President Barack Obama has proposed that healthcare reform could be funded, in part, by insuring the use of only the most effective healthcare practices, drugs and devices. A multitude of technology exists that speeds up the healthcare process, both at the bedside and in administrative offices. The big problem: a lack of interoperability. Disparate systems are islands with information in and of themselves.
Earlier this year, a national group of nurses published the Proclamation for Change, a document that outlines the four tenants needed to enact transformational change in the patient care environment. Device interoperability is a key part.
"The average nurse walks two to three miles a day during the course of a shift, and a lot of that is chasing device alarms," Steve Pregulman, global medical director for device development at Hospira (Lake Forest Illinois), told Medical Device Daily. Hospira is one of only a handful of med tech companies today purposefully making devices that ensure consistent communications, connectivity and interoperability via open architecture systems.
Pregulman was citing information about nurses from an article in The Journal of Nursing Administration that published the proclamation, which also noted that nurses spend just 31% to 44% of their time on actual patient care. It noted in one of the four tenants that to rectify some of the wasted time, "The design and operation of technology devices should be intuitive, error-free and part of interoperable systems so that healthcare providers can access information in hospital or outpatient settings and not waste time serving as human bridges that link multiple technology devices in different locations."
And in June 2009, the American Medical Association (AMA; Chicago) officially endorsed interoperability in a resolution that stated the AMA, "... believes that intercommunication and interoperability of electronic medical devices could lead to important advances in patient safety and patient care, and that the standards and protocols to allow such seamless intercommunication should be developed fully with these advances in mind. Our AMA also recognizes that, as in all technological advances, interoperability poses safety and medico-legal challenges as well."
Then there is the Medical Device Plug-and-Play Interoperability Program (Boston) which is leading the adoption of open standards and technology to interconnect medical devices for improving patient safety and healthcare efficiency. It's affiliated with Massachusetts General Hospital (Boston), Center for Integration of Medicine and Innovative Technology (Boston) and Partners HealthCare (Boston), with additional support from the U.S. Army Telemedicine & Advanced Technology Research Center (Fort Detrick, Maryland).
With so many groups in agreement that interoperability is the answer to many problems, what's the hold up?
Barriers to the widespread adoption of interoperability run the gamut from an absence of proven standards for data communication and control to a lack of reliable and safe system architectures. There are regulatory and liability concerns too.
"The current state of healthcare and health information is disconnected islands of information," Pregulman said. "It's dangerous because the person accessing particular information won't know if there is newer or more pertinent information. An institution will have different information systems that don't communicate with one another. The whole point is to allow one system to talk to another and exchange information freely without a massive effort."
Hospira, Pregulman said, is building technology with an open architecture system that enables other companies to easily work with Hospira.
"The technology vendors who don't want open architecture do it because it allows more short-term benefits to the bottom line," he said. "Everybody has to come to them to play in their sandbox. With open architecture, they give up control and potential revenue. Hospira's philosophy is by being open, it's better for healthcare and we hope it's something customers recognize and value. We'll grow a happier and more satisfied customer base that finds us an easy company to work with."
Pregulman said he believes that it's going to take both carrots and sticks to get other medtech companies to come to the interoperability table. And those carrots and sticks are likely to be presented sooner, rather than later given the push for healthcare reform.
"It's all about discharging patients sooner," Pregulman said. "The benefits will cascade out from that. There's evidence to suggest that it will lead to reduced costs. Interoperability is buried in a lot of other topics that are getting more attention. But just by virtue of everyone adopting electronic health records, I don't see how that in and of itself will achieve all the savings that we need."
Pregulman said that if all systems were interoperable, medical device companies could likely bring products to market more quickly. Patients could benefit sooner.
"Right now if I don't have interoperability, and I have a customer who already has system X and they want my device to communicate with system X, I have to go talk to the company that sells system X and we have to negotiate a contract," he explained. "I may not be a high priority. They could drag their feet to maintain their profit line or maybe it won't happen at all. If you can eliminate that aspect of product development, and you've got an open architecture to work with, we can build what the customers want and not have to get into the business issues between vendors."
Ultimately caregivers would spend less time chasing down alarms or duplicating documents in charts and they'll have more time to spend with patients, he said.
Hospira is doing its part with medication management systems.
"In most hospitals today, a nurse gets a medication order on paper or in an electronic record, then goes to a pump and uses a finger to start the infusion, but runs the risk of inadvertently making an error," Pregulman said. "Auto-programming allows nurses to scan the order, read it and confirm reducing the chance to make a mistake. Our pump gets information directly from hospital records, pulling information through, saving time for nurses and eliminating errors."
Hospira also is working on integration between medication pumps and physiologic monitoring devices to eventually connect those functions and further reduce time delays and potential for errors.
Pregulman predicts that there will be more and more collaboration between companies to improve healthcare.
"If the government doesn't step in, progress will continue," he said. "But there will be outlier companies until or unless their customers force them. There is a growing awareness on the part of customers. For example, Kaiser Permanente (Oakland, California) subscribes to the Plug and Play initiative and insists that any vendor it contracts with is focused on interoperability. When you have an organization like that behind the effort, it can move the market."
Some companies are seeing opportunity in and of itself by building bridges of interoperability for other devices. For example, Capsule (Andover, Massachusetts), which this month released a new Enterprise Medical Device Connectivity Solution enabled by the Capsule Neuron, offers the ability to deliver device connectivity across the enterprise.
Its design allows a facility to leverage existing technologies and completely integrates with caregiver work processes, according to the company. Capsule Neuron features a variety of deployment options from continuous data collection for higher acuity environments such as critical care, to periodic and mobile data collection in medical-surgical environments, or a combination of the two. It also allows the hospital to positively associate a device to the patient through either: location, bar code, or auto-sensing using passive RFID.
Capsule recently partnered with Arcomed (Regensdorf, Switzerland) to promote connectivity between Arcomed's IV pumps and hospital information systems using Capsule's vendor neutral connectivity solution. The agreement ensures that Arcomed's Volumed VP 7000 and Syramed SP 6000 IV pumps and their UniQueCONCEPT Infusion Data Management System have the most current connectivity software and creates a foundation for all future Arcomed products to connect to any hospital information system.
Lynn Yoffee, 770-361-4789;