In this post, Susan White looks at the real challenges that we face with integrating medical devices with EMR software. The lack of real industry wide standards is really at the crux of this issue and I don’t see a solution to this in sight. First, we probably need to narrow down the more than 300+ EMR vendors to something more manageable.
Technology is supposed to make our lives easier and more convenient, but when said technology makes us adopt roundabout ways to do work and takes up more of our time in the process, it is worse than useless. In such cases, it becomes a white elephant that costs more than it is worth, and it’s better to do without the technology than spend hundreds of thousands of dollars on something that’s not more than a showpiece. This is exactly what’s happening with EMR systems – they’re supposed to make medical history access, updates and management as easy as pie for hospitals and other healthcare facilities; instead, they’re becoming a headache because of integration problems.
In an ideal world (the one that the EMR was designed for), medical devices could be hooked to EMR systems which would automatically record readings for patients and store them in the right records. However, in reality, the machine spews out the values and nurses or technicians record them on paper and then feed them manually into the EMR. If this is the norm rather than the anomaly, why invest in EMRs? Why not just use a regular patient database that can be queried for patient records and updated manually?
The problem is not that the medical devices or the EMR are faulty – rather, it is the fact that there are serious integration issues between the two. Direct capture seems to be something that is destined to remain the stuff of dreams because different manufacturers adhere to varying standards and this means that the integration protocol changes. There is no industry-wide standard for the integration of medical devices and EMR systems and because of this, integration becomes a thorny issue.
The very purpose of using EMRs is to reduce medical errors, decrease the amount of paperwork, boost staff productivity, and deliver clinical results in an accurate and timely manner. When manual data entry is used as opposed to automatic data capture, all the above advantages are nullified, and this means that the healthcare facility has wasted money in the course of the EMR investment.
The trouble here is that connectivity to and integration with medical devices is an afterthought for EMR manufacturers. Besides, with each company following its own standards for connectivity hubs, there is no way that all EMRs can be uniformly hooked up to all medical devices. There are ways to resolve this issue, but it has to be consciously addressed by the healthcare facility that is investing in an EMR. They have to ensure that their devices are connected to the EMR to facilitate automatic data capture, and if they are not, they must work with the EMR provider or the device manufacturer or a third party vendor to provide a suitable connectivity interface.
But with cost being a substantial factor, most healthcare facilities are averse to such extra efforts; this leaves the future of EMR systems in a limbo – how long will people continue to invest in elephants if they know that they are white and so prone to expenditure without proving their worth? Only time will tell!
This article is contributed by Susan White, who regularly writes on the subject of surgical technician schools. She invites your questions, comments at her email address:susan.white33@gmail.com.
I agree with Susan; this integration with all the devices need to be done. At the same time, we also need to take into account, that there is no silver bullet which can make this happen overnight. Over time, competitive market place will dictate – to be in business EHR’s should have interfaces with such devices; and it might start of with the widely used devices and go deeper and broader. Its a process and will take time, I am assuming.
Current mandata and incentives are the first few steps in the right direction and should result in well coordinated standarts for images and other results as well as move towards integration of devices into health records through EHR.
I agree with Susan to a certain degree. Remember we didnt go form Model A to Mazerati in a day. Folding devices into this mix before all the uncertainties settle out a bit is like putting the cart before the horse.
I think the real failure in this entire arena is in the overlooked fact that a lot of the larger EMR vendors are in the game due to a large market share in other areas of medical sales.
I am of the opinion that this is the largest factor in the lack of commitment on the doctors parts and creates the fear keeping them from moving forward.
As my main area of sales in in helping people bridge the gap to going toward EMR by handling the back-file conversion and providing access in a format that can be easily migrated into most systems it probably affects me less than the guys selling full blown EMRs.
I think it is important to remember the entire basis of all this progress is to make storing and sharing information easier and less wasteful than the paper method.
Why is it assumed that EMR integration with devices is a good thing? When a nurse writes down the vital signs, it triggers him to process the information in a way that is very different from just hearing another alarm. If the EMR just imports that information, it will frequently be a) ignored or b) wrong. A lot of the data that is collected is just noise. And more data does not equal better data.
There is no question that we will encounter many costly technical blunders, before we get these systems working smoothly.
But look how many times the Wright Brothers had to build planes, before they finally got something that really worked?
Some day…maybe 10 years from now…we will look back, and be thankful, that we made the pioneering efforts to implement EMRs, and we will look back at the days of manual data transciption…as ‘The Stone Age’.
Meanwhile…hold onto your hats! Its going to be a bumpy ride!
[…] and HIPAA guest author Susan White covers in depth how a lack of connectivity standards affects EMR integration. There are no mandated standards for EMR vendors to follow, making it hard to coordinate data […]
[…] and HIPAA guest author Susan White covers in depth how a lack of connectivity standards affects EMR integration. There are no mandated standards for EMR vendors to follow, making it hard to coordinate data […]
I agree with Susan. I was having similar questions in mind, but at the same time, I think, we will not know how deep the ocean is, until we get into it. What I meant to say is, the vendors do not give you an opportunity to see a demo of how the whole system works, in order for us to assess the pros and cons of the whole medical device integration with EMR system. Based on the facts, articles, papers, news, all we hear about this EMR integration as a very successful, helpful, skillful in our day-to-day lives at our health facility, which we will know only when it has been installed and running.
Mohan,
One of the best ways to check this is to get an EHR vendor’s entire client list or at least the list of clients from your specialty. Then, call and/or visit a bunch of them to learn first hand what it’s like using the system. It’s still not perfect, but can help you understand some of the details you wouldn’t realize until you start using it.
I’m actually part of our strategy team for implimenting medical device integration into our EHR (Allscripts EEHR). Basically they have an approved device list, and if it’s not on the list then the interface needs to be created by the manufacturer of the device (good luck). They have a pretty small list but for example Welch Allyn is on the list and has some nice integration. Further, there is no standard as mentioned; HL7 can’t do it, the data format is all wrong (Hl7 typically has one descrete value ie blood glucose which does not work for clinical instruments like EKG and spirometers. Lastly i will note that the concept of writing it down ensures that they pay attention, this is not really true. Someone, typically a NA, or RN is performing the test, so they can see the test in real time, and thus they can do a real time assesement of any issue. This is far different from blood tests where you send out a tube of blood and wait a few days and get a result back somehow. In that case, yes the physician should be alerted (which allscripts (mostly) does).