Presenters. Technology Interoperability at the Bedside. Learning Objectives. Learning Objectives 8/30/2012. Wednesday, October 3, :15 5:15 pm

Transcription

1 Technology Interoperability at the Bedside Maximizing the Value of your Systems and Equipment Wednesday, October 3, :15 5:15 pm Presenters M. Terry Miller, BSEE Executive Vice President, GBA Victoria L. (Vicki) Bechet, BSN, RNC Project Manager, GBA Learning Objectives 1. Define medical technology and review recent advancement in bedside medical technology both equipment and IT Learning Objectives 2. Identify the types of information captured in the medical record how generated, where and how captured and how it supports patient care 1

2 Learning Objectives 3. Assess physical, operational, privacy and safety challenges typically faced in both newer and older facilities, and how patient information captured in the record changes with EMR Learning Objectives 4. Evaluate the impact of technology and EMR integration on nursing workflow specifically, what is the role of integration and how do we design for it now and in the future? The future of healthcare is streamlined care delivery supported by integrated technology Defining medical technology Advancements 2

3 Second largest line item in the typical project budget Technology 30 yrs ago 30-40% Technology 30 yrs ago Technology Today PACS still a theory Proprietary monitoring systems/infrastructure Most equipment was stand-alone Hybrid OR 3

4 Medical Technology Tools of the Trade Medical Technology 30 years ago So technology is advancing with many exciting developments! It s easy to become too focused on technology. Our primary mission is healthcare. How does medical technology support patient care The role of information 4

5 Nurses deliver the majority of direct patient care mostly at the bedside. Past Now What does Medical Technology mean to a nurse? Beds had cranks How has this changed in recent years? then electric Now they are smart Past Now Past Now Thermometers were mercuryfilled glass Thermometers are infrared, digital, and electronic IV s were dispensed by gravity - dosage adjusted by drips/minute IV s are dispensed by infusion systems with bi-directional connectivity to the EMR 5

6 Past Now Past Now Patients were weighed on scales Now the bed tells you Nurse Call was a bell Now it tracks your movements. What information is captured in the chart? information 6

7 Who uses the Chart? How do you Access the Chart? Where? Admission Data Physician Orders Advanced Directives Progress Notes Nurses Notes Medication You must design for all these clinicians to access the EMR. History & PX Consults Report of Operation Lab Reports X-Ray Reports EKG/EEG Graphic Chart Dietary Misc. How is information collected How does the EMR change that Where does the information come from? 7

8 Vital Signs Vital Signs Traditional methods blood pressure, systolic/ diastolic pulse, respiration, oxygen saturation, heart rate, pain, respiration, and temperature Electronic methods blood pressure, systolic/ diastolic pulse, respiration, oxygen saturation, heart rate, pain, respiration, and temperature Data Collection Devices How has this changed Nurse Call System Bed-Exit alarms Scale Infusion Pumps Ventilators ITV system Bed rail position, brakes, height, tilt protocol reminders Vital signs monitor Physiological Monitor Diagnostic set Fetal Monitoring Neuro Monitor / Seizure Monitoring Telemetry EKG/EEG Diagnostic set Staff / Visitor Presence Patient fall detection Hand-washing detection There s a lot more It s all electronic 8

9 The Role of Technology Integration The Impact on Planning and Design Challenges Faced in Both New and Older Facilities First to realize integration is an operational challenge first planning starts with: Operational analysis Needs assessment Workflow charting this will determine the technology needed Planning involves all technologies all systems and equipment not just IT Types of Information - Locations Quantitative vital signs, numerical values, primary observations ideally at the bedside Qualitative physicians progress notes, nursing notes, medication orders near the room - avoid distraction Collaborative care plan assembly and updates, treatment planning, discharge planning team meeting space not the nurse station Who uses the Chart? Admission Data Report of Operation Physician Orders Advanced Directives Progress Notes Nurses Notes Medication You must design for all these clinicians to access the EMR. Lab Reports X-Ray Reports EKG/EEG Graphic Chart Dietary History & PX Consults Misc. 9

10 Good Bedside Options Footwall Charting Not Ideal The WOW Is a Tablet the Answer? Ideal solution? Big and bulky Requires charging Wireless is limited Bar code required? Infection control? Storage? Apple iphone ipad 10

11 Handheld PC? Equipment Connectivity Direct Pick-up Nuvon Capsul - Wireless / RFID / RTLS? We want the ventilator to talk to the EMR 11

12 Equipment Connectivity Direct Pick-up Cerner iaware Designing for Technology Integration Infrastructure Support Medical Technology Tools of the Trade Low Voltage Systems 12

13 Infrastructure Planning Infrastructure Planning Infrastructure Planning Don t try this at home! 13

14 Good Design vs -??? Design Why Integrate? Improve accuracy Save time Improve clinician workflow Improve patient care, safety, and satisfaction Improve outcomes Reduce readmissions 4 th Floor Nurse Station 5 th Floor Nurse Station We want the wireless option 14

15 EMR Hospital Network Workflow Nurse Call System Medical Technology Integration Today Bed Vendor Apps Mobile Communication Device Connectivity Server In-Room Connectivity Device Nurse Call Port Bed Vendor s Server Room Nurse Call Serial Data Port Hardwired Wireless HL7 Other Compare - Manual vs. Integrated Nurse s Time Spent Per Shift Manual Data Entry 1. Read/note data 2. Keyboard entry 3. Trend-line analysis 4. Care plan decision/adjust 5. Key in order Integrated Technology 1. Direct data capture 2. No entry 3. Analysis ready 4. Select adjustment 5. Pre-order ready 15

16 Integration is more than data drops - 1. Physical Connectivity 2. Logical Connectivity 3. Security 4. Data Sharing 5. Operational Configuration all five levels needed to achieve Interoperability Summary Every new hospital must be designed to support Medical Technology and to support EMR Planning and Design must include: 1. Operational Analysis / Needs Assessment 2. Workflow and the Tools needed 3. IT infrastructure now and for the future Properly applied technology can improve: Patient satisfaction, safety and outcomes Staff workflow and efficiency Questions / Discussion The future of healthcare is streamlined care delivery supported by integrated technology vicki.bechet@gbainc.com terry.miller@gbainc.com Follow GBA on 16