Well before federal EHR efforts went into high gear, healthcare systems transitioning to electronic records were looking for ways to integrate point-of-care devices. The impending requirements for electronic medical records (EMRs) and meaningful use of electronic data will only heighten the need for device integration.
The problem is that many of these devices—such as vital sign monitors, infusion pumps—use vendor-specific protocols, and aren’t designed to share information. A clinician may be able to access bedside device data, but specialists or nurses elsewhere may have no way of seeing it, unless it’s manually recorded in the patient record. Despite efforts to develop standards for these devices, there is no standard format for point-of-care device information exchange.
EHR and EMR vendors support direct integration of device data into an electronic record system, easing enterprisewide connectivity as hospitals build on connections they have already. Such device integration efforts have been going on for more than a decade at WellSpan, a health system serving the greater Adams-York County region in Pennsylvania, according to R. Hal Baker, MD, FACP, the organization’s vice president and CIO.
WellSpan includes two hospitals and a multi-specialty medical group that includes 30 primary care practices. Together, the hospitals account for 614 beds and more than 1 million office visits per year. The goal of integrating devices was originally part of “a desire to get more efficient, although not necessarily paper-free,” says Baker.
WellSpan uses Cerner’s CareAware architecture in its inpatient EHR, which enables data to be input directly from supported devices into the patient health record. The healthcare system is currently in the third year of a five-year agreement with Cerner to integrate more devices, starting with nursing records, moving to ventilators and monitors in the facilities’ intensive care units. Getting IV pumps connected to the EHR is WellSpan’s next move, says Baker.
Cerner writes the interface program that allows the CareAware technology to convert the monitor/device output into a data field in the EHR. “Most vendors have a device-specific output. Cerner’s system makes bringing it into the Cerner record easier, but [it’s] not quite yet ‘plug and play’,” Baker says.
Because information moves from devices directly to the record, this returns time to caregivers, who can spend more time with patients, he says. “It’s very unusual to walk around the floors a few days after go-live, and have nurses tell you how much they like it.”
“It’s a big win for clinicians because it gets them out of the middle of having to enter everything into the record by hand,” he adds.
Another integration option combines hardware/software to deliver information. This technique, used by vendors including CliniComp and Capsule Systems, transmits device data to a concentrator or repository, which converts the data to a network packet and forwards it to a server. Data are converted to a useable format, such as a flavor of HL7, and forwarded to the facility’s health information system.
At Baptist Health South Florida, a five-hospital health system and the largest not-for-profit health care organization in the region, the effort to integrate devices began in 2002 as part of the healthcare system’s effort to get away from paper records, says Melissa Barthold, MSN, RN-BC, CPHIMS, FHIMSS, Corporate Manager, Nursing Informatics at the health system.
Baptist Health South Florida has implemented CliniComp’s Essentris clinical documentation system for their perinatal departments in three of the five hospitals, says Barthold.
The CliniComp system collects data from bedside devices in all perinatal units, including neonatal intensive care units (NICUs), and sends it to the documentation module via two routes. A data acquisition system (DAS) connects serially to bedside fetal monitors, ventilators, and non-networked physiological and cardiac monitors, and stores data from these devices. Data from centrally networked devices can also be collected and stored by the DAS. Essentris software then converts the data into usable information. Data buffering capabilities allow each DAS to continuously receive data and store it into local memory for a minimum of 24 hours.
“As long as a device can send the data out, the Essentris system can interface to that device through the DAS. No matter where they go in the system, in Essentris,