Jim Piepenbrink: A Need to Balance Technology, Clinical Workflow, and Human Behavior

Over two days at the Medical Device Connectivity Conference, there were discussions and presentations that centered on  challenges with the infrastructure, such as wireless, managing implementations, the convergence of technologies, and the challenges associated with the ownership or stewardship of technologies between clinical engineering and IT.

It seems to me there were a few common threads in all of these discussions:

Definitions: Defining systems, IT and CE governance, solutions, risk, and usability seems to be a daunting task because there are many varied definitions that could be crafted depending on who owns what.  While the delineation of responsibilities of IT and CE are blending, as represented in a several excellent presentations, it is clear that we, as an industry looking at this, will struggle with how we can translate the work of a few leading organizations to the masses. Cedars Sinai, Kaiser Permanente, Partners Healthcare, Spectrum Health, and others have shown that there is a method to sensibly blend these two worlds, and it seems as though the critical junctures are understanding roles, defining ownership, and most importantly, focusing on the future.

Aggregation: Extracting the huge volume of data and making it accurate, timely, and useful is something that will take further development, careful thinking, and likely consistent standards that manufacturers will adopt. If too much disparity exists in the manner in which data is available and integrated, the challenges of verifying and validating will make the system so cumbersome to use there will be little value in this for hospitals without the benefit of robust engineering teams, expensive system integrators, and clinical informaticists. It seems as though manufacturers struggle with how they can provide this while creating sustainability for their product and services.  And hospitals struggle with how to ensure we can self manage it and leverage it for things like alarm management and other useful tools.

Process: It is vital to define strategies for creating structure behind not only the extraction and integration of data from devices, but also the management of the many parts that each owner shares. Maybe this is the greatest challenge. There’s been a great deal of work, involving several organizations, to create public domain standards documents. They’re working with agencies in an attempt to build a robust specification to help create some boundaries in creating connected systems.

To close, I heard one statement from several presenters that may sum it up the best: This challenge, in its entirety, is a balance of technical solutions, clinical workflow, and human behaviors.

It is a wicked problem, but there are wicked smart people working on it.

Jim Piepenbrink


Department of Clinical Engineering

Boston Medical Center

2 thoughts on “Jim Piepenbrink: A Need to Balance Technology, Clinical Workflow, and Human Behavior

  1. Once upon a time, I did a major upgrade of the equipment on a 38-bed telemetry floor. I replaced the old with a new digital telemetry with full disclosure work stations. The hospital spent great gobs of money wiring the fiber and cat 5 runs to the data center, buying servers, PCs etc. The nursing staff received round the clock in services, on admitting patients to the system, printing reports and patient cardiac events using the full disclosure work stations. All was well the day the system went live. Within two weeks, the nursing staff was back to cutting and pasting strips into their paper charts, and admitting to the system was replaced by sticky notes with patient names on the side of the central stationte full disclosure work stations pushed to the back of the desk, unused. The nurse manager was largely unconcerned about all this. The point, no matter how well intentioned at technology upgrade engineers develop, aregivers may care less about it. All they wanted was a system that showed them the patient ECG wave forms and allowed them to print and save strips for their charts. Given all the other stuff they do, they did not want to deal with technology any more than they had to. Admitting and discharging patients to the monitor system was too time consuming, they said. It was just faster(for them) to print cut and paste strips, than run the computer and print a report for the chart. My major question about medical device integration is: Are things being thought of and designed that caregivers will actually incorporate into practice and patients derive benefits from? Will medical device integration be something today and tomorrow’s caregivers can wrap their heads around or it is something that only the next generation of caregivers will appreciate?

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