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Technology Interoperability at the Bedside

Wednesday, October 3, 2012

4:15 – 5:15 pm

Maximizing the Value of your Systems and Equipment

Presenters

M. Terry Miller, BSEE

Executive Vice President , GBA

Victoria L. (Vicki) Bechet, BSN, RNC

Project Manager, GBA

Learning Objectives1. Define medical technology and review recent

advancement in bedside medical technology –both equipment and IT

Learning Objectives

2. Identify the types of information captured in the medical record – how generated, where and how captured – and how it supports patient care

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Learning Objectives3. Assess physical, operational, privacy and safety

challenges typically faced in both newer and older facilities, and how patient information captured in the record changes with EMR

Learning Objectives

4. Evaluate the impact of technology and EMR integration on nursing workflow – specifically, what is the role of integration and how do we design for it now and in the future?

The future of healthcare is

streamlined care delivery

supported by integrated technology

Defining “medical technology”

Advancements

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30-40%

Second largest line item in the typical project budget

Technology 30 yrs ago

Technology 30 yrs ago

• PACS still a theory

• Proprietary monitoring systems/infrastructure

• Most equipment was stand-alone

Technology Today

Hybrid OR

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Medical Technology – “Tools of the Trade” Medical Technology 30 years ago

So “technology” is advancing – with many exciting developments!

It’s easy to become too focused on technology.

Our primary mission is healthcare.

How does medical technology support

patient care

The role of information

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Nurses deliver the majority of direct patient care – mostly at the bedside.

What does “Medical Technology” mean to a nurse?

How has this changed in recent years?

Past Now

Now they are “smart”

Beds had cranks

then electric

Past Now

Thermometers were mercury-filled glass

Thermometers are infrared, digital, and electronic

IV’s were dispensed by gravity - dosage adjusted by drips/minute

Past Now

IV’s are dispensed by infusion systems with

bi-directional connectivity to the

EMR

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Past Now

Patients were weighed on scales

Now the bed tells you

Past Now

Nurse Call was a bell

Now it tracks your movements.

informationinformationinformationinformation

What information is captured in the chart?

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History & PX ConsultsMedication

Nurses Notes

Progress Notes

Advanced Directives

PhysicianOrders

Admission Data

Misc.DietaryGraphic

ChartEKG/EEGX-Ray

ReportsLab

ReportsReport of Operation

You must design for all these clinicians to access the EMR.

Who uses the Chart?

How do you Access the Chart? Where?

How is information collected

How does the EMR change that

Where does the information come from?

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Vital Signs

Traditional methodsblood pressure, systolic/

diastolic pulse, respiration, oxygen saturation, heart rate, pain, respiration, and temperature

Vital Signs

Electronic methodsblood pressure, systolic/

diastolic pulse, respiration, oxygen saturation, heart rate, pain, respiration, and temperature

Data Collection Devices How has this changed

• Nurse Call System • Bed-Exit alarms• Scale• Infusion Pumps• Ventilators• ITV system• Bed rail position, brakes, height, tilt –

protocol reminders• Vital signs monitor• Physiological Monitor• Diagnostic set• Fetal Monitoring• Neuro Monitor / Seizure Monitoring• Telemetry• EKG/EEG• Diagnostic set• Staff / Visitor Presence• Patient fall detection• Hand-washing detection

• There’s a lot more• It’s all electronic

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The Role of Technology Integration

The Impact on Planning and Design

Challenges Faced in Both New and Older Facilities

First – to realize integration is an operational challenge first – planning starts with:

• Operational analysis

• Needs assessment

• Workflow charting

this will determine the technology needed

Planning involves all technologies – all systems and equipment – not just IT

Types of Information -Locations

• Quantitative – vital signs, numerical values, primary observations – ideally at the bedside

• Qualitative – physicians progress notes, nursing notes, medication orders – near the room - avoid distraction

• Collaborative – care plan assembly and updates, treatment planning, discharge planning – team meeting space – not the nurse station

History & PX ConsultsMedication

Nurses Notes

Progress Notes

Advanced Directives

PhysicianOrders

Admission Data

Misc.DietaryGraphic

ChartEKG/EEGX-Ray

ReportsLab

ReportsReport of Operation

You must design for all these clinicians to access the EMR.

Who uses the Chart?

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Good Bedside Options Footwall Charting – Not Ideal

The WOW

Ideal solution?• Big and bulky

• Requires charging

• Wireless is limited

• Bar code required?

• Infection control?

• Storage?

Is a Tablet the Answer?

Apple iPhone

iPad

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Handheld PC? Equipment Connectivity –Direct Pick-up

- Wireless / RFID / RTLS?

Nuvon Capsul

“We want the ventilator to talk to the EMR”

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Equipment Connectivity –Direct Pick-up

Cerner iAware

Designing for Technology Integration

Infrastructure Support

Medical Technology – “Tools of the Trade” Low Voltage Systems

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Infrastructure Planning Infrastructure Planning

Don’t try this at home!

Infrastructure Planning

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Good Design – vs - ??? Design

4th Floor Nurse Station 5th Floor Nurse Station

Why Integrate?

• Improve accuracy

• Save time

• Improve clinician workflow

• Improve patient care, safety, and satisfaction

• Improve outcomes

• Reduce readmissions

“We want the wireless option”

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Hospital Network

Mobile Communication

Workflow

Bed Vendor Apps

EMRNurse Call System

In-Room Connectivity Device

Room Nurse Call

Device Connectivity Server

Bed Vendor’s Server

SerialData Port

Nurse Call Port

Hardwired

Wireless

HL7

Other

Medical Technology Integration Today

Compare - Manual vs. Integrated

Manual Data Entry1. Read/note data

2. Keyboard entry

3. Trend-line analysis

4. Care plan decision/adjust

5. Key in order

Integrated Technology1. Direct data capture

2. No entry

3. Analysis ready

4. Select adjustment

5. Pre-order ready

Nurse’s Time Spent Per Shift

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Integration is more than data drops -

1. Physical Connectivity

2. Logical Connectivity

3. Security

4. Data Sharing

5. Operational Configuration

… all five levels needed to achieve Interoperability

Summary

• Every new hospital must be designed to support Medical Technology – and to support EMR

• Planning and Design must include:

1. Operational Analysis / Needs Assessment

2. Workflow and the “Tools” needed

3. IT infrastructure – now and for the future

• Properly applied – technology can improve:

– Patient satisfaction, safety and outcomes

– Staff workflow and efficiency

The future of healthcare is

streamlined care delivery

supported by integrated technology

Questions / Discussion

Follow GBA on

http://www.gbainc.com/

vicki.bechet@gbainc.comterry.miller@gbainc.com800-443-1415