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Keep new technology leashed until you learn its behavior

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May 1, 2009

New federal funds coming

Keep new technology leashed until you learn its behavior

Given the Obama administration’s goal of improving healthcare information technology (IT) systems, many hospitals are taking a hard look at how medical equipment interacts with such networks.

The way these items coexist—in harmony, one hopes—is defined as “convergence.” It’s a new term because up until a few years ago, most patient monitoring systems and other devices plugged into the wall and worked on their own. Now, many of these machines send information directly into the hospital’s main network and interact with software such as electronic recordkeeping programs.

Unfortunately, when devices and networks don’t converge as planned, errors can occur, especially when:

  • Caregivers ignore safety alerts and alarms from devices
  • Patient privacy rules are violated as machines automatically pass protected health information into unprotected, accessible areas of a network
  • Staff members enter wrong drug names into pharmacology systems

Devices closely interact with technology

“Medical devices are becoming more and more computer-based,” says James Keller Jr., vice president of health technology evaluation and safety at the ECRI Institute, a health research firm in Plymouth Meeting, PA. “Much of the data that is being stored and used within medical devices is being transmitted across hospital networks.”

In fact, it can be difficult to tell the difference between a computer and a medical device.

Safety managers, even if they’re not convergence troubleshooters, play an important role in sniffing out problems and marshaling the resources to fix them. According to a Joint Commission Sentinel Event Alert issued in December 2008, safety officers also need to get more vocally involved in equipment purchases.

“This is a really big issue,” says Frank Painter, MS, CCE, hospital technology consultant at Technology Management Solutions in Trumbull, CT. “It’s a change in the way information is going to be obtained and passed around the healthcare organization ... It’s going to affect not only the quality and reliability, but the integrity of care and their confidence in the system.”

Stay grounded as funds become available

Hospitals will likely buy more hardware and software this year compared to years past if Congress passes President Obama’s healthcare reform bill as written at presstime in mid-March. The bill calls for $19.2 billion to be disbursed to hospitals for upgrading their IT infrastructure.

Keller and Painter say that hospitals, especially those that receive grant money, should heed warnings about hasty spending decisions and take time to evaluate new technology and how it will integrate into a facility’s particular environment.

Given the money available, Keller warns of hospitals being sold on technologies that aren’t ready for the medical setting. Rushing a purchasing decision can lead to costly mistakes.

Painter recommends that hospitals avoid buying cutting-edge equipment unless the facilities have sophisticated biomedical departments that can handle such projects. Instead, hospitals should consider systems and equipment upgrades that already have proven track records in the industry, he says. (See “Answer these questions about your next technology purchase” on p. 7 for more assistance in determining how new technology fits in with your existing systems.)

Get involved in piloting new technology

The Sentinel Event Alert, titled “Safely Implementing Health Information and Converging Technologies,” warns that technologies designed to cut down on medical errors can, in some cases, actually create more of them.

Although The Joint Commission (formerly JCAHO) references specific information management and leadership standards in the alert, it stated in an accompanying press release, “Since technology is so common in healthcare, from admitting patients to the operating room to ordering and administering medication, any Joint Commission accreditation standard can be tied to technology.”

The Joint Commission and the ECRI Institute, which participated in announcing the alert, recommend hospitals create multidisciplinary teams that review current technology and evaluate new gear ahead of purchasing to make sure it fits in with the hospital’s existing systems and the way staff members work. Safety managers need to be part of that evaluation, along with physicians, nurses, IT staff members, and others in the facility involved in buying or using technology.

Multidisciplinary analysis of new technology is critical in seeing through marketing and sales smoke, which is often based on optimistic laboratory tests that can sound good to your IT department, but may not reflect actual performance in your hospital, Painter says.

Strategies to consider

The Joint Commission recommends hospitals take 13 specific steps to combat technology convergence problems. The steps are somewhat similar to those set forth in a guidance document published in the ECRI Institute’s October 2008 Health Devices. They include the following:

  • Get safety managers involved in risk assessments before new technology is introduced
  • Encourage IT buyers to visit other facilities using a prospective technology to see how it works in the real world before signing a purchase order
  • Monitor staff members to make sure technology work-arounds aren’t causing or obscuring errors
  • Develop a system of safety alerts and a protocol for dealing with them
  • Monitor skipped alerts and investigate how and why they happen
  • Establish training programs for each department that will interact with a new technology

The multidisciplinary team that safety officers should be a part of should develop what the ECRI Institute calls a strategic vision, defined in a mission statement for implementing new technology that aligns the business and safety values of the facility.

“It’s important for safety managers to participate on a collaborative team to help establish a vision and provide their unique perspectives on patient safety and general safety in the hospital,” Keller says.

Editor’s note: To read the full Sentinel Event Alert, go to www.jointcommission.org and click the Sentinel Event tab near the top of the page.

Answer these questions about your next technology purchase

If you can answer yes to the following list of questions when considering the safety implications of a new piece of equipment or software at your hospital or evaluating existing equipment in a routine review or after a problem arises, you’re well on your way to avoiding error-prone technology:

  • Do we have a strategic safety vision that defines our approach to integrating new equipment and technology?
  • Does this piece of equipment or software fit into that vision?
  • Have we done a risk assessment of this technology?
  • Have we concluded that the pros outweigh the cons for this technology?
  • Does this technology’s ease of integration with our hospital’s servers and operating systems compare favorably to its competitors?
  • Does this technology meet our standards and fit into our best practices for that category of device or software?
  • Have we critically analyzed our staff’s work flow, including that of physicians and nurses, and determined that this product will help the work flow, not hinder it?
  • Has this technology’s performance in pilot projects and test runs satisfied us?
  • Did we consult with caregivers, nonclinical staff members, and patients in choosing the best device or software for the job?
  • Have we addressed all the issues that caregivers, nonclinical staff members, and patients have raised related to this technology?
  • If this technology involves medication, have we consulted with pharmacists?
  • Can this technology’s safety alarms be forwarded or passed over? If so, do we have staff members who are trained and able to monitor alarms so that they don’t get forwarded to a dead end?
  • If this technology eliminates any safety checks we currently conduct, can we replace the lost checks with equally effective ones?
  • Does the vendor understand our clinical area, and is this technology recommendation based on that understanding?
  • Do we have a schedule for maintenance and upgrading equipment and its various components?
  • Have we limited potential distractions in the environment for users of this technology?
  • Has the hospital planned for any unique or additional maintenance activities that this product will require?
  • If a device works on its own proprietary network, is it worth the purchase as opposed to a device that integrates into the hospital’s servers and operating systems?
  • Does this technology protect private patient information when applicable?
  • Has the hospital’s wireless device point person determined that this product will not interfere with other devices?
  • Will our Wi-Fi signal reach this technology, if applicable?
  • Has our hospital’s medical error reporting system been updated to reflect the new product going into service?

Additional comments and observations:

Sources: Based on material from The Joint Commission, the ECRI Institute in Plymouth Meeting, PA, and Frank Painter, MS, CCE, hospital technology consultant at Technology Management Solutions in Trumbull, CT.




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