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What’s up in the clinical world? . Thoughts and musings care of ECRI Institute. Healthcare providers need IHE standards . They know we need to spend money on IT to get money from ARRA/HITECH, even if they don’t know what use is “meaningful”

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what s up in the clinical world

What’s up in the clinical world?

Thoughts and musings care of ECRI Institute

healthcare providers need ihe standards
Healthcare providers need IHE standards
  • They know we need to spend money on IT to get money from ARRA/HITECH, even if they don’t know what use is “meaningful”
  • They’re afraid that CMS/insurers will require proof of administration before they will pay
  • eMAR and electronic documentation is seen as essential
    • … but nurses and caregivers already have trouble keeping up with documentation!
    • How do we get the data where it needs to be?
    • My monitor says plug and play, it lied!
    • Why isn’t there an app for that?
clinicians see this mess
Clinicians see this mess

So many infusion lines- which one is to which bag?

Sticky tape is magical for keeping track of each medication on its pumping channel

Imagine how long that took to program… and to document!

facilities and suppliers see this mess
Facilities and suppliers see this mess

You’ll notice that there are a lot of lines here…

And “wireless” is never as simple as it seems.

Facilities and suppliers need a ROADMAP to figure out which messages apply where

honorable mentions
‘“Honorable Mentions”
  • A few suppliers have gotten started with proprietary interfaces while we’re waiting for standards
    • CareFusion pump server tie to Emergin for alarm notification
    • Hospira tie to med orders and documentation (Epic? Cerner?)
    • Who else? Let’s give you credit!!
healthcare providers need to know why they need standards
Healthcare providers need to know why they need standards
  • PIV standards are “down in the weeds” of safety and documentation
  • This could make it harder to get facilities’ attention in the morass of connectivity, BUT…
    • Smaller community to work with- just pump suppliers and eMAR/PhIS/BPOC suppliers for now
      • (should we get location tracking involved?)
    • Well-contained workspace- we can draw a box around what we own
    • Interested parties in facilities-
      • FTEs dedicated to pump library management and log analysis- and thanks to the pump suppliers, we know who these people are!
      • “Techy” pharmacists and Nursing Informatics professionals are great allies- reach out through eMAR/PhIS suppliers
in a deceptively simple ideal world
In a deceptively simple ideal world
  • We can find the right people to reach out to…. and give them a clear message and tools

PIV messages are married to clinical function

  • Auto-programming an infusion pump
  • …..
  • Step X: Sending Initial Program
  • PhIS or BPOC sends PIV message XX that contains the program (rate, VTBI, mode, etc) to pump server
    • RFP NUGGET 1: “(PhIS or BPOC) system shall support outgoing XX message containing xxx and do yyy”
    • RFP NUGGET 2: “Pump server shall support incoming XX message containing xxx and do zzz”
  • (pump does its thing and starts delivery after clinician confirmation)
  • Pump server sends message YY to eMAR to tell it infusion has started…

Info is organized in same order facilities think

RFP drop-in language is located where you need it

however
However….
  • My ideal world can only happen when suppliers SELL commercial systems that support fully developed PIV messages
  • Potential roadblocks?
    • Raising support at supplier leadership level- developing one-off systems for Connectathon is one level of investment, we’re talking a whole new ballgame when it comes to commercial offerings
      • Raising facility awareness and RFP requests may help
    • Time required for verification and validation of incoming and outgoing message support is expensive
    • Unclear regulatory environment- ‘propose something and we’ll see’
can we help
Can we help?
  • What can we do as a group to ease the ‘burden of entry’ for suppliers?
    • Develop a regulatory roadmap for FDA comment-
      • here’s what a supplier should provide in a 510(k) in order to add PIV (or heck, any PCD) support to an existing cleared product
      • Clearly define which systems need clearance (easier than it sounds, pump servers are still in limbo)
    • Develop a “QuickStart” guide to PIV compliance for Sigma, Smiths Medical, Curlin, and PhIS/ eMAR/ BPOC suppliers who aren’t involved yet
      • The facility-based guide to PIV should be a good enough start
      • Include contact information for joining PIV conference calls and f2fs
      • Someone in this group must have a contact at each…