Connecting a Diagnostic Medical Devicewith Your EMR

Healthcare providers across the country recognize the benefits of electronic medical records (EMRs) to improve the quality of care, reduce costs and improve efficiency. But as medical professionals, we know the challenge of keeping up with technology. Provided are some suggestions for you as you start to digitally capture information from diagnostic medical devices in your exam room intoyour practice’s EMR.

INTEGRATED VS. INTERFACED: WHICH IS BETTER?The �rst medical devices to be connected to the EMR in 1996 were integrated. The term ‘integrated’ meant that the medical device manufacturers developed software for their devices that could be embedded directly into the EMR for test acquisition and post-test review. Although integration was an innovation at the time which eliminated the need for scanning test results, the solution had some limitations. In the last ten years technology and software have allowed many vendors to vastly improve device connectivity. The most important dynamic in connecting any medical device is work�ow as it relates to the requesting of the test, acquisition of the test and saving the data created from the medical device into the EMR after on-line review and con�rmation.

Seamless connectivity and work�ow are the most important ingredients to your device connectivity solution, whether your medical device is PC-based or purpose-built. It does not make a di�erence if your device is integrated or interfaced, but what does matter is ease of use and clinical accuracy! Seamless connectivity means minimizing mouse clicks and having the ability to save test results with discrete data elements when, where and how youwant them.

HOW DO YOU CHOOSE THE CORRECT MEDICAL DEVICE?First and most importantly you should make the decision. Some EMRs have developed solutions with medical device companies that give the EMR a �nancial interest in referring a certain manufacturer. Most EMRs vendors do a great job with developing software but it is the physician’s medical expertise that is required to select which device would best �t the clinical requirements of your practice. If you or your practice is purchasing a medical device such as an ECG, Holter Monitor, vital signs, weight scale, fetal monitor, lab product, spirometer, ophthalmology device, bone densitometer, PACS*, etc., make sure you select the best, most clinically accurate product �rst. Once you have selected a product, then make sure it has a connectivity method that �ts your practice’s EMR requirements.

In addition to working with the device vendor, verify with your EMR vendor that the device can connect to the EMR. Request a connectivity demonstration to ensure that it supports the clinical

and patient work�ows for your practice and patient needs. If the medical device does not have connectivity, call your EMR vendor and ask if they can assist with the connectivity analysis and solution identi�cation.

CONNECTING YOUR DEVICE TO THE EMRConnecting to the EMR has many di�erent possibilities. The most common solution today is the USB connection, which is a hard-wire connection to your PC. If the manufacturer o�ers only serial connections, beware; this will tell you that the manufacturer has not kept current with technology. A conversion product that becomes USB is not an acceptable solution. Wireless connections are becoming more and more available, and blue tooth technology today is also a possibility for consideration. Ask your device manufacturer if they o�er a solution that will work with a thin client network. Will the solution landscape work on your tablet PC? Does the solution require a separate server? Are there advantages to a separate server? Does it work with a tablet pen? Would voice activation be important?

HOW SHOULD YOUR DATA BE SAVED? Keep in mind some important issues in relation to data capture and image quality. A PDF is a static image and cannot be used for data mining in the future, which means that you will be unable to query results. A PDF is a less than adequate �le format for storing ECG wave forms that are 100% reproducible. Another suggested standard is HL7 or Health Level 7 which is normally used to store text such as lab results or test interpretations. Current HL7 standards lack clinical reproducibility of wave forms as it relates to ECG and spirometry. It is important for you to ask questions such as: • How will you track, as an example, “all patients with COPD” from a spirometry test? • Can you mine test results? • Can you save, as an example, the discreet data from a resting 12-lead ECG into a cardiology template? Can you also save the interpretation and the critical measurements?

©2007 by the Healthcare Information and Management Systems Society (HIMSS). www.himss.org

*PACS: Picture archiving and communication system.

Connecting a Diagnostic Medical Devicewith Your EMR

©2007 by the Healthcare Information and Management Systems Society (HIMSS). www.himss.org

The HIMSS Ambulatory Information Systems Committee, Practice Leadership Task Force developed this brochure for physicians in private practice, practice managers and other medical professionals. Other available brochures are “Getting Started with an EMR,” which looks at the transition process from paper to EMRs, with tips on how to manage that process effectively and efficiently. “Selecting the Right EMR Vendor” provides a step-by-step guide on how to find and evaluate the vendors in the marketplace and select the best suited to individual practice settings and needs. "The Legal Electronic Medical Record" discusses why the EMR needs to be a legal medical record and what criteria to look for in a product that will ensure the EMR will meet the requirements for a legal medical record. These brochures are available to reprint/reproduce for your own use on the HIMSS web site at www.himss.org/EMRbrochures. No prior permission is required by HIMSS. For further information please contact HIMSS Director of Ambulatory Information Systems, Mary Griskewicz at mgriskewicz@himss.org or 203-421-8317.

MY EMR SUGGESTS SCANNING THE TEST RESULTSIf your EMR manufacturer suggests scanning test results, they are not considering your sta�’s time and work�ow. Why would you purchase an EMR that has a scanning solution? Scanning requires a great deal of memory, is not clinically accurate for measuring wave forms, and has signi�cant sta�ng and support demands. Scanning o�ers poor reproducibility. Ultimately it is not a viable solution.

WORKFLOWWhen considering work�ow, think about how the EMR solution will work in your practice. Will it save you and your sta� time and eliminate redundancy? Can you save discrete data points for future data mining? Think about eliminating work, not adding to the equation.

For example, you, the physician, need a 12-lead resting ECG test performed on your patient. Do you need to leave the exam room to ask the nurse to run an ECG, or should you be able to click on “order an ECG” and have your nurse noti�ed immediately through a task to perform the ECG? Once the nurse completes the test, will the test automatically appear in the “Physician’s In Box” for your review and electronic signature? Will ordering the test automatically trigger a billing code or charge? This example may not capture all of your speci�c work�ow requirements, but you can request what you need. All of this functionality is available today.

PC-BASED DIAGNOSTICS VS. YOUREXISTING DEVICESAgain, you make the choice. Ask your sta� if your current product has a connectivity solution that works for your practice and your sta�. You may have invested thousands of dollars in that last stress product; do you really need to replace it? Will a PC work with your new work�ow? What happens if your PC is not functioning correctly? Do you want to eliminate the related paper? The size of your practice, as well as the number of existing devices and their age, should help you decide.

INDUSTRY STANDARDSAt the time of this writing there are no industry standards for medical device integration. Integrating the Healthcare Enterprise (IHE) is a global initiative that is currently creating a framework for passing vital health information seamlessly between applications. IHE has 76 participating organizations with 51 health IT vendors that are able to demonstrate interoperability with 74 EMR products.

Currently, IHE is in �nal stages of developing an ECG standard, and is working on stress and Holter Monitor standard pro�les. These standard pro�les will support DICOM, which is currently used in conjunction with image management systems. The drawback with DICOM is the expense of the PACS, which are usually found more in hospitals, large group practices, and clinics. DICOM has a solution for the small o�ce; however, editing and other tool sets are not available without the full PACS solution.

Special thank you to Michael D. Paquin, MDP Group, Inc. for hiscollaboration on this brochure.