Connecting Diagnostic Devices into your EMR

Healthcare providers across the country recognize the benefits of electronic medical records (EMRs) to improve the quality of care, reduce costs and improve efficiency. But as medical professionals, we know the challenge of keeping up with technology.

Provided are some suggestions for you as you start to digitally capture information from diagnostic medical devices in your exam room into your practice’s EMR.

INTEGRATED VS. INTERFACED:

WHICH IS BETTER?

The first medical devices to be connected to the EMR in 1996 were integrated. The term ‘integrated’ meant that the medical device manufacturers developed software for their devices that could be embedded directly into the EMR for test acquisition and post-testreview. Although integration was an innovation at the time which eliminated the need for scanning test results, the solution had some limitations. In the last ten years technology and software have allowed many vendors to vastly improve device connectivity. The most important dynamic in connecting any medical device is workflow as it relates to the requesting of the test, acquisition of the test and saving the data created from the medical device into the EMR after on-line review and confirmation of the test.

Seamless connectivity and workflow are the most important ingredients to your device connectivity solution, whether your medical device is PC-based or purpose-built. It does not make a diference if your device is integrated or interfaced, but what does make a difference is ease of use and clinical accuracy! Seamless connectivity means minimizing mouse clicks and having the ability to save test results with discrete data elements when, where and how you want them saved.

HOW DO YOU CHOOSE THE CORRECTMEDICAL DEVICE?

First and most importantly you should make the decision. Some EMRs have developed solutions with medical device companies that give the EMR a financial interest in referring a certain manufacturer.

 Most EMRs vendors do a great job with developing software but it is the physician’s medical expertise that is required to select which device would best fit the clinical requirements of the practice. If your practice is purchasing a medical device such as an ECG,Holter Monitor, vital signs, weight scale, fetal monitor, lab product, spirometer, ophthalmology device, bone densitometer, PACS*, etc.,make sure you select the best, most clinically accurate product for your practice. Once you have selected a product, and then make sure it has a connectivity method that fits your practice’s EMR requirements. In addition to working with the device vendor, verify with your EMR vendor that the device can connect to the EMR. Request a connectivity demonstration to ensure that it supports the clinical and patient workflows for your practice and patient needs. If the medical device does not have connectivity, call your EMR vendor and ask if they can assist with the connectivity analysis and solution.

CONNECTING YOUR DEVICE TO THE EMR

Connecting to the EMR has many different possibilities. The most common solution today is the USB connection, which is a hard-wire connection to your PC. If the manufacturer offers only serial connections, beware; this will tell you that the manufacturer has not kept current with technology. A conversion product that changes the connection to USB is not an acceptable solution.

 Wireless connections are becoming more and more available, and blue tooth technology today is also a possibility for consideration. Ask your device manufacturer if they offer a solution that will work with a thin client network. Will the solution landscape work on your tablet PC? Does the solution require a separate server? Are there advantages to a separate server? Does it work with a tablet pen? Would voice activation be important?

HOW SHOULD YOUR DATA BE SAVED?

Keep in mind some important issues in relation to data capture and image quality. A PDF is a static image and cannot be used for data mining in the future, which means that you will be unable to query results. A PDF is a less than adequate file format for storing ECG wave forms that are 100% reproducible. Another suggested standard is HL7 or Health Level 7 which is normally used to store text such as lab results or test interpretations. Current HL7 standards lack clinical reproducibility of wave forms as it relates to ECG and spirometry. It is important for you to ask questions such as:

• How will you track, as an example, “all patients with COPD” from a spirometry test?
• Can you mine test results?
• Can you save, as an example, the discreet data from a resting 12-lead ECG into a cardiology template?
• Can you also save the interpretation and the critical measurements?

MY EMR SUGGESTS SCANNING THE TEST RESULTS

If your EMR manufacturer suggests scanning test results, they are not considering your staff’s time and workflow. Why would you purchase an EMR that has a scanning solution for device results? Scanning requires a great deal of memory, is not clinically accurate for measuring wave forms, and has significant staffing and support demands. Scanning offers poor reproducibility. Ultimately scanning it is not a viable solution.

WORKFLOW

When considering workflow, think about how the EMR solution will work in your practice. Will it save you and your staff  time and eliminate redundancy? Can you save discrete data points for future data mining? Think about eliminating work, not adding to them equation.

For example, you, the physician, need a 12-lead resting ECG test performed on your patient. Do you need to leave the exam room to ask the nurse to run an ECG, or should you be able to click on “order an ECG” and have your nurse notified immediately through a task in the EMR to perform the ECG? Once the nurse completes the test, will the test automatically appear in the “Physician’s In Box” for your review and electronic signature? Will ordering a test automatically trigger a billing code or charge? This example may not capture all of your specific workflow requirements, but you can request what you need.  All of this functionality is available today.

PC-BASED DIAGNOSTICS vs. YOUR EXISTING DEVICES

Again, you make the choice. Ask your staff if your current product has a connectivity solution that works for your practice and your staff. You may have invested thousands of dollars in that last stress product; do you really need to replace it? Will a PC work with your new workflow?

What happens if your PC is not functioning correctly? Do you want to eliminate the related paper? The size of your practice, as well as the number of existing devices and their age, should help you decide.

INDUSTRY STANDARDS

At the time of this writing there are no industry standards for medical device integration. Integrating the Healthcare Enterprise (IHE) is a global initiative that is currently creating a framework for passing vital health information seamlessly between applications. IHE has 76 participating organizations with 51 health IT vendors that are able to demonstrate interoperability with 74 EMR products.

Currently, IHE is in final stages of developing an ECG standard,and is working on stress and Holter Monitor standard profiles.These standard profiles will support DICOM, which is currently used in conjunction with image management systems. The drawback with DICOM is the expense of the PACS, which are usually found more in hospitals, large group practices, and clinics.

DICOM has a solution for the small office; however, editing and other tool sets are not available without the full PACS solution. The DICOM solution for the small office practice is very expensive.