this could be satisfied through manual recording, yet manual documentation is not only a waste of nursing time, it also leads to transcription errors and decreases the overall patient care experience. Automating the clinical documentation process through device integration will help hospitals meet this objective.
Medical device interoperability: 2015
Medical device interoperability is a stated 2015 objective. While Phase 3 criteria have not yet been detailed, the intent of this objective appears to be for all devices to be interoperable with EMRs and clinical information systems. The theory of all devices being interoperable is a good one; however, the reality is that the chance of this actually being achieved across all device manufacturers is not realistic under these time frames. Here’s why: Only a small fraction of devices today can send interoperable HL7 data; this means that many of the devices already installed within the hospital are not interoperable. Therefore, hospitals may be required to purchase new devices to meet the objective. With already strained budgets and resources, many hospitals may not be able to do so.
Let’s assume, however, that a hospital is willing and able to purchase HL7-compliant, interoperable devices. First, it is very likely that all the device types a hospital needs would not be available. The average development cycle of a biomedical device can be as long as four years, if not longer, and while manufacturers are adding in the HL7 requirement to new devices when they can, this is not something that can be incorporated into all devices, and certainly not within the required time frame. Second, if a hospital was able to purchase the various HL7-compliant devices it needs, doing so would mean that each device would have its own interface that would have to be managed. This would result in a very complex architecture, with an inordinate amount of HL7 feeds that would be very difficult to manage and support and would not offer the flexibility and scalability a hospital needs.
Bottom line: Interoperability is important; as hospitals purchase new devices, it is good practice to purchase HL7-compliant ones. This will not, however, meet all interoperability requirements. The most cost-effective and realistic means to meet the interoperability objective now and in the future is by implementing a vendor-neutral connectivity solution that would convert all data from all connected devices to HL7, so multiple receiving information systems can accept it. Such a solution would enable interoperability, allow a hospital to use the equipment it has in place and minimize the points of integration for easier management, flexibility and scalability.
Current state of meaningful-use attestation
It is important to note that while hospitals became eligible to begin meaningful-use attestation in 2011, not all have done so to date. In an announcement in late 2011, the Department of Health and Human Services (HHS) postponed the start of Stage 2 meaningful use from its original 2013 date to 2014. As a result of the postponement, some are recommending eligible hospitals wait until 2012 to attest to meaningful-use requirements. The reasoning is that there are no incentives lost for starting attestation in 2012. In fact, waiting until 2012 gives many hospitals greater visibility into Stage 2 requirements, which will be fully defined in June of this year. While hospitals are at varying phases of implementation to meet requirements, 2012 will be an important year to evaluate the big picture and create a scalable plan to meet all three phases.
Making more meaningful use of data through device integration
It is clear from the above assumptions that medical device integration could play an important role in helping hospitals meet meaningful-use criteria in all three phases. It is also clear that its implementation can improve overall patient care and safety because nurses have more time for patient care, errors are virtually eliminated and decision making is improved because data is available in near real time in the patient’s record. These reasons alone justify its implementation.
However, let’s explore how device integration will evolve to deliver the even greater benefit of transforming patient safety and outcomes. Imagine the ability to take collected data and compare, contrast and analyze it from multiple sources and then deliver it back to caregivers in a meaningful way. Imagine the possibility of being able to create and deliver encounter reports to help manage sepsis. Imagine the ability to effectively manage smart-pump connectivity and bi-directional communication. These are all possible through a middleware device-integration solution.
Device integration: an agile, scalable solution that delivers benefits today and tomorrow
As with any government regulations, requirements may be explicitly defined, but the path to meeting those requirements is not. Hospitals must be strategic in the way they approach technology investments and implementations. To meet meaningful-use requirements in return for federal stimulus money is a step but not the goal. Hospitals must not lose sight of the reasons they implement technologies: to increase efficiencies and improve patient care. The year 2015 will come and go and hospitals will still remain. Decisions and investments made now will have a long and lasting impact on the future of healthcare. The best approach is to create an agile, scalable healthcare environment that can adapt to the changing needs of patients for years to come. With all the benefits hospitals can realize with device integration, it should be one technology on the short list for implementation.
About the author
Stuart Long is president, North America, Capsule Tech. For more on Capsule Tech, click here.
