This article first appeared in the July 2012 edition of DOTmed Business News

Over the last several years, infusion pump woes have been linked to a magnitude of adverse event reports and hundreds of fatalities, resulting in the introduction of the 2010 U.S. Food and Drug Administration’s Infusion Pump Improvement Initiative. Since the initiative’s inception, OEMs have encountered stricter regulations, and end users have been on the lookout for ways to boost their own infusion pumps’ ability to keep patients safe.

More than half of all surveyed providers in the country agree that integrating an electronic medical record system with infusion pumps is the next big step. Despite the consensus, fewer than 10 providers countrywide are actually doing this, and only 60 percent of providers currently have the proper wireless technology in place required for EMR integration, according to a KLAS report from March, which surveyed 251 providers from 218 organizations.



However, the demand for better, faster, more integrated data in the infusion therapy space has been gaining speed. And according to Eric Melanson, director of marketing, infusion systems, B. Braun Medical Inc, many providers previously reluctant to fully integrate pumps with EMRs have since changed course, now expressing their intent to do so in the near future. That about-face isn’t surprising — KLAS’ report notes over half of providers actually consider EMR integration key to future pump selection.

Cerner Corp. is currently the only EMR provider that has taken an active role in working with all pump vendors, including integration alliances with CareFusion Corp., Hospira Inc., and B. Braun. Epic is currently working on an EMR integration initiative with CareFusion, while GE, McKesson Meditech, and Siemens Healthcare have not yet engaged in EMR integration.

Perks of EMR implementation
In a nutshell, the largest cost in managing a health care facility is the nursing staff that spends 40 percent of their time documenting care — and if that care documentation is broken out, the lion’s share of it entails documenting IV medications. EMR can potentially give the nursing staff 20 percent more time to allocate where their expertise contributes the most value. Fully implemented, EMR reduces risk, lowers cost and improves patient care, according to Melanson.

Several health care providers have already implemented IV clinical integration technology and have seen positive results, such as a 27 percent reduction in nursing time to start a new infusion, according to a June 2011 statement from integrated health system WellSpan Health.


“Now that we have several hospitals that have implemented IV clinical integration technology, we’re seeing positive, tangible, real-world results,” says Rich Nevin, vice president of medication management systems in the U.S. for Hospira.

Further examples of positive results were published in a study by the American Journal of Health-System Pharmacy in May. The study found that, due to this implementation, there has been a 32 percent reduction in reported heparin administration errors.

The first infusion pump provider to integrate with EMRs was Hospira. Hospitals are using IV clinical integration to network the company’s infusion devices and
Hospira MedNet safety software with hospital information systems to achieve real-time sharing of patient and medication information between management platforms, medication pumps and other devices.

“Right now, we’re seeing a shift of customer interest toward more advanced technology, such as IV clinical integration of smart infusion pumps with EHRs, which is available on Plum A+ and Symbiq pumps,” Nevin says.

CareFusion is continuing to make progress on solutions to improve connectivity and interoperability between the Alaris Infusion System and a hospital’s health care information technology system.

“We recently went live in limited commercial release with a new, bi-directional infusion pump connectivity solution that helps hospitals improve patient safety and reduce medication administration errors by enabling nurses to remotely program IV medication orders from the hospital’s EMR system to the CareFusion Alaris System smart infusion pump through barcode scanning,” says J. C. Kyrillos, senior vice president and general manager of infusion systems at CareFusion.

Nevin believes the industry will likely see an increased use of wireless technology and an uptick in adoption of integrated systems like IV clinical integration technology.

“Using this integrated technology to link smart infusion pumps with EMRs helps deliver the trifecta for hospitals: safety, efficiency and avoided costs,” says Nevin. “Additionally, I believe we’ll see the possibility of integrating infusion pumps with other systems and devices.”

Alternative safety features
Increasingly, today’s infusion systems focus on three core capabilities: reliability of design; robustness of the safety features; and wireless connectivity that enables data analysis of infusions and better, faster understanding of how the device is functioning, explains David Ferguson, vice president of infusion systems at Baxter Healthcare Corp.

An array of safety features are usually available on most pumps, including drug libraries, which issue alerts if a programmed infusion of a drug is outside of recommended parameters.

In April, Baxter completed its acquisition of SIGMA International. Baxter’s SIGMA Spectrum smart infusion system utilizes sophisticated drug error prevention software that helps clinicians avoid programming errors that may result in incorrect administration of infusion therapies. This software, embodied in the Master Drug Library, allows a facility to deliberately set upper and lower dosing limits on infused medications to ensure that programming errors by a clinician do not exceed the facility’s therapeutic guidelines.

Hospira’s Symbiq, with built-in MedNet safety software, was the first general infusion system developed to provide additional medication error protection by requiring users to select a drug library entry from the safety software for all drug delivery programs. KLAS’ report states that Symbiq infusion pumps have the highest reported safety software drug library compliance among large- volume pumps, at 93 percent. It is also one of the first devices to achieve smart pump EMR integration, also known as IVCI.

Although drug libraries catch most errors, blunders can still occur. In KLAS’ report, 23 percent of surveyed organizations reported serious medication incidents in the past two years and 60 percent of those were made while using drug libraries. In fact, the FDA continues to receive reports related to programming and administration errors, even when clinicians utilize drug libraries.

One case reported through the FDA’s Medical Device Reporting program dealt with an accidental administration of a non-therapeutic anticoagulation dose to a patient. The mix-up ultimately led to a lower extremity amputation. The dosing error possibly caused or contributed to this outcome, though the report was not conclusive. The user facility has since updated the drug library with new minimum hard and soft dose limits for heparin and implemented additional education for the nursing staff to prevent recurrence of this programming error.

KLAS’ report notes that EMR integration with auto-programming would help eliminate such errors, and wireless technology can supply providers with information, enabling them to improve how they administer IVs.

Complications and skeptics
Although the advantages of the integrated EMR model are evident, KLAS’ report indicated the complexity of the setup deters many. Part of the issue boils down to the fact that without the proper infrastructure, a hospital cannot support the pumps, and achieving wireless integration and device interoperability can prove a significant challenge. A great deal of coordination is required between EMR users, IT, clinical analysts and other team members, often involving changes to existing technology infrastructure, workflow and clinician behavior.


“It’s a complicated project to undertake, involving a lot of connections between systems and people within an organization,” B. Braun’s Melanson says. “The changes require a team approach and the requirements and implications to each area need to be carefully thought out and understood.”

Another reason for the slow uptake is that there currently isn’t enough data to confirm the initial installs are paying off, and, according to Ferguson, with just the pump manufacturers and their health information systems’ partners touting the benefits, there is skepticism about the overall impact.

“[Manufacturers must offer it] at a price and simplicity of installation such that the hospital can readily recognize a return on its investment, quickly,” he explains.

But in the coming years, as the number of devices that can be integrated increases, and facilities come under greater cost and patient care pressures, Ferguson believes the skepticism will fade away.

“The expanded benefit of 24/7 wireless connectivity in the real world patient care continuum is beginning to be more understood by administrators and clinicians who historically have connected only for library updates and reports,” adds Melanson.

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