Janet Dillione, CEO of Cardiopulmonary Corp., developer of the Bernoulli medical device integration system, is...
a health IT veteran who was formerly executive vice president and general manager of Nuance Communications Inc.'s healthcare division and president and CEO of Siemens AG's health services division.
In this Q&A with SearchHealthIT, the first of a two-part series, Dillione talked about the benefits of linking medical devices from disparate vendors and in different care settings to the healthcare network, and using MDI systems to manage medical device alarm "fatigue," a problem that has been flagged by the Joint Commission.
Dillione -- whose company recently merged with MDI-informatics vendor Nuvon Inc. -- also touched on meaningful use, "tele-ICUs," predictive analytics, integrating MDI into EHRs, and the role of the CIO and chief medical informatics officer in managing MDI, among other topics.
Do many healthcare providers have fully realized medical device integration (MDI) systems or are most provider organizations relying on siloed proprietary devices without a coherent integration strategy? And if it's more of the latter, how can they properly implement a comprehensive enterprise-wide MDI system?
Janet Dillione: The West Health Institute has done some recent work in the area that says less than 30% of the providers have an MDI solution in place. And even of the ones that have an MDI solution in place, a small percentage of the devices inside the provider are actually attached or integrated. So there's a tremendous amount of productivity savings from getting that integration done in the healthcare market.
I think what you're seeing is that in the first wave of MDI, it was folks who had a monstrously complicated project implementation plan to get their EMR live, and get to meaningful use stage 1. Then they get to meaningful use stage 2. So what we're seeing now is customers coming back and saying: 'Okay. I did that. I checked the box. I maybe got some ventilators attached or I got some physiologic monitors in high traffic areas attached, and now I'm taking a step back and I'm looking at what's happening in my enterprise across connectivity of real-time data. Wait a minute here. I've got a solution in my ED [emergency department]. I've got a solution in my cardiac areas. I've got a solution in ICU [intensive care unit]. I've got a different solution in the OR [operating room]. I've got solutions in ambulatory clinics. Oh, wait a minute. We bought a provider. They've got another one.'
The CIOs and the CMIOs are taking a step back and saying: 'This is similar to an enterprise layer of software I have around my EMR around documentation, around clinical results. Why is it different here?' I'm quite bullish on the opportunity. I think that the market, again, is coming out from under. I think we have a more educated buyer.
What are some of the biggest advantage of state-of-the-art MDI systems and what's the business case for them?
Dillione: To me, MDI is connecting things to integrate into the EMR. What you really want to do as an enterprise is get your arms around the real-time data that's around the patient. So what you're looking for in a state-of-the-art provider for integration of real-time data is, number one, can this provider do more than MDI? MDI is significant but insufficient, because what I really want to do is leverage that real-time data to take care of critical workflows in the enterprise.
For instance, I have an alarm management imperative because of the [Joint Commission] patient safety goal. I have alarm fatigue. I have an HCAHPS [hospital consumer assessment of healthcare providers and systems] score for patients who are telling me my rooms are too busy. I have clinicians who are saying, 'Stop the insanity. I'm wearing a tool belt. Don't give me the phone if the phone is just going to be constantly beeping.'
There are workflows around alarm management. There are workflows around tele-ICU. It's great that you can take the data off the devices but I'm looking for real-time workflows because I now own three, five, 10 ICUs that are geographically distributed and I don't have enough intensivists. I've got to embrace some kind of telehealthcare. There you need somebody who can get real-time data, including waveforms in real time, and get them available on dashboards in an ICU bunker.
And then lastly, the CIO is more often engaged in these areas. [Health IT managers] know that the acuity of the patients is only going in one direction, which is increasing. We are simply older, we are simply comorbid, we are simply sicker. This idea of trying to monitor patients is going to continue to move outside of ICU and outside of telemetry. It's why there's so much buzz around sensors. It's why there's so much buzz around consumer products and others trying to monitor patients. In your environment, you're going to have to have some kind of a real-time data platform that can make sense of that real-time data that's going to be generated by continuous monitoring. If I'm a buyer and I'm looking for state of the art, again, I'm looking for MDI because it's an important workflow, but it's just one of the important workflows around real-time data that I need to get a platform in my enterprise and get supported.
What are the factors driving hospitals and healthcare systems to put MDI strategies higher on their lists of priorities? And what meaningful use requirements are involved in driving adoption of MDI?
Dillione: The meaningful use requirements are around vital signs and vital signs charting and getting that information as part of the EMR. I think that's critical. Most of the phone calls we are getting, or the RFPs [requests for proposal] we are getting right now [are one of] two things. Number one, it's the [Joint Commission] alarm imperative, the national patient safety goal. Get your arms around the numbers of alarms and have a strategy around alarm fatigue, alarm reduction, alarm noise. That's first and foremost. The second -- and the most typical reason we get a call -- is usually from a CMIO [chief medical informatics officer], a CNIO [chief nursing informatics officer], or a CIO, saying, 'My clinicians are screaming at me.' It's because the device connectivity is so complex.
If providers and healthcare leaders ask themselves if their MDI systems can scale and adapt to their evolving needs, what are they likely to have for answers if they look deep inside their organizations?
Dillione: I think most often we are going to have a classic MDDS [mobile device data system] type of a solution, a Class 1 device that's got quote-unquote FDA clearance to take some type of a data feed from a device and then take that feed and pass it over to an EMR's HL7 [Health Level 7]. I think that was a historic requirement that the solutions out there met. I think what you're seeing now, especially the academics and some of those folks who are thinking about predictive analytics, working on predictive analytics, thinking about real-time data, [they] are the ones [saying] 'I want the real-time data. I need the real-time data to know what's happening with my patient.' I want to have one platform to leverage that real-time data on, and I want to use that real-time data to do things like alarm management, like clinical, continuous surveillance across my different med-surg units and telemedicine, whether it be ICU, or if you're an ACO [accountable care organization] and you have an at-risk patient population.
You want to have one platform that can be monitoring Janet Dillione's data. When I came into the ED, here's my real-time data. I had surgery. I came through [the] OR. I went through [the] ICU. I hit med-surg and I went home. In every one of those care settings, I probably had a different type of device, but I had a lot of real-time data. The folks want to have one platform that can manage that, that can handle those different devices. And specifically in med-surg, what we're expecting to see in the very near term, not the distant future, are sensors. So wearable monitors in the med-surg units for patients that were never before monitored because they are sicker, because there is less time to be devoted to these more acutely ill patients. So, here come sensors that have no primary alarm capability. And then I'm going to discharge patients to [their] homes.
I probably am going to send them home with some kind of glucose monitoring, some kind of blood pressure monitoring, maybe some EKG monitoring. How am I going to get that data back into my patient record? I probably am going to have some kind of surveillance of those patients for whom I am now at risk, even post-discharge. That's the platform the market is … looking at.
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