HITECH, Meaningful Use & Medical Device Integration: The Missing Link

Introduction

Providers and patients alike may wonder why there has not been more significant traction in the use of technology to improve quality of care. The HITECH Act is a transformative piece of legislation that was established to improve the delivery of quality patient care with the goal of improved health outcomes. Questioning why there has not been greater adoption of technology in healthcare raises additional questions that point to organizational, management, and staff challenges . It’s not so much a delay caused by lack of enabling technologies but rather everything else that surrounds it (i.e. people and process issues) that have delayed the realization of the promised benefits.

The ability to receive incentive payments by demonstrating “Meaningful Use” of an electronic health record system (EHR) raises the bar even higher for providers and facilities.  Implementing an EHR system is a difficult undertaking, primarily because it involves deploying new technology, addressing training needs for staff and providers, and most of all, addressing the “cultural” issues of exchanging protected health information (PHI) between providers and facilities.

Designing a Safer Healthcare System

The importance of health information technology vis-à-vis designing a safer health care system involves looking at a multiplicity of factors that can contribute to error conditions. Detecting and preventing errors is, and should be, a primary aspect of any patient safety goal. Errors can be prevented with better use of health information technology that supports care delivery, but only if implemented correctly with consideration for multidimensional and multi-disciplinary aspects of the goal. That said, without technology to aid the documentation process, errors can occur because either patient information is not available, incomplete, or on paper in disparate locations. Other errors may occur because today’s healthcare system explicitly relies on the human element – the ability to recall large amounts of data to be used real-time.

Key examples of these new challenges include:

1. Organizations both public and private are establishing standards through which technologies can support migration from paper-based records to EHRs;
2. Software vendors are entering the healthcare industry with automated electronic health record solutions; and
3. Patients are demanding access to their personal health records.

Technology giants like Microsoft and Google are answering their demands, providing low-cost solutions. Yet, privacy and confidentiality of personal health information remains a challenge that results insignificant confusion. Despite these technical advances, providers and facilities are still concerned about how to proceed in this new healthcare environment. For example, since January 2010, there have been breaches of protected health information for approximately 1 million U.S. citizens.

The Importance of Real-Time Device Data

The IOM (2001) report Crossing the Quality Chasm cites the growing complexity of science and technology, resulting from tremendous advances made in clinical knowledge, drugs, medical devices and technologies used in patient care. These attributes of the U.S. healthcare system can impact the quality of care delivery.   Reduced mortality in the presence of high technology or its proxies has, however, been shown to be an effective modality. “Today, no one clinician can retain all the information necessary for sound, evidence-based practice. No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature.”  These challenges will almost certainly become more pronounced when different approaches are adopted.

The HITECH Act brings new opportunities to the healthcare industry, not only because the Act anticipates a massive expansion in the exchange of electronic protected health information (ePHI) among participants, arguably an undertaking for which the healthcare industry as a whole is largely unprepared, but also, because of the cultural transformation it implicates with respect to use of technology and regulatory compliance. The magnitude of change that the HITECH Act presupposes represents a radical departure from the status quo.

Barriers to Adoption

Bio-Medical Device Integration (BMDI) is a solution that can remove errors in transcription in the ED, OR and medical-surgical units in a hospital environment. BMDI is the technology platform that provides automatic collection of device data (e.g. vital signs) and transmits the data to an EMR, removing potential manual transcription errors from the equation. Some believe that BMDI may be the most effective form of ROI for a facility’s technology investment.

Nurses are at the front lines of patient care. They ensure coordination of care among the various healthcare professionals that involves a broad spectrum of activities. Any opportunity to minimize administrative or indirect patient care activities can save money for the organization as well as provide nurses with more time to devote to direct care of patients. Without BMDI, a significant portion of the nurse’s day is spent documenting patient care information. Manual documentation combined with fatigue and long work hours can contribute to error conditions as well as inefficient workflow. BMDI that safely and securely transmits data directly from devices to an electronic health record system saves documentation time and eliminates errors in transcription. Innovation is needed to sustain growth and improve patient care and health outcomes. In short, it is a people, process, and platform barrier that will require cultural changes in the way healthcare is delivered today.

At the present time, most healthcare facilities and practices are focused on meeting 2011 Meaningful Use Criteria with the implementation of electronic records. Not only is effort expended to migrate from paper to electronic media, it is performed in addition to the daily activities of BioEngineering, IT, Help Desk and Clinicians. To make matters more complex, the HITECH saga continues. After achieving 2011 criteria to receive incentive payments, the next set of criteria for 2013 and 2015 will require the EHR to become interoperable, not only within the campus, but also external to it.

Some believe that in order to achieve interoperable data exchange external to a facility, aggregation and digital storage of internal data is a necessary first step. Error reduction, improved patient safety, coordination of care, and clinical data exchange are key factors that promise improved clinical decision support to achieve better patient care.

In Elizabeth Teisberg and Michael Porter’s book, Redefining Health Care, they speak about a case study where safety improvement and error reduction took place between 1985 and 1990. 

“The American Society of Anesthesiology (ASA) launched a study in 1985 of closed malpractice claims to determine sources of patient injury and ways to avoid them. The studies revealed that one-third of the claims were due to respiratory injuries – usually resulting in death or permanent brain damage. Further analysis concluded that better patient monitoring would have prevented adverse outcomes in 72 percent of these cases.

The ASA then developed guidelines and training materials that encouraged its members to switch to the use of automated means of monitoring oxygenation of a patient’s blood and the level of carbon dioxide exhaled. Most hospitals viewed the $10,000 cost as an expense to be avoided. But when the guidelines became official, out-of-compliance hospitals were exposed to malpractice liability and for the ones who acquired the new equipment, major safety improvements were achieved by 1990.”

This study illustrates the value of a point solution. Device integration technology is capable of integrating point solutions to provide better patient monitoring and a comprehensive view of the patient’s condition, within a single console. The pursuit of quality care should not presume that it will cost more. There are a myriad of inefficiencies that currently exist in healthcare that when eliminated, can save money.

Some believe the technology is too immature or too costly to meet criteria objectives for the HITECH Act’s Meaningful Use. But as history has shown, technology innovation often moves at a pace that exceeds an organization’s ability to absorb it. Consider the last 20 years as an example. In 1990 the migration from mainframes to personal computers occurred. Five years later the Internet became an everyday occurrence with email at its forefront.  The same is true for healthcare. The HITECH Act will transform the structure of healthcare delivery as we know it today, and it is already in progress. This is not your daddy’s healthcare system any longer.

Conclusion

So where do we go from here? Certainly interoperability becomes a looming item for hospitals who have not yet “gone digital.” We live in a “connected”  plug-and-play world – but not in health care. Successful establishment of standards for interoperability have been achieved through use of HL7, SNOCOM, DICOM and others. Public and Private organizations, such as Integrating the Health Exchange (IHE), are defining opportunities that will improve healthcare systems and data exchange.

According to an article in Healthcare Informatics in 2009, Dr. Julian Goldman  believes that the absence of plug-and-play interoperability is a barrier to the integration of device data and the electronic record. He also stressed that the lack of interoperability just adds “cost and complexity” to the situation resulting in slower progress. He said “efficient data transfer is the added functionality for patient safety. If systems are smartly integrated, they can flag suspicious data.”
Innovative ideas such as connecting patient data at the point of care to the electronic record with BMDI, can improve accuracy, reliability and availability of patient data for clinicians while, at the same time improving workflow that provides more time for direct patient care. These innovative ideas can be translated into improvements in patient care that can lead to improved health outcomes – the overarching goal of Meaningful Use.

(with Dean J. Driebe), "Complexity Science and Health Care Management,"in John D. Blair, Myron D. Fottler and Grant T. Savage, (Eds.) Advances in Health Care Management, Stamford, CN: JAI Press, 2001, volume 2, pp. 11-36.

Patient Safety: Achieving a new standard for care; 2004; National Academy of Sciences

Crossing the Quality Chasm; 2001; National Academy of Sciences (IOM, 2001a:25).

Redefining Health Care: Creating value-based competition on Results; Michael E. Porter, Elizabeth Olmsted Teisberg; 2006; Harvard Business School Publishing

 Medical Device Integration: CIOs must bridge the digital divide between devices and electronic medical records; David Raths; Healthcare Informatics; February, 2009

About The Author

Deborah Leyva, RN, BSN

Clinical Solutions Executive

Nuvon, Inc.

www.nuvon.com

dleyva@nuvon.com

Deborah Leyva, RN, BSN is the Clinical Solutions Executive for Nuvon, the leader in next generation medical device data integration solutions that enhance the clinical decision support infrastructure and enable clinicians to focus on patient care and safety utilizing its Point of Care … Anywhere™ platform (www.nuvon.com).  As an experienced nurse, she brings in-depth understanding of the complexities of hospital care and home health that will aid Nuvon in developing the clinical components of its product line.  Her insights will define breakthrough solutions that leverage Nuvon’s next generation VEGA patient care data integration and interoperability platform.  Her experience as a healthcare professional working on the front lines of care ensures that the voice of the clinician will drive Nuvon’s development efforts.

Deborah is a seasoned executive who brings a unique triad of experience across healthcare, technology, and policy & law.  She is a recognized Healthcare & Technology Blogger, co-author of the HITECH/HIPAA Survival Guide, and serves as Co-Chair for the Ambulatory Workgroup of CCHIT (Commission for Certification of Health IT).  Her industry knowledge and functional expertise have made her a sought after resource for journalists in leading Health IT Journals and a requested speaker at numerous national, state, and local conferences. Last month, she participated in a Live Webcast and panel discussion Tools for Medical Collaboration: Telemedicine at Bloomberg Businessweek’s NYC studio.
She can be reached via email at dleyva@nuvon.com.

About Nuvon

Nuvon, Inc. is a privately held company dedicated to simplifying the management of healthcare technology, enabling clinicians to focus solely on the care of their patients, and providing real-time medical device data to improve decision-making and patient safety. Nuvon’s flexible, scalable, and configurable VEGA (Vectored Event Grid Architecture) platform is designed to capture, display, and transmit real-time data at the point of care, anywhere. Nuvon’s VEGA distributed network architecture supports true mobility enabling caregiver access to data and devices in any location. Nuvon has an installed base of major institutions that have recognized the value of Nuvon’s breakthrough approach to defining and implementing a rich model for patient data capture, transmission, and integration in complex healthcare environments.