Disruptive opportunities to make things better often occur as the direct result of an unintended convergence between breakthrough technologies and their more incremental counterparts. Infusion pump interoperability with electronic medical record (EMR) systems is an example of a disruptive opportunity.
Infusion pumps, for the most part, are islands of technology. Medication administration is a matter of manually transcribing the EMR medication order to program the pump. A better and much safer way is to automatically populate the pump’s programming parameters from the EMR order management system. At first, technology may appear to be the biggest challenge to making that happen. It isn’t. Technology plays a very important role. Fault-tolerance, store-and-forward, active directory, and other enterprise-class capabilities are necessary since the infusion pumps are now a real-time extension of the EMR system. However, we found the barrier to success is much broader than the technology itself.
Integrating closed-loop infusion pump interoperability marks the first time a medical device is connected in real-time at the “application layer” between the IT back-end EMR system and biomedical infusion device. This intersection blurs the traditional lines of what it considered IT and what is biomedical. It is disruptive. Everything from rebuilding and mapping master formularies to supporting real-time IT interfaces has not traditionally been the expertise of medical device vendors or biomedical hospital personnel.
Project planning to incorporate full infusion interoperability looks and feels quite a bit different than implementing a stand-alone pump. A good goal is to achieve full autoprogramming from the EMR to every pump for every situation. This requires a new look at medication formulary management. Every order—no matter how complex, including multi-ingredient—should have a counterpart dose error reduction software (DERS) entry on the pump. This is the only way to ensure the patient and clinician have continuous protection after the first autoprogramming event occurs, even in situations with titratable drugs. Next in the planning stage is defining who does what when things don’t go right. When that happens, it is no longer an “IT problem” or “biomedical engineer problem.” The convergence—or collision—of these traditional roles will make or break the eventual success of full house-wide infusion to EMR interoperability.
In order to take advantage of these breakthrough opportunities, we must rethink conventional roles for medical device vendors and hospital personnel. Change is never easy. But in this case it is necessary and exciting, raising the bar for patient safety.
Dan Pettus is vice president of IT and connectivity at CareFusion. He and Tim Vanderveen, vice president of CareFusion’s Center for Safety and Clinical Excellence, are coauthors of “Worth the Effort? Closed-Loop Infusion Pump Integration with the EMR,” an article published in the November/December 2013 issue of BI&T, AAMI’s peer-reviewed journal.