Purna Prasad: EMR and the Clinical Internet of Things

Think of an electronic medical record (EMR) as a clinical instrument. It is a platform for integrating monitoring, diagnostic, and therapeutic (MDT) data for the patient, the provider, the payer, the researcher, and the regulator. However, an EMR is only as good as the accuracy and precision of the data it contains.

The instrumentation infrastructure of an EMR includes physiological monitors (such as an electrocardiogram, electromyography, and end-tidal carbon dioxide detector), diagnostic imaging systems (such as an X-ray, ultrasound, and computed tomography), and therapeutic modalities (such as defibrillators, ventilators, and anesthesia machines) connected to sensors to collect the physiological signals or images, or deliver therapies—to make up what I will call a Clinical Internet of Things (CIOT). A majority of these modalities are networked to a server that delivers HL7 formatted data to an interface engine that ultimately directs this data into the flow sheets of the patient’s EMR. These interfaces are links in a continuum of network that delivers the physiological signals from the bedside to the EMR. A network is only as good as the strength of the interfaces. If the interface fails or is taken down for maintenance, no physiological signal lands on the EMR.

Now imagine an MDT system that is the EMR. No interfaces are necessary to port the signals from the bedside to the EMR. You have a cloud-based EMR, with one end being an MDT device collecting the data and the other end being a device (whether work stations, laptops, tablets, or mobile phones) to display that data. From the patient to the user, all touchpoints act as a CIOT.

A physician using a stethoscope enabled for a CIOT places the heart, lung, and Doppler sounds directly into the appropriate flow sheet of the patient’s EMR. The stethoscope identifies the patient and the provider because the patient and the provider are components of the CIOT. Imaging systems become a component of the CIOT, enabling interface-free data transfer from the patient to the provider. Therapeutic devices such as ventilators and anesthesia machines are components of the CIOT with direct data interface from the patient to the user.

There are several advantages to adopting the CIOT concept to the deployment of clinical information technology, including the installation of network-controlled medical device security to enhance patient safety. Making every touch point in the continuum of care a part of the network enables better monitoring and control, and mitigates unauthorized intrusion. From the network infrastructure point of view, physical and logical network segmentation enables the installation of a security posture with real-time operational controls.  Network access control has the potential to enable the concept of a CIOT with end-to-end monitoring, detection, and real-time mitigation.

The main hurdles to deploying a CIOT strategy include the following:

  1. Medical devices lack network standards.
  2. Physical and logical segmentation of real-time clinical data on healthcare network lack policies and industry accepted standards.
  3. Treating patients and providers as a segment of a CIOT is a disruptive thought yet to be tested and accepted by the clinical community.

The arrival of wearable monitoring technology and the technical creep of therapeutic devices into the consumer space will force the medical community to adopt a CIOT approach. The time is right to plan for such a strategy. Early adopters of CIOT will see clinical, technological, security, and economic advantages. Those who hesitate will regret their lack of pro-activeness.

Purna Prasad, PhD, is a vice president and chief technology officer at Northwell Health in New York.

2 thoughts on “Purna Prasad: EMR and the Clinical Internet of Things

  1. With the new era of EMRs and complex medical software that links multiple platforms and processes, we now have a new malady to add to alarm fatigue: “distracted caregiving.” It results when caregivers are so drawn into issues entering data and complying with the demands of the keyboard and mouse that they loose sight of the real job — paying attention to the patient. My dad recently told me during a recent hospital visit he could not understand why all the doctors and nurses spent so much time with the computer terminal and very little time with the sick humans. File this under “for what it’s worth.”

  2. Some reminders about ‘the cloud” from a post of mine elsewhere. The cloud isn’t a magical place; it is someone else’s server.To help remember this, one might describe the function with the acronym USES (Using Someone Else’s Server).The challenges that this can present might be reflected in TDOT (Totally Dependent on Them) or OOMH (Out of My Hands, with the associated BTP (But They Promised).And for those who don’t quite understand what they have done there is BMU- (Beyond My Understanding).

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