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20 April, 2013The Ritz-Carlton
Doha, Qatar
Enterprise-Wide Medical Device IntegrationFirst CIS Qatar International Conference
1Wednesday, April 17, 13
The majority of clinical data originates from biomedical devices. For maximum efficiency, data quality and
timeliness of data, the acquisition of biomedical device data must be automated.
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ConnectivityWorkflow automation through the integration of medical devices and information systems
InteroperabilityThe ability of two or more systems or components to exchange information and to use the information that has been exchanged
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Manual Data AcquisitionData collected or entered late or period missed: 15 min - 8 hoursTypographical or transposition data entry errorsRight data entered into wrong patientFor nurse, entering data read off medical devices into EMRs is extra work for no value
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FunctionalityAutomatically acquires medical device data at specified periodsAcquisition period definable by patientProvides clinician validation of data when required
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BenefitsAcquired data reduces transcription and documentation errors - to zero if barcodes are used
Data immediately available once acquired
Larger volume of consistent data
Increases adoption of EMRs and CPOE
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Productivity Impact
01
23456
78
Hours
Before After
Vitals Capture Time Per Day
Documentation
Vitals Capture
Average vitals capture time = 3.79 minutesApprox. 33% of taking vitals is adminAutomating vitals saves 1.12 minute per vital eventTime saved = 28 to 38 hours per day
Source: Automating the Vitals Capture Process, Michael Phelps, 2005, VA Medical Center, Minneapolis, MN
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Improving patient care with more than $30 billion
in annual health care savings
THE VALUE OF MEDICAL DEVICE
INTEROPERABILITY:
MARCH2013
Impact on Patient OutcomesPolicy white paper evaluating impact on U.S. health care costs
Source: http://www.westhealth.org/institute/interoperability
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Connectivity Impacts
Costs resulting from redundant testing: $3 Billion
Clinician time spent manually entering data: $12.4 Billion
Increased length of stay: $17.8 Billion
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Typical WorkflowsPatient ManagementPatient ContextSchedulingOrder WorkflowData acquisitionData analysis
Clinical documentationSurveillanceMessagingData managementReport generationDevice specific workflows
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Use CasesA methodology used in systems analysis to identify, clarify workflow and organize system requirementsDay-in-the-life story, formal very structured text, flow charts, sequence charts, etc.An agreement between users and product developers regarding how a system will operate
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Use Cases Vary by Medical Device
Vital signs monitors - spot checkContinuous patient monitors - sampling of data stream Infusion pumps - limited EMR supportVentilators - limited EMR supportWorkflows for the same device can vary across clinical areas - e.g., ED, surgery, ICU or Med/Surg units
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Workflow matchesWorkflow gaps
Flexibility - configurabilityEvaluate trade-offs
ProductUse Cases
Physician Writes Medication Order
Rx Order Reviewed
Pharmacy Information
System
Pharmacist on Floor or
In Pharmacy
If paper, RPh enters into PIS and rechecked by second RPHRx Order
Rx Order Validated
Order Items Are Picked from
Inventory
PIS or Workflow
Automation Application
Formulary
Pharmacist or Tech
Using the formulary, the PIS or workflow
app generate a picklist
Nutritional Deficit Diagnosed
Patient Assessment CDSS
Physician on Floor or In
Office
Number of EMR applications vs
manual tasks will vary by site
Patient Hx
Dx Test Results
Clinical Guidelines
Physical Assessment
EMR for:Patient HxDx TestsCPOE
Resulting order can be electronic
or paper worksheet
Previous Therapy
Clinical practiceuse cases
Items Assembled for Compounding
Item's Lot Number,
Expiration Date Checked
PIS or Workflow
Automation Application
Formulary
Inventory
Pharmacist or Tech
Barcode Scanned or Written in Log
Book
Items Ready for Compounding
Medication Compounded
PIS or Workflow
Automation Application
Formulary
Tech
Artifacts Retained for Subsequent
Review
Compounded Medication
Compounded Medication
Review
Workflow Automation Application
Compounding Artifacts
Pharmacist
Inspected manually or may
use workflow application
Medication Compounding
Complete
Medication Prepared for
DeliveryPharmacist
or Tech
Place in delivery bag, affix warning
labels
Medication Delivered
Preprinted Labels
Activity Diagrams: http://en.wikipedia.org/wiki/Activity_diagram
==/13Wednesday, April 17, 13
RecommendationsDocument your workflow with use casesRequire vendors to disclose their uses casesInclude use case requirements in purchase agreements to ensure vendor compliance
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Tim Gee
Medical ConnectivityConsulting
medicalconnectivity.comTim Gee
Medical ConnectivityConsulting
Tim Gee
Medical ConnectivityConsulting
Blog at:
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Patient Management
Database of relevant patient demographicsAdd, edit and delete patients and associated dataSupports flow of patients’ contact with medical device systemData captured prior to, or at the time medical device is applied to patientAnalogs: department marker boards, dashboards
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Patient ContextAssociates medical device data with the patient attached to the deviceCreates and breaks down association with application and removal of deviceMaintains reliable association during use - wireless makes this challengingEssential step requires backup methodsBest managed at point of care
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SchedulingPatient and resource schedulingCan be time-specific or a work listPatient remindersDriven by order setOrder-specific prerequisitesComplex rules-driven scheduling algorithms
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Order WorkflowOrder initiates workflow; can initiate patient managementSpecifies how medical device is to be used Monitoring or therapy orders define device configurationDiagnostic orders define device configuration and procedureCan include establishing patient contextDependent on patient management Includes a formal end step
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Data AcquisitionMedical device data is acquiredCan be continuous, periodic or bothAcquired data can include multiple data setsCan include data annotation - both automatic and manualAcquired data is often edited for reporting or clinical documentation
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Data AnalysisProprietary algorithms extract physiological data and improve data qualityData analysis to render proposed diagnosisCan be done in embedded device or via networkCan be automated or user directed
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Clinical Documentation
EMR or procedure documentationSubset of medical device data is often usedCombination of automated or user-generated dataMay require data validation step
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SurveillanceDisplay of device data in locations beyond the medical deviceContinuous steam of data Near real time requirementHighly variable transmission distancesWide variety of client devicesImplemented as “slave” monitor or part of broader workflow
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MessagingCan include audio, text data and waveformsBroadcast or narrow cast Contextual clinical data often requiredMay require escalationMay track event driven messages to conclusionMay include complex rules-driven Wide variety of client devices
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Report Generation
Fulfillment of order workflowDiagnostic report generationProcedure documentationReport generation, review and approval workflowStructured or unstructured dataManagement reporting
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Data Management
Supports patient management and order workflowEvent reviewMay include annotation or editing of dataData queueing for review or analysisStorage and retrievalData archiving with appropriate retrievalTeaching file generationClinical trial and research support
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Device Specific Workflows
Basic templates: diagnostic, monitoring, and therapeuticDevice specific variations and combinations of preceding workflowsIV pump Drug Error Reduction Systems (DERS)QA requirements
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