By Jim Fedele
Medical equipment integration issues seem to be all my team is working on – from changing settings and gathering MAC addresses to identifying ports and troubleshooting issues. There is daily activity around it. There are many benefits to integration, like X-ray images instantly uploaded and then quickly read by a radiologist and lab results posted to a patient’s app on their phone. However, connecting to an EMR does add costs to operations. Lately there is a push to integrate every possible device, whether it is diagnostic or therapeutic. I am wondering if the benefit is ever critically evaluated.
To the clinician the integration to EMR has become almost as important as the actual function of the device. The benefit is often declared as increased efficiency, more accurate documentation and patient safety. I often wonder what the ROI is? I feel a lot of times it seems like we do things under the umbrella of patient safety without understanding the costs and the value. The integration components have licensing costs, software maintenance and support costs, along with adding another level of complexity to the system that can fail. Resources are needed to setup, troubleshoot, and protect the networks and connections to the devices and the information they send. I feel it might be useful to critically evaluate the value of integrating a device or devices.
Recently, I have been involved with some new equipment purchases that were originally setup for stand alone local use. No network connection or integration was discussed or originally requested. However, once the units were put into service the customer decided they wanted them to be integrated to the EMR for patient safety’s sake. Working in HTM for over 30 years, I hear this proclamation weekly or more. It is often used by customers to escalate a situation that may not be getting the expected attention. However, has the need and situation been critically evaluated. I find it interesting that a piece of equipment that has been doing a job successfully for many years without being connected/integrated now is a patient safety issue because it can’t connect to an EMR.
I blame salespeople, they romanticize the functionality of a connected device with the promises of increased efficiency, improved documentation and patient safety. Often omitting the information about the licensing fees, the software maintenance costs, the risks to the network and the labor needed for installation and future maintenance.
I am not saying that integrating to the EMR is not important, for a lot of modalities we are presently enjoying the benefit of integration. Images, lab work and various therapies can be read and almost instantly available to the patient. The data points that can be analyzed now are largely available because we can capture them electronically. I am saying that maybe everything doesn’t need to be integrated for the sake of integration. The expense is not insignificant, for instance we have our in-room basic vital sign units connected, they cost $2,200. The license to connect them to the EMR is an additional $500. This increases the cost of the device by 23%. Now, multiply that by 200 units and it is $100,000. Is the claimed efficiency gain equal to this amount? I think you would need to account for the users’ time accessing the feature (they must log in) and verifying the data. Also, you must account for the continuous maintenance costs, not just in the licensing fees, but in support labor. Since we have embraced integration, our labor needed to solve problems is probably up 30 percent, especially when you factor in multiple software updates, network configuration changes and general adds. Every time IT needs to update the network, it ripples to my team to get hands on the units and test them.
The landscape for the HTM professional is certainly changing. Thankfully, medical equipment has become more dependable, and we don’t need to spend as much time on repairs as we used to. However, the demands on our labor are shifting to more IT-based activities. No doubt integration is being embraced by our customers as a necessary feature, but what cost is it adding to health care? What is it really saving?
– Jim Fedele, CBET, is the senior director of clinical engineering for UPMC. He manages six Susquehanna Health hospitals. He has 30 years of HTM experience and has worked for multiple service organizations.
