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5/8/2012
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Smart Pumps Play Catch Up With EMRs

Healthcare providers want wireless EMR integration with smart pumps, but a KLAS study suggests the complexity of the setup deters many.

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Fewer than 10 providers in the country are integrating their electronic medical record (EMR) system with smart pumps and only 60% of providers currently have the proper wireless technology in place required for EMR integration, according to a KLAS survey of 251 providers from 218 organizations.

Smart infusion pumps help prevent medication errors by alerting healthcare professionals about pump settings that don't match their facility's drug administration guidelines. The smart pump's software has a drug library that issues an alert if a programmed infusion is outside of recommended parameters for a certain drug. Traditional infusion pumps are more likely to encounter errors because they were manually programmed.

According to the KLAS report, drug libraries and continuous quality improvement (CQI) data are designed to make smart pumps smart. However, drug libraries can be bypassed, which is why wireless technology is valuable: it can supply providers with information and enable them to improve how they administer IVs.

[ Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs. ]

For health systems, integrating smart pumps with EMRs can be a challenge, in part because hospitals need the infrastructure to support the pumps. "Historically the pump was wireless but didn't need to maintain wireless connectivity 24/7. [Connectivity] was only needed for reports and drug library downloads," Kristen O'Shea, clinical transformation officer for WellSpan Health, and VP for patient care services at Gettysburg Hospital in Gettysburg, Pa., told InformationWeek Healthcare. Wellspan was one of the respondents in the KLAS survey, and one of the few providers who have taken definitive action to integrate smart pumps.

But, O'Shea pointed out, 24/7 bi-directional communication between the smart infusion pump and the EMR is now needed. This is complex and requires a team approach. "Each member of the team needs to understand implications. The clinical analysts needed to make sure the medication order sentences in the electronic record were consistent with drug library settings on the pump. There are lots of important connections so we all need to be working closely so as to not interrupt any processes." WellSpan has created a new hybrid biomedical/IT position to manage device connectivity, said O'Shea.

Wireless EMR-pump integration has been implemented in 90 beds within the WellSpan system and it expects to expand implementation later this summer. Hospira provides the pump technology and Cerner is WellSpan's EMR vendor.

Mark Neuenschwander, president of The Neuenschwander Company and co-founder of the unSUMMIT for Bedside Barcoding, said that auto-programming from EMRs to pumps reduces pump programming errors. "Real-time data transmission from pumps to EMRs increases accuracy of documentation, notifies pharmacy of activity, warning them of interruption, notifying them that the administration is almost complete and a new IV needs to be prepared and sent," Neuenschwander said.

According to the KLAS report, Cerner is the only vendor that has taken an active role in working with all pump vendors. Cerner has integration alliances with CareFusion, Hospira, and B. Braun. Epic is working on an EMR integration initiative with CareFusion. Allscripts, GE, McKesson Meditech, and Siemens have not engaged in EMR integration; however, Allscripts reports that it has a site in process, according to KLAS.

Wireless technology, according to the report, allows for more-frequent adjustments to the drug libraries based on report data and a more-automated process to push updates to pumps. The report states that providers that use wireless technology were "45% more likely to actively use report data and 39% more likely to know drug library compliance rates."

"You can choose to purchase a smart pump without wireless capabilities, much like you can buy a computer with wired, wireless, or no network capabilities," Coray Tate, VP of clinical research at KLAS and lead author of the report told InformationWeek Healthcare.

Tate added that wireless allows you to pull usage reports from the smart pump that show how nursing staff is using and complying with the safety features of the pump. "It also allows them to make changes to the drug libraries and push those changes out to each pump. CareFusion, Hospira, and Baxter all have a significant portion of their customers using wireless technology. Since it was only recently cleared by the FDA, only a few of the B. Braun and Smiths customers are using wireless," Tate said.

Providers who participated in the survey said they were ready to take the next step of EMR integration, with one in four saying that they were "either actively pursuing pump/EMR integration or listed it as a top priority." One-quarter said that EMR integration was important but that it took a back seat to meaningful use, while half of the providers said that EMR integration should be part of meaningful use requirements.

KLAS's Tate said that the biggest takeaway from the report is that when it comes to EMR integration, the industry is moving in the right direction. "For the past several years there's been three or four sites that have been doing this integration or some level of EMR integration. The thing that was revealing this year, there's six now, but there's a chance that by the end of the year that could be pushing 20," Tate said.

The 2012 InformationWeek Healthcare IT Priorities Survey finds that grabbing federal incentive dollars and meeting pay-for-performance mandates are the top issues facing IT execs. Find out more in the new, all-digital Time To Deliver issue of InformationWeek Healthcare. (Free registration required.)

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