Experts think hospitals' purchasing power will be the driving force for greater interoperability. One obstacle, however, is the traditional hospital purchasing model, in which large capital purchases such as patient monitoring systems occur once every decade or so. “We have legacy systems, and it's very expensive to update devices and many devices are not updateable yet,” Goldman said.
Even so, some hospital systems are moving forward. The Baylor Health Care System, which recently merged with Scott & White to create Baylor Scott & White Health, set up its patient monitoring system to integrate with its EHR. That project took three years to roll out, and required the health system to purchase a “middleware” software system allowing its Allscripts EHR to “talk” to the patient monitoring system. The former Scott & White hospitals also have patient monitoring systems integrated with EHRs. Plans are underway to integrate anesthesia machines with the EHR as well.
As at Baylor, often the only way for many hospitals to connect EHRs to patient monitoring systems or infusion pumps is to purchase middleware software solutions that need to be tailored to each hospital. But the use of middleware is problematic. West Health estimates that a hospital might pay up to $10,000 per bed in one-time costs for medical device integration. It “adds another link in the chain and creates another possible weak point,” Maddock said.
Aaron Goldmuntz, vice president of business development for the Center for Medical Interoperability, said he expects that adoption of standards would reduce the need for middleware and eventually eliminate it. However, he noted that middleware companies currently have a role in bridging the gaps of interoperability due to the number of legacy devices still in operation.
Scripps Health in San Diego will require medical devices to connect to its $6 million medical-grade wireless utility system once that system is deployed next May. The wireless utility system is expected to boost adoption of wireless health technologies. Currently, none of Scripps Health's medical devices are connected to the EHR system, said Dr. James LaBelle, Scripps' corporate senior vice president and chief medical officer.
LaBelle said the successful devicemakers will be the ones who figure out early that interoperability improves patient care and adds greater value, and who partner with providers to make it happen. He said the question hospital systems should ask is, “How can your device drive my nurse to spend more time at the bedside because it's able to eliminate waste?”