Survey: Lack of medical device interoperability leads to medical errors
Hospital rooms contain an increasing number of medical devices that don't talk to one another, which some say is a growing patient safety problem
Look into a patient room in the ICU at any hospital across the country and you'll see one patient hooked up to nearly a dozen devices, all of which play a vital role in keeping that person alive. But there's one problem: None of the devices know what the others are doing.
Device interoperability, or the ability for different medical devices to communicate with one another, is severely lacking in healthcare. According to a survey released in March by West Health Institute in San Diego, 60% of nurses indicated that medical errors could be significantly reduced if medical devices were connected and shared data automatically. Furthermore, 74% of surveyed nurses strongly or somewhat agreed that it is burdensome to coordinate the data collected by medical devices, and half of the respondents said they have witnessed a medical error because of the lack of device coordination.
"Nurses enter the profession because they want to care for patients, not because they are interested in programming machines," Patricia H. Folcarelli, RN, senior director of patient safety at the Silverman Institute for Health Care Quality and Safety at Beth Israel Deaconess Medical Center, said in a release from the West Health Institute. "As many as 10 devices may monitor or treat a single patient in an intensive care unit. The nurse not only has to program and monitor the machines, he or she often spends a significant amount of time transcribing data by hand because the devices are not designed to share information."
Nurses offer a valuable perspective on this issue, according to Joe Smith, MD, chief medical and science officer at West Health Institute. They are the frontline staff members who interact with medical devices the most, often transferring information from one device to another.
"I think they are in the best position to understand whether the devices are servicing the patients in a way that is safe and effective," Smith says. "And they are in the best position to talk about whether they add to the safety and efficacy of patient care or take away from it in some way."
The lack of interoperability is a problem that needs more attention from vendors and hospitals as medical devices continue to evolve.
What's the problem?
Patient rooms contain various medical devices. Each one does a different job?measuring oxygen saturation, heart rate, or delivering medication, among other functions. However, these devices are frequently manufactured by different vendors and rarely talk to one another, leaving nurses to monitor them independently to ensure patients' safety and well-being.
Smith contrasts this lack of device interoperability with the automobile industry. "You can buy a car that parks itself or stops if you're ready to hit something, but that automatic braking function doesn't exist in the intensive care unit," he says. "If you're getting an infusion of something that is meant to relieve your pain, but it also impairs your breathing, it's not as if that infusion automatically stops if your breathing becomes too slow."
Ultimately, monitoring devices or transcribing data forces the nurse to pull his or her attention away from the patient. Further, different units will have equipment that may have different levels of interoperability despite being designed to perform the same task.
Although 60% of nurses say that improved interoperability would reduce medical errors, Smith admits there aren't any statistics on how often errors actually occur because of interoperability issues.
"That's one we'd like to get the answer to as well," he says. "The reason it's tough is because there really isn't a good model today of a smoothly interoperable system to compare against. We can't yet say how much better it would be if you didn't have this issue."
One of the reasons that medical devices don't talk to one another is because of the way the FDA approves the technology. Historically, the FDA process has focused on isolated systems rather than integrated suites of devices. Smith says West Health Institute has asked the agency to contemplate how it would approve a suite of equipment, and the FDA has promised to issue guidance, but nothing has been released as of yet.
Additionally, since providers are not demanding interoperability, vendors are not necessarily motivated to create it. Smith argues that this is because many healthcare providers don't realize that it's an option.
"I think there is an issue where this interoperability runs counter to existing business models where, frankly, if switching costs are elevated, then for those that have the dominant market share, there's a certain impediment to change," he says.
However, Smith believes providers can be the catalyst for change. In April, the Center for Medical Interoperability, which was started by West Health Institute in 2013, announced its board of directors, including executives from large, well-known U.S. health systems like Northwestern Memorial HealthCare, the Robert Wood Johnson Health System, Johns Hopkins Medicine, and the Hospital Corporation of America. Smith hopes this new board will help get the attention of vendors and manufacturers regarding the need for device interoperability.
"What we're trying to do is use the purchasing power of large healthcare systems to speak with a common voice to vendors and say, 'Look, we want this solution,' " he says.
Some hospitals have taken steps to add hardware and software to certain devices, allowing them to import data to the hospital's electronic health record, but that doesn't necessarily create an automatic fail-safe in which a device would know to stop a morphine drip when a patient's oxygen saturation falls. Smith admits this is one step in integrating, synthesizing, and interpreting data on a larger platform; however, internal IT resources will be required to make those adjustments.
Smith says he remains optimistic about the future of device interoperability, but recognizes that as medical device technology moves forward, the gap between various medical devices will continue to grow.
"As we grow medical device technology to be more ubiquitous, it better communicate, otherwise we are overburdening patients and their providers to be the safety net that replaces the Internet," he says. "That's a burden that will be more difficult. Each one can be singularly life-saving, but when clustered together in an uncoordinated fashion you get unanticipated perils. So this issue will only grow in urgency."
How do nurses interact with medical devices?
Here are some of the most interesting statistics generated from West Health Institute's survey of nurses about device interoperability:
Half have witnessed a medical error because of lack of device coordination.
41% spend three hours or more each shift working with medical devices, including programming, setting up equipment, or transcribing data. 69% spend an hour or more.
63% of nurses spend their time troubleshooting device malfunctions, while 58% spend their time transcribing data.
91% of nurses report they could spend more time with patients if they didn't have to take so much time dealing with devices.
91% of nurses say that it would be extremely or very helpful if devices could share data with one another.
Source: West Health Institute's "Missed Connections: A Survey on Interoperability and Improved Patient Care."