By Inhel Rekik
How do you support biomedical device integration (BMDI)? How involved are you in the overall strategy? Meaningful use – which is the use of EMR to improve quality, efficiency and safety of health care – has led more and more medical devices to integrate with the EMR. Now, every hospital is catching up and integrating more and more devices to support this initiative. This allows clinicians to spend more time providing care rather than charting. The ability of integrating vitals from every single medical device at the bedside, as well as alarms, while prioritizing the information sent to the caregiver is not very far away. Soon enough, electronic records will always be available to clinicians regardless of where the patient received a treatment.
How are we as HTM departments preparing for this? Are we aware of our organization’s BMDI strategy and the impact it might have on the operation of our department? Have we looked at the skills our department needs to develop? What has been our interaction with IT?
Supporting BMDI varies from one health care organization to another. For the most part, the way this solution is supported has to go through a maturity process as you get all parties involved in BMDI to get acclimated with their roles and the list of issues they might run into.
IT can be the first line of support or that may be the responsibility of clinical engineering.
The support model where IT is the first line of support has the advantage of not adding any workload to your HTM department. The only time that requires heavy intervention from biomed is during daylight savings or testing of new devices. Some networked devices, such as patient monitors, will get the time automatically from the hospital’s time server while others need to be updated manually. This model doesn’t bring any issues with off-hour calls since the IT helpdesk is usually 24 hours. However, it means that the HTM department is less involved in the overall BMDI strategy. This could lead to less interaction between CE and IT and risk the purchase of non-compatible devices or deploying devices before they are tested by the BMDI team.
Certain organizations choose to put clinical engineering as the first line of support. In this support model, the HTM department will mostly be responsible for the connectivity hardware (gateway, connectivity engine and device adapters). This support model has the advantage of having CE involved in the BMDI strategy. They will not be seen as a break-and-fix department but rather as a technology department that can support equipment and systems. The off-hours support might be an issue since most clinical engineering departments are not 24/7, but having someone on call and any intervention that requires clinical engineering to be on site will be delayed. This will have an impact on the operational budget and will increase your overtime. Ideally, this additional workload should be planned from the beginning of the project.
Another challenge will be the skills that your department has. You will need to do an assessment of what classes they need and the skills they need to develop. They will also need to gain an understanding of the BMDI workflow and understand the procedure when they need to pass the call to the application team or the networking team. With training, clinicians start recognizing who to call minimizing the number of false positive calls that clinical engineering receives. Some HTM departments will add read only access to EMR server and gateways allowing them to easily identify issues remotely and escalate them to the correct team. Learning basic EMR application functionalities can also help HTM professionals solve user-related issues.
Regardless of their involvement in supporting this integrated solution, HTM professionals need to learn as much as they can about BMDI by getting engaged, networking with others in the industry and sharing ideas and participate in the roadmap discussion of their organization. They should focus on building a solid collaboration with all IT departments. As the scope of the systems we support expand, one can ask the question: “Should we become a 24-hours department?”
– Inhel Rekik, MS, is the clinical engineering manager at Medstar Georgetown University Hospital.
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