SCENARIO: A patient is newly admitted to an intensive care unit from the emergency department at a suburban hospital. The patient is placed ona physiologic monitor and a ventilator in the ICU. The nurse associated the patient to the monitor so that she could automatically chart vital signs in the EHR. The patient has labs drawn and resulted every two hours via a POC (Point-of-Care) device. The patient had radiology exams in the ED prior to arriving in the ICU. An interactive infusion pump (Smart Pump) administers medications intravenously and interacts with the EHR to record titration of the medications automatically in real time. Twenty-six miles away, at a remote monitoring center (tele-ICU) stationed in a large metropolis hospital is also monitoring the patient.SCENARIO: An alarm sounds from the physiologic monitor at the bedside while a secondary alert sounds within the tele-ICU unit alerting staff at the patient’s bedside as well as in the tele-ICU that the patient has gone into VT (Ventricular Tachycardia), a lethal heart arrhythmia that requires immediate intervention. While the care givers at the bedside start advanced cardiac life-saving measures, the remote clinician can begin searching the electronic health record for the patient’s most recent lab results, pertinent medical history, medication history, as well as radiology results.SCENARIO: The remote clinician has special software that enables the remote clinician to review real-time vital signs, track and review trends, and recognize changes. The remote clinician can view the activities occurring in the patient room via a two-way camera with audio as well as call a code for the bedside, thus allowing the bedside clinician to remain at the bedside providing direct patient care. The bedside and remote clinicians methodically work together to resolve the issue, convert the patient, and stabilize the patient....According to Medical Strategic Planning, Inc., over the last decade the number of devices that need to be interfaced has grown from a handful to over 400 major devices (MSP Industry Alert, 2009). Medicat device connectivity is expected to increase efficiency and productivity, improve clinical workflow, lower costs while improving patient quality and safety.MEANINGFUL USE The HITECH ( Health Information Technology for Economic and Clinical Health) Act allows eligible providers and eligible hospitals to qualify for the Center for Medicare Medicaid Services (CMS) incentive payments if they achieve “meaningful use” of certified EHR technology to provide patient care (Center for Medicaid and Medicare Services, 2013).The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) are providing meaningful use criteria for both acute care (hospital/ER) and provider practices (clinic) settings. Eligible providers and eligible healthcare facilities that comply will receive incentive payments. In time, those failing to comply. will be penalized.Meaningful Use is a three-phased approach building upon each other. HITECH does not provide incentives specifically for medical device connectivity in itself but connectivity drives the adoption of EHR use and thereby meaningful use adoption.According to HIMSS, “interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user” (HIMSS, 2013).HL7 or Health Level Seven According to Interface, HL7 is by definition “an ANSI (American National Standards Institute) standard for healthcare specific data exchange between computer applications. The name comes from ‘Health Level 7,’ which refers to the top layer (Level 7) of the Open Systems Interconnection (OSI!) layer protocol for the health environment. The HL7 standard is the most widely used messaging standard in the healthcare industry around the world” (Interfaceware, 2013).Middleware enables integration of data between two or more programs, devices, or information Systems:it facilitates communication and data sharing.MATT aNIntegration engines use HL7 to characterize their ability to manage all interfaces. The engines aggregate and share data regardless of the transmission protocol. They are responsible for message routing and translation.Data can also be transferred through a device gateway. These are usually transferred through a central server that consolidates and collates data and then forwards the information to the EHR.Medical Device Data Systems (MDDS) are hardware or software products that transfer, store, convert formats and display medical device data, and it does not by itself control the functions or parameters of any other medical devices.Examples of MDDS include: : Software that stores patient data such as blood pressure readings for review at a later time y/ Software that converts digital data generated by a pulse oximeter into a format that can be printed . Software that displays a previously stored electrocardiogram for a particular patientA Class II medical device used-for active monitoring is utilized in the aforementioned ICU scenario as the software that allows the remote clinicians to review real-time vital signs, track and review trends, and recognize changes.The POC solution serves as middleware where the POC device or component associates the patient to the medical device and compiles the information from the medical device to send to a server (DiDonato, 2013)POC devices generally link to the medical device via a wired serial connection or wirelessly.Periodic or episodic devices are those that obtain a single set of measurements from a patient at single points in time or spot checks (DiDonato, 2014; ECRI Institute, 2012).Examples of common episodic devices are portable vital sign monitors, glucose meters, pulse oximetry, and ECG machines.CONTI ONS NETWORKEDContinuous devices are divided into stand-alone or networked devices. Continuous networked devices are commonly stationed in a patient room to treat a single patient over a continuous time span.CONTI ONS ST ee TNTContinuous stand-alone medical device solutions are used to continuously monitor a single patient over a period of time but the device is portable and not hardwired or networked to a vendor- specific server, thereby requiring a POC component within the patient room or attached to the medical device itself.Ay DEVICE teenThe linking of the medical device data with the right patient is referred to as patient association. There are historically two approaches to patient association: patient centric and location centric (ECRI Institute, 2012).Patient-centric identification involves associating a medical device with-a patient based on a unique patient {BD number, often the patient’s unique medical record number.In location-centric association the patient is typically identified by a location such as a room or bed.Auto-ID technologies such as bar code scanning and passive RFID is becoming increasingly useful and available as a means to assist with mobility and periodic device use (McAlpine, 2011).Radio Frequency Identification (RFID) refers to a wireless system comprised of two components: tags and readers. The reader is a device that has one or more antennas that emit radio waves and receive signals back from the RFID tag. Tags, which use radio waves to communicate their identity and other information to nearby readers, can be passive or active.USES: «Inventory control *Equipment tracking *Out-of-bed detection and fall detection *Personnel tracking Ensuring that patients receive the correct medications and medical devicesData are continuously being sent to the EHR, the nurse must validate which data are accurate and should be recorded within the permanent patient medical record. This process of manual verification of data and recording them into the medical record is known as data validation.Device connectivity solutions were unidirectional, or the flow of information was from the medical device to the EHR only; this is also often referred to as classic or one-way connectivity.Smart pumps use drug libraries which allow infusion pumps to perform functions that assist with programming and calculating dose and rate delivery as adapted by a healthcare institution and to patient care areas (Cummings & McGowan, 2011).Soft limits can generally be overridden after a clinician acknowledges a safety alert whereas hard limits are generally set for high-risk medications (Cummings & McGowan, 2011).The clinicians were identified when entering the room by ultrasound-enabled badges identifying them to the patient and families. Each patient room has a patient- and family. centered screen that can be used to identify caregivers, provide a schedule of the day activities for the patient, as well as access to. view educational programs.The rooms include a direct care touch screen which aids in documentation and provides important clinical attributes such as allergies, labs, and meds (Cerrato, 2011; Hagland, 2011).Alarms are intended to alert a caregiver when an immediate or potentially adverse event occurs or could occur.Considering our scenario of the patient/in the ICU, alarms could be emitted not only from the physiologic monitor, infusion pump; and ventilators but the nurse must also respond to call lights, bed-exit devices, feeding pumps, sequential compression devices, telephone calls, texts/pages, etc. (Cvach, 2012).Due to the aforementioned issues, many caregivers become immune or desensitized to the alarms and are not as timely to respond to alarms (Sentinel Event Alert, 2013).Medical device companies are exploring technology to develop safer and more effective alarm management. Medical device vendors are seeking to improve parameter acquisition techniques as well as improve alarm and alert designs to reduce nonclinically significant alarms (ACCE Healthcare Technology Foundation, 2013).1 aa teHealthcare institutions’ information systems transmit and store a great deal of sensitive and protected information; therefore, mitigating risks and safely securing the information are as important as safely caring for the patient.Device vendors and healthcare providers must work together to continue development of automation that will enhance patient care, safety, and workflows. When new types of technology or devices are introduced in the healthcare setting, it must increase efficiency or adoption will not occur.From a vendor standpoint, it is timely.and costly to research and develop devices, device drivers, and software. From a structural standpoint, it can be very costly to add network components after a structure is constructed so as healthcare facilities expand or rebuild.SCENARIO REVISTED The patient recovered from her life threatening arrhythmic event and is ready for discharge from the hospital. Due to having a life threatening cardiac event, she will be discharged with a wireless home holter monitor and pulse oximetry. A visiting nurse will visit and download the information from the holter monitor and oximetry weekly. In the meantime, the patient will record all her activity, rest, and recovery.