Making the Connection
Even before the federal government began pushing for universal adoption of electronic health records and the establishment of a nationwide health information network, most hospitals saw the need for systems integration. Being able to access critical patient data at the point of care, at the nurse's station or from remote sites became the rallying cry of doctors and nurses.
Understandably, this has put additional pressure on IT departments and vendors since it often requires the writing of elaborate interfaces between best-of-breed systems.
But while interfacing challenges still exist, vendors are beginning to seriously address the needs of clinicians.
“The end goal is clinical intelligence with a lot of connectivity between systems,” said John Doherty, the global marketing manager for monitoring solutions at Milwaukee, WI-based GE Healthcare.
Calling it “clinical information logistics,” Doherty says the strategy is to create a closed-loop system, which pulls together all data that can then be easily accessed by a clinician at the point of care.
To that end, GE Healthcare recently developed two products that facilitate the gathering and dissemination of clinical information.
The Unity Network Interface Device (ID) is a plug-and-play switching hub that integrates data from third-party devices into GE's Centricity Clinical Information System, as well as to other third-party HIS or CIS products, Doherty says. By using Device Identification Communication Adapters (DIDCA), Unity Network ID automatically identifies a device as soon as it is connected. And because most third-party devices transmit data using an RS-232 interface, this device repackages the data, transmits it through the Unity Network Ethernet protocol, then transmits it to a hospital system via an Aware Gateway interface, thus providing a single point of access for all bedside data.
Up to eight stand-alone bedside devices can be connected, including ventilators, anesthesia machines, infusion pumps and vital signs monitors.
But what makes this device truly unique is that while all data is stored at the bedside, rules can be set up that split the feeds between different clinicians so that each will only see the data that is pertinent to his role on the healthcare team, Doherty says.
Similarly, a product called “iPanel” is a clinical review station that provides quick, one-touch access to monitoring data.
As a patient-centric search engine, iPanel allows the clinician to locate and select pertinent diagnostic images, cardiology data, lab results, H&P information and other HIS information from one location — whether that's at the bedside, nurse's station or office.
Integrated with the patient's bedside monitor, iPanel uses the hospital's network infrastructure to access multiple clinical applications and information resources.
“It pulls the whole picture together,” Doherty says. “And it could be a stepping stone for facilities that are integrating clinical information systems with an electronic medical record.”
Lisa Jones, application system administrator at Aurora Healthcare in Milwaukee, has been testing iPanel as a first step in integrating ICU systems in all 12 hospitals operated by Aurora.
Although she says no final decision has been made as to whether Aurora will purchase the system, she says clinicians appreciate “having one point of access to different applications and having everything at their fingertips.”
And because all data is integrated, the addition of the Aware Gateway interface allows clinicians to monitor the vital signs of patients anywhere in the enterprise from a centralized location, she says.
Keeping track of vital signs can be time consuming and sometimes confusing. But managing all of this data, especially at the bedside, is easier when mobile workstations are used, says Keith Washington, vice president and general manager of Norcross, GA-based Flo Healthcare which, in May 2006, was acquired by Emerson.
A provider of wireless workstation solutions, Flo Healthcare introduced the Flo 4000 over a year ago, which was designed to integrate a hospital's EMR with a wide range of Welch Allyn devices, including the Vital Signs Monitor Series 300 and the newly released Spot Vital Signs LXi device.
Washington says vital signs monitors are connected to the workstation via a USB or serial cable and then integrated with the CIS via an HL7 interface.
“Nurses love it,” he said. “Nurses will usually do spot vitals and this avoids having two carts in the room.” And because the data is in real-time, there's no duplication of efforts, he adds.
Tal Senior, RN, clinical informatics specialist at Children's Healthcare of Atlanta, hasn't as yet upgraded to the Flo 4000, but he's seriously thinking about it.
“Our goal is to eventually integrate all vital signs,” he said, adding that vital signs taken during admission are already being entered into a mobile unit.
In 2003, Children's Healthcare implemented an EMR at all three of its hospitals and in September 2005 rolled out the Flo 1750 wireless mobile workstation — an initial order of 300 carts.
Senior says the carts have been especially effective in the intensive care units. Children's Healthcare has two pediatric ICUs, one cardiac ICU, one neonatal ICU and two “technology-dependent” ICUs for patients on ventilators.
“In our ICUs we have one cart per two bed spaces,” he said.
Ventilators Go on the Record
Mobility and connectivity often go hand in hand. At AnMed Health Medical Center in Anderson, SC, physicians no longer have to be at the bedside to check their patients' ventilator parameters. As part of its strategy to go paperless, AnMed Health connected all 26 of its SERVO ventilators to a hospital-wide computer system early in 2005 so that all respiratory records could be produced and stored electronically.
The project took less than four months, including the installation of an ethernet port in each ICU room so that the ventilators could be connected to the system, says Darrell Hickman, chief information officer for the hospital.
By integrating the SERVO ventilators, manufactured by Bridgewater, NJ-based Maquet Inc., with the hospital's EMR, clinicians can now view real-time data from any computer terminal connected to the network. For physicians this means being able to track trend data so they can make more informed clinical decisions. For the pulmonologist it means being able to respond faster and more efficiently. And for the patient it means shorter stays on the ventilator. In fact, AnMed Health reports that the majority of ventilator patients can now be weaned in about three days.
Given the huge amount of patient data traveling over a hospital network, managing clinical data is crucial.
“We want to put the patient data where the clinician is,” said Steve Monet, director of Enterprise Patient Monitoring and Information Technology at Telford, PA-based Draeger Medical Inc.
One solution offered by Draeger is called “Infinity OneNet.” Although it works only with the company's own lines of physiological monitors, Infinity OneNet takes wireless networking to the next level by providing seamless wired and wireless real-time patient monitoring over a hospital's existing network.
By incorporating application management systems from companies like Packeteer, Infinity OneNet can control the amount of wireless bandwidth allocated to different application traffic, thus giving life-critical information the highest priority over the network.
“This ensures that patient information gets to where it's supposed to go with the priority it deserves,” said Monet.
Timothy Rhue, certified biomedical equipment technician at Samaritan Medical Center in Watertown, NY, explains the underlying technology this way: “At the heart of OneNet is Packet Shaper from Packeteer, which identifies the data packets coming from components, gives priority to those coming from patient monitors and sends those to the nurse's station.”
The system, which Samaritan rolled out about a year and a half ago, also is bidirectional, so changes to alarm settings on patient monitors can easily be made from the nurse's station, he says.
In addition, Rhue says clinicians that use the system also can request a patient's vital signs history, such as all the BPs taken over a specified period of time or the patient's average heart rate.
Gains in efficiency resulting from systems integration also can be seen in the OR, according to Stephanie St. Amand, RN, MSN, perioperative strategist for Kansas City, MO-based Cerner Corp. The company's SurgiNet solution, originally released in 1999 as part of the Cerner Millennium line of products, is a modular system that merges administrative and patient care applications.
Modules designed to automate workflow include scheduling; preference cards; pre-, intra- and post-operative documentation; anesthesia documentation; case tracking; and clinical supply chain management. SurgiNet also interfaces with bedside medical devices and can be integrated with the Cerner Millennium EMR, she says.
Barbara Doster, RN, MBA, administrative director of perioperative services at the University of Alabama Hospital in Birmingham, says that by implementing the Cerner Millennium SurgiNet solution in August 2003 her hospital was able to move from an outdated DOS-based system to a fully integrated Windows-based system. And because it's integrated with the hospital's ADT and billing system, documentation done at the point of care automatically generates the appropriate charges to the patient's account.
But even more important is the fact that SurgiNet's documentation modules allow clinicians to pull up necessary clinical data such as lab results and images from radiology at the point of care.
Doster says the decision to purchase SurgiNet was part of a long-term strategy that will include the roll out of an EMR in 2008.
“Looking to the future, we knew we wanted an integrated record,” she says.
Evidently, Doster is not alone. As clinicians continue to demand more and better access to clinical data, systems integration will assume an even larger role in the acute care environment. <