- At the University of Arkansas Medical Center last year, Director of Clinical Informatics and Innovation Amy Hester, PhD(c), BSN, RN, BC, has had a pair of huge health IT projects on her hands. Not only was the 517-bed academic medical center going through a massive overhaul of its EHR infrastructure, but Hester was charged with leading a medical device integration team that hoped to go live with its implementation at the very same time.
The all-or-nothing project was a daunting one, but it was also successful. In this Q&A case study, Hester sat down with HealthITAnalytics to discuss how improving UAMS’s medical device integration helped to streamline workflows, improve access to real-time patient data, and boost organizational efficiencies during a time of significant and widespread change.
To learn more about pairing EHR implementation with medical device integration, read part one of this interview on EHRintelligence.com.
What prompted your move into more sophisticated device integration?
We have been EHR users for several years, and we were on our second EHR. We were getting ready to implement Epic enterprise-wide as our third system. We were already doing some device integration in our intensive care units, but we were handling that on our own and dealing directly with integrating data from the device vendors themselves. We found that to be a very dissatisfying and fractured process, and we knew that we didn’t have the framework in place to be successful with device integration on a larger level moving forward.
So with our new EHR integration, we lobbied for and garnered a budget specific for device integration, and were able to develop a project team out of that budget that included IT, clinical engineering, and nursing. That allowed us to have all of the key stakeholders at the table to make the right decisions and establish processes that would be more sustainable and more staff friendly.
We knew that the medical/surgical areas included the largest segment of our patient population, and that our critical care areas would benefit from that technology the most, so that’s how we decided that those two areas would be really the most effective places to start.
Why was streamlining your data collection from medical devices necessary to improve patient care?
It used to be, especially for our unlicensed assistant personnel (UAP) with 10 to 15 patients to look after, that they would collect all their vital signs and record those on a piece of paper that they kept in their pocket. Then, sometime later in the day, they would sit down and document those vital signs all at one time. Sometimes they would go through their whole shift before doing that. Some people were better than that and would collect all their vital signs and then document them in the record, and then four hours later, they would do that whole workflow again.
It was the same thing for nursing staff, especially post-procedure. A lot of times, nurses would collect their vital signs and they would write it down on a piece of paper, and then when they got ready to chart medications or something like that, they would take that time to go in and put those vital signs into the record there as well. In our ICUs, the respiratory therapists would do their rounds and they would take their vent settings and they would do the same thing.
Some of that documentation was still on paper, and so the physician staff had to be on the unit to be able to access that information. They couldn’t access those vent settings without either calling someone on the unit coming to the unit to look at the paper chart themselves, and so workflows were very inefficient.
In general, we’re pretty savvy when it comes to data governance. We have an enterprise data warehouse. We’re a translational research institute. So we’re good stewards of our data, and we’re very cognizant of how we build our EHRs up front to make sure that our data is cached and translated and stored so that we can research and review information in a very ready fashion.
But what we have noticed is that when it comes to the access of that information, our world is completely different today than what it used to be. Under the old way of doing things, it was possible for a patient’s vital signs to be 8 or 12 hours old by the time they were entered into the record.
It’s not like that anymore. When we collect a set of vital signs or information from other devices like ventilators, or anything that falls under our device integration program, that information is validated right there at the point of care. It goes into the record straight away. So everybody that needs to make care and treatment decisions about that patient has up-to-date, real-time information on that patient regardless of where they’re accessing that record from.
They don’t have to be on the unit. They can be at home and access that information, or on their mobile device and access that information. So our ability to have real-time access to data brings us into a whole new world now that we have our devices properly integrated.
Did you see any other tangible benefits from implementing the program?
We have seen some interesting things that we did not anticipate from device integration. Some of our older techs that work on the floor were really planning on retirement when Epic came along. They were very intimidated by a whole new EHR system. A lot of their documentation had been on paper in the past, and they didn’t feel like they were going to be able to make the transition in a non-painful way from a paper to an electronic chart. What device integration did for them was buffer a lot of those pain points.
About 90 percent of what a tech does can be documented straight from that vitals platform. So that has eased the burden of that human/technology interface that some of our older generation techs thought they were going to have to negotiate. So it has let us preserve a segment of our workforce that we really anticipated losing.
And then, of course, staff, we have surveyed our staff to figure out what their perceptions of device integration are. That was actually a scientific survey that we did. They perceived that device integration is a safer way to document things, it’s more efficient, and it’s accurate. They believe there are fewer transcription errors and that they’re able to make better treatment decisions in real-time, because they have the tools they need to do that now.
How will you continue to leverage your health IT infrastructure to provide more robust device integration?
Improving notifications for clinical staff is one of the next steps for us on our journey in device integration. When we set the parameters on the devices that we do have integrated, we use a separate communication technology to provide alarms and notifications, so staff are alerted via that technology that there is something coming directly from their machine.
But we will continue to push deeper integration. We do have some vendors today that we use around some workflows, like dialysis, who aren’t ready to integrate. We’re really pushing them hard in that direction because there’s so much data output that comes from those devices when they’re hooked up to a patient, and you really can make better and faster care and treatment decisions if you have access to that information a lot sooner. So we are working with external vendors to push them in the direction of being capable of device integrating, because that’s what we want.
The other question is how to expand our footprint of device integration so that it continues to touch as many patients as possible. We are going to be moving device integration into our infusion areas. We have a very large oncology program here – just one of our infusion centers along sees 200 patients a day, seven days a week, and we can service 53 patients at a time in that one infusion clinic. And so you can see where device integration in an area like that would have a very high impact, both on the number of staff that are working in that clinic and the volume of patients and data that we’re generating on a daily basis.
What is your advice to other healthcare organizations who are investigating medical device integration technology of their own?
I think the first step, especially with vendor selection, is really determining what your organizational goals are with respect to device integration, and then vetting the vendors thoroughly to see if they can meet those goals. We had very specific goals that we demanded around device integration, and there was only one vendor that was able to meet those demands, which helped us to make very objective decisions up front that were unbiased.
The other piece is having that project team that includes IT, clinical engineering, and any of the clinical stakeholders, whether it’s respiratory or nursing or other clinicians. I think it’s critical to bring all those stakeholders to the table together so that you can make sure that those goals are congruent with one another and congruent with the organizational mission as a whole.