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Interoperability and the OR of the Future

In today’s technology-centric world, most people expect their various tech devices to be able to communicate with each other. If you have an iPhone and an iMac, for example, the devices are synced so that you can access data on either device from the other one.

It’s surprising that many of the high-tech devices in modern operating rooms don’t have this kind of data interoperability.

“OR technicians and clinicians often have to go back 25 years in technology because of this lack of interoperability,” says Kelly Aldrich, DNP, MS, RN-BC, FHIMSS and chief clinical transformation officer for the Center of Medical Interoperability. “The question I ask is: ‘Why do we tolerate this for our frontline clinicians?’”

A Long Way to Go

“Interoperability has a long way to go in the perioperative environment because of the vast array of medical devices, surgical equipment, supplies and technologies utilized in the operating room,” says Janice Kelly, MS, RN-BC, the president of AORN Syntegrity Inc.

“The OR is filled with patient care devices, each of which may include information about the patient,” adds Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN vice president, Informatics with the Healthcare Information and Management Systems Society (HIMSS).

“This information needs to be uploaded into the electronic health record (EHR),” Sensmeier adds. “But the lack of connectivity between the devices and the EHR creates gaps in information that can impact patient safety.”

According to Kelly, perioperative nurses are required to transcribe data collected from multiple devices into the EHR. “For example, they must monitor the length of time a pneumatic tourniquet is inflated and alert the surgical team at established intervals,” she says.

“Interoperability is necessary to decrease the time perioperative nurses spend at the computer and thus allow them to focus on patient-centered care,” Kelly adds. “However, it must be developed with perioperative workflows in mind.”

Sensmeier believes that a lack of interoperability compromises patient care by not ensuring that OR clinicians have accurate and timely patient information.

“For example, misinformation could come from a device that is not connected or an electronic system that is not identifying the correct patient information,” she says. “Lives are literally at stake.”

Challenges to Improving Interoperability

Kelly lists several challenges faced by perioperative nurses when it comes to improving interoperability in the OR.

“One challenge is ensuring that reliable data from multiple sources and formats can be shared and turned into actionable data for the surgical team to utilize, or for medical devices to safely initiate an intended purpose,” she says.

Another challenge is aimed at the standardization of clinical data, because different terms may be used to document the same clinical observation result.

“For example, nurses may document the observation for the sound heard when fluid is in the small airways as crackles or rales,” Kelly explains. “While crackles and rales represent the same clinical observation, the terms are different, which inhibits the sharing of clinical observations.”

According to Bronwen Huron, BSN, RN-BC, MS, PMP, manager, Interoperability Initiatives with HIMSS, different personnel will use different systems in the same OR to document. “For example, the circulating nurse may be using the EHR system, but the anesthesia team is using the anesthesia machine, which will automatically document medication administration and vitals.

“Information from the anesthesia machine may populate a note, but it may not be charted directly into the flowsheets the nursing staff are using,” she adds. “This can cause errors and double documentation.”

During a code, this is even more complicated. “The nursing staff may transition to documentation on paper, while the anesthesia machine continues to monitor the patient,” says Huron. “This creates two records that are not synchronized.

“Add in physician dictation and there may be multiple accounts of what happened in the OR,” she adds. “Determining which is the most accurate becomes very complex.”

Benefits of Better Interoperability

Aldrich says there are many benefits to health care organizations and patients to successfully meeting interoperability challenges.

“Patients will have a better experience because they won’t have to answer the same questions over and over again before surgery,” she says. “And better interoperability will boost overall efficiency and reduce cybersecurity risks for health care organizations, while also improving patient safety by lowering clinical risk.”

Improving operability will also help reduce frustration among clinicians, who Aldrich says are being “processed to death. They work in the knowledge, not data entry, realm. I know some clinicians who have left the field because data entry isn’t what they signed up for.

“Instead, imagine an OR where systems talk to each other and the OR nurse can easily manage them all from one device,” she adds. “This will give nurses more time to deliver high-quality patient care.”

Aldrich believes it’s critical that perioperative leaders be engaged and vocal when it comes to connecting the needs of clinicians to technology functions.

“First, you should ask clinicians what they need and listen to their frustrations,” she says. “Then, you can compare the current state to the ideal state. By looking at these differences, you can identify gaps that will shape your action plan.”

And cost should not be a factor when it comes to improving interoperability, Aldrich stresses.

“This should be built into the cost of health care delivery, just like the electrical or HVAC system,” she says. “Every patient has the right to the best possible outcome, and all possible barriers need to be eliminated.”

Improved Connectivity

According to Sensmeier, devices will become smarter and smaller as technology advances, and connectivity will become easier. “Information will be able to be delivered more easily through headsets or other communication vehicles that are close to the surgical table,” she says.

“And robotics informed by artificial intelligence will be available so that surgeons and surgical procedures are augmented with this technology,” Sensmeier adds. “Clinical decision support systems will be readily available to allow for more timely and accurate decision making at the point of care.”

Kelly believes that interoperability will have a major stake in the future due to the increasingly sophisticated technology being utilized in the operating room. “The OR of the future will allow clinicians to focus on patients and their families and provide the safest, high-quality patient care,” she says.

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