Hospitals expected to press devicemakers, EHR vendors to make their products 'talk'

The typical hospital bed in an intensive-care unit is surrounded by as many as a dozen medical devices that monitor the patient, track blood pressure and heart rate, dispense medications and perform other vital functions. Many of the devices have the capability to transmit data they gather directly to the patient's electronic health record.

For example, an “interoperable” infusion pump that gathers data about when a patient received fluids or insulin could transmit that data to the patient's EHR, preventing medication errors and creating a detailed record of the patient's clinical treatments and how the patient responded to medications. Experts say that would improve quality of care and lower costs.

But that's not happening in most U.S. hospitals. Less than one-third have integrated their EHR systems with even some of their medical devices, according to the Healthcare Information and Management Systems Society. When that information is not transmitted electronically, it has to be manually entered into the EHR by nurses, taking them away from direct patient care and potentially leading to dangerous errors. It's estimated that improved interoperability between medical devices and EHRs would save the U.S. healthcare system $30 billion a year.

There are many barriers to creating interoperability of devices and EHRs, including large upfront costs and lack of industry standards. But experts say some makers of EHR systems and medical devices also tend to limit interoperability because they don't necessarily see any profit in making their systems interoperable. Devicemakers that want to make their products interoperable have to design them to interact with multiple EHR systems instead of using a uniform standard. In addition, many hospitals are using medical devices that may be a decade old and lack the capacity for interoperability.

“It's difficult or impossible in most hospitals to have real-time or electronic transfer of infusion pump information available and sent to the (EHR),” said Dr. Julian Goldman, an attending anesthesiologist at Massachusetts General Hospital and medical director of biomedical engineering at Partners HealthCare in Boston. “If we had that kind of data, then as a nation we could identify these gaps and problems and put the resources in where appropriate.”

“You put these systems in, but if they don't have the ability to talk to any other system or one another, you're creating numerous silos of information that really aren't available to create an environment of best care,” said Nicholas Valeriani, CEO of West Health, a not-for-profit organization that seeks to lower the cost of healthcare. “The connection of this data longitudinally is what's going to unlock the real power of HIT investments in healthcare.”

Despite the current lack of interoperability, many hospital executives say there is momentum to connect the devices and IT systems and use the data in valuable ways. A group of medical device manufacturers signed a pledge in January to make their devices interoperable and to share data gathered by their devices that had previously been considered proprietary. For example, GE Healthcare promised to maintain “open interfaces that enable third-party devices and systems to communicate” with its patient monitors, therapy devices and clinical information systems.

The Food and Drug Administration, which regulates medical devices, recently recognized 25 voluntary standards that are expected to help manufacturers as they develop interoperable devices. Using one of the standards in the development process is expected to make the FDA approval or clearance process more certain for device companies.

The Medical Device Plug-and-Play Interoperability Program, founded by Goldman, is working with participating health systems including Kaiser Permanente and Partners HealthCare to encourage hospitals to produce and use medical devices that are interoperable in the future. West Health also is calling for “functional medical device interoperability” between regulated devices such as infusion pumps and electrocardiographs and with data systems such as EHRs and pharmacy dispensing systems. Improving interoperability between EHRs and health information exchanges is also becoming an issue for providers increasingly seeking to coordinate care across different settings.

“Providers are going to have to be the ones who push for this,” said Kenneth Maddock, vice president of facility support services for Baylor Scott & White Health in Dallas. “This is going to benefit patients and providers the most.” But, he said, the devicemakers “are sitting there thinking, 'We're going to have to spend money in developing it and what do we get out of it?' ”

Telecommunication billionaires Gary and Mary West, who founded and fund West Health, in September formed the Center for Medical Interoperability to bring together hospitals, which will be its members, and encourage improvements in device interoperability and utilization of standards. The organization estimates that improved device interoperability could lead to $30 billion in annual U.S. healthcare savings through improved quality of care, reduction in redundant testing, increased clinician productivity and shorter lengths of stay for patients. It says reducing the time spent manually entering information, and the resulting increase in clinician productivity, by themselves will yield $12 billion in savings. Some studies have found that nurses spend one-third of their shift time on documentation.

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?”

The lack of industry standards is a challenge, however. Unlike the consumer electronics business, which follows a “plug and play” model that allows products marketed by different companies to use the same interface, no single standard exists in healthcare. Experts say EHR and device companies tend to create technology barriers that limit the interoperability and functionality to their products unless interoperability immediately benefits their bottom line.

Now, though, group purchasing organizations are starting to see the value in encouraging interoperability in devices. The Premier healthcare alliance said interoperability is an issue it's looking at on behalf of its hospital members.

One devicemaker that's marketing interoperability is CareFusion, a San Diego-based manufacturer of infusion pumps and pharmacy dispensing technology. A spokesman said CareFusion is committed to working with EHR vendors to create interoperability between devices and IT systems. The company already has established interoperability between its infusion pumps and the asset-management and tracking system produced by Waltham, Mass.-based Stanley Healthcare. That interoperability helps hospitals locate and track utilization of infusion pumps.

“That makes our devices more compelling if we're able to talk to a Cerner or an Epic, or work with a pharmacy system, or send a notification to a different platform,” said Dr. Carlos Nunez, CareFusion's CMO and senior vice president of medical affairs.

Other devicemakers are urging their industry colleagues to join the movement. “We believe that everything in the hospital should be connected,” said Joe Kiani, chairman and CEO of devicemaker Masimo, which spearheaded the manufacturers' pledge. “If everything is connected, whether it's the ventilator, IV pump, (or) the monitor, then the patient has a better chance of surviving the hospital visit.”

Follow Jaimy Lee on Twitter: @MHjlee