The bewildering variety of new medical devices
in U.S.
hospitals promises higher standards of care. But it also poses new
opportunities for error. A growing number of physicians believe that the
interoperability of medical devices–their ability to communicate with each
other–could make hospitals safer and more efficient.
“Today, there are many
proprietary systems available from different vendors, but the problem is, these
systems can’t talk to one another,” says Douglas Rosendale,
a surgeon who works on information integration at Veterans Health Administration
and Harvard Brigham and Women’s Hospital. “If they can’t interface, then they
can’t share information, which could have an impact on patient care.” Estimates
of the number of preventable deaths caused each year by medical errors in
American hospitals range from 98,000 to 195,000.
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Julian Goldman, director of the Center for Integration of Medicine and Innovative
Technology’s Medical Device Interoperability Program, based at Massachusetts General Hospital, has developed two
demonstration projects that illustrate the idea of the “plug and play”
operating room. The first project is an integrated ventilator. A common problem
in hospitals is taking chest x-rays of patients on ventilators, says Goldman. To
keep the lungs’ movements from blurring the image, doctors must manually turn
off the ventilator for a few seconds to take the x-ray. But then they run the
risk of inadvertently leaving the ventilator off for too long, says Goldman.
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To simulate an x-ray machine, Goldman
used a webcam, which he connected to a ventilator and a computer. He synched the
camera with the ventilator so that it would capture images only when the
ventilator was at the point of full inhalation or exhalation. Goldman says that
as a result of his demonstration, standards for ventilators are in the process
of being revised so that future versions of the devices will include a pause
function and will be subject to network control, moving toward
interoperability.
“That’s an example where you
actually avoid the risk by simply not having to turn off the ventilator at
all,” says Peter Szolovits, a professor of computer science at MIT who studies
medical data integration. “In other cases where you have a bunch of data
simultaneously, you can do a better job of trying to understand what’s going on
with the patient,” he says.
Device interoperability could also
reduce the large number of false alarms that nurses must contend with. “If you
go into an ICU, it’s a madhouse,” says Szolovits. “There are alarms going off
constantly, because each alarm is separate from the others, so none of them
have an integrated view of what’s going on with the patient.” If the data from
medical monitors were integrated, he says, alarms would be more likely to indicate
something truly important.
Goldman’s second plug-and-play demonstration
simulates a self-administering pain medication pump, a device widely used in
hospitals despite its occasional adverse effects. Monitoring devices strive to eliminate
the risk that patients will accidentally overdose, but they set off many false
alarms. Goldman speculated that if a computer received data from two or more monitoring
devices, it could much more easily distinguish false emergencies from real ones.
In his demonstration, simulated patient data is fed to an oximeter and a respiratory
monitor. The program sounds an alarm only when both sensors suggest that the patient
is undergoing a crisis.
Goldman admits that, while his
demos are relatively straightforward, obstacles to device interoperability
remain. Monitoring systems are expensive for hospitals to replace, he says:
“We’ve made it too difficult to integrate systems to have smart alarms.”
Another barrier is old-fashioned competitiveness. A vendor that produces
medical equipment tends to make its devices compatible only with each other.
But as Goldman points out, many
emergency rooms need such specialized equipment that no one vendor can produce
all of it. So selecting a single vendor won’t solve the interoperability
problem. “We’re probably a ways off from true interoperability,” Rosendale says.
“However, there is clearly momentum growing in this area. As computer
technology and device dependence grows, that means interoperability is going to
be more and more obvious.”
“I think everyone recognizes
that there’s a lot of data generated for patients, but it’s not always used as
effectively as it could be,” says Daniel Nigrin, chief information officer and senior
vice president for information services at Children’s Hospital Boston. “Over the
course of the last 5 to 10 years, there have been several studies that came out
that showed basically that there’s room for enormous improvement in reducing
errors in medicine. That’s why efforts like [Goldman’s are] so crucial.” Nigrin
suggests that hospitals are slowly starting to move toward medical devices that
share data with one another and with electronic medical-record systems. “There
are instances where you’re starting to see some of the devices connected.
Whether that’s having monitoring systems or ventilator systems attached to
electronic medical records, you’re starting to see some systems like that
implemented in a real-world environment,” he says.