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Getting Connected

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From analyzing data to improving patient safety, medical devices can do a lot of things. But what good are they if they can't talk to each other?

With everyone from the federal government to medical associations pushing for increased use of electronic medical records—not to mention the $19 billion allocated to healthcare information technology in the American Recovery and Reinvestment Act—medical device connectivity is becoming an increasingly critical issue for chief information officers.

Medical devices have myriad purposes, including improved diagnostic workflow, alarm notification, surveillance, data analysis, reporting, and documentation. But if a device can't communicate data to the EMR or is unable to identify the patient with whom it's associated without manual data entry, reaping the benefits of technologies like the infusion "smart" pump or bedside patient monitors becomes virtually impossible, says Tim Gee, principal of Medical Connectivity Consulting, in Beaverton, OR. "You have to think of medical device connectivity as workflow automation through the integration of medical devices and integration systems. Many people tend to think of connectivity as just the connection itself, but in fact that's an enabling capability and really the least important as far as whether the resulting solution will be successful," says Gee.

Gee says one of the most fundamental issues facing every provider is a lack of plug-and-play interoperability standards. "Currently there is no common format for exchanging data. Because each device vendor has its own proprietary protocol, there is no clear path to connectivity," says Gee.

The absence of standards has left nurses and physicians creating dreaded "workarounds," like writing patient identification numbers on hands or pieces of paper to later enter the information in the patient chart manually, increasing the chance of errors. "These are exactly the types of problems paperless charting is supposed to overcome," Gee says.

In 2004, Boston's Massachusetts General Hospital and the Center for Integration of Medicine and Innovative Technology launched the Medical Device Plug-and-Play Interoperability Program to lead the evaluation and adoption of open standards and technology for medical device interoperability. In November 2008, the program collaborated not only with Massachusetts General, but also with Partners Healthcare System in Boston, Johns Hopkins Medicine in Baltimore, and Oakland, CA-based Kaiser Permanente to promote vendor adoption of connectivity standards by crafting contractual language that providers can use when negotiating with vendors.

The result was MD Fire (Medical Device Free Interoperability Requirements for the Enterprise), which brought together five groups from the four organizations—clinical engineering, IT, clinicians, purchasing, and attorneys—to draft a two-part document. The first part is a call to action of sorts, explaining to vendors why standards are important from a patient safety perspective. The second contains sample request-for-proposal and contract terms, including language that asks vendors for a complete description of specific functionality and interoperability capabilities. Both documents can be accessed at http://mdpnp.org/.

To date, however, the problem still remains just that, says Gee. "What these providers are asking for is reasonable and needed. The question is whether vendors will pick up the pace of connectivity adoption, or will instead continue to drag their feet."

Kathryn Mackenzie

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