Interoperability: Are we there yet?

It’s not that simple.

Medical device interoperability – that is, the ability of equipment and devices to interface with the electronic medical record and other devices — remains a tough nut to crack. But that hasn’t stopped the feds, EMR developers, equipment and device manufacturers, and healthcare providers from continuing to work toward that goal.

“We are involved in discussions” about interoperability with others across the continuum of care, says Ken Harris, executive vice president, sales and marketing, Health o meter. “To the extent manufacturers can be involved, our role is to ensure our messaging is clear and that caregivers can easily record accurate information for safe and consistent care.”

Why it’s important
In February 2019, the National Science Foundation issued a Request for Information asking those in the industry to help determine “whether a vision of sustained interoperability in the hospital and into the community is feasible, and if so, what it will take to realize it.”

“While healthcare systems are rife with medical devices and the data they produce, to date, these devices are not interoperable and cannot effectively interact with each other and the broader healthcare ecosystem,” wrote the agency. Interoperability, on the other hand, “will provide greater support for patient safety, decrease medical errors, reduce provider burden, reduce practice variability across healthcare facilities/geographic areas, and ultimately enhance medical care quality and outcomes.”

The absence of interoperability comes with a human cost.

Researchers from the University of Texas Health at San Antonio studied the accuracy – or lack of accuracy — of insulin-related decisions made on the basis of point-of-care blood glucose testing among critically ill patients.

“Transcribing these values from glucometers into a paper log and the electronic medical record is very common yet error-prone in intensive care units, given the lack of connectivity between glucometers and the electronic medical record in many U.S. hospitals,” they wrote in the March 2019 issue of “JMIR Medical Informatics.”

A total of 5,049 blood glucose tests (pertinent to 234 patients) were studied. Transcription errors in the paper log, the flow sheet, and in both resulted in eight, 24, and two insulin errors, respectively, the researchers found. As a consequence, patients were given a lower or higher insulin dose than the dose they should have received had there been no errors. Overall, 30 unique insulin errors affected 25 of 234 patients (10.7%).

If achieving total interoperability were easy, it would already be here. But it’s not that simple.

“The primary obstacles are the customer’s priority and access to technical and EMR resources,” says Harris. “All EMR integrations require resources, whether the scale is being connected directly or through a monitor, and customers don’t always have the time or resources for integration projects. For scales in particular, every interface, regardless of brand, requires project management and project resources for a single vital sign.”

“Ease of use and ease of deployment are two primary obstacles for interoperability of medical devices,” says Chad Darling, senior product manager, EMR Business Development, Midmark Corp. “First, if a system is difficult to set up, requires each device to be preconfigured or is not stable, you will most likely not see that device connected to the EMR.

“Once the hurdle of connecting the device has been overcome, daily adherence becomes the next hurdle,” he continues. “If it is easier to manually key in values or if the interoperability fails when the device is being used, staff will scan or key in the information instead of using the connected device as it was intended. Oftentimes the end-user experience is overlooked for better interoperability.”

Garrison Gomez, executive director, marketing, patient monitoring and diagnostic cardiology, Hillrom, points out that the primary barrier to interoperability doesn’t always lie with medical devices or systems. “It is getting the right balance with the customer of its security versus clinical workflows,” he says. “We have dedicated teams that work with the customer to apply best practices that we have obtained through our experience with both large and small systems.”

Interoperability as a selling point}
What kind of response should contracting executives expect when they ask their vendor or supplier this question: “Will this device interface with our EMR?”

“For the majority of our devices the simple answer is ‘Yes it will,’’” says Gomez.

Says Darling, “The typical answer is ‘yes’. But we always double check if the EMR is uncommon or unique to a niche. We try to be very clear about the user workflow very early in the customer conversation. This is a major advantage, as it saves everyone time and ensures the dealer and the end user are very satisfied with their buying experience.”

”Every system is unique in some way,” says Harris. “It’s important that the [distributor] rep and the customer talk to the manufacturer so everyone understands what the installation looks like for their particular setup.

“Each customer organization decides which patient information can be entered, how it is entered and by whom,” he says. “So while our equipment is compatible with EMR systems, having the discussion of how each system is set up is critical to understanding how an implementation will take place.”

And what if the newly installed device or system falls short of expectations, at least insofar as interoperability is concerned?

“It’s almost impossible for a [distributor] rep to understand all of the technical issues between the EMR system and the myriad of EMR-compatible equipment,” says Harris. “It’s important that the rep coordinate discussions between the user and the manufacturer if an issue occurs … so that the manufacturer can take care of it.”

“Hopefully that doesn’t happen with Welch Allyn products as we provide on-site installation and configurations of our products with the customer,” says Gomez. “That said, if the rep was to get that call, they could quickly get Welch Allyn tech support on the phone with the customer. We have a host of tools that [allow us to] quickly diagnose the situation remotely. In the event we can’t resolve the issue, we also have a direct support model with the majority of the top EMR companies, where we can quickly get their team on the phone with the customer to resolve the issue.”

Says Darling, “If a Midmark device is not working with a compatible EMR, Midmark technical support can work with our EMR partner to help resolve the issue affecting connectivity. Our national technical support network has partnered with leading EMR systems to ensure that if there are issues, we can get them resolved as quickly and as painlessly as possible.”

The paths to interoperability

Repertoire asked several manufacturers of medical devices and equipment to talk about their path toward interoperability.

“Health o meter® Professional scales were the first in the market to be able to connect to an EMR system, and we have been the leader in connected scales for over a decade,” says Ken Harris, executive vice president, sales and marketing. “Our scales can be connected directly into an EMR system or connected via multiple vital signs monitors.

“In order to increase their workflow and simplify the transmission of data into a patient record, most customers choose to connect through a vital signs monitor that can transfer weight, height, BMI, blood pressure, blood oxygen saturation and temperature all with a single EMR interaction.”

“Midmark has been integrating medical devices for over 15 years, and has partnered with leading EMRs to solve interoperability issues and provide an integrated workflow that makes device interoperability easy to adopt,” says Chad Darling, senior product manager, EMR Business Development, Midmark Corp.

“We sometimes see this type of transcription errors [i.e., the errors described by the researchers at University of Texas Health at San Antonio in the accompanying article] with vital signs devices. The Midmark Vital Signs device is fully integrated into leading EMRs, eliminating transcription errors and fitting seamlessly into the user’s workflow, promoting interoperability.”

“Hillrom is a market leader when it comes to proven, secure, safe, and simple connected solutions inside and outside the hospital,” says Garrison Gomez, executive director, marketing, patient monitoring and diagnostic cardiology. “Through over a decade of innovation and collaboration on the development and deployment of our Welch Allyn Vital Signs Monitors, we have EMR partnerships with over 150 EMRs.

“We have also recently received our authority to operate with the risk management frame (RMF), the Department of Defense latest security standards that we have also applied to our commercial customers. In addition, the two largest health systems in the U.S., along with over a hundred other IDNs, have standardized on our solution for patient monitoring, which has enabled them to diagnose and treat patients earlier.”