Going HITECH.

As the medical world begins to adopt technological innovations, all health care disciplines are searching for the most efficient, cost-effective, secure devices and software to expedite the delivery process. But choosing and implementing the right information technology system requires careful consideration.

According to Michael Stevenson, director of product management at MediServe Corp, Chandler, Ariz, the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed by Congress in February 2009, created a “foundation for interoperability between systems.” He says, “This foundation will allow for greater confidence of critical patient information being shared between systems for the improvement of patient safety and outcomes.”

Stevenson adds, “Respiratory departments expect technology to facilitate management for a mobile and dynamic workload; deliver consistent, quality outcomes; and provide reports to manage clinical performance and productivity. Information technology should be used as a tool to help the therapist become as informed and efficient as possible, while providing safe care for the patient.”

A number of devices have been released to market for use in the respiratory care field. Bridge-Tech Medical, Alpharetta, Ga, has created Connectivity Solution, a “true plug and play solution that attaches to the serial port of the medical device, identifies the medical device, and immediately begins acquiring data,” says Terry Davis, RRT, CEO at Bridge-Tech. He adds, “The data can be streamed directly to the electronic medical record (EMR), and can also be sent to a clinical validation application, allowing the therapist point-of-care data verification and sign-off. All data is sent to our Smart Hub for storage, display, and EMR interface staging.”

Data can be integrated in a similar process whether acquired from a tablet or a handheld or other mobile device, according to Davis, who adds that multiple device types ensure fast and consistent bedside patient care. Some devices have built-in calculations that help weaning assessment, and others provide lung-protective strategy calculation and documentation as well as records related to spontaneous breathing trial (SBT) progress.

Different workflow-specific modules are available that address a variety of respiratory needs, notes MediServe’s Stevenson. “For example, even our own product, MediLinks, can be purchased in modules, such as Respré for spontaneous breathing trial management, Forecast for workload management, or the entire department solution,” he says.

CHALLENGES TO IMPLEMENTATION

One of the most significant challenges facing respiratory therapy departments is determining how to close the critical gaps that exist between the medical device and the EMR. Bridge-Tech’s Davis points out that very few solutions can gather vital medical device data from mechanical ventilators, for instance, and then transmit all the device parameters in a user-configurable display for on-the-spot validation and also stream data for a cumulative record.

But he emphasizes that the most common critical gap is manual input of medical device data. “Trained clinicians tend to paper chart, then keyboard numbers into the EMR. This is not the best use of their skill sets when a solution for electronic data transfer is available,” he says. “Transcription and keyboard errors are big contributors toward this critical gap.”

Additionally, competition among wireless devices can create congestion in a hospital’s Wi-Fi bandwidth, hindering efficiency. Spurious radio-frequency (RF) emissions from treatment equipment, a side effect of operating devices such as electrocautery units or MRI imaging systems, may make wireless operation in certain areas of a hospital impractical; wired connections will be required in these cases, Davis notes. “The most common wireless connectivity issues are related to configuration and security management. This is often easily resolved with the hospital IT department during system setup and testing,” he says.

Stevenson also points out that many respiratory care departments are required to use large EMR vendors who do not offer the tools and reporting necessary to manage and effectively report the performance of their department, which may hamper efficiency.

While compatibility posed a challenge in the past, it rarely raises concern these days. “We are more than 10 years into the ‘Wi-Fi Revolution’ and the specifications, implementations, and experiences with early mis-implementations have produced a stable and widely compatible system,” says Davis. However, should new protocols emerge and be rushed to market before standards are complete, incompatibility may occur.

THE BOTTOM LINE

According to an article in Respiratory Care,1 since the costs involved with acquiring and operating an IT software system can be a financial barrier, facilities should “develop a clear and unquestionable understanding of what the system can actually do.” To achieve optimal response, systems should follow a patient-driven protocol.

For example, Respiratory Services at the University of California, San Diego, Medical Center specifically configured its system “to identify evaluations and treatments due, track indications for therapy, monitor patient response to therapy, investigate respiratory therapy compliance with the protocol care plan, trend transitions to alternative therapy, identify patient outcome, and quantify the impact of patient-driven protocols on department operations.”1

Although the initial financial investment in Bridge-Tech’s technology may be considerable, the ultimate benefit to the bottom line may outweigh any reluctance for the expenditure. For instance, installing newer software and wireless devices eliminates expensive hardwired interface solutions. Additionally, the technology can recapture 40 minutes of documentation labor per day per ventilator if checks are performed every 3 hours. “For 20 ventilators, that means 13.3 hours per day,” Davis says.

MediServe’s Stevenson adds, “At a financial level, charge capture can impact revenue, consistent protocol management solutions can improve quality and reduce risk of unreimbursed care, and real-time staffing tools can control labor costs. Linking all three of these features into a specific solution can optimize the effectiveness of the respiratory department and hospital.”

LEARNING CURVE

Implementing information technology systems takes time, depending on the solution you purchase, cautions Stevenson. “If you are required to build something in a large EMR system, there are likely hundreds or thousands of hours of configuration time required, even if the software license is free. There are also some increased department labor costs when inefficient tools are used by the therapist and department managers,” he says. “The learning curve varies based primarily on two factors: first, the product that you purchase and, second, the training process used. If a solution was not tailored for the respiratory workflow, usability will often not be intuitive, which results in increased training efforts and ultimately less-satisfied therapists.

Mary P. Griskewicz, MS, FHIMSS, senior director for Ambulatory Information Systems at the Healthcare Information and Management Systems Society (HIMSS), indicates that successful implementation of any IT system relies on training and the quality of training for clinicians and ancillary providers. “There is a saying: ‘Train and train again.’ Training will become a baseline requirement of the organization using the [EMR] as system upgrades will be necessary to accommodate new functionalities and the new requirements to be identified for meaningful use Stages 2 and 3, yet to come,” she says. “Training and the use of power/expert users to train others will be critical to any organization implementing an [EMR].”

MEANINGFUL USE

Most hospitals are currently focused on meeting the “meaningful use” criteria set forth by the Office of the National Coordinator for Health Information Technology (ONC). Stevenson says, “Once attestation is complete and the true meaning of the standards is adopted, there will be a better platform for specialized solutions to ‘plug in’ and work in parallel with larger EMR vendors to optimize the efficiency of care delivered by respiratory care departments and other departments.”

The federal government has committed $27 billion over a 10-year period as incentive payments to facilities that execute EMR. In August 2010, the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (DHHS) released two groups of requirements for meaningful use for the first 2 years (2011 and 2012) of the incentive program. The first—core objectives—includes basic functions, ie, recording vital signs, medications, current diagnoses, and smoking status, as well as use of software applications that improve patient safety and care. Second, providers must choose five tasks from a list of 10 that will lead to full EMR implementation. This list comprises offering patient reminders, performing drug formulary checks, and incorporating clinical laboratory results into EMRs, among others.2

In February 2011, HIMSS Analytics, a not-for-profit subsidiary of HIMSS, reported the results of a meaningful use regulation compliance survey: 44% of hospital respondents fall within the “Likely” or “Most Likely” categories for meeting Stage 1 of meaningful use. Within this group, 58% expect to achieve all meaningful use core measures by May 2012. To receive full EMR incentives, facilities must be meaningful users of certified technology by FY2013.

While medical technology has made enormous strides, more targeted systems must be developed to ensure optimal patient care. Davis says, “We feel the trend has been moving away from [respiratory therapy]-specific needs to a more generic platform provided by the big EMR providers. In most cases, [respiratory therapy] needs are not being met, and it will be up to the department leaders to get their voices heard. Money continues to be tight, and it will require the [respiratory therapy] departments to get very engaged with their administrations if they want to be able to take advantage of the services available to them that are not being provided by the primary EMR vendors.”


Phyllis Hanlon is a contributing writer for RT. For further information, contact [email protected]

References

  1. Ford R. Respiratory care management information systems. Respir Care. 2004;49:367-75.
  2. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363:501-4.