It seems like only yesterday that the worlds of biomedical engineering and information technology were totally separate. On the one hand, there was the galaxy of biomedical devices, from patient monitors to intravenous pumps, oximeters, hemodialysis machines, and a host of other medical equipment, all managed by biomedical engineers and clinical department staff. On the other hand, there were computers of all sorts, with software for administrative, clinical and other purposes, managed by IS executives and staff.
The two worlds have collided just as hospital-based organizations are implementing EMRs and other advanced clinical information systems. Today, virtually every piece of biomed equipment is microchipped, and has in effect become a kind of computer, with many biomed devices that are highly sophisticated machines capable of providing clinicians with tremendous amounts of actionable clinical data.
Most agree that the potential improvements in care resulting from true integration between clinical information systems and biomedical devices are enormous. Yet a visitor to most U.S. hospitals will still see nurses reading live data from patients' vital sign monitors, then scribbling notes onto pieces of paper which later they will type into an EMR. Why? The answer is that most biomed equipment has remained in isolated electronic islands. That is until now.
In the past few years, pioneering hospitals and health systems have been moving to make biomedical device integration a reality. There are a host of issues involved, from the governance level to the clinical, practical, and yes, technological. But for CIOs, the opportunity to help co-lead teams of IT, biomedical engineering, and clinical professionals towards device integration is an imperative emerging patient care environment.
And if any patient care organization exemplifies a systematic way of tackling this opportunity, it is Trinity Health, the 44-hospital system based in the Detroit suburb of Novi, Mich. At Trinity, a multidisciplinary team of IT, clinician, and biomed leaders are leading the charge to integrate a flotilla of devices (110,000 biomedical devices are registered in the system's database) into the organization's system-wide EMR. This initiative is occurring in tandem with the health system's strategic push towards advanced clinical computing (Trinity Health officials estimate that 25 to 30 percent of those devices have been integrated into its EMR to date).
“We have a great opportunity to become incredibly consistent in the care that's delivered,” says Paul Browne, senior vice president and CIO at Trinity Health, who leads a team of 1,300 IT professionals. “And when I think about clinician productivity, for example, the need for nurses to be constantly writing down vital signs, and just the fact of having the capability to automate some of that documentation, the potential productivity gains are exciting and interesting.”
What's exciting about the device-integration initiative, Browne notes, is that it aligns with Trinity Health's Project Genesis, a massive clinical computing plan that is bringing an integrated EMR to 34 of the system's 44 hospitals (Trinity Health runs several managed hospitals, some of which are on alternate EMRs). The EMR movement is driven partly by a system-wide quality improvement initiative.
Browne counts several executives as key partners in his effort, including J. Michael Kramer, M.D., MBA, Trinity Health's vice president and CMIO, and Lou Fierens, the health system's senior vice president, supply chain and capital projects management, to whom the biomedical engineering department reports.
The biomed integration initiative actually began several years ago in an effort to cut costs, Fierens reports. But as Project Genesis has moved ahead, and as the technology in the biomed equipment area has advanced, the broader goals of improved care quality and workflow have come more fully into focus, he says. The biggest challenge, says Fierens, is that “you've got to balance the economics with the infrastructure and support, along with the service element, along with the clinical outcome you're trying to support.”
And to do that, IT and biomedical engineering need to work as true partners. He strongly credits Browne with helping to create a great working relationship between the two men and the two areas. “The relationship I have with Paul is really an integrated partnership,” he says. “And I use the word ‘partnership’ very carefully, because in my world, I use that term to describe a situation in which you can leave the room, and know that they'll look out for your best interests. I feel we can do that for each other. And there's never a moment where I feel our priorities are not in alignment. We spend a lot of time talking about priorities, and aligning them. It's hard to overemphasize how important that working relationship is.”
Then of course, there is the task of linking clinical informatics goals with biomedical equipment strategy. And that's where Kramer comes in. Indeed, Kramer says, “a critical success factor is creating a compelling vision for automation-enabled patient care, and then translating that several levels down.” Such an approach requires a lot of collaborative thinking and work.