What if the future came and no one knew it had arrived?
That, in essence, is how many CIOs and other IT executives in hospitals and health systems have been feeling lately about the constellation of medical devices — from cardiac monitors to ventilators to intravenous medication pumps — operating quietly across their facilities. What were until recently seen as discrete pieces of patient care equipment — and usually purchased and managed by clinical departments or nurse managers, biomedical engineers, or even materials managers — are becoming smarter and more complex every day; and, since the vast majority now have embedded computer chips, are being connected to a variety of wired and wireless networks.
Suddenly, the potential for viruses to enter core clinical information systems (IS), or for wireless networks to be brought down, has ratcheted up tremendously. Not surprisingly, smart CIOs are rethinking medical devices.
As Greg Walton, CIO of the Roanoke, Va.-based Carilion Health System, puts it, "I became aware of the implications of all this about five years ago. And what dawned on me then is that, from a clinician perspective, it is now virtually impossible to distinguish between where a computer begins and a medical device ends; for end-users, it's all technology."
Four years ago, Walton combined the 21-member biomedical engineering department with his 185-member IT staff to deliver more integrated service. End-users, he says, have been happy with the improved service.
To each their own
Not every hospital will bring biomedical engineering under IT, but all those interviewed agree that one key implication of the computerization of medical devices is a strong need for close coordination between biomed engineering and IS management, and as much technological integration as possible.
Those are two top recommendations of a white paper on medical device connectivity published in November by Long Beach, Calif.-based First Consulting Group. Coauthors Fran Turisco and Erica Drazen (both based in FCG's Boston office) concluded that devices are simply "becoming a part of IT, the way medical records came under IT years ago in many organizations." Pay-for-performance programs — with their voracious need for analyzable data — will be one of the trends driving the need to stream data from devices into electronic medical records (EMRs), Turisco predicts.
Workflow and the definition of tasks are all changing because of such advances, notes Dan Pettus, director of enterprise applications at San Diego-based Alaris Medical Systems, which makes the IV medication and infusion therapy pumps that Turisco cites as an example of smart, programmable medical devices. Going forward, he says, clinical department, IT and biomed managers will have to work together to develop parameters and protocols for the pumps.
Many CIOs agree that their responsibilities are changing as a result of all this device computerization.
"It changes the landscape of what we deal with pretty dramatically," says Larry Sharrott, chief informatics officer, Horizon Blue Cross Blue Shield of New Jersey. "It used to be that we would say, if it has a computer in it, you need to call us before you buy. Now, we pretty much say, if it's electronic and plugs in, you need to call us." Staffing upward to provide needed 24/7 tech support, and determining what networks devices should run on and how to interface them with other technologies, will be among the issues to be tackled, he says.
"But the biggest issue," says Bill Spooner, CIO of the Sharp HealthCare system in San Diego, "is really the cultural change that we're going through, to recognize that this product needs to be selected strategically," in order to fit each device into an overall EMR strategy.
As a result, "Everything now that's to be connected to a network here has to be reviewed" by both IS and biomedical engineering, says Paul Maurer, director of applications at the multi-hospital Main Line Health, Bryn Mawr, Pa.
Mark Hagland is a contributing writer based in Chicago.