August 30, 2011

A look toward the future - interoperability of devices by Michael Paquin

A recent post by our good friend Michael Paquin:

 Michael D. Paquin, FHIMSS
Chair, HIMSS Digital Office Task Force 

What should we expect in the future?  Quite possibly, we should start with a standard for interoperability for devices.  A standard that works for the small ambulatory practice as well as the enterprise would be a great start.

Trends to look forward to are: device interoperability that will improve clinical efficiency by allowing devices to talk to each other. Today, devices typically operate independently. There is no direct connection, for example, between a stress test and an echo. There is no connection between simple office-based blood pressure devices and the at-home blood pressure devices.  An ECG done in the physician’s office should be able to be seen at the emergency room.

Medical device manufacturers must look forward and develop open architecture software solutions that include device agnostic viewers.  Device agnostic viewers would allow a physician the opportunity to view diagnostic tests in a singular common graphical user interface or GUI. Imagine seeing all your ECGs, spirometry (lung function) readings, vitals, etc. the same way without concern about device used to acquire the information. Direct connection and interoperability could offer great benefits.
There is a meaningful use roadmap milestone for medical device interoperability in 2015. To really achieve this deadline, we must act aggressively now, and we must push device vendors to give us solutions that not only work, but are cost-effective and smart.

In the future, the data derived from the device must be accessible; it will probably not be a PDF. We will receive discreet data elements that we can then access from our EHR to develop decision support tools through leveraging device data. A good clinician or caregiver can aggregate data from many devices, observe trends and potentially determine that a patient is trending toward a chronic condition.
The medical device of the future will be “smart,” able to send data, aggregate that same information, and then, send it to the caregiver wherever he/she needs it. This is the premise of decision support. The device of the future could gather the full set of data and apply evidence-based algorithms. If it is determined a patient was trending toward a given condition, the device could alert caregivers, allowing them to perform their own assessment and begin treatment.

One of the trends to look forward to is keeping the device information on separate servers or clouds.  We must protect the data; I have been concerned for some time now that some manufacturers using integrated solutions for test results might very well have a problem, if the provider switches from one EHR solution to another. 
  • How will the test results be transferred?
  • What will be the result saved?
  • What will be the cost to the provider?
  • If integrated device solutions are used what will the issues be if a device is recalled?
The best part of device connectivity will be when vendors start cross-pollinating certain test results with algorithm’s that are smart and can suggest next steps and or next tests that lead to beneficial clinical outcomes.

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