At WellSpan Health York Hospital, setting up an infusion for a patient is as easy as scanning groceries. Nurses who once may have had to interpret notes scribbled on a scrubs leg now scan barcodes on a patient, on a drug bag and on the pump. The patient’s information then appears like magic, without the frustration — or danger — of hitting a wrong button.

York Hospital was one of the first to take the plunge into integrating infusion pumps with EHRs, teaming up with Cerner and Hospira back in 2010. Since then, only 10 or so hospitals have done the same, according to KLAS research, though an upcoming KLAS report will itemize the growing number of facilities with integration in the works.

“I think everybody wants it, everybody talks about it, but there’s a lot of competing resources for IT time and for the hospital organization just to focus on,” says Coray Tate, VP of clinical research at KLAS.

Plus, the ease of workflow after implementation belies the complexity of setting up an integration program.

“It has been extraordinarily hard and complex, even though it’s just scan-scan-scan,” says Kris O’Shea, clinical transformation officer at WellSpan Health.

Despite the challenge, and the piles of health IT knowledge O’Shea was made to absorb along the way, she says the transition was worth it. But that doesn’t mean facilities should jump to educate their smart pumps without the prerequisites. O’Shea, along with other infusion pump experts and vendors, shared with DOTmed Business News the challenges and rewards of building a wireless, integrated system for pumps.

Pumps under pressure
ECRI lists medication administration errors using infusion pumps second on their list of top-10 health care technology dangers for 2013, after alarm hazards, which also apply to infusion pumps.

“As they’ve become a more complex technology, hospitals are using them on sicker patients, and they’ve really transitioned over to a life sustaining device,” says Erin Sparnon, senior project officer, ECRI Institute.

“Smart pumps,” infusion pumps loaded with drug libraries, have been around for a decade now, and have done much to improve safety. Facilities load drug information along with dose parameters specific to each drug that can’t be exceeded.

But smart pumps aren’t always geniuses, and can’t prevent all user errors. In an ECRI survey of 100 infusion pump errors, 29 percent were concentration issues and 19 percent were programming issues.

“Smart pumps are very good at catching a gross programming error,” says Sparnon. “But since you have to set your dose parameters to allow most therapies, you don’t want to alert on every single medication, so the ranges are pretty large. That means a drug library might not catch a subtle mis-programming change.”

And when patients are high-risk, even a small error can throw off an important infusion.


Get smarter
When a smart pump is integrated with hospital information systems and EHRs, its intelligence skyrockets. The ECRI report says that 75 percent of the reported errors could have been prevented with integration, which allows for real-time data transmission from pump to HER so pump programming syncs with doctors’ orders, or for auto-programming of the pumps with a simple scan. (Some errors, such as the pump being unplugged, only people can prevent.)

Hospira, the first infusion pump vendor to embrace HER integration, reports that health care providers that have implemented IV clinical integration technology saw the ability to avoid an average of 30 adverse drug events in a two-month period, according to Rich Nevin, vice president of marketing for medication management systems at Hospira.

O’Shea of WellSpan Health says in just six months, nurses were stopped by the pump’s safety guardrails around 1,600 times.

“I don’t think that many errors would have gotten to the patient, but some percentage would have,” says O’Shea. “For me, the pump is a tool that helps to protect the patient, at least have that safe guard or safety net.”

Pump data in EHRs also helps facilities pinpoint problem areas.

“Having relevant infusion data aggregated in one therapy practices, leading to enhanced IV medication safety initiatives,” says Eric Melanson, director of marketing at B. Braun.

Integrated pumps boost efficiency as well, as they eliminate the time-consuming manual chart entry process. Once WellSpan Health integrated its pumps, it experienced a 27 percent reduction in nursing time required to start a new infusion and a 50 percent reduction in time needed to titrate an existing infusion and document it.

The latest pump software releases bring the pharmacy into the conversation as well. Once a frenzy of frustrated calls from nurses waiting for infusions, the pharmacy at WellSpan Health now runs smoothly thanks to a color-coordinated graph that lets pharmacists know what infusions should be top priority, and shows nurses at what time infusions bwill be ready.

CareFusion also recently introduced a web-based dashboard that links the pharmacy with the rest of the hospital.

“The application uses a proprietary algorithm to show how much time remains and the amount of medication volume that is left to be infused, enhancing workflow between pharmacy and nursing,” says Dan Pettus, vice president of IT and connectivity at CareFusion.

Wireless woes and other challenges
Before beginning the pump integration process, facilities should have a sturdy IT foundation, including reliable wireless connectivity, an EMR program, updated infusion pumps and appropriate middleware to bring everything together.

Wireless connectivity often proves to be the most formidable step.

“The hospital needs to understand the robustness and limitations of its wireless network,” says Tim Vanderveen, VP of the Center for Safety and Clinical Excellence at CareFusion. “Just being wireless doesn’t translate to a hospital being ready to implement some of these complex interoperability platforms. Careful planning and consideration of the hospital’s wireless network is a critical component to a successful solution.”

In addition to sturdiness on the tech side, a strong team of reliable staff has to be built up, too.

“Infrastructure building is complex, it requires your team to work differently,” says WellSpan Health’s O’Shea. “We have new roles, for example the liaison between biomed and IT, and that role evolved out of this whole topic of bar code scanning and connectivity.”

If different devices are communicating, that means people from disparate departments have to be in touch, too.

“This is very much a multi disciplinary project, so you need to be able to bring together your leadership from the IT department, the pharmacy, nursing, you also need to make sure to bring your biomed folks into the conversation,” says Steve Kirsch, vice president of the DeviceWorks division at Cerner.

Communication is especially important when it comes to user support systems. A nurse might be accustomed to calling the biomed department, but as pumps become more connected to the overall system, there may be a different number to call, says Kirsch.


Pump partners
The next step is to select infusion pump vendors that already sync with the facility’s EMRs. Currently, Hospira, CareFusion, B. Braun and Baxter Healthcare can all connect with EMRs.

While the major infusion pump players offer pumps capable of integrating, EMR/EHR vendors have been slower to join in the field.

“Due to the software enhancements and implementation work the EMR vendors need to complete to help their customers achieve Meaningful Use, most of the EMR vendors have not fully prioritized resources against the smart pump integration projects,” says Eric Sato, senior director of marketing at Baxter.

Cerner and Epic are EMR vendors with live sites. Siemens, McKesson and Meditech are currently in talks with customers.
Bernie Nikolski, clinical engineer at Saratoga Hospital in Saratoga Springs, N.Y. advises finding vendors that have worked on similar projects and are familiar with the HER or pump systems the facility uses or plans to use. He uses the middleware company Accent on Integration, which works with Meditech.

He also recommends contacting peers for tips. “I think the biggest advice is just to reach out to other hospitals and find out who’s done it, find out what’s a good process to follow through,” says Nikolski.

Smart pumps graduate to smart hospitals
Even once they’re linked in, school is still in session for smart pumps. EHR integrated pumps will someday be part of a larger “smart hospital” system, with pieces like patient monitors and hospital beds connected as well.

Altogether, one recent report from the West Health Institute estimates that improving interoperability between medical device systems in hospitals can save up to $30 billion a year, with $2 billion in savings coming from avoided adverse events and $12 billion from increased clinical productivity. That statistic alone suggests that facilities will be pushing for more device-EHR integration sooner rather than later. Even if current progress is only plodding along, pump integration is inevitable, experts say.

“It’s going to follow how wireless was,” says Tate of KLAS. “It was, ‘oh it would be nice to have,’ and now it’s seen as a part of the system. How long it takes to get there, we’ll have to wait to see, but I think we’ll pick up momentum as we’re going on.”

DOTmed Registered DMBN May 2013 - Infusion pumps Companies

Names in boldface are Premium Listings.
Domestic
Anwar Abdelqader, CBE Medical, Inc. , CA
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Randy Lowers, L & R Services, FL
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Dominick McCann, Mobile Medical Maintenance, IN
Eric Ebejer, Argo Surgical Repair Svcs., MI
Sarah Stem, J2S Medical, LLC, OH

International
Danny Raiz, versatile, Australia
Rick Meerkerk, Mediproma B.V., Netherlands